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Aids and Behavior: An Integrated Approach
how the virus relates to the brain and to behavior is just beginning to be explored. Recent and current research suggests a bidirectional relationship: that is, the virus may affect the brain (e.g., infected cells produce neuropathology, such as dementia) and the brain may in turn effect the virus (e.g., psychosocial coping strategies boost immune system functioning). Unlocking some of the remaining mysteries about the complicated relationship between HIV, the brain, and behavior requires cross-disciplinary research, research at the intersection of biology and behavior. Ultimately, this should lead to the development of appropriate interventions, pharmacological, psychosocial, and social-structural. These issues are addressed 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 context in which this research has been supported. Chapter 5 describes the general context within which the NIAAA, NIDA, and NIMH AIDS 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 NIH; (3) the budget process; and (4) the grant review process. A discussion of these elements makes evident the level of complexity and uncertainty at the institutes while they were part of ADAMHA and as they were being transferred to NIH.
The committee was asked to assess the balance between biomedical and behavioral AIDS research in the portfolios of NIAAA, NIDA, and NIMH (notwithstanding this fluctuating context). The committee began by examining the programs and priorities for AIDS research as articulated in various planning and reporting documents produced by the institutes. In addition, the committee engaged in a grant-by-grant analysis of the three institutes' AIDS programs. Together, these efforts yielded some interesting findings. In particular, the committee determined that the very act of counterpoising these two categories of "biomedical" and "behavioral" research—while common in health science policy discussions—not only is inadequate for describing the nature of research supported by the institutes, but also undermines the possibilities of advancing the very sort of cross-disciplinary research needed to address the AIDS epidemic. In order to address the spirit of the question, but to more adequately describe the institute programs, the committee developed its own simple scheme