State of the Science Round Up

State of teh Science Heading

April 29, 2014

Welcome again to our new Blog Series that brings you state of the science and health equity findings, as well as community reactions to scientific breakthroughs.  Keep us posted of what you are reading and we will do the same!

This week we have a special focus on the HIV Prevention Pill or PrEP (Pre-exposure Prophalaxis). This is a relatively new HIV prevention tool where people who are at high risk of becoming infected can take a daily medication to lower the chance that they will get infected. This has been approved by the US Food and Drug Administration (in 2012) and the Centers for Disease Control and Prevention has published guidance on prescribing PrEP; while research has shown evidence of its effectiveness, is still a lot to understand in terms of how people use the pill, access, adherence and stigmatization (which was highlighted in our blog last week). Here are some new findings on these issues from the Conference on Retroviruses and Opportunistic Infections (CROI) held this past March, as well as a journal article recently released in the Lancet.

HEARD LogoImplementation of PrEP in STD Clinics and a Community Health Center: High Uptake and Drug Levels among MSM in the Demo Project

Starting with PrEP “uptake”, which these researchers define by looking at how many people agree to be in the PrEP study out of how many people were eligible. For instance, if 100 people were screened and were eligible for the study, and 50 agreed to be in the study, the “uptake” would be 50%.  A few interesting points they have in their tables are that there was a much higher uptake among 1) those self-referred vs. clinic-referred (makes sense); 2) older folks; 3) those with higher risk (also makes sense); and 4) those who already knew about PrEP.

HEARD LogoUptake of PrEP for HIV slow among MSM

“Uptake” in this report is not defined in the same way as in the above study. In fact it is not defined at all. It’s a bit more general. This report discusses challenges, concerns and areas for additional study around barriers for Men who have Sex with Men (MSM) in the US to utilize PrEP as a tool for HIV prevention. The key issues discussed are around communication and messaging, dosage and risk behavior.  A couple of the points that resonated most with me are:

  • 1) the difficulty in communicating with one’s family doctor around sexual experiences and
  • 2) the need to collect more information about dosing – meaning how effective is PrEP if you take it less than once a day?
  • While there is some data on this already, this remains a primary concern that we hear among service providers and needs to be examined further.

    From the article: “Kenneth Mayer, professor of Medicine at Harvard University and the medical research director at Fenway Health, a community centre in Boston, MA, USA, believes that as with other innovations, uptake of PrEP will be slow until knowledge of past and ongoing trials become widely known in both the MSM community and the general population. Mayer also points out that there are many more MSM actually using PrEP, but currently this is within clinical trials. Thus prescriptions could rise substantially once the current crop of clinical studies in the USA comes to an end.”

    HEARD LogoEarly Adopters: Socio-demographic and Behavioral Correlates of Chemprophylaxis Use in a Recent National Online Sample of Men who have Sex with Men in the U.S.

    In line with the previous article, researchers found that only 1.2% of over 9,000 MSM who completed the survey reported using PrEP in the past. The survey took place in August 2013 and participants were recruited from an online sex-seeking network site. The majority of the respondents identified as white (85.7%), with 7.5% identifying as Latino and 3.9% identifying as Black. Although these percentages are low, the sample size is high – thus it would be interesting for the authors to do specific sub-population analyses and see how PrEP use and access is different within Black and Latino MSM communities.

    From the source: “Although MSM in this online survey reported significant HIV risks, their experience with PEP and PrEP was limited. In order to increase PrEP uptake among MSM, PCPs need to be educated to provide culturally competent care, so that patients will be comfortable discussing HIV risks that could be decreased by PEP or PrEP.”

    HEARD LogoWillingness to Use Pre-Exposure Prophylaxis among Community-Recruited Injection Drug Users

    Injection with equipment that has HIV is the most “efficient” way to contract the virus. Meaning, one is at the highest risk of contracting the virus by sharing injecting equipment such as needles, cotton, and water (compared to contracting HIV through sex). Although the rate of HIV among people who inject has dropped dramatically, PrEP may be another tool to help “get to zero,” the slogan representing the global goal of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One of the main concerns for this, however, is that one gets the medication through a doctor, and that many people who inject may not have access to a doctor or insurance.  This study interviewed over 300 HIV-negative injection drug users and found two interesting points:

  • 1) About 70% said they were somewhat or very likely to use PrEP if it was free.
  • 2) About 88% said that they would still need to sterilize/clean needles or use condoms during sex if they were taking PrEP.
  • This second point addresses a major concern some people have – that if a person has this prevention pill, then that person wouldn’t use any other protection.  Based on the above article, it doesn’t appear that this should be a primary concern; however, there is plenty of forthcoming research that is looking at this very concern.

    From the source: “A large proportion of active IDUs in Washington, DC reported being willing to use PrEP if it were available at no cost. IDUs who were younger and had more sex partners reported to be more willing to use PrEP, suggesting that these groups could be targeted first to explore the practicality of PrEP use in this population. Further research should be done to explore availability, uptake, and adherence of PrEP among IDUs.”

    Written By: Emily Klukas
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    And then there were a hundred!!!

    We have posted our 100th blog article and we want to take a moment to thank all of our followers! The Institute for Hispanic Health Equity has been blogging for the past year with the intention of raising awareness and discussion on bridging the gap in health disparities throughout the United States and Puerto Rico. A big thank you to all our readers and followers for helping us spread the word!

    In case you missed them, here are the top ten most popular articles as of today:

    Please scroll bellow and take a look at what our followers are saying too…
    THANK YOU!

    Health Promotion and Communities of Faith: A match made in Heaven?

    Or maybe a match made on earth, I am actually not sure, but I know that this is indeed a good match. In recent years, the work of many communities of faith in promoting HIV testing and prevention has been labeled by the media as a “ground breaking” tool in the fight against AIDS. There are two reasons we say “groundbreaking” here: first, communities of faith provide a captive audience; and second religious leaders are perceived as influential in the individual’s decision making process.  This synergy makes the faith environment an opportune space to build health literacy. As of late, media has framed this as a new key to fighting HIV/AIDS.  Yet, communities of faith have been promoting healthy practices, advocating on behalf of those who lack access to care, and providing a range of health services like nutrition, mental health counseling and HIV testing for years. Most faith traditions promote a social wellbeing and justice environment, which responds to their mandate of caring for those most in need, including the poor and the sick.

    While many faith communities have been providing health ministry for years, this mission is sometimes drowned out by more controversial beliefs.  We can see this in strong focus of the mass media on the most controversial points of view, such as those regarding contraception and reproductive health. But there is much more to holistic health than those two issues! In our work with communities of faith, through the Latino Religious Leadership Program (LRLP), we have Roman Catholic Churches, for example, that promote HIV and Hepatitis C testing among couples getting ready for marriage. Also, historical churches, like the Episcopal (Anglican), Methodist, Lutheran and many Pentecostal churches actively promote health awareness through health fairs, health ministries that include health education workshops and referrals to services, while actively participating in coalitions to promote healthy habits, like proper nutrition, diabetes awareness, tobacco cessation, and drug & alcohol counseling. It is important to remember that not all “churches” (a common way to refer to communities of faith) believe the same; we have variations in doctrine regarding social issues, like abortion and same sex relationships. But there is one important common denominator among them: all communities of faith seek to promote wholeness (the capacity of the individual to achieve her/his best potential) through health, and that includes physical, mental, and spiritual health. Also, communities of faith value health as a way to preserve and honor what God has created.

    One of the main challenges I see from other health organizations, especially AIDS Service Organizations, is that they have doubts and fears about approaching communities of faith.  The fact is there are a few key strategies we have learned over the 17 years in our work that may help you get started.

    FIRST, do some homework and learn all you can about the local community in which the particular community of faith is located. Take a walk in the neighborhood during the day and, if it is safe, in the evening. This gives you a chance to learn about services available already in the area, like homeless shelters, recovery meetings, and health clinics. It also helps you understand the characteristics of the area and particularities about this community of faith, as well as learning whether the support you want to offer is an innovative idea or if it will complement services already existing.  Also, pay attention to other aspects of daily life, like business activity and transportation; these give you an idea how the needs, opportunities and infrastructure of the community influence the quality of life of the residents. When possible, attend a religious service in the community of faith you are interested in engaging.

    SECOND, reach out and establish a relationship with the leadership of the community of faith that you are interested in approaching. The leadership of a community of faith usually has the Pastor, Priest, Deacon, Reverend, Rabi, Imam, etc; but there are also lay leaders (leaders that are not clergy, but play an active role in the life of the community).  Think about these lay leaders as gatekeepers, and approach them with a conciliatory tone. Remember all you have learned through your observations, but acknowledge that the leadership of the community of faith might have specific experiences and points of view that could be different from yours. At this point, you might be more interested in them than they may be in you. Cultivating this relationship takes time and effort. If you find skepticism from the leadership in the beginning, don’t be discouraged and visit them from time to time; this will allow both parties to get to know each other better.

    THIRD, once the relationship is established with the leadership of the community of faith, remember that your primary role is to promote your services in the community, and not to challenge the beliefs and traditions in place. In our experience, some service providers come with a second agenda to challenge doctrine or theologies, which often closes doors for the health service organization.  A few tips that will help maintain a good relationship with the faith leaders:

    • Always ask what is appropriate to offer and what topics are out of boundaries.
    • Avoid confrontations at all cost, particularly those regarding theological and pastoral issues, because confrontations will undermine your initial efforts.
    • Respect all the traditions of the place, and, when appropriate, participate with the community in their activities.

    Occasionally, after the work of building the relationship, you may decide that this particular partnership does not fit your goals as a health promoter. This is ok!  Remember to be polite about the changes that you would like in the partnership and thank the leadership for opening the doors to you.  Often it helps to explain that you might not be coming as frequently, but leave the door open for future collaborations. If possible, come back once in awhile to say hi.

    These are just some basic ideas that can help you navigate a new territory. During your free time, read online about different faith traditions, and learn what they believe and how their approaches change from region to region. Feel free to download the 2011-2012 LRLP Evaluation Report and learn more about the scope of our work. So, as you can see, health education and communities of faith can be “match made in heaven”, and the community is there, ready to work with you!

    By: Daniel Leyva, Program Director Latino Religious Leadership Project

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    Real Stories Series: “Knowing that you have this disease can be a catalyst…”

    Today, we continue our Real Stories Series with people how are living with hepatitis in honor of Hepatitis Awareness Month.  As some of you know, this is the second year of National Hispanic Hepatitis Awareness Day and we will be continuing with a series of webinars throughout June. Stay Tuned!

    A big thank you to all those who were interviewed or shared their stories with us about living with hepatitis.  More to come in the next weeks!

    Interview with Dan Rosario

    1. How long have you had Hep C

    I’ve had Hep C for over 40 years. As far as I can tell, and depending on my theories it is likely that I got it either through IV drug use or a homemade jail house tattoo.

    2. What are the greatest challenges?

    The never ending fatigue is the most physically challenging thing. And the stigma associated with having a contagious disease that few people know about or understand. I still have to keep it secret at work and in many other social situations where I simply feel people would not understand. Depression and the constant battle to do things that will pick me up spiritually and emotionally are also serious challenges. The best way I can describe it is that it’s like waiting for a bus/train without a schedule; you never really know when it (death) will get here. So far I’ve been lucky with the way I’ve managed my disease, through doing things that address the mind, body and spiritual aspects of Hep C.

    3. How has Hep C changed your life?

    Having Hep C has seriously changed my life. Some of the ways it has changed are very difficult, for example having to be ever vigilant that I don’t accidentally contaminate someone. Since it can ultimately lead to cancer or death, the disease has a way of putting things in perspective for you. For instance many things I took for granted such as a sunny day, a warm smile, a kiss or a hug from a loved one, the ability to work, exercise, sing, enjoy music, love, be loved and just enjoy life in general, are just a few of the things I feel I can experience on a deeper more meaningful way than before I knew I had the disease.

    4. What hope do you have for your future health?

    Since I’ve been living with Hep C for so long, and have been managing it in a way that I believe will prolong my longevity, at times I remain optimistic. I sometimes believe that when I do die, it will be of something other than Hep C. Those are the feelings and thoughts I experience on the good days. On my down days, I am absolutely sure the Hep C bus is coming sooner now than before. And, I have in my mind at least, started to make preparations for my family when I am gone. It’s a tough thing to accept and actually act on. I guess, it’s not unlike anyone in life thinking about their place in the world, their own mortality and what exactly will be the legacy they leave here on earth. Having said that, and having gone through 4 courses of treatment as a non-responder, I still look forward to a day when I can be Hep C free. And with all of the new developments in the field, there’s still a realistic possibility that I will one day be free of the Hep C ball and chain attached to my leg. Pray that I’m right!

    5. What do you want the world to know about Hep C?

    The first thing I’d like the world to know about Hep C is, that much like AIDS, it is not a disease that is easily transmitted. You must have blood-to-blood contact with an infected person. Hopefully this would take away some of the stigma associated with Hep C. Removing some of the stigma could help people to start thinking about the disease and perhaps get themselves tested. If it isn’t already happening, I’d love for it to be a mandatory that all medical personnel to have a good working knowledge about Hepatitis. This could be part of their primary education in their field, or part of their mandatory continuing education to maintain their licenses in their respective medical fields. I would also like for the people who have just been given the devastating news that they have Hepatitis, to know that it is absolutely NOT a death sentence but that it is a LIFE sentence . Meaning, that knowing that you have this disease can be a catalyst to a much more fulfilling existence in this world.

    -Compiled by Bethsy Morales-Reid

    @NHHAD