of the extent and manner in which the medical system acts (intentionally or not) to exclude drug users from care.

4.12 The committee recommends that NIAAA, NIDA, and NIMH support research on the relationship between adherence to HIV/AIDS medical treatment and disease progression among individuals from diverse gender, racial/ethnic, and cultural groups.

4.13 The committee recommends that NIAAA, NIDA, and NIMH support research that integrates substance abuse and mental health treatment; in particular, demonstration projects for integrated multidisciplinary treatment systems that include mental health.

4.14 The committee recommends that NIMH support research on positive as well as negative consequences of HIV, for example, how people with AIDS and their caregivers maintain positive coping strategies in the face of the disease.

4.15 The committee recommends that NIAAA, NIDA, and NIMH support research on how families (broadly defined to include persons who consider themselves to be family through mutual commitment) from diverse racial/ethnic, socioeconomic, and sexual orientation backgrounds cope with the reality of having family members who are infected with HIV or have AIDS. Special attention should be given to patterns and consequences of caregiving in such families.

In order to analyze the AIDS research programs of NIAAA, NIDA, and NIMH, one must understand the larger context in which they have been operating. The most significant elements for this study are: (1) the passage of the ADAMHA Reorganization Act of 1992 (PL 102–321), which separated ADAMHA's research and services entities into two different agencies (NIH and SAMHSA respectively); and (2) the NIH Revitalization Act of 1993 (PL 103–43), which assigned the NIH Office of AIDS Research (OAR)—housed in the office of the NIH director—new budgetary authority over