Proposal for HIV/ Mental health work in India

[Guest guest]

Dear colleagues,

First, thank you to all of the people who forwarded my initial email regarding a

grant proposal that I have started regarding HIV and mental health. Your

commitment to health care and compassion extended my reach 500 times farther

than I could have managed.

I am one of two physicians here in New York City interested in mental health

training work that would stem the spread of AIDS and/or the suffering caused by

it. I have attached [designated by **] the guidelines of the Glaxo-France

grant, 3 requirements, some possible ways we could join with your work, along

with my areas of interest. Glaxo ideally wants to fund an international group

[but we can overcome this bias] and they want to know how it will impact the

communities (if you can give me a number of people potentially served that would

be great).

Please send me your expressions of interest, capacity, and time-line as soon as

possible if you are interested in collaborating with me. The due date for the

grant proposal is near.

As a short introduction, I was born in Houston, Texas. I read/write/speak

Gujarati, Hindi and Urdu. I can conduct psychotherapy in Hindi/Urdu best, and

my writing of Hindi/Gujarati is more error-free than Urdu. After medical

school, I completed an internship in psychiatry, and now I am completing in June

a residency in Preventive Medicine. I spend most of time helping to coordinate

systems of health care, social activists, and political bodies here - when I am

not seeing patients for psychotherapy. Since 1994, I have visited numerous

activist and health care groups in India, Pakistan, and Sri Lanka. Suffice it

to say that I think it is very exciting, complex, and rewarding to do what you

are doing. I very much enjoy the exposure I have had to the humane world of NGO

work.

In August 2002, I spent the month with 4 Ahmedabad NGOs providing trauma

recovery consultation and therapy in response to the carnage and madness there.

I am always looking for opportunities to work with & learn from work with

vulnerable populations because I gain so much from my countrymen/women.

Warmly,

Siddharth

Siddharth Shah, MD

Department of Community Medicine

Mt. Sinai Hospital, Box 1043

New York, New York 10029

(212) 241-7873

E-mail:siddharth.shah@...>

**My areas of interest are:

* Training grassroots workers to identify vulnerable people and give services

* Psychotherapy for the consequences of HIV & its treatment

* Mind-Body medical techniques for enhanced wellness [hypnosis, guided imagery,

relaxation techniques, yoga, prayer]

* Psychoeducation for patients, families, and high-risk groups

* Children at Risk

* Combating the State> '> s repression of HIV prevention and sex education

**There are 3 requirements that I must observe at this point. If you can

address all 3 in your proposal to me, please read on.

1) an infrastructure to responsibly receive funds from a French granting

agency

2) scope to benefit from HIV prevention training work from a mental health

point of view [for 1-2 years as a pilot program] - number of staff who would be

able to utilize our work and number of people potentially served

3) some access to an Institutional Review Board, or equivalent, that would

review our proposal and render an opinion on whether it meets ethical standards

of the community in which the work will be done

**Below is some work that has already been done regarding HIV-mental health in

Africa. I have included it to give you idea of what is possible. You need not

propose something similar.

Introduction

Although ultimate control of AIDS depends on effective prevention, there is

increasing recognition that HIV care and clinical support is a powerful tool for

expanding the response to the epidemic. In poor countries, optimal care for HIV

infection is limited by multiple factors, including infrastructure, lack of

access to antiretrovirals, and inadequate numbers of trained personnel to care

for patients with HIV/AIDS and its c> omplications. Moreover, many studies have

correlated improved survival and quality of life with the enhanced skill of

those who regularly care for those with HIV infection.

Why HIV/AIDS Neuropsychiatric Training

1. HIV invades the brain at the time of initial infection, and has profound

effects n it, including such complications as mood disorders, psychotic

illnesses, cognitive impairment, and frank dementia. The identification and

management of these disorders a re critical to the medical management of

HIV-infected people.

2. Medications used to treat HIV infection and the associated opportunistic

illnesses, as well as the opportunistic illnesses themselves, can also have

serious neuropsychiatric complications that are essential to identify and treat.

These include the many potentially life-threatening conditions that underlie the

common problem of delirium.

3. Many psychiatric disorders are associated with HIV infection, either through

their relationship to HIV-related risk behavior, the psychosocial impact of

having HIV infection, or the associated medical problems described in points 1

and 2 above. Such disorders in need of adequate treatment include alcohol and

other substance use disorders; depression; anxiety disorders, including

post-traumatic stress disorder; adjustment disorders; and severe and persistent

mental illness.

4. The HIV epidemic has brought psychosocial consequences that mental health

care can help to address. These include:

a. Effective prevention strategies for halting the spread of HIV, including

the reductions in sexual and drug use risk behaviors and in violence against

women.

b. Adequate pre- and post-HIV test counseling.

c. Enhancing adherence to recommended treatments.

d. Managing bereavement, loss, and stigma.

e. Understanding the psychosocial adjustment of orphaned children and

implementing strategies to enhance it.

f. Understanding the nature of caregiver burden and implementing strategies to

reduce it.

Curriculum

APA/WPA will use an established curriculum which outlines a wide range of

topics including, but not limited to:

* Complications of the Central and Peripheral Nervous System

* Mood Disorders

* Anxiety Disorders

* Sleep Disorders

* Pain Syndromes

* Substance Use Disorders

* Psychotic Disorders

* Severe and Persistent Mental Illness

* HIV prevention

* HIV-related diseases

Trainers will be responsible for the following:

* delivering and refining lectures for their respective course

* facilitating interactive sessions with trainees including discussions and

clinical case studies

* providing instruction in both outpatient and inpatient clinical settings

* providing introductory computer support to trainees

* participating in clinical activities

**Below are the grant guidelines. Any proposal you make must satisfy its

wording.

GLAXO SMITH KLINE GRANT

For the next two years, the GlaxoKline France Business Foundation wishes

to support health care programmes in developing countries based on its

priorities and action plan defined over the last five years.

Our aim is to encourage the development of healthcare in the field of HIV/AIDS

while achieving tangible, measurable and quantifiable results in terms of the

number of people covered and positive changes in local political, medical and

social policy in favour of fighting AIDS and providing healthcare to people

living with HIV/AIDS. In all cases, the local authorities will be approached to

solicit their agreement, support or commitment.

COMPANY PRIORITIES

Taking into consideration the local health situation, the means available and

the public health priorities of the countries concerned, projects filed for

application can cover the following:

1. Prevention and HIV vertical transmission risk reduction programmes for

pregnant women with coverage for mothers, children and family;>

In countries where there is no significant activity or national action plan in

the field, this could involve encouraging activities and financing the set-up of

pilot programmes.

In countries where pilot programmes have been set up, projects could deal with

improving operational conditions and encouraging their deployment within the

scope of the relevant national health policy. In the framework of these

projects, the Foundation could facilitate contacts with other possible partners

with the aim of improving access to different materials (HIV screening tests,

drugs, substitute products for breast-feeding).

2. Healthcare/treatment programmes for adults & children with HIV.

3. Programmes improving access to and quality of healthcare. There are three

priority areas:

§ Educational programmes for HIV-positive patients on antiretroviral treatment,

with the Foundation financing the following activities:

- Training healthcare givers and social workers to educate patients about their

treatment

- Training educational officers to set up educational activities.

- Distributing a methodological guide, an educational tool kit designed for

HIV-positive patients and an educational guidelines brochure.

- Setting up a supervisory and activity evaluation system.

§ Programmes that innovate in terms of financing HIV-risk coverage and

healthcare

- Particularly programmes that finance HIV-risk coverage in mutual health

insurance organisations or healthcare coverage in mutual health centres.

§ Programmes that encourage private companies to provide a healthcare offer for

HIV-positive employees and claimants.

BACKERS AND SELECTION CRITERIA

Project backers for projects can include:

- Public entities (governments, health ministries, national programmes against

AIDS, public hospitals or health organisations, etc.)

- Private entities (private or charity healthcare centres, company health

services, NGOs, etc.) if they can guarantee the following:

§ Quality: quality of projects submitted,

§ Relevance: relevance of the project taking into account health priorities and

needs, and consistency with national AIDS policy and development areas,

§ Feasibility: technical and organisational abilities of backers to ensure

effective healthcare delivery,

§ Fairness: no discrimination against populations who could benefit from the

programme.

TYPE OF ASSISTANCE

The funding provided by the Foundation for this type of programme can apply to:

§ Providing assistance to teams, e.g. organising training courses for

healthcare providers,

§ Providing assistance to rehabilitate healthcare and laboratory

infrastructures,

§ Providing assistance for operational aspects: healthcare and biological

follow-up, voluntary screening, providing information and advice to patients

under treatment, bottle-feeding activities to reduce the risk of HIV vertical

transmission, supervising and evaluating programmes.

The Foundation can finance these different requirements but does not provide

any direct technical assistance which may be necessary to carry out this type of

operation.

As a French-based business foundation, the supply or funding of medicines is

not carried out by the Foundation and is dealt with by the pharmaceutical

companies concerned.

The Foundation's activities can also balance other initiatives aimed at

improving access to healthcare and treatment for HIV.

The Foundation can also act as a private financial partner, along with other

corporate financial partnerships, to accelerate the operational implementation

of a national action plan.

TIMETABLE FOR PROPOSALS

§ Deadline for submission of applications: 31 March 2003

§ Assessment of applications by the Scientific Committee: April 2003

§ Decision by the Board of Directors: May 2003