Theodore J. Gordon

Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD’s individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0–24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.

In planning, prospective policies are often subjected to “what if” resiliency tests. The question is asked: would intended decisions work as well if unanticipated events were to occur? This testing approach has two principal problems: there are psychological impediments to an unbiased choice of the test events and the inventory of events from which to choose test events is essentially unbounded. This article describes a database of about one thousand future headlines that help overcome both issues. The headlines in this database describe future events; they are randomly accessed to avoid bias in the selection of events for testing resiliency and the large number of forecasts, while not an “unbounded universe” covers a broad spectrum of possibilities. In addition, many other uses are possible, including improving foresight, finding new market and product opportunities, analyzing competitive differentials, and testing possible strategies for novelty.