In an age where there is proper and successful treatment of HIV/AIDS, is the public health approach to it of public health significance? This may seem like a rhetorical question, but there are plenty of people out there who would like to see HIV moved into a category of diseases that “just happen,” like so many sexually-transmitted infections which we now just hear about and shrug our shoulders. They want HIV-infected individuals to be a group that healthcare providers deal with, not public health authorities. They want screening for HIV infection to be a personal matter that people do because they want to be healthy not because we tell them to for the good of The Herd™.
After all, Cuba no longer has mother-to-child transmission of HIV, and life expectancy for people living with HIV are is getting closer and closer to the average (with some caveats). But thinking that these good news somehow justify a move from public health models to purely clinical models of dealing with HIV is a very narrow way of thinking. It might even be a little bit dangerous. Continue reading
For one of my classes this term, I was reading the story of John Snow and how he put together a bunch of clues in order to convince London authorities that their cholera epidemic came from a water pump, was transmissible from person to person, and that it could be caused by some sort of microorganism. I think that his reasoning and actions were nothing short of genius. See, at that time, everyone with a good reputation and good education in science and medicine thought that diseases were transmitted by “miasmas” or “bad air.” In the case of cholera, the predominant thinking was that “effluvia” emanated from the sick people (or their bodies once they died) and that healthy people would get sick by breathing in that effluvia.
It would be quite a number of years before the idea of microorganisms causing disease — what we call “germ theory” — became the proven and accepted way in which diseases were transmitted. This was the case even with the many clues that infectious diseases didn’t emanate from a vacuum. Though John Snow was not the first one to have these ideas and put them forth as possibilities, he was the first one to gather all the available evidence and present it in a coherent manner.
I went to watch the Baltimore Pride Parade today. It was fun. A friend of mine from Hopkins participated along with a group of nurses who do a lot to care for HIV/AIDS patients. He said it was important for them to show the LGBT community that they are there and that they care. After all, as far as Baltimore goes, it’s that community that is the most hit by HIV/AIDS. Talk about public health in action!
Here’s some of the video I caught today, followed by a few pictures:
In my ethics class this week, we talked about the ethical issues raised by an antiretroviral treatment (ART) protocol in Lesotho, a small country landlocked within South Africa. The protocol was meant to give ART to people who needed it the most and people who would stick with it. Sticking with the treatment was paramount to prevent resistance to the treatment. The people developing the protocol decided that ideal candidates would have the knowledge and ability to take the medicine themselves on time every time, and that the candidates would also disclose their HIV-positive status to a friend or family member. That friend or family member would be their “coach” or “advocate” and help keep the patient in line with their treatment, a sort of peer pressure to keep the patient in compliance.
There were several problems with this protocol. For instance, not everyone in the community who was HIV-positive knew about the program. There were also instances when people who didn’t qualify for some reason were still taken into the protocol because they knew the right person or managed to have a compelling story. Also, people who were too sick from AIDS would not be able to go to the clinics and get the medication on their own. And then there were all of those people who would not disclose their status for fear of the very real and many times very bad stigmatization in the community. Continue reading
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. Continue reading