Photo Credit: Rod Spark

Does Twitter Matter When it comes to a Reaching a World Without HIV/AIDS?

Highlights from the HEARD Institute presentation at the International AIDS Conference in Melbourne

Ask anyone on the street – is social media changing our world? Indefinitely you will hear how Facebook and Twitter are both bringing people closer together and ripping the fabric of our world apart.  Researchers are using social media more and more to understand more about us as humans and how our online environment impacts us to predicting elections and flu outbreaks. Continue reading

It is 2014: Don’t act like it is 2005 if we are to reach a world without AIDS

Throughout the first full day of the International AIDS Conference, there was a recurring theme. Well, rather there was an unofficial recurring theme not listed in the books. That theme essentially boiled down to: It is 2014: Don’t act like it is 2005 if we are to reach a world without AIDS.

In the last few years there has been an exponential growth in the number of prevention science results. We went from a scarcity of knowledge regarding what works in terms of prevention to an almost-gluttony of scientific results that has led to a fully packed prevention toolbox.  Yet, there are still 6,000 new HIV infections each day. The top ten countries account for 61% of the new infections. The top ten countries are as follows:  South Africa, Nigeria, India, Kenya, Mozambique, Uganda, Tanzania, Zimbabwe, USA and Zambia. Continue reading

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

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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    State of the Science Round Up

    State of teh Science Heading

    April 22, 2014

    We are starting a new Blog Series that will bring 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!

    HEARD Logo Gay Men Divided Over Use of HIV Prevention Drug

    This article has gone viral across Facebook and pulls together arguments for and against using HIV treatment drugs to prevent transmission. The past few months the Commission has hosted several Town Halls where we are hearing version of this across the country. Know the debate and participate!
     

    From the article: “It’s the Truvada conundrum: A drug hailed as a lifesaver for many people infected by HIV is at the heart of a rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms…”

    HEARD LogoCommunity-based HIV prevention can boost testing, help reduce new infections

    We talk a lot around here about comprehensive prevention – meaning using a mix of different types of interventions to have a greater impact. This is a key strategy in CDC’s approach to HIV prevention and is well documented in public health field in areas such as preventing traffic fatalities (e.g. seatbelts, speed limit, driver’s license, child safety seats). This new article is provides support that comprehensive prevention (in this case community mobilization, mobile HIV counseling and testing, combined with post-test support services) leads to increased HIV testing, decreased risk behaviors, and a modest reduction in HIV infection.

    From the article: “Communities in Africa and Thailand that worked together on HIV-prevention efforts saw not only a rise in HIV screening but a drop in new infections, according to a new study in the peer-reviewed journal The Lancet Global Health.”

    HEARD Logo New Obamacare Patients Stock Up on Drugs, Except Birth Control
    As today is the last day for open enrollment for the Health Exchanges (without penalty), what do we know at this point about who are the 7.5 million individuals hwo have indeed enrolled in the exchange? Well, based on this report by prescription provider Express Scripts, there are much higher rates of individuals in the exchanges who have accessed expensive specialty medications, such as those for HIV and multiple sclerosis, compared to those in employee covered plans.  What does this mean? Well, it could mean that people who are now getting coverage under the exchange are people who need life-saving treatment that could not get it before. Good news, right?

    From the article: “The report from prescription provider Express Scripts shows many more new patients than usual filled prescriptions for drugs that fight the AIDS virus, for pain medications, for pricey specialty medications to treat chronic conditions such as multiple sclerosis or rheumatoid arthritis, for anti-seizure drugs and for antidepressants…”

    HEARD Logo Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination
    Past research shows that discrimination indeed impacts a person’s health outcomes. But what is the case when someone has multiple stigmatized characteristics? This comes up a lot in our work, for instance being an immigrant, gay, and HIV+, our clients can experience discrimination on multiple levels. This relates to the first article in this post – the discrimination or judgment within the gay community around using HIV drugs to prevent transmission.  Read on to uncover recent research on how multiple levels of stigma and discrimination impact an individual’s physical and mental health.

    From the abstract: The double disadvantage hypothesis predicts that adults who hold more than one disadvantaged status may experience worse health than their singly disadvantaged and privileged counterparts… The results suggest that multiply disadvantaged adults are more likely to experience major depression, poor physical health, and functional limitations than their singly disadvantaged and privileged counterparts. Further, multiple forms of discrimination partially mediate the relationship between multiple stigmatized statuses and health. Taken together, these findings suggest that multiply disadvantaged adults do face a “double disadvantage” in health, in part, because of their disproportionate exposure to discrimination.”

    HEARD Logo NIH releases comprehensive new data outlining Hispanic/Latino health and habits
    Are you writing a grant, report or newsletter and need some data to help paint a picture of health among Latinos? This report summarizes the study findings that assessed cardiovascular disease and risk factors for cardiovascular disease among 16,415 Hispanic/Latino adults. The finding show difference between Latino nationalities across various factors, including smoking, obesity, diabetes, health insurance, diet and exercise, to name a few.

    Excerpt: “Although Hispanics represent 1 out of every 6 people in the U.S., our knowledge about Hispanic health has been limited,” said Larissa Avilés-Santa, M.D., M.P.H, a medical officer in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, and project officer of the HCHS/SOL. “These detailed findings provide a foundation to address questions about the health of the U.S. Hispanic/Latino population and a critical understanding of risk factors that could lead to improved health in all communities.”… – from NIH Press Release

    Written By: Emily Klukas
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