African American Women and STI'S

Recent news has not been kind about women and girls of color and their sexual health. In 2008, a Centers for Disease Control and Prevention (CDC) study reported that almost one-half of adolescent black females were infected with at least on STI (Sexually Transmitted Infection). Now, new evidence has further documented the impact of STI'S on women and girls of color. According to the CDC, 48 percent of black women between ages 14 and 49 have the virus which causes genital herpes. Blacks in general are more than three times as likely as whites to have herpes simplex virus type 2 (HSV-2) (39.2 percent vs. 12.3 percent). Biological factors make women more susceptible to genital herpes than men. American women in general are nearly twice as likely as men to be infected (21 percent vs. 11 percent). Moreover, up to 80 percent of genital herpes infections in the United States are undiagnosed.

The news is no better on the local front. A recent report from the Philadelphia Department of Public Health revealed a dramatic 238% increase in primary and secondary cases of Syphilis in females. Many of the cases in females occurred in adolescents and young adults aged 15-24 years old.

The high rates of genital herpes infections and syphilis, as well as other STI'S among women of color, may contribute toward the high rate of HIV in the black community by making transmission easier. In 2007, more than 25% people infected with HIV in the United States were among women and girls aged 13 years and older. More than 278,000 women and adolescent girls in this country are living with HIV. For female adults and adolescents, the rate of HIV/AIDS diagnoses for black females was nearly 20 times as high as the rate for white females and nearly 4 times as high as the rate for Hispanic/Latino females.

Last year, the CDC implemented new guidelines to encourage HIV testing to be a part of routine medical care. Clearly, sexually transmitted infection screening should also be a part of this routine care. Significant progress in reducing the spread of HIV in Sub-Saharan Africa has been made by preventing, diagnosing and treating STI's. It's time we apply these priorities in this country, especially in women and girls of color.

Don't Believe the Hype

I recently ended a very frustrating e-mail correspondence with a well meaning, yet uninformed woman who originally contacted me to sing the praises of a herbalist who she claims has cured HIV (and lupus and cancer, by the way). In response to my polite skepticism, she directed me to his website where the "documentation" of his alleged success (and no doubt the pictures from his Nobel prize for medicine) could be found. Needless to say, I found no concrete evidence that his treatments cured anything, let alone HIV. Most troubling was her insistence that his claims were "proven." It reminds me of another conversation with a gentleman who read a book written by a dietitian who claimed that he had evidence that there was no link between HIV and AIDS. Supporting his claim were 1500 people who placed their name in the book indicating support of this theory. Not one, of course, held any reputable position at any research institution or university.

Those of us who have worked in the HIV/AIDS field have experienced communication with people who are convinced that there is a cure for HIV and that either:
1. The Government has it and wants "black people to die so they are hiding it or;
2. The Pharmaceutical companies have it but want people to keep spending money on
medication or;
3. Some other individual (usually an alternative medicine professional) has it but
the government and pharmaceutical companies have banded together to stop it
from being distributed.

We call these beliefs: "Conspiracy Theories." The troubling thing about these theories is less that a few individuals will submit to an unproven treatment and possibly have there hopes dashed, but that many of us are so willing to believe in theories and claims with so little basis in fact. Moreover, there cynicism makes HIV prevention efforts that much harder.

I pray that, one day, a cure for HIV/AIDS is found. However, HIV is a very difficult viral adversary, perhaps one of the most difficult that we have every encountered. Many of the greatest minds in the world have been struggling, without success to find a vaccine or a cure. Maybe, one day, someone will find a natural substance or treatment that will cure HIV. But, shouldn't that individual be required to subject that treatment to the rigors of science to prove, not only that it works, but that it doesn't harm the patient? Don't get me wrong, I believe that we should should not blindly believe everything we are told. Moreover, there are many non-medication treatments such as accupunture and light therapy (for Seasonal Affective Disorder)that work! Yet, why are we so willing to embrace treatments that have never fully been studied, but reject those with reams of documented evidence supporting them-not just for HIV, but for other conditions such as mental illnesses? Many cite the Tuskegee study as the underlying reason for this skeptisism, but many people to whom I speak, have never even heard of the Study. Clearly, the scientific and medical communities have a long way to go to regain the trust of the American Public. Until it does, we will continue to see people shun, and even reject modern medicine, often to our detriment.

World AIDS Day was on December 1, 2009- Did you notice?

Each year, despite the ever growing AIDS epidemic, it seems that media coverage of World AIDS Day steadily decreases. Started on December 1, 1988, the objective of World AIDS Day has been to increase awareness about the AIDS epidemic, raise money and to help to dispel the myths, sterotypes and prejudices that continue to abound. The theme for this year's World AIDS Day theme was 'Universal Access and Human Rights'.

According to UNAIDS estimates, there are now 33.4 million people living with HIV, including 2.1 million children. In 2008, 2.7 million people became newly infected with the virus and an estimated 2 million people died from AIDS. Approximately one-half of all people who become infected with HIV do so before they are 25 and are killed by AIDS before they are 35.2

2008 also achieved another somber milestone: HIV/AIDS is now the leading cause for women internationally. Maybe its just me, but as HIV/AIDS becomes younger, darker and impacts more women, is there any coincidence that it falls further off of our radar screen.

Obama Lifts HIV Travel Ban

On October 30, 2009, President Barack Obama announced that the United States would be doing away with its 20 year old ban preventing people living with HIV/AIDS from entering the country. The U.S. has been one of about a dozen countries that bar HIV+ travelers. The change will officially take place starting January 1, 2010, after a 60day waiting period. The ban was established in 1987 when there was widespread fear and ignorance about HIV. The federal government's tried to eliminate the ban in 1991, but was thwarted by Congress. In 1993, Congress made HIV infection the only medical condition specifically listed as ground for inadmissibility to the U.S.

While many may feel that such a law protected Americans from HIV infection from immigrants and travelers, there has been no evidence that it has done so. In reality, HIV rates continue to soar, especially among the poor and minorities. The law also had other adverse consequences by keeping out hundreds of thousands of tourists, refugees and students. Another impact of the law was the unforseen obstacle that it created for the international adoption of children with HIV. Moreover, no major international HIV/AIDS conference has been held in the U.S. since 1993, because HIV-positive activists and researchers were not allowed to enter the country.

The elimination of this law is another example of how the Obama Administration may have begun to turn the corner pertaining to the HIV/AIDS epidemic. However, there is still a long way to go.

New HIV Vaccine Shows Promising Results

Researchers and HIV/AIDS activists are have been encouraged by the results of an experimental HIV vaccine. According to a Wall Street Journal/Associated Press report: "For the first time, an experimental vaccine has prevented infection with the AIDS virus." The vaccine reduced the risk of HIV infection by more than 31%. While this result may not seem overwhelming, it is a significant moment in the often frustrating race to find a vaccine for HIV. Previous efforts have resulted in failure after failure. One such effort, Merck's experimental Phase II vaccine trial which began in late 2004 and involved HIV-negative volunteers was stopped after the experimental vaccine failed to prevent HIV infection in participants or prove effective in delaying the progression of the virus to AIDS. As a result, several vaccine trials were being postponed or modified following the abrupt halt of Merck's vaccine trial. As a result of so many recent failures, many researchers had begun to feel that a vaccine might not be possible and that resources should be redirected to new techniques to prevent HIV infection such as microbicides and cheaper versions of the female condom.

However this new HIV vaccine trail, involving 16,000 volunteers in Thailand, might just provide new hope. The new vaccine combined two previously ineffective ones: the first to rouse the immune system to launch an attack on the virus and the other to strengthen the response. Researchers caution that we are still a long way away from implementation of widespread immunization of any type of vaccine. However, for the first time, scientists and epidemiologists are expressing optimism that a HIV vaccine is possible.

Every day, 7,500 people world-wide are newly infected with HIV and two million died of AIDS in 2007 , according to the U.N. agency UNAIDS.

Demonizing HIV

AIDS activists have been buzzing lately about a new German HIV awareness advertisement depicting a woman having sex with Adolph Hitler. By now, I am sure you are wondering: what does the Fuhrer have to do with AIDS? Well, in the ad, which is available online, a heterosexual couple is seen having sex. The man's face becomes that of Adolph Hitler followed by a slogan describing AIDS as a "mass murderer. Print versions of the campaign also use Saddam Hussein as well as other despots.
The company that created the campaign, Das Comitee, defended the advertisement stating that it was meant to show "the ugliness of the illness."

I understand the philosophy of using 'shock value' to get people's attention. Its discomforting to realize that in 2009, we have to 'shock' people to make them aware of HIV/AIDS. However, the designers of this campaign are obviously missing something and it underscores the danger of developing public awareness campaigns in a vacuum-with vetting them with a diverse audience, especially people living with HIV. Now, I don't know for sure if that was done. However, given the tremendous stigma associated with HIV, I would hope that someone would have realized that many people viewing the ad would associate the people living with HIV with these dictators. Despite good intentions, it's the wrong message!

HIV Testing

Few would argue that HIV testing is one of the most vital tools in addressing the HIV epidemic. But, does everyone feel that way, or even understand the significance of knowing his/her HIV status. A recent study conducted by the Kaiser Family Foundation (June 2009) found that despite efforts to encourage more HIV testing, including making it a part of routine medical care, "reported rates of HIV testing have remained flat over time." In fact, the share of non-elderly (ages 13-64) who report having been tested within the last year has not changed in over a decade. Although some groups, such as African Americans, Latinos and young adults are more likely to report having been tested, even their rates have remained virtually unchanged over the last several years. In 2009, less than one-half of the adults in the United States say that they have ever been tested.

Another study conducted by the Centers for Disease Control (Morbidity and Mortality Report-June 27, 2009) suggests that many people do not submit to HIV testing until late into the course of their infection. In the study, 45% of the testers progressed to a full blown AIDS diagnosis within 3 years of their positive HIV test. More troubling is that over a third (38%) progressed to full blown AIDS within a year. Moreover, minorities, especially African American men, were more likely to progress to full blown AIDS within 3 years of HIV diagnosis, e.g... were late testers.

The moral of the story, get tested: even if you do not think you are at risk. Too many people are apparently waiting until they get sick to get an HIV test. Consequently, they are giving HIV a head start and limiting the possibilities for successful treatment. HIV may be becoming a chronic disease, but the quality of life may be significantly improved by early testing and treatment. So, what are you waiting for?