Category: Sexual Health

World AIDS Day: who is at-risk?

As the World AIDS Day is approaching on December 1, AIDS is more discussed openly and with compassion instead of in secrecy and shame.
Do you still believe population with high-susceptibility are sexual workers, drug users, and men who have sex with men? Yes or No!
Yes. They do have high risk of being infected by HIV.
No. There is a large number of teenagers being infected by HIV. According to CDC, youth aged from 13 to 24 accounted for a substantial number (estimated 26%) of all new HIV infections in the United States in 2010.
However, although previous research studied the knowledge, attitudes, practice, and influencing factors concerning AIDS among teenagers in the United States,  a group of teenagers is missing.
Chinese international students, a vulnerable group, need to be taken care!

With high-susceptibility of being infected by HIV, Chinese international students did not be studied before. Based on the report published by National Center for AIDS/STD Control and Prevention (China), there was an increasing number of students who were infected by HIV. Those students accounted for 1.64% of the total HIV carriers and people living with HIV/AIDS in 2011, increased from 0.96% in 2006. Of those students, almost half of them (49%) were aging from 20 to 24. Therefore, teenagers, especially college students, are the most vulnerable group concerning the chance of getting AIDS (He et al., 2008; Liu, 2006; Wang, 2002). Unfortunately, most of the previous research in China studied the knowledge, attitudes, and practice (KAP) concerning AIDS among college students in mainland China, instead of studying Chinese international students in the U.S.. Similarly, there is no study mainly focus on this group of students in the U.S.. Therefore, study on Chinese international students is in demand.

Additionally, the number of Chinese students studying in the United States is increasing according to the data published by the U.S. Department of Homeland Security. Nearly 100,000 Chinese students came to U.S. universities between 2009 and 2012, which contributed to a quarter of all foreign students in the U.S..

With an increasing number and high-susceptibility of being infected by HIV, Chinese students in the United States deserve research to learn their KAP, and develop effective preventions.

 

Photo credit: https://top5ofanything.com/list/ecdb3c65/Countries-with-The-Highest-HIV-AIDS-Prevalence-Rates

 

He et al.. (2008). Analysis to the effect of health education for college students’ AIDS-related knowledge and attitude. Chinese Journal of Health Education 24 (2): 102-104

(贺莉萍, et al. “健康教育对大学生艾滋病相关知识态度的影响.” 中国健康教育 24.2 (2008): 102-104.)

Liu, L.R.. (2006). Summary of health education of AIDS prevention in Beijing. Chinese Journal of Health Education 22 (2): 146-148

(刘利容. “北京地区预防艾滋病健康教育研究综述.” 中国健康教育 22.2 (2006): 146-148.)

Wang, Q.L.. (2002). 全球艾滋病流行进展. 中国艾滋病性病, 1, 000.

UNC Student’s Global Experience

By Hillary Murphy, UNC-CH MPH:Health Behavior candidate 2016

Summer of 2015 I found myself unexpectedly working in sub-Saharan Africa on a pilot intervention involving breastfeeding practices among mothers with HIV.

File:Malawi in Africa.svgJust to help you, the reader, understand how out of my element this was, here is a little background on me. My public health experience up to this point involved local food movements, health disparities in rural North Carolina, and, for a few months, community engagement and education in permaculture practices in Java, Indonesia.  Despite my obvious lack of experience, I was lucky enough to be offered a practicum position, and less than a month later, I began working in Malawi, a small country in southern Africa.

Currently in Malawi, 13% of pregnant women are HIV positive. Without intervention, 5-20% of their children will become infected from HIV exposure though breastmilk, suggesting that prevention of mother-to-child transmission is of critical importance.

During my time in Malawi our goal was to tailor and pilot test an Infant and Young Child Feeding (IYFC) promotion intervention among HIV+ Malawian women in community-based village savings and loan associations (VSLAs). We tailored training materials and IYFC learning sessions on 1) breastfeeding, and 2) complementary feeding for use with Malawian trainers and VSLA volunteers, and pilot tested these materials to further refine them for use in Malawi.

Although this practicum certainly helped build my skills in program implementation and tailoring, and gave me a deep love for sub-Saharan Africa, it most importantly was a reminder to be open to unexpected experiences. There is no way to know what your true passions in life are unless you welcome opportunities that are out of your element.

Photo source: Wikimedia

Immediate HIV treatment can save additional millions, WHO says

 

The World Health Organization (WHO) recently came up with new guidelines that could expand population on HIV drugs by millions.

In the past, the HIV infected would start treatment when their viral load reaches a certain level of severity. Under the new guidelines, however, anyone infected with HIV is recommended to begin treatment immediately after diagnosis. This expands the number of people who are eligible for anti-retroviral drugs to about 28 million to 37 million over the world.

In addition, the guidelines recommend protective medications for those who are at substantial risk of HIV infection as studies on pre-exposure prophylaxis, or PrEP, have shown to be effective to lower the risk of becoming infected.

The WHO hopes that the revised guidelines will help halt the epidemic, but who will pay for the cost to execute those remains questionable.

 

Bias on using HIV-blocking drug

The Boston attorney, as a gay man, thought he was discriminated for having HIV-blocking drug.

The attorney tried to ask his doctor to prescribe Truvada, an HIV-blocking drug, to be responsible for preventing himself from being infected by HIV. But he failed to get long-term care insurance from Mutual of Omaha. The reason why Mutual of Omaha turned him down is it does not cover anyone who takes the drug. As a result, the man will sue the insurer for the discrimination of being gay. He already filed a complaint with the Massachusetts Commission Against Discrimination this Wednesday.

According to the article published in the associated press, the man said:”I thought maybe they misunderstood me. I’m HIV-negative. I’m not HIV-positive. I was taking Truvada as a prophylactic.” The objective for him to sue the insurer is to ensure that people like him will not be worried about the discrimination for using Truvada.

Truvada, a preventive drug, was approved for reducing the risk of being infected by HIV among uninfected people by FDA. Moreover, in accordance with the data published by CDC, Truvada is able to largely reduce the risk in people at-risk.

However, there are a group of critics of Truvada claim that the use of Truvada may increase the prevalence of risky sexual behavior such as condom-less sex, though it is effective to some extent.

What do you think about the advantages and disadvantages of HIV-blocking drug? Will it really increase risky sexual behaviors in people at-risk?

Photo credit:http://www.wehoville.com/2014/04/08/worth-read-truvada-lifesaver-party-drug/

Drug Shown to be Effective in Preventing HIV Infection

What if there was a pill that could protect against the HIV virus?

What many people don’t realize is that such a drug already exists and has proven to be incredibly effective at blocking the spread of the virus.

Last week, Kaiser Permanente published their findings for a 2.5 year study of Truvada, the pre-exposure prophylaxis drug for HIV. Truvada is actually a combination of two medicines, tenofovir and emtricitabine, that when taken daily can prevent HIV infection in an HIV-negative person if they are exposed to the virus.

Of the 657 people who began using PrEP over the 32-month observation period, none contracted HIV during the study. Previously conducted clinical trials had shown efficacy rates as high as 92% for preventing infection when the drug was taken properly, but the Kaiser Permanente study was the first to produce evidence supporting the drug’s efficacy in a real world setting.

It is important to note that Truvada is only recommended for people who are continually at high risk for contracting HIV (due to sexual practices or injection drug use)*. It is also a promising option for HIV discordant couples (in which one partner is HIV positive and the other is negative).

Also, to be effective Truvada needs to be taken very consistently each day which raises questions of practicality and concerns about the regular access to healthcare services that successful management requires. Still, PrEP remains a very promising tool for the continued battle to control the spread of HIV worldwide.

You can find more information on PrEP from the CDC: http://www.cdc.gov/hiv/prevention/research/prep/

 

*If a person is exposed to HIV in a single high-risk event, they could begin treatment with postexposure prophylaxis (PEP) within 72 hours of their exposure to the virus to mitigate the chance of infection.

Early treatment saves more lives

The benefits of early treatment are clear for both people living with HIV (PLWH) and the whole society. Last Wednesday, based on the findings of the largest clinical trial, federal health officials announced that the benefits of the early treatment are obvious. Besides, they also said that people with HIV should take antiretroviral drugs as soon as they are diagnosed.

This trial is a strong evidence to show that those who got treatment immediately were 53 percent less likely to be infected and develop AIDS or die during the trial. Therefore, the early treatment saves more lives. At present, according to the Centers for Disease Control and Prevention (C.D.C.), 450,000 of the estimated 1.2 million with HIV are on treatment. Although the influence of early treatment is sound and profound, only 37 percent of infected Americans had the access to get the prescriptions of the drugs. This small percentage is partly due to the limited access to HIV testing, health insurance. Therefore, people infected by AIDS could not afford the drugs or did not see doctors.

In addition, though the substantial evidence of the benefits of early treatment is defining, the shortage of funding is the main cause of a small amount of people living with HIV have the access to the early treatment — antiretroviral medicines. For instance, the Global Fund to Fight AIDS, Tuberculosis and Malaria constantly struggle to raise money.

It’s true that antiretroviral treatment (early treatment) is the best way to curb AIDS. The shortage of money is the mainly daunting challenge facing organizations targeting at HIV.

Photo credit from: http://www.bchdmi.org/cchs/hiv

“Epidemic Bad Laws” vs. Human Rights

What is “an epidemic of bad law?” According to Global Commission on HIV and the Law, the “bad law” punishes and discriminates people living with HIV. For instance, HIV travel restriction allows to detain or deport foreigners who pose risks to the economy, the security, the public health, or the morals. At present, there are 50 counties impose this restriction on entry or stay of people living with HIV (PLWH).

These “bad laws” violate the human rights, especially for vulnerable groups of people such as transgender people, sexual workers, and injection drug users. Based on an article published in the New York Times, a Chinese transgender sex workers was punished by a policeman.  Xiao Tong (the transgender sex worker) was selling sex on the streets of Beijing when a man lured her into his car. The man took her to the police station and punched her. It is obvious that Xiao Tong, as a transgender sex worker, is the most marginalized and vulnerable populations in China. She was discriminated and punished by the policeman due to the absence of non-discrimination laws. However, the precondition of this case is Xiao Tong was selling sex in public place. Although it is inhumane to punch her, she deserves punishment from my point of view.

I do not believe that it is legal to sell sex in public places in other counties! It is true that we need some laws to protect vulnerable groups such as prisoners, sexual workers, injection drug users, transgender people, women and children. But the precondition is those groups of people do not influence or damage other people’s interests.

Therefore, what is “bad law?” I think a new definition is needed.

Photo credit: http://business-ethics.com/2010/02/10/1241-catching-bad-guys-international-law-enforcement-ups-the-ante/

 

 

DC Takes on HIV: An Evaluation

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Campaigns such as DC Takes on HIV acknowledge that marketing is not just for commercial products. Using a social marketing approach, the campaign promotes HIV testing, medical care, and treatment, condom use, and healthy relationships. The umbrella campaign consists of several topic specific campaigns, including Ask for the Test (HIV testing), Know Where You Stand (intimate partner communication), Rubber Revolution (condom use), and I Got This (HIV treatment).

A recent study evaluating the effectiveness of the campaign shows that the efforts were successful, especially among those most affected by HIV. According to the report, Public Awareness, Resident Engagement, and a Call to Action, the campaign had high visibility in terms of reach as well as a high degree of recall from the 810 participants, who were interviewed by telephone interviews.

It appears that the campaigns helped facilitate an increase in awareness of Washington’s free condom (71% gained knowledge) and HIV testing services (50% gained knowledge). On the behavioral side, 36% reported getting more HIV information, 35% reported finding out their STD status, 28% reported using condoms more frequently, and 27% reported getting tested for HIV.

The DC Department of Health will be hosting a webinar on implementing social marketing campaigns for HIV/AIDS prevention.

 

Sources:

http://dctakesonhiv.com

http://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/DC_Takes_on_HIV_Public_Awareness_Resident_Engagement_and_a_Call_to_Action.pdf

http://www.multivu.com/players/English/7379651-dc-department-of-health-study-shows-dc-takes-on-hiv-campaign-effective/#body_text

 

Tanzania’s HIV/AIDS Campaigns Get Motorized

On the crowded dirt roads of Tanzania yellow taxis are not available for the locals to use when they need a quick ride across town. Instead, there are these very unique motorbike taxis, known locally as “boda bodas,” that can bob and weave through the hectic African traffic.

Revered for their life on the road as opposed to the far more common farm life, boda boda drivers (who are overwhelmingly male) are very popular and influential in the Tanzanian community. But the thrilling life as a boda boda driver does come with a price – there is a high risk of injury and fatality.

But earlier this spring, IntraHealth International hosted a two-day event in which more than 400 boda boda drivers gathered in Kahama Town, Tanzania to learn about motorcycle safety and male circumcision – an event IntraHealth refered to as a “public health one-two punch” for increasing driver safety and decreasing the risk of HIV/AIDS transmission.

Like many of the African countries, Tanzania unfortunately suffers from high prevalence and transmission of HIV/AIDS. For years, both local and international organizations have worked to combat the deadly virus through awareness campaigns and free sexual and reproductive health services, but even today over 1 million Tanzanian adults live with the virus and over 2 million Tanzanian children have been orphaned by it.

As a result, HIV/AIDS campaigns have been forced to get creative – even motorized. For the two-day motorcycle safety and male circumcision event not only raised awareness, it provided male circumcision services to 474 Tanzanian boys and men.

In addition, IntraHealth gave the event’s participants motorcycle helmets and safety reflector jackets decorated with the message, “Pata tohara ya Mwanaume, punguza uwezekano wa kuambukizwa VVU”—“Get circumcised and reduce the chances of getting HIV.”

According to the project’s director from IntraHealth, prior to this event boda boda drivers had never been reached by an organization with a health message. For years these drivers have been zipping by projects as an untapped resource, but in the course of two days IntraHealth was not only able to provide hundreds of men with much needed male circumcision services, but the organization got a crucial HIV/AIDS prevention message out and on the backs of the popular boda boda drivers.

It’s too early to determine what the effect of the boda boda campaign will have on male circumcision rates and HIV/AIDS prevention, but at least it came with a 474-person head start!

 

Post source:  “Hundreds of Motorcycle Taxi Drivers Gather to Learn Road Safety and HIV Prevention in Tanzania” by IntraHealth International, published on April 22, 2014 at http://www.intrahealth.org/page/hundreds-of-motorcycle-taxi-drivers-gather-to-learn-road-safety-and-hiv-prevention-in-tanzania

Image courtesy of IntraHealth International

AIDS Turns 30

“First, the probable cause of AIDS has been found: a variant of a known human cancer virus. Second, not only has the agent been identified, but a new process has been developed to mass produce this virus. Thirdly, with the discovery of both the virus and this new process, we now have a blood test for AIDS. With a blood test, we can identify AIDS victims with essentially 100% certainty.”   -Margaret Heckler, President Ronald Reagan’s Health and Human Services Secretary, May 6th, 1984

Margaret didn’t give a perfect speech that day.  She claimed U.S. credit for what was partly a French discovery, misidentified the virus, and predicted that there would be an effective vaccine ready within 2 years (there still isn’t one.)

But this speech, given 30 years ago last week, did inform the country about the source of what would become one of the worst plagues in human history, and sparked huge amounts of change in the worlds of science, medicine, and society, much of which is still going on today.

There are some like David Patient who have had the virus for over 30 years, since before doctors even knew how it spread and during a time when it was called GRID (Gay Related Immune Deficiency Syndrome).  In the early 1980s experts discovered that this virus also killed hemophiliacs and injection drug users, as well as their partners and newborns, and was spreading all over the world.

HIV (Human Immunodeficiency Virus) is a virus that, at the final stage of infection, leads to a condition called AIDS.  Our immune systems are usually able to attack and clear out viruses.  This is not the case with HIV, for which there is still no cure.

Gay, bisexual, and other men who have sex with men (MSM), especially young black/African American MSM are currently the groups most seriously affected by HIV.

From 1996 to 2000, annual AIDS deaths declined by nearly 60% in the United States (from 38,000 to 16,000).  Unfortunately, during the same time the global toll rose by the same proportion during that period, growing from 1 million to 1.6 million a year.

There are currently more than 1 million people living with HIV in the United States.  Of these, 1 in 6 are unaware of their infection.

Though we can’t completely defeat it, modern medicine has made it possible for those infected to successfully control HIV.  But in order to control the virus, the individual first has to know they have it.

If you or someone you know might have HIV, make sure they get tested as soon as possible at a local testing site.

 

Photo Credit:  Luiz Sousa