Category: Sexual Health

Implicit Bias in Prescription of PrEP

African American men who have sex with men (MSM) are disproportionately affected by HIV; however, recent research suggests that medical providers are less likely to prescribe Pre-Exposure Prophylaxis (PrEP), a preventative treatment for HIV, to black MSM (Calebrese et al, 2014). This is a direct result of implicit racial bias, prejudice, and a lack of institutional knowledge on the part of medical providers. Current stereotypes about gay men exist among many medical practitioners, specifically with regard to “Truvada Whores.” It is assumed that MSM who take PrEP will participate in more risky behaviors and thus be at greater risk of HIV, though PrEP is an important measure for reducing risk of HIV. This is further exacerbated by implicit racial bias which corroborates beliefs by providers that black MSM are even more likely than white MSM to partake in risky sexual behaviors if they are prescribed PrEP. As such, medical providers are less likely to prescribe PrEP to black MSM, barring them from access to an important and potentially life-saving measure to prevent HIV, a disease that they are disproportionately affected by.

This research suggests that public health interventions that focus on black MSM might be misplacing their efforts by focusing on changing the behaviors of the individuals or encouraging use of PrEP if they don’t have the necessary support from their doctors. Perhaps, public health interventions should focus on developing additional institutional knowledge to prepare medical providers for caring for black MSM and providing adequate sexual health care.

Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x

World AIDS Day 2017

Friday, December 1st marks the annual observation of World AIDS day. Since starting in 1988, World AIDS Day has provided an opportunity to support those living with HIV, and to commemorate individuals who have died from AIDS-related illnesses. It is estimated that there are nearly 37 million people worldwide living with HIV, and more than 35 million people have died of HIV or AIDS.

The theme for this year’s World AIDS Day is Let’s End It, to promote ending isolation, stigma, and HIV transmission. With advances in HIV treatment and prevention continuing to increase, the fight against stigma and discrimination that people living with HIV experience. This stigma also discourages people from getting tested for HIV. Regular HIV testing is important, since early detection of the virus, and subsequent early treatment, are vital from both an individual and a public health perspective. Those with an undetectable viral load, where the amount of HIV in their blood cannot be detected with current technologies, are unable to transmit the virus to others.

Here at UNC, the Student Health Action Coalition (SHAC) HIV is partnering with Student Wellness to provide Free HIV testing on Friday. The event will be in the Great Hall in the Student Union from 10:00 am – 4:30 pm, testing in confidential and quick. Stop by, get tested, know your status, and help fight HIV stigma! #LetsEndIt #TarHeelsGetTested

 

Sources –

World AIDS Day – https://www.worldaidsday.org/

 

PrEP for Life

Reflecting on the models of health discussed previously (part 1 & part 2), a queer man without human immunodeficiency virus (HIV; disregarding other illnesses) would be healthy, whereas a queer man with HIV would be unhealthy within the medical model of health. In the sociocultural model of health, both a queer man with HIV and without HIV would likely be considered healthy. Given current treatments, there would likely be no affect on an individual’s ability to perform the five activities of daily living. Finally, in the psychological model, we have no easy way to estimate beforehand.

However, within the “drugs for life” model, since queer men are identified within the public health discourse as high risk for HIV, they are immediately seen as bodies-at-risk. Within this model, being queer men can become a predisease for HIV. Much like pre-hypertension for hypertension, the predisease becomes an illness to be treated in itself. Here, we treat the predisease with public health interventions, but the predisease is the behavior of men having sex with men. However, with the best intentions, public health interventions and health communications campaigns can exacerbate the stigma within the queer community with regards to HIV and pre-exposure prophylaxis (PrEP).

Within this model, PrEP becomes another “drug for life.” There’s no point at which individuals can stop taking PrEP to prevent HIV. It has to be consistently taken in the same way that one would consistently take drugs after contracting HIV. Hence, the treatment for the disease and the treatment to prevent the disease have the same consequences. Presumably, patients would only stop taking PrEP after finding a long-term partner with whom they are monogamous (also presumably both partners would be HIV negative). However, this assumes compulsory monogamy and perhaps even compulsory matrimony. For queer men who don’t want to become monogomous or get married or who are worried about their partner’s (or partners’) infidelity might still be taking PrEP. This combination of high NNT (especially high NNT when we consider the effectiveness of condoms, which should still be used while taking PrEP, since it isn’t 100% effective) with the endless length of the prescription results in considerable profits for drug companies and a significant economic injustice for queer men.

The Newest Style of Sex Education

About a week ago, our class had the pleasure of listening to Alexandra Lightfoot, EdD discuss her involvement in one of the more revolutionary forms of public health circulating the block. As a professional, she has focused on the intersection between the arts and public health and how the two can be combined to create more effective health messages.

The topic of her discussion was the Arts-based, Multiple-component Peer Education (AMP!) Program that first came to UNC from UCLA a few years ago. AMP! utilizes interactive theatre techniques with college students who create scenarios to deliver sex-ed to 9th grade students in a novel way, especially down here in the South.

The critical component of this program is its use of satire, humor and storytelling to disseminate knowledge and start discussions about sexual and reproductive health with high school students and their health teachers. Research has shown that this traditionally complicated conversation is facilitated by this arts-based approach and the AMP! intervention has significantly increased student knowledge about how to prevent HIV and maintain sexual health.

Given that the live performance model of AMP! is delivered by college student “near peers” in locations close to their universities, it has been difficult to scale the program here in North Carolina. However, it has scaled well in the Los Angeles Unified School District, so hopefully that will provide a blueprint for sharing this creative and fun program to more youth in North Carolina. Lightfoot and her partners at the UCLA Art and Global Health Center are currently developing a compendium of video scenarios made by NC-based college students and a manual for teachers so that the intervention can be implemented more widely via digital delivery in classrooms across the state. The team is currently applying for funding to further refine the digital model and pilot and evaluate the implementation process and impact on student outcomes.

What do you think? Is this something you feel is appropriate for NC high school students? What do you think are the barriers and challenges such a program might encounter here? What are the positives about this kind of approach to sex education? Let us know below in the comments.

National Coming Out Day: Empowering, Heteronormative, or somewhere in between?

Tomorrow, on Wednesday, October 11th, the Human Rights Campaign (HRC) will commemorate the 29th annual observance of National Coming Out Day, to “celebrate coming out as lesbian, gay, bisexual, transgender, queer (LGBTQ)”. Many fine this day an opportunity to reflect back on and share their own coming out story, the HRC frames the day “as a reminder that one of our most basic tools is the power of coming out”. While my own process of coming out, at least in the sense mentioned above, I have some issues with this notion that it is a process with a shareable end goal, that I am able conveniently post to social media (based on the privilege I have in society), to remind my friends and family that I am queer, in case how I am living my life did not make that obvious enough.

On one hand, there is something to be said about the need for visibility, simply having a presence of owning your identity can be empowering, and it can help others in their process of finding their identity. But at the same time, I cannot help but wonder if the emphasis placed on coming out only serves to be heteronormative in nature, this need to distinguish yourself as the “other”. I also have issue with the idea that only LGBTQ+ individuals need to take the time to process what their sexual attractions and gender identities are, and more importantly how they define them and their place in the world. Why is it so normalized to own and share this counter narrative, when say, someone who identifies as a cisgender straight man is just accepted and believed in their identity?

Coming out also reinforces this idea that this process has an end goal, you spend some time, realize you’re not straight, share it with your friends and family, and done. This week, I want to encourage everyone to take a moment, think about how you feel with sexual orientation and gender identity, and consider how it positions you in the spaces that you occupy and the world around you, and the think about the ways that it can make it easier or more difficult for those in your circles who are not straight, are not cisgender. Does it give them space, and does it allow others to be open to themselves, and do you use your privilege to challenge that status quo to make that easier?

PrEP for HIV Prevention? Here’s what you need to know

Pre-Exposure Prophylaxis, or PrEP, has changed the way in which we talk about HIV Prevention. After being approved for preventive use by the FDA in 2012, there has been a sharp increase in PrEP prescriptions in the U.S. over the past several years. Currently, the only prescription available for PrEP is Truvada, which also serves as a treatment drug for those who are HIV positive.

Truvada is a nucleoside reverse transcriptase inhibitor, or an NRTI. When exposed to HIV, a NRTI works by masking itself as a building block of the virus’s genetic structure. While our own cells are able to recognize and correct for this coding mistake, HIV cannot, and as a result is unable to replicate and mount a widespread infection.

A quick distinction: Truvada as a drug is a form of PrEP, PrEP is a general class of preventive measures. Birth control can be thought of as a form of PrEP, preventing a pregnancy before it occurs. Even sunscreen is a form for PrEP. You apply lotion to prevent sunburn before it occurs.

But PrEP only works if you take it. According to recent findings from the Centers for Disease Control and Prevention, the majority of uptake of PrEP in the United States has been among middle-aged, white, gay men. But the HIV epidemic has shifted, with the CDC noting continuous inequalities in the southern states and among young African Americans.

More concentrated efforts need to happen to ensure that those who can benefit from PrEP are able to access and receive it. Gilead, the company that produces Truvada, has a copay card available, where they pay up to $3600 a year in copays for those living under 500% of the national poverty level. For more information on PrEP, UNC campus health also serves as a great resource on campus, and students can get more information by making a free appointment with Student Wellness by emailing LetsTalkAboutIt@unc.edu or by calling (919) 962-WELL(9355).

For additional Resources on what to know about PrEP, and how to have a conversation with your provider, please see the resources below for information from the CDC. For those looking for a PrEP friendly provider, here is a list of providers in the State of North Carolina who actively prescribe PrEP.

Sources –

Gilead Copay Card: https://www.gileadadvancingaccess.com/copay-coupon-card

Centers for Disease Control and Prevention PrEP Resources: https://www.cdc.gov/hiv/risk/prep/index.html

Centers for Disease Control and Prevention PrEP Information: https://www.cdc.gov/hiv/basics/prep.html

List of PrEP Providers: https://www.med.unc.edu/ncaidstraining/files/PrEPProvidersforDownload.pdf/view

What’s the Deal with Male Birth Control?

By: Aria Gray MPH: Maternal and Child Health candidate 2017

I have been on many different types of birth control in the past 10+ years, all with varying levels of success and each with a new set of side effects including migraines. It has never been a question of if I should try a new method since no there is no effective reversible male birth control available.

Recently, it has made headlines that a male birth control shot has been found to effectively prevent pregnancy in a newly published study. Unfortunately, participants in the study reported adverse side effects including mood changes, depression, and increased and 20 participants dropped out of the study leading researchers to stop the study earlier than planned.

These reports come very soon after another recently published study that was in the news, which cited that hormonal birth control can cause depression in women.

While this particular study was cut short, it is my hope that research continues to search for a safe and effective method of male birth control. Over 80% of the male participants in the study responded that they would use this method of contraception outside of the study, which is hopeful for the future, and a sign that this method is very much wanted and needed. Both women and men deserve to have reproductive freedom without having to jeopardize their health or mental health.

But for now, until male birth control that is safe and effective is developed and approved, women must bear an unequal burden to prevent unwanted pregnancies.

Read more about this interesting topic here.

Could Your Birth Control be Making You Depressed?

depressed

By: Aria Gray MPH: Maternal and Child Health candidate 2017

Could your birth control be making you depressed? A new study was released a few weeks ago claiming just that.

A nationwide study in Denmark was conducted to analyze the potential link between depression and hormonal birth control. What was found was that users hormonal birth control were more likely than non-users to be prescribed anti-depressants, though the risk is very small. The main conclusion of the study found that use of hormonal contraception, was associated with the subsequent use of anti-depressants and a first diagnosis of depression, and the authors of the study concluded that depression might be a potential adverse effect of hormonal contraceptive use. Currently, mood swings, and not clinical depression are listed as a potential adverse effect of hormonal birth control.

When this study was first published, I woke up to see news articles about it posted all over my Facebook timeline and my Twitter feed. Many of the people posting about this study felt vindicated after not feeling believed about how their birth control was making them feel. I also felt like my past bad experiences with hormonal birth control could potentially be explained by this study. For years, doctors had told me that there was no way that my birth control could be making me depressed, but my doctor’s explanation did not seem consistent with how my friends felt on their birth control or how much better I have felt after discontinuing certain methods in the past.

What I also saw online was great dissent and controversy about the study and the reporting about the study online from various news organizations and outlets.

While I did not agree with some of the comments I read online, I do agree that further research needs to be done on this topic, but I am excited that steps are being taken to further understand women’s health, especially in this context, and hope that this study sparks more research and discussion on this topic.

Time for a Change (in birth control)?

By: Aria Gray MPH: Maternal and Child Health candidate 2017

Over the summer I got married and moved into a new apartment and if that was not enough change combined with the start of the Fall semester, I am thinking about changing my birth control method. This is a common struggle that many women who rely on contraceptives often face. There is no “One size fits all” birth control, and often we must try several different options before finding our perfect method. It is sometimes very obvious when changes in your health or negative effects on your quality of life are a result of your birth control method, and other times it is not as apparent. Your health needs may also have changed since the last time you started a new method or you may have new priorities in your life.Birth control

If you are having trouble remembering to take your pill or change your method every month you may want to consider a new method that is easier to use. Additionally, if you are experiencing mood swings or depression, acne, a decrease in libido, headaches or migraines, and heavier periods it may time to schedule an appointment with your doctor to discuss your current method and options for switching. nuvaring

When faced with dissatisfaction with their method of birth control, many women choose to discontinue their current method without immediately starting a new method or without consulting their doctor, which places them at increased risk of unintended pregnancy. Click here for more specific information for how to switch your birth control method, and don’t forget to make an appointment with your doctor to discuss your options.  IUD

This new period tracking app is “Spot On”

By: Aria Gray MPH: Maternal and Child Health candidate 2017

Adjusting to the start of the school year and being back on campus can be very stressful and overwhelming. It can start to seem like you don’t have time to take care of everything on your list, including keeping track of your own health and your body including keeping track of your period. Your period is a normal (though not always fun) part of life, and tracking can be helpful to understand your own unique cycle and to observe if your cycle is changing at all. To help keep track of your menstrual cycle and your birth control method, consider downloading the new Planned Parenthood Spot On app.

Spot On is for anyone who gets a period or who uses birth control and does not make assumptions about your gender identity or sexual orientation. You can track your flow, symptoms, mood, and also daily activities. The app also has features that help you remember to take your01 birth control. Unlike other period tracking apps that are available, Spot On does not assume that you are trying to get pregnant and doesn’t treat your period like a part of your life that should stay hidden.

The app also includes FAQs and other helpful period resources as well as statistics based on information tracked in the app, which will make filling out forms at your next doctors appointment so much less stressful.