Thank you Mr. Sterling

Strange title, eh? After all, why would I thank someone attributed to insensitive racial comments about African Americans in 2014? With an African American president, thousands of African Americans now listed among the elite, but elusive, top 1% (over a dozen of whom, by the way, who actually work for Mr Sterling) don't we now live in, as many idealistic pundits and scholars call it, a 'post racial' society? Well, this blog is not intended to thank him for reminding us that racism is alive and well. I am thanking Donald Sterling for getting HIV back in the news. Now, one would think that the greatest epidemic in modern history alone, would remain in the headlines by virtue of well, it being the greatest epidemic in modern history. Its amazing to think that 75 million total infections, over 36 million deaths and over 2.3 million new infections annually rarely makes the news. Nor is it the fundraising leadership of 'twinBill" of Bill Clinton and Bill Gates; or the dramatic breakthroughs in HIV treatment that have enabled millions to live longer, more productive lives; or even the tenacity of the advocates who have fought for access for these treatments. No, it takes the uniformed comments of an 80 year old man about one of the most iconic figures in the history of this epidemic, Magic Johnson, to justify front page news. So thank you, Mr Sterling for reminding us that HIV infection is not the same thing as AIDS and that people can LIVE with HIV. Thank you for reminding us that many people still blame the victim ( 32%- according a 2012 survey by the Kaiser Family Foundation). And last, but not least, thank you for reminding us that we still have a long way to go to reduce the crushing stigma still associated with HIV. The attention that you brought to this issue, misguided as it may have been, has produced the rare public 'teachable moment" that we HIV advocates and educators so often yearn for. Now, I guess we will just have to wait for the next major, public faux pas to get in the headlines again.

Ignorance is Bliss (Not!)

As someone working in the field of HIV/AIDS, I have had many conversations about the topic with people ranging from politicians to middle school students. However, I will never forget the recent conversation that I had with a long term (25+ years)survivor who shared how he could manage the symptoms, the side effects of the medication and even accepting that he may not live as long as he planned; but it was the stigma that he struggled with the most. So why, at the ripe old age of 32, does the stigma of HIV/AIDS remain so devastating? A new survey by the National AIDS Trust demonstrated how the lack of knowledge about HIV/AIDS, despite our access to social media and the internet, remains significant. For example: * 20% of the survey respondents believed that HIV/AIDS is a death sentence and that the life expectancy of a newly diagnosed person is about 10 years; * Over one-third of the respondents believed that people living with HIV were not allowed to work in schools, hospitals or restaurants; * Over 25% believed that people living with HIV are legally required to disclose their status. After reading these results, I recalled a conversation that I had with a Miami cab driver. I often share what I do for a living, partially to gauge the reaction, but also to ascertain what they know about HIV/AIDS. I was mortified when this cab driver, who looked to be in the 25-35 year old range and was deftly welding the GPS on his smartphone to navigate, said that he knew that there was a drug to treat AIDS: AZT! For those of us even remotely familiar with HIV, to hear someone express that s/he knew of only one medication to treat it-which happens to be the first anti-retroviral medication to treat HIV/AIDS AND was introduced in 1984! Is it fair to expect people to know more about HIV/AIDS? At what point does personal safety take over? Doesn't over 25 million deaths, with over 34 million people living with HIV/AIDS at least inspire some curiosity? I am a little biased of course, but it would certainly make my work and others like me, not to mention the lives of the tens of millions living with it a little easier if more people took the time to avail themselves of the tons of information available to them. Isn't it worth the time?

Were Michael Douglas' comments about HPV helpful?

Megastar actor/director Michael Douglas recently caused a stir when he implied that his stage 4 throat cancer was caused by the Human Papillomavirus (HPV), which he believe he contracted through oral sex. He went on to say that cunnilingus was also the "best cure for it." As I have written previously, one tract of HPV (HPV16) is known to be linked to oral cancer, manifesting itself in the back regions of the throat and mouth. HPV, the sexually transmitted virus best known as a cause of genital warts as well as being linked to cervical and anal malignancies, is thought to be responsible for an increasing proportion of oral(oropharyngeal) cancers, including throat cancer. However, lifestyle may present even greater risk factors and Mr. Douglas' tobacco habit, coupled with, at times, excessive alcohol consumption appear to be the most likely culprits. In 1992, he was hospitalized for an addiction which some at the time claimed to be sex. Douglas himself denied this and said he was in rehab for alcohol abuse. He has also spoken of recreational drug use. Many believe that the rise in HPV related cancers may be the result of a change in sexual behavior, especially an increase in oral sex. Oral sex may seem for many to be a safer alternative to penetrative sex, which are know to result in a host of sexually transmitted infections (STI'S) , including HIV. Most people seemed surprised to learn that STI'S such as Gonorrhea and Syphilis, not to mention HPV, may be transmitted through oral sex. A physician once said to me that the throat is an almost perfect breeding ground for infection. To his credit, Mr Douglas later backtracked and acknowledged that his cancer may not have been caused by HPV-he was just sharing how oral sex may lead to throat cancer. However, were his comments helpful in raising awareness in the public about HPV? Certainly his assertion that more oral sex can help cure it, was not. My fear is that many people do not take the time to read or even listen to the whole story and are more likely to get the gist of it from headlines and sound bites. Nonetheless, even if he had to pull his foot from his mouth (no pun intended), I am grateful to him for having the courage to bring to light an important issue. Now it is up to the rest of us to make sure that we provide the accurate information to the public.

HPV Vaccination-A Wasted Resource for African Americans?

The United States has no reporting system for Human Papillomavirus (HPV) infections. Infections and the development of warts appear to be common throughout life. In general, genital HPV infection is considered to have become dramatically more frequent over the past several decades. In the United States, young adults aged 15-24 years account for approximately one half of new HPV infections each year. The highest rate of infection is among young females aged 20-24 years. Using data from these sources, the US Centers for Disease Control and Prevention (CDC): there are an estimated incidence of more than 6 million new patients a year in the United States (in 2008) and an estimated prevalence of more than 20 million. HPV infections has been identified as a potential cofactors in a number of serious diseases including cervical vancer and even HIV infection. In the United States, African Americans have a rate of HPV infection that is 1.5 times higher than their white counterparts. One US survey reported that among women, the prevalence of HPV infection due to any HPV type was 39% for non-Hispanic blacks, and 24% for non-Hispanic whites and Mexican Americans. From 1987 to 1991, the age-adjusted cervical cancer death rate reported by the US National Cancer Institute was higher among black women than among white women, with a ratio of 6:1. HPV may also linger longer in African American women. Because most HPV infections are transient, it is usually cleared by ones immune system within one or two years. However, a recent study of college aged women by the University of South Carolina found a tendency for more persistent HPV infection. It also found black women to have a 70% greater chance of abnormal pap smears than white women. A vaccine for HPV was first licensed in 2006. The vaccine, distributed under the name Gardasil, was the first vaccine known to protect against approximately 70% of the strains of cervical cancer in girls as well as roughly 90% of the strains that cause genital and anal warts. It was not for another 3 years before the vaccine was considered for use in boys and 2010 until it received licensure from the United States Food and Drug Administration for the prevention of cancer in boys, especially anal cancer. However, despite its proven effectiveness, most African American young people are not accessing it. In 2010, only 1% of boys recommended to receive the vaccine did. Only 8% received one dose but did not complete the series. A recent survey of adolescent black girls and their caregivers conducted by the Pennsylvania Department of Public Health found that only one in four eligible black adolescent girls has received the vaccine. Many of the 71 young people surveyed, most of whom were black, expressed that they thought that the vaccine was "safe and effective." Moreover, the 45 caregivers who were surveyed agreed, but most of them said they didn't remember the HPV vaccine being mentioned by their health-care provider. Young people, particularly minorities, and their parents/guardians need to edcuate themselves about HPV infection and vaccination and become their own advocates. They cannot assume that health care providers will mention it. Many are still struggling with performing routine testing of HIV. Vaccine is paid for by most insurances, is available at sites such as Planned Parenthood and will be required under the Affordable Care Act (Obamacare).

Compulsory Sexual Education

The Centers for Disease Control (CDC) recently released its report on Sexually Transmitted Diseases for 2011. Sadly, there are few surprises. With a total of 1,412,791 cases Chlamydia trachomatis infection remains the STD leader. This figure is the largest number of cases ever reported to CDC for any condition and represents an increase of 8.0% compared with the rate in 2010. The national Gonorrhea rate increased as well after over a decade of fluctuation and/or decline. However, the greatest concern about the "clap" as we used to call it is its increasing resistance to the medications commonly used to treat it, cephalosporins and azithromycin. Syphilis, which we once actually believed could be eliminated, continues to thwart those efforts. Although the 2011 rate remained unchanged from 2010, it continues to grow in MSM and now, women. With other STDs such as HPV, Trichomoniasis and Herpes also showing consistent increases, the overriding conclusion that one must draw is that we continue to experience this epidemic of preventable diseases. The most troubling aspect remains the disparities in race and age. Younger minorities continue to be disproportionately affected by STD'S. Which brings me to my main point: the need for compulsory sex education in schools. A recent report by the Guttmacher Institute highlights the information gap: * One in four adolescents ages 15-19 received abstinence education without any instruction on birth control or disease prevention. * 46% of teen males and 33% of teen females receive no formal instruction about contraception before the having sex. * Of older teens, ages 18-19, 41% said that they knew little or nothing about condoms and 75% say the same thing about the birth control pill. * Only 21 states and the District of Columbia mandate sex education. See the disconnect here? With STD rates rising in children especially minority children, over half the states don't require education to prevent STDs, as well as unwanted pregnancies. I understand that discussions about sex education in school are like the proverbial "third rail," because parents feel that they should be the ones providing the information. The problem is that many don't do it and others are poorly informed. While the Guttmacher report states that parents are considered an important source of information on sexual health for teens, it adds that their knowledge may often be inaccurate or incomplete. The report also fails to mention the number of children who are not living with their parents, such as those living with other relatives, in foster care or in group homes. The bottom line here is that this belief system that sex education should remain at home isn't working. As there is no evidence to support that sex education promotes more sexually activity (most parents greatest fear), then it is time that we have a substantive dialogue with parents to allay their fears and gain their support. Legislators too, should be more assertive is passing legislation to mandate it. Its time that we address this issue before more young lives are ruined.

World AIDS Day 2012

Saturday was the 25th commemoration of World AIDS Day. The theme this year was "Getting to Zero: zero new HIV infections; zero deaths from AIDS-related illness and; zero discrimination. While these may sound like lofty goals, the last year has shown some real progress. Internationally, there are approximately 34 million people living with HIV, two thirds in so-called developing countries. In 2011, 2.5 million people were newly infected with HIV. An estimated 1.7 million people died. That is 700,000 fewer new infections worldwide than ten years ago, and 600,000 fewer deaths than in 2005. In the United States, there are approximately 1.1 million people living with HIV with about 50,000 new infections annually. Currently, only 33 percent of those who are HIV positive in the US are on anti-retroviral treatment and only 25 percent have a suppressed viral load. Perhaps the most disturbing news has been the impact of HIV/AIDS in young people. According to a CDC report, young people ages 13 to 24 years accounted for more than a quarter of new HIV infections in the United States in 2010. That amounted to approximately 12,000 cases, but only about a third of the persons in that age group had been tested. Every month, approximately 1,000 youth are becoming infected with HIV. One of the major implication of this new data is the increasing future healthcare burden: approximately $400,000 over one's lifetime. There has also been some significant new developments: * Oraquick- The first rapid at-home HIV test that does not require the sample to be mailed in to obtain a result. * Pre-Exposure Prophylaxis (PrEP)-an FDA approved medication (Truvada) to reduce the risk of sexual transmission from the infected to the uninfected. * Stribilid: the first HIV medicine to combine four separate drugs and is the third HIV drug that can be taken once daily. * The number of antiretroviral drugs tentatively approved or approved for use under the President’s Emergency Program for AIDS Relief, or PEPFAR, has surpassed 150. PEPFAR is a program to treat those infected with HIV/AIDS in countries that lack the tools needed to fight the HIV/AIDS epidemic. Yet with all of the progress being made and the advances in medical treatment, we continue to have millions of new infections every year and over a millon deaths. Over two thirds of HIV+ people throughout the world who need antiretrovirals do not take them including in the United States. We cannot allow ourselves to be lulled into a false sense of security with our successes. We still have a lot of work to do.

Do the Needs of the Many Outweigh the Needs of the Few?

Does Leonard Nimoy's famous quote (the titile of this blog) from Star Trek II: The Wrath of Khan, apply to people living with HIV in the prisons of two southern states? Not according to the American Civil Liberties Union, who has brought a class action suit against the Alabama Corrections Department where HIV+ inmates are isolated from the general prison population. South Carolina is the other state with the same policy. In Alabama, inmates are tested for HIV when they enter prison. HIV+ men and women are housed in special dormitories; eat alone (not in the cafeteria); cannot hold jobs around food; and have to wear white armbands that identify them as being HIV+. The policy is designed to to limit the spread of HIV through consenual sex, rape, or when inmates tatoo each other, even though most medical experts say that isolation is unnecessary. It is also counterituiative to treat HIV differently than other, more rampant, viruses such as Hepatitus C and B. According to the Bureau of Justice Statistics there were a little over 20,000 inmates in state and federal prisons in the U.S. at the end of 2010. The rate of HIV/AIDS among state and federal prison inmates declined from 194 cases per 10,000 inmates in 2001 to 146 per 10,000 at year end 2010. A study, published by the Centers for Disease Control and Prevention in 2006 found that although male prisoners have a relatively high rate of HIV infection, very few of them acquire the virus while behind bars. For example, about 90 percent of HIV-positive men in Georgia's prison system -- the nation's fifth largest -- were infected before they arrived, the study found. Over a 17-year period, 88 men became infected in prison by the virus that causes AIDS, chiefly through same-sex intercourse. Therefore, if there is a declining number of HIV+ inmates in prison, and if few acquire it there anyway, why the draconian policies in Alabama and South Carolina? Sadly, the answer has as much to do with our own attitudes about HIV/AIDS as it does with those two prison systems. There is not a lot of sympathy about the incarcerated in general and certainly even less for those infected with HIV. The point missed here is that treating HIV+ prisoners as lepers only exacerbates their shame and disgrace at being incarcerated. It also continues to foster the stigma that drives HIV underground and prevents people from getting tested. As a society, we should criticize any excessive policy that limits the rights of human beings to live in basic dignity. If not, we too might find ourselves on that 'slippery slope.'