the AIDS programs of all NIH institutes. Other factors, such as the overall federal budget process and procedures for program planning and grant review, affect the nature of the AIDS programs of NIAAA, NIDA, and NIMH. Chapter 5 discusses these contextual factors.


Overall, the reorganization appears to have had only a limited effect on the research programs of the three institutes to date. Their organizational structure and staffing have been left largely intact, and their review processes remain the same as they were at ADAMHA for the period FY 1993 through FY 1996, as mandated by the reorganization legislation.

ADAMHA never had an official, authorized, functioning AIDS office. Because the Department of Health and Human Services (HHS) was considering reorganization, ADAMHA created an acting AIDS office rather than a permanent one. This office was headed by a part-time acting coordinator, who also directed the NIMH AIDS office. Each institute at ADAMHA devised its own way to manage its AIDS program: NIAAA had only one or two staff acting as AIDS coordinators on a part-time basis; NIDA had an official AIDS coordinator located within one of its regular divisions; and NIMH had a formal Office on AIDS Programs with a full-time director. These organizational structures were maintained after reorganization. Only three of the 24 programs that were transferred from ADAMHA to SAMHSA as a result of the reorganization are directly related to AIDS: AIDS health care worker training (moved from NIMH to CMHS); AIDS health care worker training/AIDS hotline (moved from NIDA to CSAT); and AIDS service delivery demonstrations (also moved from NIDA to CSAT).

Simultaneous to the ADAMHA reorganization, NIH underwent changes in its leadership, and under the NIH reauthorization bill passed in 1993 developed a much more centrally managed AIDS research effort as new and greater authority over the AIDS budget was given to OAR. The bill requires a comprehensive plan for the expenditures of appropriations, and authorizes an emergency discretionary fund for the director of OAR. According to the legislation, the plan must: (1) provide for the conduct and support of all AIDS activities at NIH; (2) prioritize the various AIDS activities, which are required to have objectives, measures, and a time frame; (3) ensure that the budget is allocated accordingly; (4) be updated

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