HIV/AIDS Epidemic: Changing or Staying the Same?

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LGBT Pride

We have come a long way since HIV was labeled the “gay disease.” This label was spawned from fear of HIV, and based on the observation that the first cases of HIV appeared in gay men in the early 1980’s. However, this label was not only discriminatory but also inaccurate as intravenous drug users also became infected. Furthermore, by the mid 1980’s children (usually those born to drug users) began to show symptoms of Acquired Immune Deficiency Syndrome (AIDS). Some people also contracted the virus via blood transfusions. Despite our best efforts and advances in medicine, HIV/AIDS still affects roughly 34 million people worldwide; people from many different ethnic groups and religions, with different socioeconomic backgrounds and sexual preferences. However, disparities still exist. According to AIDS.gov, in the United States, 61% of new HIV cases in 2009 were via male-to-male sexual contact; the ethnic groups most severely affected were Blacks/African-Americans and Latinos (even among females). What do all of these statistics tell us? We need to do a better job.

Lesbian, gay, bisexual, and transgender individuals (LGBT) experience various health disparities, not just those related to HIV/AIDS. This effect is compounded if the person belongs to multiple minority groups (for example, Latino and gay or female and transgender). Many studies have shown a direct correlation between the number of minority groups one belongs to and the discrimination he or she faces. This discrimination, in addition to identity issues and problems fitting in or strained relationships with unsupportive friends and family, can lead to many mental health problems. These problems include depression, anxiety, substance abuse and suicide. According to Youth Pride, Inc., gay and lesbian youth are three times more likely to attempt suicide and suffer higher rates of verbal abuse and isolation than their heterosexual counterparts. Additionally, LGBT youth are more likely to be isolated, homeless and be victims of physical and sexual abuse. All of this contributes to poor physical and mental health …and so the cycle continues.

Disparities surrounding access to proper medical care also exist for LGBT individuals. Bias or cultural incompetence within the health care system create barriers to care. Lesbian and bisexual women are not screened as often for breast and cervical cancer. Transgender individuals are less likely to have health insurance. Marriage inequality and a lack of equal rights for LGBT domestic partners (compared to married individuals) also exacerbates these problems. The Patient Protection and Affordable Care Act (ACA), seeks to alleviate some of these problems by improving access to health care for all Americans, guiding state Medicaid agencies on financial protections for same-sex couples and improving health data collection for the LGBT community and other minorities.

In commemoration of the Stonewall Riots in New York City in 1969, June is celebrated as LGBT Pride Month. Since the 1960’s the LGBT community has increased its visibility as a social group and successfully demanded rights it was not previously afforded. However, discrimination, inequality and health disparities still exist. Individuals from all walks of life can play a part in resolving these issues. Strive to be accepting of others and encourage leaders and lawmakers to enact legislation that will ensure equality for all.

Harlem, Take Care of Yourself 2011

By Alexa Mieses

On May 14, 2011 I felt as though our event, the Harlem, Take Care of Yourself Health Fair, had come full circle. So much had changed, yet so much remained the same. I remember when I was the Secretary of MAPS in 2009, our event attracted less than ten members from the Harlem community (yes, you read right)! MAPS worked furiously planning the event and while we may not have had the turnout for which we had hoped, we at least laid out a clear and distinct framework to follow the following year (with special effort from former MAPS President Maurice Selby). Our theme was and continues to be "education, legislation and participation," as we focus on health from these three angles. That year, Dr. Lynne Holden of Mentoring in Medicine, Inc. accepted the Bynoe-Thomas Memorial Award and Senator Bill Perkins and Council Member Robert Jackson addressed the guests.

By 2010, after being elected President and inspired by my summer position at Gay Men's Health Crisis, I suggested MAPS devote our second annual event to HIV education and prevention. HIV/AIDS is one of the leading causes of death among Harlem residents and black women. With old fashioned team work and the creation of various planning committees, MAPS was able to host over thirty organizations and over 100 community members from Harlem and Washington Heights. We had increased our turnout by twenty-fold!

Last week I stood outdoors at the City College Quad to begin the opening remarks on a gray and windy day. We had prayed for sunshine all week but could live with potential rain as long as we were actually spared the precipitation. What started off as a slow and dreary day turned out to be our best event yet!

HTCY 2011: Healthy Youth, Healthier Tomorrow, welcomed over 200 members of the Upper Manhattan community as we focused on pediatric/adolescent health. We welcomed pediatrician Dr. Andre Gray as he answered guests' questions and advised them on ways to remain healthy. Council Member Jackson attended the event, just as he did in 2009. This year he accepted the Bynoe-Thomas Memorial Award for his efforts to improve public education and contributions to the Upper Manhattan community. The Department of Parks and Recreation hosted a Zumba workshop and LatinFX hosted a dance workshop. We had successfully continued the theme of education, legislation and participation! The CCNY Middle Eastern Dance and Music Club performed, in addition to vocalist Jami Jackson and the LatinFX dancers. Coloring, face painting, food and give-aways were provided.

Bynoe-Thomas Memorial Award

From Left to Right: MAPS President Alexa Mieses; Council Member Robert Jackson;

MAPS Faculty Advisor Michael Samms

At the end of the day on May 14, it finally hit me: this would be my last HTCY health fair as a MAPS member/leader. I feel so lucky to have been a part of the event's evolution and grateful to have had the opportunity to work with people that are just as dedicated as I to serving the community. The event united students, health care professionals, children, parents, politicians and performers, for the same goal, to make a difference in Harlem. In just two short years, I believe we did.

MAPS Members Pose After the Event

Positive Message from a Pornographic Film

By Alexa Mieses

The New York Times reported today that a South African producer recently made the country's first all-black pornographic film. More than just the first all-black film, the film features a message about safe sex practices as the film's stars were not only tested for HIV but used condoms on screen. The New York Times also said that this film not only answers South Africans' complaints that all adult entertainment comes from the US or Europe, but it also encourages condom use in a country where a negative attitude about condoms still remains.

Despite the industry's adherence to regular HIV testing, the virus is still able to spread among the industry's performers. In 2004, an American male adult entertainment performer transmitted the HIV virus to three female performers. In October 2010, another performer tested positive for HIV, causing Vivid Entertainment, a popular adult entertainment company, to halt production. Read more here. Perhaps the use of condoms in pornographic films in the US would not only help protect the performers, as testing is not 100% sufficient to cease transmission of HIV, but it would also encourage viewers to engage in safer sexual practices.

HIV Testing Is Now a Routine Part of Health Care in New York

HIV is a leading cause of death the Black community. Please share this colleagues and patients.

HIV Testing Is Now a Routine Part of Health Care in New York

Change in state law requires health professionals to offer voluntary HIV tests to patients 13 to 64 years old. New law also simplifies informed consent process, allowing for verbal consent in some circumstances

September 1, 2010 – Voluntary HIV testing is now part of routine medical care in the state of New York. As of today, due to a change in New York’s State Public Health Law, New York residents receiving health services at most medical facilities should now expect to be offered a voluntary HIV test. With limited exceptions, the new State law requires health care professionals to offer all patients between the ages of 13 to 64 a voluntary HIV test. The law applies to anyone receiving treatment for a non-life-threatening condition in a hospital, a hospital emergency department or a primary care setting, such as a doctor’s office or outpatient clinic.

The new law also simplifies the process for consenting to a voluntary HIV test. Under the state’s old law, patients had to provide specific written consent before receiving a test. The newly amended law lets patients give oral consent if the test will produce results within an hour. The patient’s consent must be documented in the patient’s medical record, and the provider must share seven specified points of information about HIV. Patients must still provide written consent for HIV tests that don’t yield results within an hour, but the process has been simplified. Consent for HIV testing can now be included in a patient’s general consent for routine medical care, as long as the consent form lets patients opt out of HIV testing.

“This State law will have its greatest impact here in New York City, where more than 107,000 residents are living with HIV/AIDS and thousands more do not know they are infected,” said Dr. Thomas Farley, New York City Health Commissioner. “These people may not be receiving the care they need and may be unknowingly infecting their partners. If you are not offered an HIV test the next time you visit a health care provider and you want to know your status, ask for it.”

Statewide, a third of HIV-positive people learn their status only after reaching advanced stages of infection. In 2006, the federal Centers for Disease Control and Prevention recommended routine testing so that infected people could get diagnosed earlier and take steps to preserve their own health and protect others. With this revision of the State Public Health Law, New York joins the 45 states that have acted on this important recommendation.

Under the new law, providers must link people with positive test results to care and treatment if they consent. The requirements apply to physicians and physician assistants, internal medicine providers, family medicine and pediatric practitioners, primary care obstetrician-gynecologists, nurse practitioners and midwives.

“Past New York City initiatives have highlighted the benefits of routine HIV testing,” said New York State Senator Thomas K. Duane, the legislation's prime sponsor. “The Health and Hospitals Corporation’s pilot testing project and the Health Department’s “Bronx Knows” initiative both showed that when HIV testing becomes a routine part of medical care, the number of people who know their status increases and the stigma surrounding HIV and HIV testing declines. With this law now in effect, the whole state of New York should start to experience those benefits.”

“We hope New Yorkers will take advantage of this law and view HIV testing as part of routine, quality medical care,” said Dr. Monica Sweeney, assistant commissioner for the Health Department’s Bureau of HIV/AIDS Prevention and Control. “We all need to know our status, and the only way to know it is to get tested.”

Governor David Paterson signed S8227 into law on July 30, 2010. The legislation amended New York State Public Health Law Articles 21 and 27-F that govern HIV testing and confidentiality in the state. People under 18 donot need parental consent to be tested for HIV or other sexually transmitted infections. Physicians in New York City are required to report positive diagnoses to the NYC Health Department, and laboratories are required to report HIV-positive cases to the New York State Health Department. But like all other medical information, HIV tests results – whether positive or negative – are kept strictly confidential in accordance with the law.

Any New York City resident can get a free HIV test at one of the Health Department’s STD or TB clinics. For a complete list of locations throughout the city, call 311 or visit www.nyc.gov/health./hivtesting.

Regards,

Aletha Maybank, MD, MPH

Assistant Commissioner, New York City Department of Health and Mental Hygiene

Director, Brooklyn District Public Health Office (DPHO)

An International Dilemma: Barriers to Sexual and Reproductive Rights

By Alexa Mieses

Picture taken from Nature.com

The New York Times reported today that a vaginal microbicidal gel has given women in one study a 39% chance of protection from the HIV virus. The microbicide contains a nucleotide reverse transcriptase inhibitor, which prevents the virus from reproducing. The study involved a double-blind, randomized controlled trial which compared tenofovir gel (the microbicide) with placebo gel in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural parts of South Africa. The study involved 30 months of follow-up with each of the women to assess their HIV serostatus, safety, sexual behavior, and gel and condom use. Read the original journal article here.

If such a microbicide is approved, to what extent will African women have access to the vaginal gel? One issue is cost. As the New York Times article mentions, each dose of gel is cheap, however, the patented applicators are rather expensive (forty cents each). Also, men have the authority in most African sexual relationships. While the microbicide may allow an African woman to decrease her chances of contracting HIV without the man's knowledge, will the fact that many physicians are male create a barrier to access of the gel? As of 2006, 70% of all physicians registered with the Health Professions Council of South Africa were male. Will a male dominated world serve as a barrier for African women to obtain the gel? I ask this question because in other countries like Chile and the United States, religious beliefs or political agendas, not whether one is male or female, has created barriers to certain reproductive rights.

The recent history of the emergency contraceptive pill in Chile is more of a flip-flop story of conflicting ideals. In 2006, first female and former Chilean president, Michelle Bachelet, began to more firmly advocate for women's contraceptive rights. By 2007, a presidential mandate made authorities ensure that public health centers made emergency contraception, or the morning-after pill, available. By 2008, courts ruled to only make the pill available in pharmacies and required a prescription. Read more here. Pharmacists would often refuse to sell the pill to women, even with a prescription, sometimes claiming the pill was "out of stock." In reality, religious beliefs instilled in many of the country's people (and pharmacists), often served as the basis for such behavior. Nearly 100 pharmacies were found failing to stock the pill altogether. In early 2010, at the end of her presidency, Bachelet once more was able to sign legislation that allowed the pill to be distributed freely throughout Chile. However, women in Santiago still report a stigma surrounding the purchase of the morning-after pill.

Africa and South America are not the only continents in which access to certain reproductive rights has been an issue. Abortion, while it is a very sensitive subject to some, has been the center of American media and political debate for some time. Since the Supreme Court ruling of Roe v. Wade in 1973, abortion has been legal. However, despite the fact that it is not illegal in many states, there are many barriers that sometimes make it impossible to have an abortion. While most restrictions regarding length of gestation are put in place for good reason, many states create certain restrictions which make it difficult for a woman to undergo an abortion. Also, women with little money or no health insurance often cannot pay for abortions. Additionally, in some places there is limited availability for medical training on abortion. The Association of Reproductive Health Professionals reported that although the Accreditation Council on Graduate Medical Education now requires that training in abortion be made available to all Ob/Gyn residents, as of 2008 only half of Ob/Gyn residency programs offer routine training in abortion care. Finally, violence and harassment of women seeking abortion and/or health care professionals that perform abortions, has created a barrier to the procedure.

As technology develops and new procedures and drugs are created, the political milieu of countries across the globe and women's rights also evolve. Regardless of the moral foundation upon which you stand, it is important to always remain well-informed of scientific developments to better take care of your health.

Flashblood: Part of the Cycle

By Alexa Mieses

Today I read a rather disturbing article in the New York Times. Recent reports indicate that in some parts of Africa, intravenous drug users are injecting other addicts' blood in order to get high. This practice has been coined "flashblood." The first thing that popped into my mind was the effect this practice has on the transmission of HIV. While the spread of HIV is dangerous and a serious matter, I could not help but wonder about the socio-econimic factors that may explain why one uses drugs in the first place.

Published in Addiction, a cross-sectional study was conducted in Tanzania with 169 female intravenous drug users. The study found that the women who used flashblood were more likely to live in short-term housing, to have been raped by a family member as a child, to have smoked marijuana at a younger age, and to have contaminated water.

Poverty often has many implications that stretch beyond contaminated drinking water. Poverty is an umbrella for a vicious cycle in which it is hard to determine which comes first. Does a child live in a broken home because he or she is impoverished, or is it difficult to rise out of poverty because he or she lives in a broken home? The answer is both are sometimes true. Perhaps a woman started using heroin because she smoked marijuana at a younger age. Perhaps she smoked marijuana at a younger age to numb the pain of her rape. Perhaps her father raped her because he was drunk. Perhaps her father was an alcoholic because he could not find a job. But why can't he find a job? You can see how the cycle continues.

Even here in Santiago, Chile, where I am spending my summer volunteering with VE Global (VE), the issue of poverty comes up every day. According to the CIA Chilean country-profile, the richest 10% of Chileans possess 41.7% of Chile's wealth, while the poorest 10% possess just 1.6%. The children with whom VE volunteers work often come from poverty and broken homes. Many have been sexually, physically and emotionally abused by their family members, or their families are unable to care for them due to a lack of resources. These children often go on to use drugs and have children at a very young age, thus proliferating the cycle. How can we break this vicious cycle? Even if the work of VE is not the "cure-all" answer, I believe it is a step in the right direction.

Image from www.maryscomfort.org

Antiquated U.S. Blood Donation Ban Against Gay Men Contributes to Stigma and Blood Shortages

GMHC Report Explores Alternatives to Lifetime MSM Ban

New York, NY — The Food and Drug Administration (FDA) currently bans any man who had sex with another man (MSM), even once, since 1977 from donating blood. The policy does not consider the potential donor’s HIV status, frequency or risk of sexual activity, or if he is in a monogamous relationship. Today, Gay Men’s Health Crisis (GMHC) released a report detailing the history of the policy, efforts towards revision, and analysis of alternative donation criteria.

Advances in HIV screening of blood supplies since the 1980s make the chance of receiving a unit of HIV infected blood one in 1.5 million. Guidance, for most donors, takes into account the “window period,” the short period after HIV infection whereby a HIV screening would not detect infection. Current FDA guidance includes a questionnaire of potential blood donors that asks 48 questions about current health status, medical history, blood donation history, sexual practices, drug use, and other behaviors. But risk factors are not uniformly applied. A heterosexual donor who has had sex with a knowingly HIV-positive partner 366 days ago would be eligible for donation. By contrast, a man who has had sex with another man, regardless of the frequency, safe sex practices involved, or duration since the episode, is denied for life.

“Across the country, we experience critical shortfalls of blood supplies on a consistent basis,” said Janet Weinberg, Chief Operating Officer at GMHC. “Yet only five percent (or less) of Americans that are able to donate blood do so. We call on the FDA to re-examine discriminatory policies that categorically exclude potential blood donors, including gay and bisexual men,” added Weinberg.

The report analyzes alternative recommendations for blood donation by gay and bisexual men using a comprehensive framework to assess actual risk of HIV transmission and increased availability of blood supplies. The framework, called “DONATE,” provides a way to understand how the use of advanced technology and objective screening standards can decrease the risk faced by recipients of blood products, while at the same time reducing the discriminatory impact on MSM, expanding the pool of blood donors (thereby reducing the potential for blood shortages), and raising awareness of HIV/AIDS risk among donors in general, regardless of sexual orientation or gender.

The report also examines how other countries, including Russia, South Africa, and Spain, treat gay and bisexual male blood donors.

HIV Travel Ban to be Lifted

By Alexa Mieses

The HIV Travel Ban has been in place since 1987, when some members of the global community were still unsure about the means by which HIV was transmitted. It was believed that HIV could be passed via respiratory or other physical contact and as a result, HIV was put on the list of communicable diseases by Health and Human Services. The HIV travel ban prohibits HIV-positive tourists from visiting the United States and prevents such individuals from gaining permanent residence in the United States. Though heterosexual couples from other countries with at least one HIV-positive member can apply for a waiver, similar homosexual couples are not granted this right.

The HIV travel ban is discriminatory against HIV-positive and homosexual individuals alike. This ban also conflicts with the values put forth in the global community by the United States (over $6 billion of global AIDS funding). This ban has also prevented the United States from hosting global conferences related to HIV/AIDS since persons living with HIV/AIDS would not be allowed to attend. Thankfully, President Obama overturned the ban and will finalize this decision on Monday, November 2, 2009. The United States is one of about a dozen countries with an HIV travel ban in place; however, after Monday and a 60-day waiting period, the US will be one less on the list.