The Minority AIDS Initiative (MAI):Then and Now

Edwin M. Craft, Dr.P.H., M.Ed., LCPCHealth Systems Branch, Division of Services ImprovementCenter for Substance Abuse TreatmentSubstance Abuse and Mental Health Services Administration

September 11, 2015

HIV and Substance Use

• Substance use and abuse are important factors in the spread of HIV.

• Alcohol and other drugs can lower a person’s inhibitions and create risk factors for risky sexual behavior and HIV transmission.

• Vulnerable populations are more likely to have higher rates of alcohol and substance use.

CDC Fact Sheet - HIV and Substance use in the US, Mar 2013

Vulnerable populations include:• People who live in poverty• Gay and bisexual men• People with mental illness• People with a history of abuse

• Up to 50% of people with a serious mental illness will develop a substance use disorder at some time in their lives.

• Alcohol dependence is four times more likely to occur among adults with mental illness than among adults with no mental illness.

• Many health care systems to treat substance abuse and mental illness are disconnected: a missed opportunity.

Substance Abuse and Mental Illness Are Linked

Substance abuse and mental illness share risk and protective factors.

3

National HIV/AIDS Strategy for the US

• National HIV/AIDS Strategy (NHAS) for the US was updated in July 2015.

• NHAS is a five year plan outlining priorities, and actions to guide our national response to the HIV epidemic.

National HIV/AIDS Strategy for the United States, Updated to 2020, July 2015 4

National HIV/AIDS Strategy (NHAS)

There are four primary goals of the NHAS:

1. Reducing new HIV infections

2. Increasing access to care & improving health outcomes for people living with HIV

3. Reducing HIV-related disparities and health inequities

4. Achieving a more coordinated national response to the HIV epidemic

SAMHSA’s HIV programs address all 4 goals

from: White House HIV Care Continuum, 2013

HIV Care Continuum in the USA

According to CDC data, only 25% ofpeople currentlyliving w HIV are virally suppressed.

SAMHSA’s aim isto help improve access to HIV careat all stages in the HIV care continuum.

6

• Increase access to substance abuse (SA) and HIV treatment and prevention services for at-risk and hard to reach racial and ethnic minority populations and communities through:HIV testing for early detection and diagnosis.Implementing SA/HIV direct evidence-based

practices, and environmental strategies and policies,

Providing referrals to support/care and treatment services (ancillary/community).

CSAT’s MAI GOALS

Beginning of the MAI

• MAI begin in October of 1998• Result of March 1998 meeting between

CDC official and African American community service providers.

• African American community leaders declared State of Emergency.

• Congressional Black Caucus (CBC)Primary Supporter.

8

Beginning of the MAI

• White House ceremony to launch the MAI in October 1998.

• Targeted funding begin with the Appropriations Act of 1999.

• MAI funds to complement, not replace other federal HIV/AIDS programs.

• Initially referred to as the CBC initiative.

9

Expansion of MAI

• June 2001 CBC, Congressional Hispanic Caucus, and Congressional Asian Pacific American Caucus held joint hearing on early implementation of the MAI.

• First time three Caucuses met on any topic.

10

Goals of MAI

• Develop and improve the capacity of existing and new minority CBOs.

• Provide TTA in financial mgt., program development, administration, and planning and development.

• Expand Research.• Ongoing community input.• Coordination of federal efforts.

11

Secretary’s Minority AIDS Initiative Fund

• Special Congressional Appropriation of $50 million for DHHS.

• Allocated competitively across agencies of DHHS for short-term projects.

12

SAMHSA Minority AIDS Initiative Funding-CSAT

  PPA FY 2015 Grant Cohorts - ACTIVE RFA Acronym Number of

Grants Per

Cohort

Grant Period Grant Years

Grant Period of Performance

FY 2015 Total Amount of Funding

1 MAI Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS

Ti-12-007 TCE-HIV 39 Cohort FY12-FY16 

5 YRS 9/30/12-9/29/17 

$19,036,819

2 MAI Targeted Capacity Expansion: Substance Abuse Treatment for Racial/Ethnic Minority Women at High Risk for HIV/AIDS (TCE-HIV: Minority Women)

Ti-13-011 TCE-HIV 35 Cohort FY13-FY15 

3 YRS 9/1/13-8/31/16 

$17,771,242

3 MAI Minority AIDS Initiative Continuum of Care Pilot - Integration of HIV Prevention and Medical Care into Mental Health and Substance Abuse Treatment Programs for Racial/Ethnic Minority Populations at High Risk for Behavioral Health Disorders and HIV 

TI-14-013 MAI-CoC 34 Cohort FY14-FY17 4  YRS 9/30/14-9/29/18 

$6,630,141

4 MAI Target Capacity Expansion: Substance Abuse Treatment for Racial/Ethnic Minority Women at High Risk for HIV/AIDS

 

TI-14-011 TCE-HIV 5 Cohort FY14-FY16 

3 YRS 9/30/14-9/29/17 

$2,600,000

5 MAI Target Capacity Expansion: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS

TI-15-006 TCE-HIV 24 Cohort FY15-FY17 

3 YRS 9/30/15-9/29/18 $11,806,622

6 MAI Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS

TI-14-014 ATTC-CoE

1 Cohort FY14-FY16 

3 YRS 9/30/14-9/29/17 

$576,875

  TOTAL       138       $58,421,699

13

SAMHSA Minority AIDS Initiative Funding-CSAP

Year # Grants # Years Award

2010Sept. 2010 - Sept. 2015

36 5 $300,000

2010Sept. 2010 - Sept. 2015

27 5 $300,000

2013, 2014,

2015Sept. 2013 - Sept. 2016

Sept. 2014 - Sept. 2017

Sept. 2015 – Sept. 2018

29 – 2013

21 – 2014

34 – 2015

3 $300,000

2014Sept. 2014 - Sept. 2015

18 - 2014 1 $125,000

2014Sept. 2014 - Sept. 2018

33 - 2014 4 $500,000

2015Sept. 2015 - Sept. 2020

54 - 2015 5 $283,875

14

SAMHSA Minority AIDS Funding-CMHS

Cohort # Year # Grants # Years Amount of Funding

Minority AIDS Initiative Continuum of Care Pilot

2013, 2014, 2015

34 3 $7,751,913

15

Total Minority AIDS Initiative Funding for SAMHSA

• Total # Grants Funded = 424

• Total amount of funding = $67,982,487

16

Thank You and Questions - Contact Me If You Need Help

• Thank you for your time today. • I would be happy to answer any questions

17

Edwin M. CraftHealth Systems BranchDivision of Services ImprovementCenter for Substance Abuse Treatment, SAMHSA240-276-1571ed.craft@samhsa.hhs.gov