Chapter 1 provides a general introduction to the report and its organization. Chapter 2 reviews the extent of knowledge about the range and contexts of sexual and substance-using behaviors by which HIV is transmitted. Although attempts to conduct large-scale projects on the specific behaviors involved have been hampered, significant contributions to the knowledge base have come from individual studies using the methods of qualitative, social science research and behavioral epidemiology. Chapter 3 reviews what is known about the neurobiological, psychological, and social determinants of HIV risk behavior and examines the application of that basic knowledge to interventions directed at changing behavior in positive ways.
While preventing the initial transmission of HIV is the top priority from a public health perspective, it is equally important to develop effective treatment interventions for those people who are already infected. This requires knowledge about disease progression and how it might differ among individuals and populations. With respect to mental health and substance abuse, a key issue is the relationship between HIV, the brain, and behavior. This is explored in Chapter 4.
After highlighting some of the significant developments and outstanding gaps in AIDS-related behavior, mental health, and substance abuse research, the report moves in Part II to a discussion of the specific AIDS programs of NIAAA, NIDA, and NIMH. Chapter 5 describes the general context within which these programs have been operating. The most salient elements of that context are: (1) the recent reorganization of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA); (2) the new budget and program authority of the Office of AIDS Research (OAR) at the National Institutes of Health (NIH); (3) the budget process; and (4) the grant review process. Chapter 6 contains the committee's assessment of the content and management of the institutes' AIDS programs themselves, focusing on balance among scientific approaches, the use of various funding mechanisms to support research, and the overall funding picture. Finally, Chapter 7 explores the relationship between the AIDS research programs of NIAAA, NIDA, and NIMH and the services programs formerly at ADAMHA and now at SAMHSA (and elsewhere in the Public Health Service).