Future of C-L Psychiatry
C-L psychiatrists working in HIV/AIDS psychiatry currently find themselves at a moment marked by unprecedented hope for the coming years of the epidemic. Recent breakthroughs in HIV prevention and treatment have led organizations such as UNAIDS to predict that, if goals are met by the year 2020, the HIV/AIDS epidemic may be brought to an end by 2030. This hopeful outlook has been supported by scientific innovations such as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP,) in addition to the destigmatizing consensus that virally suppressed individuals living with HIV are unable to infect others. This good news has been somewhat tempered by evidence that efforts to identify and successfully treat individuals with HIV, and to curtail the spread of HIV infection, are falling short of goals necessary to halt the epidemic. Much of this research has underscored the ongoing challenges posed by HIV stigma, psychosocial disparities, and the major role of substance-related disorders and other psychiatric illnesses in perpetuating HIV incidence and morbidity. However, the last few years have also seen a large volume of scientific output on the role of psychiatric factors in HIV/AIDS, with important advances in our understanding of potential points of intervention, and underscoring psychiatrists’ central role in addressing clinical and public health goals. In this HIV/AIDS SIG-sponsored symposium, we will examine and review advances in our understanding of how mental health factors continue to shape the epidemic, and analyze how these in turn will shape the future of psychiatrists’ clinical work as leaders supporting optimal health outcomes for people living with HIV. Mark Bradley, MD, will open the session by surveying recent research on the biological, cognitive, and psychosocial impact of depression on HIV outcomes, as well as new developments regarding treating depression in HIV and the potential effect on behavioral and medical outcomes. Kenneth Ashley, MD, will discuss advances in our understanding of key relationships between substance use disorders and HIV/AIDS, including relationships between the HIV and opioid epidemics. Dr. Ashley will also describe interventions for modifying HIV outcomes with substance use treatment. Mary Ann Cohen, MD, will discuss the complex relationships between trauma, risk behavior, and HIV health outcomes, as well as clinical approaches to working with patients living with comorbid HIV and trauma-related psychiatric disorders. Finally, Dr. Luis Pereira will discuss recent research on how the mutually reinforcing effects of oppressive social conditions, mental illness, and HIV disease work together in a syndemic fashion. Dr. Pereira will review the increasing salience of the syndemic model in our understanding of the relationship between HIV and mental illness, and how it will support future work in HIV/AIDS psychiatry. The session will conclude with panel discussion and audience Q & A.