The Role of Samhsa/Csap's Minority AIDS Initiative (MAI) in Addressing Health Disparities

Introduction: Minorities are disproportionately affected by HIV/AIDS. In 2013, the rate (per 100,000) of HIV infection was 106 among African Americans and 42 among Hispanics, compared to only 14 among Whites (CDC, 2015). SAMHSA/CSAP’s Minority AIDS Initiative (MAI) aims to address this disparity by providing substance abuse (SA) and HIV prevention services to minority populations residing in communities at high risk of HIV. The program provides funding to community-based organizations and minority-serving colleges to implement rapid testing and evidence-based interventions to prevent SA and HIV transmission and improve access to and awareness of prevention and treatment services. This cross-site analysis examines outcomes for 24,631 participants served by 62 MAI grantees between 2010 and 2015.

Methods: Participants completed surveys at baseline, exit, and 3-6-months follow-up, assessing attitudes, knowledge, and behaviors related to substance use and HIV risk. Adult participants were also asked whether they knew the location of related healthcare services in their neighborhood. Pre-post change in outcomes was assessed by comparing matched baseline and exit responses. To determine significance, two-tailed matched-pairs t-tests were conducted on continuous outcomes and McNemar’s tests were used for dichotomous outcomes.

Results: Grantees were successful in reaching at-risk minorities. Of the 24,631 individuals served, 58% were African American, 23% Hispanic, and 14% were men who have sex with men (MSM) residing in minority communities. Participants were primarily young adults. Significant reductions were observed in the average days of alcohol use (17% decrease, p<.001), binge drinking (15% decrease, p=.003) and illicit drug use (27% decrease, p<.001). The likelihood of reporting protection during the most recent intercourse increased by 30% (p<.001). The percentage of participants reporting awareness of the locations of healthcare services related to SA and HIV/AIDS increased by 20% (p<.001) and 14% (p<.001), respectively.

Conclusions: MAI grantees have contributed to reducing health disparities through direct services such as problem identification and referral, testing, counseling, health education, and other risk-reduction interventions delivered to minority populations, and through information dissemination and environmental strategies implemented in high-risk minority communities. In addition to impacting participants’ attitudes, knowledge, and behaviors, the initiative has improved knowledge of and access to prevention and treatment services related to SA and HIV/AIDS in high-risk minority communities. The cross-site evaluation data also sheds light on the evidence-based interventions and combinations thereof that work best for specific high-need subgroups.