HIV/AIDS Epidemic: Changing or Staying the Same?

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The Problem With Prison

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What's On Your Table?

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Health Disparities in Infancy

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Health Disparities Among Physicians

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Listen and Learn

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The Haitian Village of Yaguate

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One Apple, BID

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The Growing Gap: Not Just a Feeling

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A Cure For Cancer But Not For Disparities

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Health Care Reform: Upheld by the Supreme Court

On Thursday, June 28, the Supreme Court upheld President Obama's Patient Protection and Affordable Care Act (ACA). The law seeks to make health insurance more affordable for all and provide increased consumer protections (e.g. prevent discrimination by health insurance companies against individuals with pre-existing health conditions). But what are some of the actual act's directives?


Since 2010, the law has already:

• ended discrimination against children with pre-existing conditions.
• extended coverage to younger adults (up to age 26) by allowing them to stay on their parents health insurance plan
• prohibited health insurance companies from dropping people's coverage when they get sick.
• increased federal matching funds for Medicaid.
• set forth initiatives to strengthen the primary care workforce.
• sought to bring down the price of health care premiums by requiring that at least 85% of all premium dollars collected by insurance companies be spent on health care services and health care quality improvement (rather than for profit).
• encouraged the use of integrated health systems (i.e. Accountable Care Organizations).
• required federal agencies to record a wider range of demographic data in an effort to understand health disparities.

In 2013, the law will:

• provide new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.
• establish a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.
• increase Medicaid payments for primary care doctors.
• provide additional funding for the Children's Health Insurance Program (CHIP).

In 2014, the law will:

•  require individuals to purchase health insurance (this is the "individual mandate" that was the subject of debate). If affordable coverage is not available to an individual, they will be eligible for an exemption.
• prohibit insurance companies from refusing to sell coverage or renew policies because of an individual's pre-existing conditions.
• prohibit plans from imposing annual dollar limits on the amount of coverage an individual may receive.
• provide tax credits to make it easier for the middle class to afford insurance.
• ask States to open health insurance exchanges to enable all Americans to easily shop for more affordable private insurance.
• increase access to medicaid for Americans who earn less than 133 percent of poverty limit.

Finally, in 2015 the law will:

• compensate physicians for the quality of care they provide to their patients rather than the volume of services they provide.

While many of these provisions will not be well-received by everyone, and some of these provisions admittedly do not do enough to reform the health care system, this is a step in the right direction.

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.

Federal Plan to Reduce Asthma Disparities Released

Yesterday, the President’s Task Force on Environmental Health Risks and Safety Risks to Children announced a new initiative to reduce asthma disparities among children, but especially children from ethnic minority groups and/or a low socioeconomic background. The U.S. Department of Health and Human Services, Department of Housing and Urban Development, Environmental Protection Agency and several other federal bodies have teamed up to execute a plan of action. Read the fact sheet here.

The initiative promotes collaboration among federal entities and streamlines resources and knowledge surrounding asthma health disparities among children. This partnership also encourages teamwork among individual, local, state and national leaders from various sectors. This forces us to think about asthma in a more holistic manner. Asthma disparities in the United States are not just a medical problem, but also the product of environmental and social inequities.


Asthma can be deadly if children do not seek routine medical care and do not regularly take the proper medication. Environmental factors such as air quality and allergens can also cause asthma attacks. Kathleen Sebelius, Secretary of the Department of Health and Human Services spoke yesterday in Washington D.C. about the new action plan. She said the following:

Minority children today are both more likely to have asthma and less likely to be prescribed or take recommended treatments to control their asthma...Without health coverage, you’re less likely to get the preventive medicine you need to keep the condition under control, making you more likely to suffer an attack...you can get great care for asthma at your doctor’s office, but it won’t do much good if they don’t know how to treat it at your school. And you can have a great community health center down the street, but it will be hard to stay healthy if the air in your neighborhood is polluted...If we’re going to reduce these disparities, we have to work together, not just across the federal government, but with state and local partners, and community and private leaders on every front.

Collaboration and leadership among governing bodies is important, and is just one of many partnerships needed to end health disparities. United, we can enact change!  

Read more about reducing health disparities here.

Primary Care Physician Shortage

By 2014, the Patient Protection and Affordable Care Act (ACA) will expand the Medicaid health insurance program to over 15 million people. Among many things, this expansion will allow millions of people access to regular primary care. But is the field of primary care prepared to deal with such an expansion?

Primary care physicians (PCP's) serve as the initial contact person for a patient’s health issue. PCP's work with the patient over a long duration of time, treating routine conditions and providing preventive services like vaccinations. PCP's also refer the patient to specialists (e.g. cardiologists, endocrinologists) when necessary. Depending on the scope of the physician’s practice, primary care providers are internists and pediatricians, but can also be geriatricians or obstetricians and gynecologists. Nurse practitioners and physician’s assistants are increasingly providing primary care to patients as well.

For many years there has been talk about a physician shortage in the field of primary care. At one time, primary care physicians constituted the bulk of American physicians. However, advances in technology, increased medical educational debt, lower reimbursements and higher patient loads for primary care physicians have caused most doctors in training to enter a specialty field. The Association of American Medical Colleges predicts that in the decade that began in 2010, nearly one-third of all practicing physicians will retire. As a result, Americans will need an estimated 45,000 primary care physicians by 2020.

This trend has far-reaching consequences. Many ethnic minorities, people with low socioeconomic status or no health insurance may use primary care physicians and/or community health centers as their only source of health care; however, access to these providers is already limited for some patients because of factors like geography and a lack of transportation, or more complex issues like language barriers. The actual shortage of physicians and lack of funding for community health centers only exacerbates this problem.

Also, one statistic from the Kaiser Family Foundation says that 56% of patient visits in America require primary care, but only 37% of physicians practice primary care medicine, and only 8% of the nation’s medical school graduates go into family medicine. Furthermore, a higher ratio of specialists to patients has been correlated with higher mortality rates overall. This suggests that a higher ratio of primary care physicians will contribute to better health. With better access to primary care, patients can prevent disease and receive early treatment in the event of an illness.

The ACA has proposed several pieces of legislation to help solve the primary care physician shortage (the following was summarized from a Kaiser Family Foundation brief):

• Add 15,000 new primary care providers to the workforce by 2015
• Allocate $300 million for the National Health Service Corps which recruits the primary care workforce in underserved areas 
• $230 million in award grants will go to “teaching health centers” to start primary care residency programs 
• 10% bonuses for primary care providers under the Medicare fee schedule (started in 2011)
• Increase PCP reimbursements at the state level from Medicaid rates to Medicare rates by 2014 
• Increase the number of Accountable Care Organizations (ACO's) which thrive on the quality and not the quantity of patient care. ACO's encourage collaboration among physicians and allied health professionals rather than overuse of medical services
• Increase the number of community health centers 

Lastly, medical education institutions are charged to shape medicine’s leaders of tomorrow. This means medical schools should continue to educate students about issues related to primary care and the state of the health care system. Shadowing and networking with primary care physicians may increase interest in the field. Curricula should include such activities. Also, the number of residency programs must increase in order to accommodate the growing number of medical school graduates.

Race and Disease

What is the difference between health inequality and health disparities? Dr. Olivia Carter-Pokras, Associate Professor at the University of Maryland School of Medicine and the School of Public Health, said that health inequality is just a difference in health; health disparities are marked not only by a discernible difference in health, but also an injustice that can be changed. Dr. Carter-Pokras has over 25 years of health disparities research experience within the Federal government and academia, and was previously the Director of the Division of Policy and Data, Office of Minority Health, Department of Health and Human Services. Here at the National Institute on Drug Abuse (NIDA), I attended a presentation Dr. Carter-Pokras gave about health disparities.

After the seminar, I began to think about race in general. When I first arrived at NIDA, research fellows were invited to the Smithsonian National Museum of Natural History in Washington, DC. The museum held an exhibit called “Race: Are we so different?” One idea the exhibit emphasized over and over is that race is a social rather than a biological construct. This means that we created the idea of race to distinguish one human from another. However, someone on the other side of the world is only 0.1% different from me at the genetic level. This may be hard to believe considering that humans come in many different shapes, sizes and colors. The exhibit had strong scientific and historical evidence to support the idea that race is purely a man-made idea.

If race cannot be defined by our genes, why do health care professionals use race to infer other characteristics about their patients? Why does the new Patient Protection and Affordable Care Act (ACA) require the Federal government to collect racial data?

There are a few instances in which race (heritage, to be more accurate) may help physicians and allied health care professionals better treat their patients. However, this is a line that must be walked carefully. For example, some ethnic groups do have a higher prevalence of certain diseases (e.g. Ashkenazi Jews have a higher prevalence of Tay-Sachs disease and African-Americans have a higher prevalence of Sickle Cell Anemia). If a physician understands these links, a diagnosis may be made sooner. However, sometimes making assumptions about race and disease can hurt a patient. The Race exhibit at the Smithsonian featured a video of a father whose infant daughter was not quickly diagnosed with Sickle Cell Anemia. The parents were both white and Sickle Cell Anemia seemed like an unlikely cause of the baby's illness. However, the father was of Sicilian ancestry. A simple blood test confirmed the baby had Sickle Cell Anemia. This was an example in which generalizations about ethnicity and disease can be harmful. Though it may not be commonly known, Sickle Cell Anemia spread to places in southern Europe as well as throughout Africa.

The ACA is working to eliminate health disparities. In a 2011 report, the American Medical Association says the first step to eliminating disparities is to detect them. If this is true then the collection of racial is data is justified. However, a closer look at what we define as race may actually be an indicator of the greater disparities that exist among social determinants of health. For example, while it is true that many minorities endure numerous health disparities, this is often due to the environment in which minorities live and inequities in education, socioeconomic status, and other factors—not race. Poor whites have similar health outcomes to those of ethnic minorities. Similarly, ethnic minorities with higher socioeconomic status have better health outcomes than their poorer counterparts. Race should not define who we are nor how healthy we can be. We should focus on improving the conditions in which many disadvantaged people live which will result in an improvement in health.

National Minority Health Month: Be the Change!

To wrap up National Minority Health Month, it is important to outline some of the steps we can take to help eliminate health disparities. These steps all include you! Age, sex, ethnicity, religion, language, sexual orientation and socioeconomic background do not matter when it comes to making a positive change in your life!

Take Charge of Your Health

Change begins with you! Though there are many external factors that can have an impact on our health, we have the power to make little changes that can make a big difference in our lives. For example, getting regular exercise does not always have to involve long hours at the gym. Walking instead of taking the train to work or school, or taking the stairs instead of the elevator can add physical activity to your day. Invest in a pedometer and/or use a calculator for an estimate of the calories you’ve burned. Work with your physician to come up with a safe exercise plan.

Making small changes to your diet can also have a big impact on your health. Control the amount of food you eat at each meal. Reduce your intake of sugary drinks like soda and artificial fruit juice, and instead drink water. Eat less processed junk food like fast food, potato chips, cookies, and sugary candy. You can treat yourself to your small “guilty pleasure” snacks a few times a week. Don’t completely cut out treats as this can make you feel deprived, but greatly reduce unhealthy food packed with sugar, fat and preservatives. Balance is the key! Also, use of a free, online calorie counter such as My Fitness Pal to keep track of your diet and physical activity habits. This website also allows you to access a free app on your phone. Quit smoking and reduce your alcohol intake. These two steps paired with physical activity and a good diet can lower your risk of obesity, cancer, heart disease, diabetes, high cholesterol and high blood pressure. Work with your physician or a nutritionist to develop a regular healthy diet!

Go for regular check-ups. Whether you visit a physician in her private practice, or visit your local health clinic—go regularly! The best way to stay healthy is to prevent disease before it begins. In the case you have developed a health problem, treating it early can yield better health outcomes. Make sure to be tested regularly for high cholesterol, high blood pressure, heart disease, HIV/AIDS and other sexually transmitted infections, and keep your immunizations current. In addition to a primary care provider, women can see a gynecologist at least once a year. The American College of Obstetricians and Gynecologists recommends that teenage girls start seeing a gynecologist between the ages of 13 and 15. Developing a relationship with your physician early on can have a positive impact on your health! Please note that your health needs change as you age. Please visit this website for recommendations for your age group: http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm

Stay Informed

Keep an eye out for current events and stories related to health (and all other issues). Before we can come up with a solution, we must know the problem! In the case of health disparities, exploring the problem and devising a solution will happen simultaneously but we must stay informed and aware. Reading the paper or online news articles, even if just for a few minutes a day, will empower you to formulate your own ideas about the world!

Spread the Word

You can be the teacher! Once you have taken control of your health and have been informed of the issues affecting your health, you can spread the word. By taking charge of your health you may inspire others to do the same. Even if you do not have a career in health care, just by talking and raising awareness about health disparities can help enact change!

For a list of resources regarding health disparities visit: http://www.nlm.nih.gov/hsrinfo/disparities.html

National Minority Health Month: Kidney Disease and Transplantation

This weekend I visited the Mount Sinai School of Medicine on the Upper East Side of Manhattan. Among many other interesting sessions, the faculty presented a session aimed to highlight health disparities. The specific topic was kidney transplantation. The brief conversation that took place made me want to do a bit of research and learn more about kidney disease and transplantation.

Certain diseases such as diabetes and high blood pressure can greatly damage kidneys. Unfortunately, minority populations are disparately affected by these diseases and thus by kidney disease. According to statistics from the University of Cincinnati, the number of new kidney failure cases diagnosed in 1997 was 873 per million in African Americans and 218 per million in whites; 73% of all cases among African Americans resulted from high blood pressure and diabetes; African Americans made up about 13% of the US population but 30% of all kidney failure cases. Obesity, diabetes and high blood pressure among African Americans has become a bigger problem since 1997, and today the health disparities continue to be rampant.

Kidneys are organs essential to life as they filter toxins from our blood, regulate our blood pressure and help our bodies remain healthy. High blood pressure and high levels of sugar in the blood can damage the blood vessels within the kidney. Once damaged, the kidney cannot keep useful substances (like proteins) in the blood. If protein is instead found in urine, it can be the mark of kidney disease.

Over time, kidney disease gets worse and worse. Chronic kidney disease progresses to end-stage kidney disease in which these vital organs completely shut down. When this happens, hemodialysis (an artificial process that  filters blood) can be a life-saver. However, over time the hemodialysis process also takes a toll on the patients’ body and quality of life. Many patients must spend up to four hours a day on hemodialysis which interferes with their daily lives. Patients leave the clinic feeling exhausted. Hemodialysis patients must also follow a strict diet which may be especially difficult for patients who already have uncontrolled blood pressure and diabetes. For people with end-stage kidney disease, organ transplantation may be their only chance at life; many die waiting for an organ.

Organ transplantation is not a cure-all solution. Finding a good organ match, undergoing the surgery and the aftercare that is required are difficult processes. According to Dr. Susan Lerner, a transplant surgeon at Mount Sinai, New York State has one of the longest waiting periods for a kidney. This is the result of a higher number of people needing a kidney combined with a fewer number of donors. While patients wait to be matched to a donated kidney, they can spend more than five years on hemodialysis and remain very ill.

Some studies have found that minority patients are less likely to be referred for kidney transplantation by their physicians. Even if referred, patients must pass a series of physical and mental health assessments. The tests also seek to evaluate the patient's emotional support system and the likelihood that the patient will adhere to the post-operative care plan, including taking prescribed medications. Aside from passing these screening processes, patients must match to a donor-kidney with similar tissue and blood type. Finally, the financial aspects of the surgical procedure must be sorted out before the transplantation can take place. The entire screening, match and transplant process can take nine years!

Social determinants of health such as socioeconomic background and level of education can interfere with a minority patient's ability to pass the physical and mental health tests. Furthermore, the process is long and arduous and many minorities fail to even complete the testing process. Even though African American patients are not required to be matched to organs from African American donors, minorities do not donate organs and tissues at the same rate as their white-counterparts. This fact only decreases the likelihood of minorities finding a perfect match.

Lack of financial resources can also affect a patient's ability to find an donor-organ match. Consider the case of the late Steve Jobs, co-founder and former chairman of Apple, Inc. Mr. Jobs came from an affluent background and was thus able to benefit from being on liver transplant waiting-lists in multiple states. Since he was on multiple lists, Mr. Jobs was able to find a match more quickly and travel to Tennessee to undergo the transplant operation. I am sure that many Americans cannot afford this luxury. Furthermore, after organ transplantation, the medications necessary to prevent the body from rejecting the organ and to treat infections, cost a lot of money. Health insurance, even public health insurance, can help cover the cost of the medication but often cannot cover everything. A patient who actually underwent kidney transplantation visited students at Mount Sinai and said that he had cleaned out his savings of more than $20,000 to pay for one year's medication.

For all that has been described here, it is very important for the medical community and society at large to work harder to raise awareness about health disparities. We must keep raising awareness to encourage research and policy change necessary to help eliminate the growing gap in health equality.

National Minority Health Month: Child Asthma

According to the CDC, 7 million children suffer from asthma nationwide. According to the New York City Department of Health and Mental Hygiene, children in New York City were almost twice as likely to be hospitalized for asthma as children in the United States as a whole. Even more alarming, in recent years, the Bronx has been the New York City borough with the highest overall rates of asthma hospitalizations, deaths and prevalence among children as well as adults. Clearly, disparities exist.

Asthma is a chronic lung disease that can cause the airways to become inflamed and narrow. This can result in coughing, wheezing and tightness of the chest which may make it difficult to breathe. Asthma attacks are often triggered by illness, strenuous activity and the environment; smoke, allergies, pets, mold, dust and pollution can be a trigger. Cockroaches can also trigger asthma attacks, as many children are allergic to the material associated with decaying roaches, and live roaches' excrement. Partners Healthcare, a team of doctors, nurses, respiratory therapists and other health care professionals, cites cockroaches as a bigger trigger than pet dander and dust. Though asthma cannot be cured, it can be treated with regular long-acting medications, and fast-acting medications in the event of an attack.

Children with asthma tend to have family members with asthma, implying that the condition is inherited. However, it is difficult to establish a link between inheritance and an entire race because race is a social construct that cannot be clearly defined by genetics. Asthma can be inherited by any child, regardless of their ethnic background, depending on the child's family history. However, asthma affects children from ethnic minority groups at disparate rates. For example, non-Hispanic black children have a higher prevalence of asthma and die at higher rates from asthma than non-Hispanic white children. Hispanic children have a higher prevalence of asthma compared to non-Hispanic white children.

Many ethnic minority children tend to live in areas in which smoke, mold, dust, pollution and roach infestation may be a problem. These triggers can greatly exacerbate asthma. Due to a lack of health insurance or a regular primary care physician, minority children suffering from asthma may be forced to use a hospital's emergency department for care. Also, due to lack of insurance and/or family instability, it may be difficult for children to regularly take required long-acting asthma medication, as prescribed. One study actually examined the degree to which instability within a family can negatively impact a child's health. Investigators found that family instability is related to poor child health, including asthma.

Additionally, cultural boundaries may contribute to disparities if they result in poor communication between the physician and patient or sub-par care. Poorly controlled asthma has also been linked to poorer performance in school (for example, more absenteeism), and may even help explain the academic achievement gap that exists among children from different ethnic groups. The aforementioned factors contribute to health disparities but are really symptoms of much greater social injustices. In order to rectify the problem, we must more closely examine our society.

National Minority Health Month: HPV and Cervical Cancer

At the American Association for Cancer Research (AACR) annual meeting on April 1, researchers said that the human papillomavirus (HPV) lasts longer in African-American women than in their white counterparts. This may shed light on some of the disparities that exist among women from different ethnic groups regarding HPV and cervical cancer.

HPV is a virus that is contracted through sexual contact. According to the Center for Disease Control and Prevention (CDC), there are over 40 types of HPV that can infect the genital area, throat and mouth. Condoms lower the risk of transmitting the virus, but areas not covered by condoms can still become infected. The CDC estimates that 20 million Americans are currently infected with HPV.

In addition to causing genital warts, another major health problem that results from HPV is cervical cancer and other genital cancers. Cancer and warts result from the body's inability to return the infected cells back to normal. In addition to the use of condoms, a vaccine (i.e. Gardasil) can lower your risk of developing warts and/or cancer. Gardasil protects against 4 types of HPV. Condoms should still be used because other types of HPV exist, and to protect against other sexually transmitted infections. Gardasil is recommended for girls and boys ages 9-26. Prevention means working to stop something before it occurs. Even if an individual has not yet had her first sexual contact, she should still be vaccinated.

In recognition of National Minority Health Month, it is important to outline the disparities associated with HPV and cervical cancer among women. While the incidence of cervical cancer among non-Hispanic white women was 8.5 in 100,000 women, the incidence was 13.8 and 11.4 for Hispanic and African-American women respectively. Despite the fact that Asians and Native Americans and Alaskins had a lower incidence of cervical cancer than their white counterparts, these minority groups were more likely to die from cervical cancer; Hispanics and African-Americans were more likely to die as well.These disparities may stem from several issues. Regardless of race, uninsured women are less likely to have regular PAP smears, and thus may not learn they have cervical cancer until it is advanced. However, it is also true that many uninsured women happen to come from low socioeconomic backgrounds and/or are from ethnic minority groups. Health and Human Services (HHS) said in a report that in 2005 many uninsured people were just above, at or well below the poverty line. The same HHS report said that Hispanics are disproportionately uninsured as they represent 14% of the general population but 30% of the uninsured population. As a group, Hispanics, African Americans, American Indians and Asians/Pacfiic Islanders constituted 52% of the uninsured population.

Many cases of cervical cancer are related to HPV. Many minority groups are not well-educated about how HPV is contracted, spread and treated. This may relate to the level of access to general education and health care. Even among minority women that are educated and have access to regular health care, cultural attitudes toward Western medicine and the health care system may contribute to these disparities. These same factors can also influence whether or not a woman chooses to be vaccinated for HPV. Lower vaccination rates can lead to an increased risk for contracting HPV, and the development of cervical cancer.

The study presented at the AACR annual meeting found a biological factor that may also contribute to disparities related to HPV. The investigators found that African-American women hold on to HPV longer in the body than their white counterparts; this may be a reflection of their genes and immune systems. Kim Creek, vice-chair and professor of pharmaceutical and biomedical sciences at South Carolina College of Pharmacy said, " [the] body recognizes it [HPV] as a viral infection and usually clears the virus within one or two years...It is those women who have difficulty clearing it that are at higher risk of cervical disease and cervical cancer." This recent finding may help explain the higher prevalence of cervical cancer among African-Americans. It would be interesting to study whether other minority groups disparately affected by HPV and cervical cancer, also hold on to the HPV virus longer than their white counterparts.

In summary, access to health insurance, education, health care, cultural attitudes and genetics are all factors that contribute to health disparities related to HPV and cervical cancer. It is clear that this is a complex problem. Cultural competency within the health care system, and initiatives that target high-risk populations will help us make great strides toward the elimination of health disparities.

Abstinence-only Sex Education and the ACA

I learn something new every day. There has been a lot of news recently about the Patient Protection and Affordable Care Act (ACA) as the nation celebrated its two-year anniversary (or not, in the case of opposition). Also, today the Supreme Court concluded its review of the health care bill. I support many aspects of the ACA. Although many aspects of the ACAwill be enacted at different times, the Act: does not allow health insurance companies to deny someone coverage because of pre-existing health conditions; allows children to be covered under their parent's health insurance until they are 26; requires health insurance companies to cover, free of charge, preventable health services such as vaccines, mammograms and screening for conditions like obesity and Type II diabetes. Also, this March it became mandatory that federal health programs collect racial, ethnic and language data which will perhaps help us better understand health disparities. However, thanks to a CNN article I learned that the Act also renewed $50 million per year for five years, for abstinence-only sexual education.

Abstinence-only sex education was something I heard about long ago. Then I really began to pay attention to the issue while I was a Public Policy Fellow at Gay Men's Health Crsis in 2009. Abstinence-only sex education places a great emphasis on waiting to have sex until after marriage. Such education often minimizes the biological aspects of sex, and often speaks very little about the use of condoms and birth control, if at all. Such education has been linked to increased rates of teen pregnancy and contraction of sexually transmitted infections. One 2011 study at the University of Georgia examined the correlation between abstinence-only sex education and teen pregnancies, births and abortions.

For every state, the investigators examined education laws and other policies regarding sex and/or HIV/AIDS education. Actual education laws were retrieved from the Education Commission on the States, while other related policies were retrieved from the Sexuality Information and Education Council of the US (SIECUS). All but two states (Wyoming and North Dakota) had education laws and/or policies on record. Each state's laws and policies were assigned a number from 0-3 indicating the level of importance each state placed on abstinence from sex; level 0 laws indicated no specific mention of abstinence, while level 3 indicated that abstinence from sex until marriage was the fundamental teaching standard. The policy level for each state was correlated with data on teen pregnancy, and birth and abortion rates. The investigators also accounted for population factors like socioeconomic status, education level, ethnicity and access to Medicare waivers for family planning.

The results? States that were described as Level 3 (abstinence was their fundamental teaching standard) had the highest rates of teen pregnancy and births among teen moms. The investigators also found that richer states tended to have a higher proportion of white teens in their teen populations, and emphasized abstinence less. These richer states also tended to have lower teen pregnancy and birth rates than poorer states. These results support the notion that abstinence-only sex education is ineffective.

Politics often involves compromise between the concerned parties. In June 2009, when I was a Public Policy Fellow, the major source of funding for abstinence-only education expired. A new bill was signed in December 2009 that provided $114 million to more comprehensive and evidence-based sex education (hooray)! Therefore, I was surprised to learn that the ACA provided funding for abstinence-only education which yields questionable outcomes. But like I said-- compromise.

The debate about whether or not abstinence-only sex education works is important; however, it is the unwanted outcomes with which we should be very concerned. The University of Georgia study found that teenage pregnancy was strongly correlated with ethnicity and socioeconomic background. Public health campaigns that target high-risk populations to educate them about teen-pregnancy and provide better access to preventative services will be invaluable moving forward.