HIV, Leadership, Teaching Styles, and Spurious Associations

This was quite the week for me at home and at school. Like I’ve told you before, I’ve been working out more and more and had it all tracked through my Nike FuelBand. It really is quite the little gadget. Based on the feedback I get from it, I’ve been more and more inclined to keep moving. So I’ve found myself a little more tired at night before bed, but in a good way. My wife says that I’m sleeping very soundly, not snoring up a storm like I did. This is a good thing. Sleep apnea is nothing to sneeze at.

But that’s not what I want to focus on for this post. I want to focus on the things I learned this week at school. First, I learned that people with HIV can become infected with a different strain of HIV and that this could cause a whole bunch of new problems. See, when you first get HIV, it infects cells in your immune system called T cells. These cells are good against a whole bunch of types of infections. Like any other viral infection, HIV uses the T cells’ mechanisms to multiply. When it finishes multiplying in the cells, thousands (or millions) of “baby” viruses burst out of the cells, destroying them. However, your body finds a way to fight back and keep the virus at bay… For a while. After a few years, if you’re not treated with anti-retroviral medication, the virus makes a comeback (or your body gets tired and can’t keep up anymore), and finally wipes out all of the T cells. Once that happens, it leaves you open to all sorts of what we call “opportunistic” infections. They’re opportunistic because you don’t usually see them in otherwise healthy people. You see them in people with suppressed immune systems.

If, for some reason, you manage to get “superinfected” with a totally different strain of HIV at a later time than your initial infection, according to some of the research presented today, you’re more likely to pass it on to your partner, your immune system mounts yet another vigorous response, and the time it takes for you to get all the way to AIDS (i.e. have the opportunistic infections set in) shrinks. It’s really quite interesting research because they’re discovering that people with HIV may be infected with more than one strain of the virus. This has implications for treatment if, for example, one strain is susceptible to anti-retrovirals but the other isn’t. It also has implications for vaccine development if the vaccine is more effective against one strain than the other. It’s really quite something.

In my leadership class, the question of the evening seemed to be “What are you willing to sacrifice to elicit change?” For example, Nelson Mandela gave up almost three decades in prison to elicit change in South Africa. Martin Luther King, Jr., was killed. And so on and so forth. If we public health students want to make a difference in the world, what are we willing to sacrifice? It’s a hard question to answer because I have a wife and pets. (We hope to have a child some day, which will make the question even harder to answer.) It’s not like I can wear a mask and a cape and run around like Batman. (Though, I do look good in eyeglasses and a pressed white shirt.)

And then there was my epidemiological methods class. We were discussing a very complicated concept in epidemiology and biostatistics called “Effect Modification”. (I touched on it briefly over at the Epi Night School.) Basically, there are things that work together and make associations look stronger, or weaker, when they interact. For example, we know that smoking increases your risk of lung cancer. If you’re a smoker and work with asbestos, your risk skyrockets. Smoking modifies the effect of asbestos, and vice versa. There are also modifications that don’t exacerbate the effect, they may tone it down. Again, it sounds simple, but finding that effect modification and doing something about it so you don’t get bad results is complicated.

Well, the professor explaining this concept to us got a little “tripped up,” so to speak. And I don’t think our questions helped. But it was a good discussion, and I appreciate the difficulty in explaining this to a bunch of grad students with different backgrounds.

Speaking of different backgrounds, I’ve been going to a school in Baltimore to teach 11-14 year old boys about sexual education. Let me tell you… It is tough. How anyone decides to be a teacher and then teach children that age without needing some sort of therapy is beyond me. They feed off each other, are always judging you, interrupt, speak louder than necessary, and are always moving in their desks. I tip my hat to teachers everywhere, especially the teachers that had a hard time with me.

This reminds me. I went to a poster presentation from several mental health counseling students, and this one caught my eye:

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It’s a poster about children with ADHD really just being “gifted and/or talented” and being bored with the curriculum at their school. So they act out. It got me wondering how many of those children that I see as “hellions” are really just not being challenged to their potential. Are they being annoying because they’re not being challenged? If we moved the class outside and I had them running around for an hour, I’m sure they’d be more mellow. Maybe. Still, I enjoy the one hour a week of teaching them about serious subjects like drug abuse and unplanned pregnancies. It is obvious from their family histories (which I won’t share, of course) that they need someone to take charge and talk to them about these things.

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