We are still in the midst of an HIV epidemic and we must not forget this: bring the ice bucket on

We are still in the midst of an HIV epidemic and we must not forget this: bring the ice bucket on

Growing up in the South Bronx I saw many individuals impacted by HIV/AIDS, although I was a bit young to understand that. However, it stayed in my consciousness and in my social justice vein. In college, HIV  was not a major concern for the overall population. However, it was still forefront on my personal advocacy front.

There was a time of increased HIV activism by the public at large and then that grand spotlight on HIV was a bit dimmed. Nowadays we are talking about reaching a worked without AIDS. However, by most scientist and politician accounts this can be achieved by 2030. Thus, lately while there is an urgency to get to zero new infections, we are still in the midst of an HIV epidemic. We must not forget this.

In the beginning of the epidemic, as a country, we were trying to grapple with the disease. In trying to grapple with the emerging epidemic back then we knew we needed more research and a stronger response. We have gotten there in terms of scaling up interventions and resources. However, while  the number of cases are evening there is also a change in the number of new infections and the key populations being impacted. One may argue more and more that HIV does discriminate. Those at social margins, who lack ready access to care are indeed being impacted. We must not forget about the marginalized.

Do we need an ice bucket challenge to give us a cold wake up call that HIV is still with us?  Who wants to take a cold splash to reach a world without AIDS?

Post by Miriam Y. Vega, PhD;  @miriamyvega

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The 49th Anniversary of Medicaid and Medicare

This week marks the 49th Anniversary of Medicaid and Medicare. On July 30th, 1965 President Lyndon B. Johnson signed the Medicare Bill into Law at the Harry S. Truman Library in order to improve the state of health care in the United States. Forty-five years later the Affordable Care Act was signed into law, but the hopes for Americans have not changed much since 1965.  Back  then, President Johnson noted,

“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.”[1]

 Today, after four years of the signage of the Affordable Care Act, we still have American families that are not accessing the medical care they need because of lack of health insurance and the means to do so. The Deep South States are especially impacted as health outcomes continue to worsen and health disparities and poverty continue to increase.  In part this problem continues to exist because there are still states that have not expanded Medicaid.

Increase in Number of People with Insurance if Deep South States Expands Medicaid[2]
States that have not Expanded Medicaid (July 2014) People with Insurance Coverage in 2016
Alabama 235,000
Florida 848,000
Georgia 478,000
Louisiana 265,000
Mississippi 165,000
North Carolina 377,000
South Carolina 198,000
Tennessee 234,000
Texas 1,208,000

 

We must set a goal in order to reach Johnson’s original vision.  It would be so grand for our health system and overall well-being if we were to have Medicaid expanded in the 24 remaining states.  It would be to our collective benefit to cover all 5.7 million Americans who would be eligible for Medicaid but are currently deprived of health care.  I hope that for the 50th Anniversary, we will be celebrating the expansion of Medicaid in our home states in the South.

[1] Lyndon B. Johnson: “Remarks With President Truman at the Signing in Independence of the Medicare Bill.,” July 30, 1965. Online by Gerhard Peters and John T. Woolley, The American Presidency Project. http://www.presidency.ucsb.edu/ws/?pid=27123.

[2] Excerpts taken from Buettgens M. Kenney GM, and Recht H. “Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.” Washington, DC. Urban Institute, 2014, http://www.urban.org/uploadedpdf/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf

Written By: Judith Montenegro.

A tale of two “public health” cities in response to AIDS

A tale of two “public health” Cities in response to AIDS

Let us start with the conclusion in terms of reaching a world without AIDS: science must intersect with and be married to social justice. The two worlds of public health science and community response need to be synchronized and interdependent.

Today we attended the New York Academy of Science event titled: Science, Community and Policy for Key Vulnerable Populations. The event was co-sponsored by UNAIDS right as the United Nations’ Open Working Group sessions on sustainable development goals are being pondered and debated. AIDS remains a global issue and as such continues to impact disproportionately vulnerable populations. Specifically, at the event it was posited that there are three epidemics: young girls, injection drug users in eastern Europe, and gay men world wide. Most likely it is children and gay men (men who have sex with men-MSM) who are not accessing treatment. Discriminatory legislation, for example, in Nigeria creates an unsafe environment in which gay men don’t dare get care. As a matter of fact, there are 82 countries have penalized MSM activity. There is a need to make these epidemics a “mainstream issue.”

As part of the opening remarks, Dr. Luiz Loures noted we are entering a new phase and there is a need for new partnerships. He was in New York at the very beginning of the epidemic where he saw his first AIDS case in 1982. He made an effort to understand the social aspects of AIDS at the time. He was in tune with the men in the community to give him a very different perspective from that of being a critical care doctor. What was astounding at that moment in time was that the people affected by the disease took on the reins in responding to AIDS. Such a community ownership of a disease was unprecedented at that time. However, as the epidemic took hold there was a need for more than a scientific and community on-the-ground response. UN Secretary General Kofi Annan established the global fund in the ’90s. Today we are spending 17 billion a year globally.

We are now entering fourth phase, per Dr. Loures. He noted that we are entering the “post science phase” where we can take this epidemic to the end. It is not the virus anymore that is holding us back. We now know how to respond.

The main aspect that differentiates this phase is a particularly acute challenge. We face the fact that the likelihood of accessing treatment, prevention technologies and knowledge is not the same for everybody. If you live in the Russian Federation, for example, there is a higher likelihood you won’t access treatment if you are an injecting drug user.

This new phase pushes us forward in thinking about social justice in more depth and more nuance. Science must not only focus on which biomedical advances work but science must investigate the what, who, when and why of our three global epidemics. Science, broadly and dynamically speaking, must help us understand why people are left behind. We need to more specifically understand who is vulnerable. We must ask ourselves what more can we do and what are the points for action? We have to find a way to make research understandable and relatable. The when is now. It is not so much about scaling up our efforts, although its still an issue, considering that 15 million people will be on treatment by 2015, but the need is 30 million. The fundamental point is to understand who is not getting treatment, where they are, why are they not getting treatment and what we can do.

We pose to you, dear reader, how can science help us bring people into care and reach equity? How do we get past the tale of two cities wherein community and science don’t walk hand-in-hand?

As Dr. Chris Beyrer noted “when HIV is anywhere, HIV is everywhere.” There are no neighborhood, city, state or country borders when it comes to HIV.

Inspired by this new phase in the fight against HIV and a need to consider geographies as well as the daily prompt.

Post and photo by
Miriam Y. Vega, Ph.D @miriamyvega
Emily Klukas, MPH @em_klukas

The Global Health Wanderer

While in-flight magazines are not always thought of as the highlight of the journey, I have grown to slightly look forward to the 15 minutes post take off where I am not yet allowed to turn on my laptop so instead I peruse the in-flight magazines. I always skip to the last few pages and examine the flight paths of the airline. Where can I go from New York? What if I stopped over in London? This is my little time to dream before the whirlwind of meetings, trainings, dinners, drinks, and repeat.

But this morning, a new infographic from Kaiser Family Foundation on US global health funding piqued a similar travel lust, oddly enough.Kaiser Info graphic How countries and communities try to ensure the health of their people is extremely different across the globe. How communities react to atrocities, war, famine, and acts of nature reflect inner creativity, culture and resilience.  Where would I first go on my tour of global health innovation?

1. After the 1994 genocide in Rwanda, for example, in which 800,000 Rwandans, mostly Tutsis, were murdered by their fellow country-men as the world stood by and watched in horror, no one expected 20 years later to see health equity as a top priority for the nation.  A mix of national and local level initiatives, including village-level funding and training of community health workers

2.  After attending a presentation at a national conference on health disparities by a member of the Brazil ministry of health, I added Brazil to my list. From what I understand, their public health system has gone through massive shifts and is now grounded in a participatory action framework, based on the pioneering work of Paulo Friere . This new system aims to put the decision-making in the hands of local jurisdictions, a very decentralized approach that is being used in developing countries around the globe.

3. While I have spent a great deal of time in Thailand, I must return as it continues to be a global health model, particularly in its HIV prevention. One of the most compelling graphs shows the projected (extremely high) rates of HIV infection, and also the actual rates (much lower) due to their proactive public health programs.  There was even an elected official called Mr. Condom – something that would most definitely cause ripples in the US congress. While radio PSAs were common in the 1990’s and early 2000s, it appears that some of the prevention messaging is shifting to highest risk groups – like the test Bangkok campaign.

What do these places have in common? What I want to see are the unique and innovative systems that people come up with all over the world. The passion that fuels these pilot programs that become large-scale programs is contagious.

For my fellow global health nerds out there, where do you want to go, work, experience?

Written By: Emily Klukas
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Post inspired by the daily prompt of: The Wanderer

Saudade

Saudade: a deep emotional state of nostalgic or profound melancholic longing for an absent something or someone that one loves.

The study of linguistics has intrigued me ever since I was little because I grew up learning English and Spanish at the same time. I sometimes would find myself pausing to find the right word to say to my friends in English, but not being sure it existed. As I grew older, I learned that different languages had words for certain feelings and moments that did not exist in English, simply because of culture differences. It was a weird, literally foreign concept to wrap my head around until I was introduced to saudade.

Saudade is a word of Portuguese origin that describes a feeling that can’t be summarized in one word in the English language—it is untranslatable. Saudade was once described as “the love that remains” after someone or something is gone. It often carries a repressed knowledge that the object of longing may never return. In some circumstances, it describes a feeling of intense homesickness. It is an emotion I have seen on my parents’ and relatives’ faces many times when they share memories of growing up in Peru.

It is a feeling that many immigrants feel after they have lived in the United States for several years while raising their children. It is a feeling of longing for what was once home, even if it wasn’t perfect. It is a longing for familiarity that they want to share with their friends but can’t find the words to describe it. It is a feeling of torment, especially if you’re powerless to do anything about it. Undocumented workers who have come here for a better life are stuck in this saudade limbo—thankful to be here, but deeply wistful for what they’ve lost in the battle.

There is another term coined by an American sociologist and anthropologist Ruth Hill Useem that I canrelateto—Third Culture Kid (TCK). A TCK is described as “a person who has spent a significant part of his or her developmental years outside the parents’ culture… and builds relationships to all of the cultures, while not having full ownership in any.” We don’t feel like we belong in this new world we’ve grown up in, but at the same time we’ve lost almost all our ties to where we came from. This is a different state of limbo from saudade. It is a limbo where we have no identity, where “we are neither of one world nor the other, but between.” A TCK is capable of feeling saudade. We have saudade for belonging. We want to be able to say “I’m from X country” and truly feel like it is home, while at the same time feeling at home where we are.

How have you felt saudade in your life?

Written By: Ingrid A Milera, intern at the Latino Commission on AIDS that studies at New York University
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