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HIV Guide: Prevention & Treatment Options for Arizonans Mental Health/Substance Use Issues

Guide to HIV Prevention

Arizona is home to many individuals living with mental health and substance use disorders who are at heightened risk for contracting HIV. Integrated, evidence-based interventions are crucial for this population to prevent infection and achieve optimal health outcomes if living with HIV. This comprehensive guide outlines key strategies for healthcare providers, policymakers, and public health leaders to address the intersection of HIV, mental illness, and addiction in Arizona.

Understanding the Elevated HIV Risk Among Those with Behavioral Health Conditions

Mental Illness and HIV Vulnerability

  • The prevalence of HIV is 4-10 times higher among people with mental illness compared to the general population.
  • Mental health conditions can impede judgment and increase impulsivity, leading to sexual behaviors that risk HIV transmission.
  • People with severe mental illness are less likely to have their HIV diagnosed and receive timely antiretroviral treatment.

Substance Use Disorders Fuel HIV Rates

  • 1 in 10 new HIV diagnoses occur among people who inject drugs.
  • Methamphetamine, cocaine, and opioid use are major drivers of HIV transmission due to injection practices and sexual risk behaviors.
  • Substance use disorders create barriers to HIV testing, prevention, and treatment engagement.

The Scope of HIV Among Arizonans with Behavioral Health Needs

Arizona Monthly HIV Testing 2019-2022
  • From 2021 to 2022, there was a 20% increase in incident cases reported. However, there was also a 19% increase in publicly-funded HIV testing in 2022 compared to 2019, with more than 70,000 tests reported in 2022.
  • After a reduction in HIV testing activities during the COVID-19 pandemic, there has been a consistent upward trend in HIV testing since 2020, with higher testing numbers recorded in the 2021 and 2022.
  • By age, the highest HIV and AIDS incidence rates were among people aged 30 to 34 years old (33.4 cases per 100,000) and people aged 25 to 29 years old (31.9 cases per 100,000).
  • The group with the greatest number of new HIV and AIDS cases was the Hispanic population, who accounted for 405 of the 975 new cases in 2022.
  • Continuum of Care: In 2022, 79% of people diagnosed with HIV/AIDS were linked to care within 30 days of their diagnosis and following treatment, 61.8% were virally suppressed, which means that a person with HIV has such a low viral load that they are able to stay healthy, and they will not transmit HIV to their sex partners. People with HIV can become and stay virally suppressed by regularly taking antiretroviral (ARV) medications to treat their HIV.
Arizona HIV_AIDS Care Continuum 2022

Preventing HIV Transmission Among High-Risk Arizonans

Facilitating Access to Pre-Exposure Prophylaxis (PrEP)

  • PrEP is a once-daily medication that reduces HIV risk by up to 99% when taken as prescribed. 
  • About 5000 people in Maricopa County are using PrEP, and by 2025 the goal is to have about 10,000 county residents using the drug.
  • Barriers to PrEP uptake include lack of awareness, stigma, cost concerns, and misconceptions about its effectiveness.
  • Arizona providers can integrate PrEP education into behavioral health treatment and provide navigation support to improve access.

Expanding Syringe Services Programs (SSPs) Statewide

Syringe Services Programs SSPs
  • SSPs reduce HIV and hepatitis C incidence among people who inject drugs by over 50%.
  • SSPs distribute sterile injection equipment and provide critical linkages to addiction treatment, medical care, and social services.
  • Lifting remaining legal restrictions and increasing state funding for SSPs are key policy priorities in Arizona.

Linking and Retaining Arizonans with HIV in Integrated Care

Co-Located and Coordinated Mental Health and HIV Treatment

  • For people with HIV and mental illness, integrated treatment significantly improves ART adherence and viral suppression rates.
  • Effective approaches include specialized psychiatric consultation within HIV clinics and patient navigation between behavioral health and infectious disease providers.

Implementing Contingency Management (CM) Programs

  • CM uses strategic incentives and positive reinforcement to promote healthy behaviors related to HIV and substance use.
  • In randomized trials, CM significantly increased ART adherence and abstinence from stimulants among people with HIV.
  • Arizona Medicaid covers CM for substance use disorders, creating opportunities to expand CM to HIV care settings statewide.
  • CM can be delivered in-person, via mobile apps, or through treatment center incentive programs.

Increasing Access to Cognitive Behavioral Therapy (CBT)

  • CBT is an evidence-based counseling approach that helps patients develop coping skills, reduce risky behaviors, and manage HIV treatment adherence.
  • Specific CBT interventions have reduced depression symptoms and improved viral suppression among people with HIV. 
  • The Arizona Department of Health Services offers CBT training programs for HIV and behavioral health clinicians statewide.
  • Clinics can refer patients to CBT specialists or integrate core CBT techniques into routine HIV and behavioral health visits.

Conclusion

To effectively combat HIV among Arizonans with mental illness and substance use disorders, a multifaceted approach is required. Expanding access to proven prevention tools like PrEP and SSPs can greatly reduce new infections. At the same time, behavioral health and HIV treatment systems must collaborate to engage and retain high-risk individuals in integrated, evidence-based care. By prioritizing the statewide scale-up of interventions like CM and CBT alongside efforts to co-locate services, Arizona can dramatically improve outcomes for people living with or at heightened vulnerability to HIV. Ongoing partnerships between public health agencies, healthcare institutions, and community-based organizations will be instrumental in sustaining an effective, equity-focused HIV response for this priority population. Through concerted action and strategic investments, we can realize a future where behavioral health status no longer predicts HIV risk or outcomes in Arizona.

Furthermore, if you want to delve into more details about how selected interventions align with the goals of the federal “Ending the HIV Epidemic: A Plan for America” (EHE) initiative, check out the attached PDF below

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