NASTAD HIV Prevention Bulletin, Dec. 2002 (PDF)

N A S T A D BUL L E T I N The use and abuse of alcohol and other drugs can place individuals at risk for HIV and hepatitis through risky sexual behaviors and/or unsafe injection practices. This month’s HIV Prevention Bulletin will provide an overview of the role of substance abuse treatment in HIV and hepatitis prevention; describe two opiate addiction treatment medications, methadone and buprenorphine; profile two jurisdictions integrating HIV and substance abuse treatment services; and offer resources for jurisdictions interested in understanding the intersection between substance abuse and infectious disease. H I V P R E V E N T I O N DECEMBER 2002 Substance Abuse Treatment and HIV/Hepatitis Prevention bisexual men who use methamphetamine have a greater HIV prevalence than MSM who do not use the drug. Numerous studies presented at the International AIDS Conference in Barcelona, Spain found that substance use is consistently associated with risky sexual behaviors by HIV positive and HIV negative MSM. The use of methamphetamine, club drugs, and other drugs may be an important risk factor in the recent resurgence of HIV, syphilis, and other STDs among MSMs. It is crucial for HIV/AIDS programs to understand the reasons for substance use and abuse, and incorporate substance abuse prevention and treatment information, education, and referrals into existing HIV prevention outreach programs. Overview: Substance Abuse Treatment as HIV and Hepatitis Prevention Since the emergence of AIDS over two decades ago, a strong link between substance abuse and HIV has been established. Over one-third of all reported AIDS cases are directly related to injection drug use (IDU) and sixty percent of hepatitis C virus (HCV) cases are attributed to IDU. IDUs, their sex partners, and their children are at risk for infection with HIV, hepatitis, and STDs through high-risk sexual and drug practices, such as sharing syringes, drugs, paraphernalia, and by practicing unsafe sex. While the role of substance use and abuse in IDUrelated HIV/AIDS is long recognized, other drugs, such as crack cocaine, club drugs, methamphetamine, and alcohol, also play a significant role in transmission of HIV and other infections. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), people with alcohol use disorders are more likely than the general population to contract HIV, and alcohol use is associated with high-risk sexual behaviors and injection drug use1. Research on methamphetamine use among men who have sex with men (MSM) has found that use of the drug is associated with increased risk for HIV infection, and that gay and Inside the Bulletin: • Substance Abuse Treatment as HIV/Hepatitis Prevention . . .1 • Methadone Maintenance Treatment . . . . . . . . . . . . . . . . .2 • Regulation of Methadone Maintenance Treatment . . . . . . .4 • Buprenorphine: A New Option for Opiate Dependence . . . . 5 • Hepatitis Coordinators’Conference . . . . . . . . . . . . . . . . . . .5 • Jurisdiction Profile: New York State, AIDS Institute . . . . . .6 • Jurisdiction Profile: D.C. Department of Health, Addiction Prevention and Recovery Administration . . . . . .7 • SAMHSA HIV/AIDS Initiatives . . . . . . . . . . . . . . . . . . . . .9 • Update for NJ Substance Abuse Treatment Providers . . . . . .10 • Resources on Substance Abuse and HIV.................................11 • FDA Approves OraQuick . . . . . . . . . . . . . . . . . . . . . . . . . .12 Adolescent and School-Based Health ................................13 The Manager ............................................................................14 Resources ...................................................................................15 Calendar ....................................................................................16 N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS 444 North Capitol Street, NW, Suite 339 Washington, DC 20001-1512 F 202-434-8092 P 202-434-8090 www.nastad.org N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 2 should work closely with their counterparts in substance abuse and develop strong links between programs. Interventions for substance abusers that incorporate HIV and other infectious disease prevention strategies are critical, and HIV prevention programs must address the role of substance abuse in disease transmission. References National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert, No. 57, July 2002. 2 National Institute on Drug Abuse. Principles of HIV Prevention in Drug Using Populations, March, 2002. Available online at http://drugabuse.gov/POHP/. 3 Academy for Educational Development. A Comprehensive Approach: Preventing Blood-Borne Infections Among Injection Drug Users, December, 2000. Available online at http://www.cdc.gov/idu. 1 Individuals use and abuse drugs for a variety of reasons; an estimated 50% of persons with a substance abuse disorder also have a co-occurring mental health disorder. Users may be attempting to cope with psychological trauma, or to feel more relaxed socially. Users may experience significant benefits from alcohol and drug use, including increased confidence and improved sensation, and these benefits may outweigh potential negative consequences. Studies on alcohol indicate that it acts directly on the brain to reduce inhibitions and diminish risk perception, however, there is also evidence that expectations about the effects of alcohol can influence sexual behavior; individuals who believe alcohol enhances sexual arousal and performance are more likely to engage in unsafe sexual practices1. While the motivations for drug use vary, the outcome of increased use and dependence on drugs is often addiction. Addiction is a brain disease; drug use causes changes in the brain structure and function, resulting in compulsive drug craving and use3. It is a chronic disease, similar to diabetes or hypertension, and it is treatable. Drug abuse treatment can be conducted in a variety of settings (e.g., inpatient, outpatient, residential) and often involves various approaches, including behavioral therapy, medications, or a combination of both2. Due to the role substance abuse plays in HIV risk behaviors, substance abuse treatment is one of the most important HIV prevention strategies. Drug users who enter and continue in treatment are more likely than those who remain out of treatment to reduce risky activities, such as sharing needles and injection equipment or engaging in unprotected sex2. Good drug abuse treatment programs offer HIV education, counseling and testing, and other prevention services. Drug treatment programs may also provide counseling, psychiatric services, and other social services to help support the client. Providing drug users with substance abuse treatment options is an important public health intervention. HIV, hepatitis, and STD programs Methadone Maintenance Treatment and HIV/AIDS Prevention As persons working in HIV and hepatitis are acutely aware, injection drug users (IDUs) are at increased risk for contracting and transmitting HIV, hepatitis C, and other blood-borne infections through sharing syringes, drugs, and drug preparation and injection equipment. Injection drug use accounts for one-third of all HIV cases in the U.S. and 60% of hepatitis C cases. It is critical to reach IDUs with disease prevention strategies in order to decrease the transmission of HIV and hepatitis. The U.S. Centers for Disease Control and Prevention (CDC) recommends using a comprehensive approach to prevent blood-borne infections among IDUs; this approach includes, among others, community outreach, interventions to increase access to sterile syringes, HIV counseling and testing services, and substance abuse treatment 1. Substance abuse treatment plays a critical role in preventing the transmission of HIV and other blood-borne diseases among IDUs. Drug addiction is characterized by compulsive drug seeking behavior; finding and using drugs can soon become the primary motivation of the user. Users may practice risky sexual and drug using NATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 3 behaviors, including trading or selling sex for drugs or money to buy drugs. Limited access to sterile injection equipment is also problematic; safe injection practices are harder to follow when the user is fighting withdrawal and only has access to used injection equipment. Substance abuse treatment, then, is an important intervention that can provide individuals with the medical, psychological, and behavioral support they need to stop using drugs. 1 In the U.S., one of the most commonly injected drugs is heroin. According to the Office of National Drug Control Policy (ONDCP) there are an estimated 980,000 heroin addicts in the U.S.2 Heroin is the most commonly abused opiate, which is a class of drugs whose use can cause euphoria, pain relief, decreased pain sensation, some sedation, and respiratory depression. 3 Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.4 Other common opiates include morphine, opium, codeine, and oxycotin. Heroin can be a white or brownish powder which is usually dissolved in water and then injected. Most street preparations of heroin are diluted, or "cut," with other substances such as sugar or quinine. Heroin is a fast acting opiate; the effects of the drug are felt very soon after administration, and withdrawal symptoms can begin as soon as several hours after last use. Heroin can be injected, smoked, or snorted. Intravenous drug use provides the quickest high, and a typical user may inject up to four times a day. Withdrawal from opiates involves flu-like symptoms such as chills, shakes, sweating, nausea, vomiting, diarrhea, increased heart rate, insomnia, and increased sensitivity to pain. Users may develop a high tolerance and physical dependency to the drug and become addicted. For opiate addiction, medication assisted treatment is effective in reducing the harms of addiction and assisting users in gaining control of their lives. Medication assisted treatment (MAT) is a form of treatment where opiate-dependent patients receive medication to block the effects of opiates. There are four medications used to treat opiate addiction: Levo-alpha-acetylmethadol (LAAM), naltrexone, buprenorphine, and methadone, which is the most commonly used medication. Methadone is a synthetic opiate that prevents withdrawal from opiates, decreases cravings for opiates, and blocks the euphoric effects of opiates 3. It has a half-life of approximately 24 hours and a slow onset of action, which blunts its euphoric effect and makes it unattractive as a drug of abuse.3 It is usually administered once per day. Methadone maintenance treatment (MMT) has been used for over thirty years as an effective medication assisted treatment for opiate addiction. Research has found that the success of MMT may depend on whether an adequate dosage is given and whether there is continuity in treatment; most patients require continuous treatment over a period of years or even life.3 The National Institutes of Health Consensus Statement on Effective Treatment of Opiate Addiction recommends that patients receive at minimum twelve months of methadone.5 MMT is also more effective when coupled with psychiatric and counseling services, due to the high co-morbidity of addiction and mental health disorders. Until recently, methadone was only available in specially licensed clinics required to follow strict requirements; consequently, these clinics had little flexibility in providing individualized treatment, and patients were often not given adequate doses. These regulations have since changed (see “An Important Change in the Regulation of Methadone Maintenance Treatment”). Over thirty years of extensive research has found that MMT reduces crime, improves health status, and helps opiate-dependent individuals attain productive lifestyles. 3 Further, MMT significantly reduces the health risks associated with injection drug use. The risks for numerous infections, including HIV and hepatitis, are reduced by the reduction in intravenous drug use. Additionally, studies have found that HIV risk associated with sexual behavior is reduced, because methadone NATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 4 patients report a lower numbers of past-year sexual partners than do untreated opiate dependent persons; HIV positive methadone maintenance participants have a delayed onset of AIDS-related illnesses; and methadone treatment reduces the health risks, such as overdose, associated with using unregulated street drugs. 3 According to SAMHSA’s, Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination, methadone maintenance costs approximately $6.00 per day, or $2,190.00 per year, while the cost of medically treating an individual with AIDS is estimated at $100,000. The rates of new AIDS infections were four times higher in those heroin addicts on the street compared to similar former addicts who received treatment in methadone maintenance.6 Methadone has traditionally been controversial; many patients and critics alike have argued that MMT is simply replacing one substance with another. Patients may feel uncomfortable attending twelve step meetings because they are not “abstinent.” These concerns are likely a result of the misunderstanding of addiction in our society; addiction is still considered by some to be a moral failing, rather than a chronic disease which requires medical management similar to other diseases, such as diabetes and high blood pressure. There has also been a strong “not in my backyard” sentiment towards methadone clinics, driven by the fear that the presence of methadone treatment will bring crime and drugs to the neighborhood. The recent relaxing of the regulations on methadone may help reduce some of this stigma, and create a greater understanding among the public of the important role that MMT plays in addiction, disease transmission, and public health. References Academy for Educational Development. A Comprehensive Approach: Preventing Blood-Borne Infections Among Injection Drug Users, December, 2000. Available online at http://www.cdc.gov/idu 2 Substance Abuse and Mental Health Services Administration. Training Begins for Accreditation of Methadone Programs, May 18, 2001. Available online at http://www.samhsa.gov/news/news.html. 3 Marlatt, G.A. (1998). Basic principles and strategies of harm reduction. In Marlatt, G.A. (Ed.), Harm reduction: Pragmatic strategies for managing high-risk behaviors (pp. 49-66). New York: The Guilford Press. 1 An Important Change in the Regulation of Methadone Maintenance Treatment In March of 2001, the U.S. Department of Health and Human Services repealed the Food and Drug Administration (FDA)-enforced regulations for methadone maintenance treatment, and created a new accreditation program managed by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT). Programs administering methadone or levoalpha-acetylmethadol (LAAM) are now accredited by non-federal agencies in accordance with standards established by CSAT. The standards emphasize improving the quality of care, such as individualized treatment planning, increased medical supervision, and assessment of patient outcomes, and are based on "best practice guidelines" developed by CSAT over the past 10 years. This change from a federally regulated process to an accreditation process is significant: it gives patients and providers more control over their medical care, helps mainstream the medical treatment of opiate addiction, and will increase the number of health care providers who can administer MMT. Previously, specially licensed clinics only offered methadone; now, with the accreditation process, MMT can be offered at more settings and by more medical providers. HIV/AIDS primary care clinics are encouraged to consider offering methadone to their clients. For more information about the accreditation process, please visit: http://www.samhsa.gov/centers/csat/content/dpt/ accreditation.htm NATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 5 National Institute on Drug Abuse. Heroin: Abuse and Addiction. NIDA Research Report Series, October 1997. Available online at http://www.drugabuse.gov/ResearchReports/Heroin/Heroin. html. 5 Effective Medical Treatment of Opiate Addiction. NIH Consensus Statement 1997 Nov 17-19; 15(6): 1-38. 6 Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination, Treatment Assistance Publication Series 11. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Rockville, MD, 1994. 4 Buprenorphine: A New Option for Treating Opiate Dependence In October 2002, the Food and Drug Administration (FDA) announced the approval of Buprenorphine for the treatment of heroin and other opiate addiction. Buprenorphine is similar to methadone in that it reduces cravings for opiates, suppresses the opiate abstinence withdrawal syndrome, and provides cross tolerance to other opiates. It is considered to have lower abuse potential than methadone or LAAM (1-alpha-acetyl-methadol) [another common treatment for opiate addiction] and to have relatively mild withdrawal symptoms. Hepatitis C Coordinators' Conference January 26 - 30, 2003 Under the Drug Addiction Treatment Act of 2000, physicians who meet certain qualifications will be able to prescribe Buprenorphine in an office setting. This is the first time a qualified physician has been able to provide anti-addiction medication from their own office and represents a significant advancement in drug addiction treatment policy in the U.S. Now, patients will be able to seek care from a trusted physician and get their prescription filled at a local pharmacy, as they would for other health conditions requiring medication. This is a major step forward in mainstreaming addiction treatment and giving patients more control in their treatment. Buprenorphine is not meant to replace methadone, which will, along with other opiate treatments, still be dispensed in SAMHSA-accredited programs. Rather, Buprenorphine will serve as an additional option for patients seeking opiate addiction treatment and will increase their options of where to seek treatment. Physicians who are interested in offering Buprenorphine to their patients must complete an San Antonio, Texas Register for the Hepatitis Coordinators' Conference online at: h t t p : / / w w w. c d c . g ov / n c i d o d / d i s e a s e s / h e p a t i t i s / c o o rd i n a t o r s / i n d e x . h t m Due to similar risks of transmission, men who have sex with men (MSM), injection drug users (IDUs), and incarcerated populations are at high-risk for infection with HIV, STDs, and viral hepatitis. Addressing these multiple disease risks requires a comprehensive, integrated, disease prevention program. The Hepatitis Coordinators’ Conference, scheduled January 26-30 in San Antonio, Texas, is designed for public health professionals interested in integrating hepatitis prevention into their existing programs. The conference will provide training and networking opportunities to assist public health and other professionals working with clients at risk for viral hepatitis. Focus will be on prevention of perinatal, infant, childhood, adolescent and adult infections, and will include sessions on working with high-risk populations such as inmates, clients in HIV/STD clinics, substance abusers/IDUs, and MSM. Models of integrating hepatitis prevention services into STD, HIV, correctional health, and substance abuse treatment programs will be presented. Attendees will learn from health professionals working on the difficult and complex issues of collaboration with disparate professions, overlapping and converging epidemics, integration and coordination of medical services, cross training, and counseling. In-depth, extended workshops or 'institutes' will address the complex issues of providing services to high risk individuals including injection drug users and men who have sex with men. N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 6 eight hour training session to qualify for a waiver from the Controlled Substances Act 21, which restricts the use of methadone and other opiate drugs to federally licensed addiction treatment clinics. Information on current Buprenorphine trainings being offered, as well as general information on Buprenorphine, is available on SAMHSA’s website at http://www.buprenorphine.samhsa.gov Interested providers can get more information by calling the CSAT Buprenorphine Information Center at 866-BUP-CSAT from 8:30 A.M. to 5:00 P.M.,EST, or by emailing infor@buprenorphine.samhsa.gov Jurisdictional Profile New York State, AIDS Institute: Linking HIV Prevention and Care with Substance Abuse Treatment In 1990, in an effort to curb the HIV epidemic among injection drug users (IDUs) and other substance users, the New York State (NYS) AIDS Institute implemented a comprehensive model of HIV prevention and care services within drug treatment clinics throughout the state. The initial model, funded by CDC and implemented in collaboration with the New York Office of Alcoholism and Substance Abuse Services (OASAS), incorporated outreach, supportive education, HIV counseling and testing, partner notification and referral services into nine drug treatment programs and two community-based programs that reached out to active users and provided prevention services in smaller drug treatment programs. Initial seroprevalence results found that 21.5% of clients tested were HIV positive. In response, the AIDS Institute pursued primary care funding from the state, and secured Ryan White Title I and II funding. The model quickly grew to include outreach, counseling and testing, supportive counseling, case management, and medical care. Currently, the model includes twenty-eight drug treatment programs, and operates in a range of treatment settings, including methadone programs, drug free residential treatment and drug free outpatient programs. In the early 1990’s, this model of integrating HIV prevention services into drug treatment settings was revolutionary; traditionally, HIV and drug treatment programs were linked through referrals. The AIDS Institute believed that integrating services within the drug treatment programs was the most effective way to make HIV prevention and care services accessible to drug users. However, drug treatment programs were initially skeptical. Jeff Rothman, Assistant Director of the AIDS Institute’s Bureau of HIV Ambulatory Care, said that there was initial resistance to the colocation model. Programs were concerned that HIV services would serve as a distraction to clients, and addiction counselor, often felt that providing HIV services would negatively impact client progress towards recovery. Rothman noted that it is critical to obtain the support of administrators in order to effectively engage clinic staff in the service model. Often, implementing these services resulted in drastic changes within the drug treatment clinics. Entire teams of new personnel were hired to administer HIV services, and some drug treatment programs began a gradual shift towards a medical model. The program has been extremely successful; from its inception through September 2001 the initiative conducted a total of 136,869 tests with 12,779 positives for a cumulative seroprevalence of 9.3%. From 1990 through 2000, seroprevalence fell from 21.5% to 7.2% and the percent of IDUs from 57.4% to 26%. Current challenges include reaching active drug users and working with treatment programs to enhance hepatitis services. In an effort to reach active drug users, the AIDS Institute has initiated a pilot project with several syringe exchange programs (SEPs). Intensive focus groups with syringe exchange programs including consumers and drug treatment programs found that SEPs and drug treatment programs often do not have established relationships, and a lack of understanding by both on the role each play in serving drug users hinders effective collaboration. N ATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 7 The pilot project provides funding for transitional case management services at SEPs, which includes helping the user navigate his or her way into drug treatment. Interviews with clients and staff found that drug users often lack the documentation needed to enter treatment; the case managers will work with the client to gather all the information needed to facilitate entry into treatment. Additionally, the case managers will take the lead in pursuing relationships with the drug treatment programs in order to achieve more effective collaboration. The program does not currently provide funding for hepatitis services. Numerous sites are providing HCV testing and vaccinations for hepatitis A (HAV) and hepatitis B (HBV) virus out of their own funds. A recent survey of a sample of eighteen of the participating programs found that sixteen provided onsite screening for hepatitis C virus (HCV), and 13 and 10, respectively, vaccinate clients against HBV and HAV. Perhaps nowhere is the need to reach substance abusers felt more strongly than in the District of Columbia (D.C.). The HIV/AIDS epidemic has devastated D.C.; it is estimated that one in twenty adults is HIV-infected, and D.C. ranks first among large U.S. cities in AIDS incidence, reporting 132 cases per 100,000. Substance abuse has played a major role in HIV transmission; from 1996 through 2000, approximately one-third (31.3%) of the reported AIDS cases were among heterosexuals with a history of injection drug use (IDU), and an additional 6.5% of the reported AIDS cases were among the sex partners or children of IDUs. It is also estimated that as many 60,000 people in the District are addicted to psychoactive substances. The potential intersection between these two epidemics is frightening. The D.C. Department of Health, Addiction Prevention and Recovery Administration (APRA) has responded to this challenge by developing and implementing a comprehensive program integrating outreach, intake, and clinical care for substance abusers living with or at risk for HIV infection in D.C. APRA is the D.C. single state agency for substance abuse prevention and treatment and the primary provider/ funder of substance abuse treatment for indigent (uninsured/ under-insured) substance abusers. The program utilizes two main components: Project Orion, a mobile medical outreach and intake unit that targets substance abusers; and the First Street Health Care Center, a medical center offering numerous health services to APRA clients and specifically focusing on those infected with HIV. While APRA has taken the lead in developing this project, its strength lies in the fact that several local public and private organizations are actively collaborating and contributing resources. Project Orion serves as the first point of entry into the program, targeting street-based substance abusers; this mobile clinic regularly travels to several different locations in D.C. with a high prevalence of substance abuse. With funds from the Substance Abuse and Mental Health Services Jurisdictional Profile D.C. Department of Health, Addiction Prevention and Recovery Administration: From Outreach to Intake: Reaching D.C. Substance Abusers Substance abusers at risk for or infected with HIV, viral hepatitis, and other infections are often difficult to reach and difficult to engage in traditional drug treatment and primary care settings. Numerous barriers, including mistrust of the public health system; previous negative experiences attempting to navigate multiple, disparate, public health programs; diagnosis with a mental health or other co-occurring disorder; and often a lifetime of being medically underserved contribute to substance abusers’ reluctance to access public health services. Due to the strong link between HIV, viral hepatitis, and substance abuse, it is critically important to address these barriers in order to reach substance abusers with disease prevention, medical care, and drug treatment services. N ATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 8 Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT), Project Orion provides disease prevention education and information; infectious disease screening for HIV, sexually transmitted diseases (STDs), tuberculosis (TB), hepatitis B (HBV) virus, and hepatitis C (HCV) virus; basic primary medical care; intake and referrals to substance abuse treatment; case management; and ongoing primary health care services. Project partners include Unity Health Care, Inc., a community based organization and the main community health care provider in D.C.; the HIV/AIDS Administration (HAA) within the D.C. Department of Health; and Family and Medical Counseling Services, Inc., a community based organization contracted to provide outreach services. Kevin Shipman, Project Director of Project Orion and Chief of the APRA Office of Special Populations Services (OSPS), notes that one of the strengths of Project Orion is that it succeeds in providing substance abusers with a safe, accessible place to access an array of services. He says, “the central philosophy of the project is ‘curbside service’; in order to engage the highest risk substance abusers, it is essential to bring the services to them. This helps eliminate some of the major barriers that may prevent them from otherwise seeking medical care, prevention services, and substance abuse treatment.” Shipman further notes that the value of Project Orion is that the outreach workers and staff are able to build connections with active substance abusers who many not be ready for treatment, but are interested in some of the other services offered on the mobile unit. Engaging active substance abusers by addressing their current needs and concerns is crucial to establishing trust. Once there is a relationship, clients will know where to go to get information about treatment if they are ready, and staff can intake them into the APRA system while on the medical outreach unit. The staff of Project Orion are also very visible and respected outreach workers in the community and this is an invaluable strength. Once a client has entered into the APRA system, they are able to access an array of health services at the First Street Health Center. The Department of Health’s HAA (the primary funder of the HIV medical care) and Unity Health Care, Inc. (the primary care partner), collaborate with APRA to provide the First Street Health Center, which is colocated with the APRA central intake center. There is a special emphasis at the Center on providing services to patients living with HIV/AIDS. Other medical services offered include adult internal medicine, OB/GYN services, laboratory, pharmacy, social services, and psychiatric services. The significance of the First Street Health Center is that the medical services are integrated with substance abuse treatment; clients’ providers understand addiction, and understand that their patients are in substance abuse treatment, and can appropriately tailor their care and work in tandem with the substance abuse treatment provider. This integrated system is extremely beneficial to clients, who are often suffering from multiple disorders and need their provider to understand all aspects of their health care. Without an integrated system, clients often receive fragmented health care and conflicting recommendations from their providers, and consequently have difficulty remaining in care. Shipman stresses that the success of these two projects is due to “partnership mathematics.” He notes that, “in regular mathematics, 1 plus 1 equals 2, but in partnership mathematics 1 plus 1 equals 4. Working with partners offers the potential to gain exponentially. When you establish relationships with other programs, you may find that there are multiple opportunities, beyond what you intended, to collaborate and combine resources.” Future goals for the program are to integrate mental health services into Project Orion, enabling staff to screen for mental health disorders on the mobile unit. Shipman would also like to have more case management services available. He plans an expansion of the First Street Health Center to include an adjacent program for co-occurring mental illness. N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 9 The program has been quite successful; currently, the APRA twelve month follow-up rate for Project Orion is nearly 70%, and in FY 2002 they reported over 31,000 outreach contacts. For more information, please contact Kevin Shipman, MHS, LPC, D.C. Department of Heath/ Addiction Prevention and Recovery Administration (APRA) at (202) 442-9216 or kevin.shipman@dc.gov SAMHSA HIV/AIDS Initiatives The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) is responsible for developing and ensuring access to effective substance abuse treatment services for individuals who abuse alcohol and other drugs. CSAT also identifies and disseminates information on best practices for substance use/abuse treatment and intervention. CSAT administers the treatment funding aspects of the Substance Abuse Prevention and Treatment (SAPT) Block Grant program, which is an annual formula grant awarded to states and territories to finance local substance abuse prevention and treatment services, and is administered by a single state authority for substance abuse. The SAPT Block Grant provides for approximately 40 percent of public funds expended on substance prevention activities and treatment services. SAPT Block Grant places a special emphasis on the provision of treatment and primary prevention services to injecting drug users, and to substance abusing women who are pregnant or with dependent children. States and territories can spend up to 35 percent of SAPT for alcohol prevention and/or treatment activities, 35 percent for prevention and treatment of other drugs, 20 percent for primary prevention activities and services and up to 5 percent on administrative expenses. The President’s FY2003 budget includes a $60 million increase in SAPT Block Grant funds. This will raise the total SAPT Block Grant to almost 1.8 billion for 2003 and serve nearly 1.9 million clients. Early Intervention Services (EIS) States with a minimum annual AIDS case rate of 10/100,000 are required to set aside a portion of their SAPT Block Grant for early intervention services. This is called the HIV Set Aside. They are required to expend between 2 percent and 5 percent of the SAPT block grant on HIV EIS. This provided an estimated $57.9 million from total block grant funding in FY2002. Projects funded by EIS are to reduce transmission of HIV among substance abusers, their sex and needle sharing partners, and their children. They do this through the provision of HIV testing and counseling and provide services in the geographic areas of the state in the greatest need. A major challenge of the HIV Set Aside is that due to the fluctuations in AIDS case rates, states may not consistently be required to set aside, challenging the sustainability of programs. This requirement is now waivable by request from the state to the Secretary. Should no waivers be approved, the FY2003 block grant HIV/AIDS Set Aside would be approximately $62.1 million. The Center for Substance Abuse Treatment’s (CSAT) primary discretionary grant activity, Programs of Regional and National Significance (PRNS), consists of the following three components: best practices; training and technical assistance; and targeted capacity expansion (TCE), under which the HIV/AIDS minority initiative is funded. CSAT Minority HIV/AIDS Initiative—TCE/HIV In FY1999, CSAT received $16 million from the Congressional Black Caucus Initiative (CBC) to address HIV/AIDS; these funds were earmarked to provide substance abuse treatment programs for substance abusing African American and Hispanic populations at risk of contracting HIV. CSAT awarded 35 Targeted Capacity Expansion/HIV grants to community-based organizations to supplement and expand substance abuse treatment, HIV/AIDS, and infectious disease services. CSAT also funded 25 HIV Outreach Projects that targeted N ATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 10 hard-to-reach, high-risk substance abusers with prevention, risk information, and opportunities to enter substance abuse treatment. Metropolitan areas with AIDS case rates of 20 per 100,000 or higher and states with AIDS case rates of 10 or more per 100,000 were eligible for funding. CSAT awarded an additional 43 grants in FY2000. Expansion of the HIV/AIDS outreach and treatment activities continued in FY 2001 with the award of 14 new grants for $6 million. Eleven grants were also funded using funds from the Department. In FY2001, a total of $53 million was spent on TCE/HIV activities which included 92 grants and 3 contracts. In FY2003, approximately $21 million will be available for new 38-42 new/competing awards for a total program level of $62.2 million. The CSAT TCE/HIV initiative has provided a significant investment in increasing the capacity of minority community-based organizations to address HIV/AIDS and other infectious diseases among substance abuses. Grantees are enhancing their ability to provide comprehensive substance abuse, infectious disease, and mental health services through linkages with other community organizations. State HIV and hepatitis programs would do well to partner with CSAT grantees and other community-based organizations working with substance abusers at high-risk for HIV and hepatitis infection. For more information, http://www.samhsa.gov. please visit who have been injecting drugs for over 12 months are infected with hepatitis C. The prevention and treatment of substance use is a critical component of hepatitis prevention and control efforts. Providing education, training and supportive resources for substance abuse treatment professionals is the primary step in addressing these prevention needs. In response to this need, the New Jersey AIDS Education and Training Center (AETC); New Jersey Department of Health and Senior Services, Department of Addiction Services and Division of AIDS Prevention and Control; Centers for Disease Control and Prevention; and the Academy for Educational Development (AED) sponsored a meeting this past October entitled, “The Dual Epidemics of Hepatitis and HIV: An Update for Substance Abuse Treatment Providers.” The meeting provided a forum for substance abuse treatment providers to discuss the link between substance abuse, HIV, and hepatitis in New Jersey. The purpose of the meeting was to increase the awareness and understanding of substance abuse treatment providers on the epidemiology, transmission, and prevention of hepatitis A, B and C. Participants could choose between a counselor, clinician, and administrator tracks; these three tracks were designed to specifically tailor information to the needs of the different substance abuse professionals. Presentations highlighted HIV/STD programs that have integrated viral hepatitis services into their existing infrastructures; discussed the challenges that addiction counselors face in educating and providing services to clients at risk for or infected with a type of viral hepatitis; and provided an overview of the hepatitis screening, diagnostic and treatment protocols. Participants had the opportunity to network with their colleagues throughout the state, and learn how different programs are addressing the challenges of integrating viral hepatitis. HIV and Hepatitis Update for New Jersey Substance Abuse Treatment Providers While the link between HIV and substance abuse has long been recognized, hepatitis C virus (HCV), has emerged as a significant threat to substance abusers, particularly intravenous drug users (IDUs). Research demonstrates that IDUs rapidly acquire hepatitis C after the initiation of injection drug use, and between 60% and 90% of persons N ATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 11 Resources on Substance Abuse and HIV A Comprehensive Approach: Preventing Blood-Borne Infections Among IDUs A technical assistance document developed by CDC which describes eight complementary strategies that when used together, can make a difference for HIV prevention among IDUs. Available at: http://www.cdc.gov/idu/pubs/ca/forword.htm CSAT/CDC/HRSA cross-training initiative A CSAT, CDC and HRSA training and technical assistance initiative available to state and local public health programs (e.g. corrections, substance abuse, mental health) on cross training and collaboration across multiple programs. Information is available at: http://www.treatment.org/Topics/infectious.html CSAT Treatment Improvement Protocols (TIPs) Best practice guidelines for the treatment of substance abuse developed by CSAT. Relevant TIPs include Tip 37: Substance Abuse Treatment for Persons with HIV/AIDS, among others. Up to five free hard copies of TIPs can be ordered from the National Clearinghouse for Drug and Alcohol Information (NCADI) by accessing its electronic catalog at http://www.health.org/about/Questions.htm or by calling 1-800-729-6686. A brief description of each TIP and its NCADI order number is available at http://www.treatment.org/Externals/tips.HTML, and many TIPS are available online for download. The NIDA Community-Based Outreach Model A Manual to Reduce the Risks of HIV and other Blood-Borne Infections in Drug Users Provides principles for HIV prevention to out of treatment drug users. Available at: http://drugabuse.gov/CBOM/index.html Principles of HIV Prevention in Drug-Using Populations This guide developed by the National Institute on Drug Abuse (NIDA) summarizes the basic overarching principles that characterize effective HIV/AIDS prevention in drug-using populations. The guide is available at: http://drugabuse.gov/POHP/ Principles of Drug Addiction Treatment This guide developed by the National Institute on Drug Abuse (NIDA) summarizes the basic principles of drug treatment and describes different treatment options. Available at: http://drugabuse.gov/PODAT/PODATindex.html Websites Addiction Technology Transfer Centers: http://www.nattc.org/ American Society of Addiction Medicine: http://www.asam.org/ Centers for Disease Control and Prevention, HIV Prevention Among Injection Drug Users: http://www.cdc.gov/idu Crystal NEON, a project in Seattle, Washington, that provides information on methamphetamine use: http://www.crystalneon.org/html/index.html The Harm Reduction Coalition: http://www.harmreduction.org National Association of State Alcohol/Drug Abuse Directors: http://www.nasadad.org National Center on Addiction and Substance Abuse at Columbia University: http://www.casacolumbia.org/ National Clearinghouse for Alcohol and Drug Information: http://www.health.org/ National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/publications.htm National Institute on Drug Addiction: http://www.nida.nih.gov/ SAMHSA Center for Substance Abuse Treatment: http://www.samhsa.gov/centers/csat2002/csat_frame.html N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 12 The Food and Drug Administration Approves OraQuick On Thursday, November 7th, the Food and Drug Administration (FDA) approved OraQuick, making it the first second-generation rapid test to receive approval for marketing in the U.S. Many second-generation tests are already used worldwide, but none have been available here until now. The first generation Sudden Use Diagnostic System (SUDS), manufactured by Abbott Laboratories, is the only other rapid test currently available in the U.S. SUDS is a complicated test requiring a laboratory and trained laboratory personnel to run and interpret. Unlike SUDS, OraQuick, manufactured by OraSure Technologies, is a simple test to administer and interpret, making it ideal for use in non-clinical settings where a lab is not readily available. Applying for a Clinical Laboratory Improvement Amendments Waiver Whether OraQuick will receive a waiver under the Clinical Laboratory Improvement Amendments (CLIA) remains a concern. CLIA, passed by Congress in 1988, regulates medical testing to ensure quality results. Under CLIA, tests can be classified as high or moderate complexity, which determines what laboratories may run certain tests. The higher a tests complexity, the higher the standards in terms of personnel, etc, required for a lab to run the test. The Centers for Medicare and Medicaid Services (CMS) has responsibility for ensuring laboratories meet CLIA standards as well as interpreting the CLIA statute. Manufacturers with accurate, simple to use tests may apply for a waiver under CLIA. A waiver removes the test from much of the oversight required by CLIAbecause of the small chance such a test would be administered incorrectly by untrained users, resulting in an erroneous result. With a waiver, the test can be more readily performed without the auspices of a laboratory. OraSure designed OraQuick specifically to qualify for a waiver, and initial data indicates that the test could meet potential waiver criteria. Secretary of Health and Human Services Tommy Thompson indicated his support for a waiver at the press conference announcing OraQuick’s approval. Some confusion exists regarding the guidelines to qualify and apply for a waiver. Although CLIA gives authority for making waiver decisions to FDA, decisions for classifying all previously approved tests fell to the Centers for Disease Control and Prevention. FDA only recently took back responsibility for making waiver decisions and developed draft revised waiver guidelines. However, FDA withdrew these guidelines last year and began developing new ones with input from CDC and CMS. At this point, it remains unclear exactly what guidelines FDA will use in determining whether OraQuick receives a waiver. FDA and OraSure are expected to discuss what standards FDA will use in determining a waiver and the data necessary to demonstrate whether OraQuick meets the standards. OraSure will likely file a waiver application sometime thereafter. Implementation of HIV Rapid Tests Much of the attention on rapid tests has focused on receiving FDA approval and on a waiver under CLIA. Because a waiver will determine what settings can use rapid tests and what roles AIDS programs and laboratories will play in providing oversight and quality assurance, discussions related to the waiver will likely continue to be the focus of much attention. Yet CDC and health department AIDS programs are beginning to examine implementation issues beyond a waiver under CLIA. Some states have been re-examining state laws that could pose a barrier for rapid tests such as laws that prohibit providing preliminary HIV results from a screening test. OraQuick only screens for HIV; positive results require confirmation. A second, complimentary rapid test could be used to confirm the results of OraQuick, but such a test will not be available in the near future. Many states have laws that prohibit providing clients with preliminary results. Health department regulations may allow some states to circumvent these laws while others N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 13 may need to approach their state’s legislature for a change. Many advocates raise concerns that opening up laws relating to HIV testing may allow some legislatures to add mandatory testing or other undesirable laws. AIDS programs have also begun assessing their counseling, testing, and referral (CTR) programs to begin deciding how rapid tests will fit. Rapid tests will not be appropriate in all settings. In general, they are recommended for settings with high prevalence (which reduces the likelihood of receiving a false negative) where return rates for results are low. Sights chosen must have the capacity to handle any additional demand for rapid testing that some pilot sites have seen. Counselors will require training on administering and interpreting the test and providing appropriate information regarding results. Counselors must also be trained to provide positive results and be prepared to provide clients with such results within a short timeframe. Clear linkages to confirmatory testing must be in place, and health departments must determine how best to provide quality assurance for rapid tests. Through a recent NASTAD survey on rapid test implementation, health departments identified several clear technical assistance needs. These needs included: • Adapting and implementing new counseling models. • • NASTAD will also work with FDA and manufacturers to bring other rapid tests to market. As noted above, a second, complimentary rapid test could provide confirmation of test results, eliminating the need for follow-up testing. NASTAD and other key stakeholders encourage FDA to issue the revised guidelines on qualifying and applying for a waiver, as well as guidelines providing standards rapid tests must achieve to receive FDA approval. Manufacturers will also be encouraged to seek FDA approval for many of the other tests already available internationally. FDA’s approval of OraQuick represents a significant step forward in ensuring people infected with HIV learn their status and are linked with care. However, it is only the first step in a process that will ultimately change how people are tested for HIV in the U.S. Adolescent and SchoolBased Health: Resources on School Health Presentation on Health and Student Achievement The Society of State Directors of Health, Physical Education and Recreation (SSDHPER) and the Association of State and Territorial Health Officials (ASTHO) recently announced that the presentation, "Making the Connection: Health and Student Achievement," will soon be available on CD-ROM. This PowerPoint presentation makes a compelling case for school health programs by outlining the major research that links the components of coordinated school health programs with student success. SSDHPER and ASTHO encourage education and health professionals to use this presentation in collaboration to show the importance of state and local partnerships in improving health and educational outcomes. This presentation was developed with support from a cooperative agreement from the Centers for Disease Control and Prevention, Division of Adolescent and School Health. There is no cost to receive this resource. Training curriculum on the new technology. Adapting/developing revised training programs for counselors. Working with CBOs to build their capacity to offer rapid tests. NASTAD will work with health departments, CDC, community planning groups and other key stakeholders to meet these technical assistance needs. Given these needs, roll out of OraQuick may begin slowly over the next year, with many states starting with small pilot projects. • N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 14 An order form that you may fax or email back to SSDHPER to get your CD-ROM is accessible at h t t p : / / w w w. t h e s o c i e t y. o rg / p d f / c o n n e c t i o n s . p d f. CD-ROMs will be mailed out as soon as they are ready. breakthroughs in scientific discovery. But while a Leonardo DaVinci or an Albert Einstein are classic geniuses, some believe that everyone can cultivate “genius” in their own lives. One of the most important steps to doing so is knowing where to look, according to Annette Moser-Wellman, author of The Five Faces of Genius: Creative Thinking Styles to Succeed at Work (Penguin Publishers, 2001). “Most of us believe that geniuses are in a league of their own. What we don’t realize is that these highly creative people use skills we all can learn.” Moser uses five metaphorical “faces” to identify the major thinking styles, each with their own unique strengths and particular contributions to make: The Seer: Seers throughout history have had the ability to make prophecies. In this usage, a seer has “the power to image.” Seers can visualize new possibilities and expand existing frameworks. The Observer: While seemingly playing a passive role, one who observes has the “power to notice detail.” Observers can then connect seemingly diverse points of information to draw new conclusions. The Alchemist: Alchemy is the science of combining different ingredients to make a new substance, hence the Alchemist has “the power to connect domains.” By bringing together different ideas, disciplines or systems of thought they can achieve an entirely new product. The Fool: In the Middle Ages, the Fool was the only one in a King’s Court who could speak the truth. In this context, the fool has “the power to celebrate weakness.” They can take existing structures and turn them upside down and inside out, sometimes leading to fortuitous new combinations or novel approaches. The Sage: The greatest wisdom can sometimes be found in the most modest proverb or most uncomplicated insight. The Seer has “the power to Surveillance Information on Adolescents CDC has made available via web a set of slides profiling the HIV/AIDS epidemic through 2001. Included in the slide set are AIDS cases among 1319 year olds and 20-24 year olds by sex and year of report, estimated male and female incidence by exposure category and AIDS cases by race/ethnicity. These slide sets can be accessed at: http://www.cdc.gov/hiv/graphics/adolesnt.htm. Upcoming Ryan White National Youth Conference on HIV and AIDS On February 14-17, 2003, the Ryan White National Youth Conference on HIV and AIDS (RWNYC) will convene in Dallas, TX. The RWNYC is the only national conference dedicated to building the HIV prevention health services skills of young AIDS activists, youth peer educators and HIV positive youth and those who work in support of young people. Over 600 youth and adults who work with youth from around the nation will attend to identify and share effective resources for HIV prevention among young people; present models of care, leadership and support services for HIV positive young people; present models of youth appropriate, culturally competent services to those infected, affected or at risk; develop leadership and advocacy skills; and strengthen youth leadership in the fight against HIV/AIDS. For more information, including registration form, visit the conference website http://www.rwnyc.org. The Manager Finding your “Genius” When we hear the word genius, we are likely to think of those few who have entered the history books for great works of art or major N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 15 simplify” and in the process to look at a situation and identify its essence – and thus its most important part. Cultivating the faces of genius Most people will have one “face” with which they most closely identify, and even these simple descriptions may be enough for you to figure out your dominant face. But unlike many management books of this type, the author encourages readers not to specialize on one area but rather to cultivate all five of the faces. Indeed, she warns against simply relying on the one face that comes most naturally or has worked best in the past and regards the least developed face not as a weakness but as a “growth opportunity.” At different times we may all be called upon to use each of the thinking styles. To develop the skills of The Seer, focus on your powers of visualization. Ask yourself: “What solutions do I see in my mind’s eye?” Try to “see” possibilities and cultivate a vision of the future, then think about what the implications would be of different futures. Because it sees “the big picture,” The Seer needs to work in combination with other styles that are more detail-oriented. To strengthen your powers of observation, encourage your sense of curiosity and try to draw new ideas out of collections of details. Ask yourself: “What do I see around me that leads to a solution?” The Observer excels in conceptual thinking that is rooted in real issues, but must guard against drawing wrong inferences from details. To become a better Alchemist, focus on the possible connections between seemingly disparate domains. Ask yourself: “What does this situation remind me of?” The Alchemist develops insights through analogies but also runs the risk of relying too heavily on others for the stimulus for new ideas. To play The Fool, ask yourself: “What happens if I invert the situation? Come up with an absurd conclusion? What if I persevered?” By inverting, toying with the absurd, and persevering in the face of tough odds, The Fool can create ideas that break through barriers – but must be careful not to persevere beyond what’s reasonable. To enhance your qualities as The Sage, ask yourself: “What simple solution could I create? What can I rekindle from the past?” By drawing on the lessons of the past, The Seer can create streamlined new ideas and develop insights into the issues that are truly key and essential. The danger here is oversimplification, and eliminating too many of the “messy edges” that spawn good ideas. Moving forward, consider drawing on your strength as The Alchemist to enable each of your thinking styles to enhance the other thinking styles. Let your Fool challenge the certainty of The Sage. Let the Observer ground The Seer while The Seer broadens the perspective of The Observer. As the author notes, “We live in an age of change. Don’t be the person who responds to change. Be the person who creates it.” Recognizing the need to support HIV/AIDS program staff members in their management challenges, the NASTAD HIV Prevention Bulletin offers “The Manager” column to bring to our readers’attention key works by professionals in the field of management. “The Manager” encourages readers to send in ideas for topics to be covered in this column. Please e-mail suggestions to nastad@nastad.org , fax them to 202-4848092, or mail them to “The Manager,” NASTAD, 444 N. Capitol St., NW, Washington DC 20001. Resources National Black HIV/AIDS Awareness Day 2003 National Black HIV/AIDS Awareness Day (NBHAAD) is a community mobilization initiative that focuses on building effective leadership within the African American community around HIV/AIDS prevention. NBHAAD is a project of the Community Capacity Building Coalition (CCBC) which is a coalition of national organizations funded by the Centers for Disease Control and Prevention through the National Minority AIDS Initiative. NATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 16 National Black HIV/AIDS Awareness Day is an annual event that will take place on February 7, 2003. There have been 16 targeted cities identified (Philadelphia/Los Angeles/ Washington, DC/ Chicago/ New York/ Atlanta/ Dallas/ RaleighDurham/ New Orleans/ Houston/ Miami/ Baltimore/ Cleveland/ Detroit/ New York/ Trenton) and lead community-based organizations (CBOs) within each of these cities will plan and organize local events and activities. Please click on http://www.nastad.org/pdf/news /BlackAIDS.pdf for information on lead CBOs for each of the targeted cities. Health departments and CBOs are encouraged to get involved in NBHAAD activities being planned within their jurisdiction. There are also many activities that can be initiated around National Black HIV/AIDS Awareness Day for health departments and CBOs that do not reside in one of the 16 targeted cities. Please refer to the official NBHAAD website for ideas on how you can get involved. The CCBC has established a toll free number (877) 867-1446 and website (http://www.BLACKAIDSDAY.org) to provide and collect additional information related to National Black HIV/AIDS Awareness Day. Community Planning Caleare listingsr meetings, conferences and other key nda of Following dates that may be of interest to those working on HIV prevention or community planning. Their inclusion does not necessarily indicate endorsement by NASTAD; please see contact information for additional details about each activity. December 1, 2002 World AIDS Day 2002. Please visit The Balm In Gilead website (http://www.balmingilead.org/wad02/contents.asp) for information on the World AIDS Day community mobilization campaign December 1-3, 2002 2nd International Conference on Substance Abuse and HIV, Mumbai, India. Sponsored by United Nations AIDS. For more information, contact The Hope 2002 Secretariat at info@hopeconference.org or visit: http://www.hopeconference.org/hope2002main.html. December 1-4, 2002 4th National Harm Reduction Conference, “Taking Drug Users Seriously,” Seattle, WA. For more information, visit: http://harmreduction.org/conference/4thnatlconf.html. January 27-January 29, 2003 Rescheduling of the November CBO Consultation in Chicago Due to unexpected logistical problems, the Regional Chicago CBO Consultation originally scheduled for November 13-16, 2002 has been rescheduled to January 2003. For more information, contact cboconsultation@cdc.gov or visit: http://www.cdc.gov/hiv/cboconsultation.html. January 27-30, 2003 National Hepatitis Coordinator Conference, San Antonio, TX. February 14-17, 2003 10th Annual Ryan White National Youth Conference on HIV/AIDS, Dallas, TX. Sponsored by the National Association of People With AIDS (NAPWA). For more information, please call NAPWA at (202) 898-0414 or visit: http://www.napwa.org. Capacity Building Assistance Training Calendar Please click on http://www.nastad.org/pdf/news/ calendar.pdf to see information on Capacity Building Assistance Trainings being offered through January 2003: N ATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 17 March 2-8, 2003 The Black Church Week of Prayer For the Healing of AIDS, sponsored by The Balm in Gilead, Inc. For more information, visit: http://www.balmingilead.org/home.asp. March 12-15, 2003 Community Planning Leadership Summit for HIV Prevention, New York City. Sponsored by AED, CDC, NASTAD and NMAC. For more information, visit: www.nmac.org and click on the CPLS button. March 28-30, 2003 RCAP National Conference, “HIV/STD Prevention in Rural Communities: Sharing Successful Strategies III”, Bloomington, IN. Co-sponsored by the Rural Center for AIDS/STD Prevention (RCAP) and the National Rural Health Association (NRAH). For more information, visit the RCAP website (http://www.indiana.edu/~aids). March 30- April 2, 2003 15th National HIV/AIDS Update Conference (NAUC), Miami, FL. Sponsored by the American Foundation for AIDS Research (AmFAR). For more information, contact Jennifer Attonito, Conference Director at (212) 805-1631 or visit: http://www.amfar.org/cgi-bin/iowa/nauc/index.html. April 4, 2003 3rd Annual CAPS HIV Prevention Conference, “Many Voices…One Mission”, San Francisco, CA. Sponsored by the Center for AIDS Prevention Studies (CAPS). April 6-10, 2003 14th International Conference on the Reduction of DrugRelated Harm Chiang Mai, Thailand For more information, visit http://www.ihrc2003.net April 26-29, 2003 Community-Campus Partnerships for Health (CCPH) 7th Annual Conference, San Diego, CA, “Taking Partnerships to a New Level: Achieving Outcomes, Sustaining Change”. For more information, please call (415) 476-7081 or visit: http://www.ccph.info. May 21-23, 2003 Call for Abstracts: National Conference on Health Education and Health Promotion, “Emerging Opportunities for Health Promotion and Health Education: Sailing into New Waters”, San Diego, CA. Sponsored by The Association of State and Territorial Directors of Health Promotion and Public Health Education (ASTDHPPHE). For more information on abstract submission, contact Sara Riedal at (202) 659-2230 x102 or sriedel@astdhpphe.org May 29-June 1, 2003 The Fifteenth Annual National Conference on Social Work and HIV/AIDS, Albuquerque, NM, “HIV/AIDS 2003: The Social Work Response. For more information, please contact the Conference Chair at (617) 552-4038 or email at lynchv@bc.edu or andertje@bc.edu. June 18-21, 2003 13th Annual National Conference of Social Marketing in Public Health, Clearwater Beach, FL. Sponsored by the University of South Florida, College of Public Health. For more information, please call (888) USF-COPH and press ‘2’ for the Continuing Education Office or call directly at (813) 974-6695. July 27-30, 2003 2003 National HIV Prevention Conference, Atlanta, GA. Sponsored by CDC and other governmental and nongovernmental partners. For more information, visit: www.2003HIVPrevConf.org September 18-21, 2003 The United States Conference on AIDS (USCA), New Orleans, LA. Sponsored by the National Minority AIDS Council (NMAC). For more information and abstract submission deadlines, please contact NMAC’s Conferences and Meeting Services Department between 9 a.m. and 5 p.m. (EST) at (202) 483-6622. NATIONAL A LLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS N A S T A D H I V P R E V E N T I O N B U L L E T I N - DECEMBER 2002 PAGE 18 If you have an idea or program relative to any of these topics that you would like to include in the Bulletin, please contact Nyedra Booker (e-mail: nbooker@nastad.org, phone: 202/434-8090). LET US KNOW WHAT YOU THINK! NASTAD welcomes feedback to issues presented in our newsletter. To submit commentary, please email us at nastad@nastad.org. Visit our Webpage! Electronic versions of the Bulletin are posted, along with other information on both NASTAD’s prevention and care projects. http://www.nastad.org The NASTAD HIV Prevention Bulletin is written and edited by NASTAD staff and participants of community planning and prevention efforts around the country. NASTAD’s production of the Bulletin is made possible through funding provided by CDC’s Division of HIV/AIDS Prevention (DHAP) in the National Center for HIV, STD, and TB Prevention. N ATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS