Poverty and Heterosexual HIV - CDC Issues a Report

In the August 12, 2011 issue of the Mortality and Morbidity Weekly Report (MMWR), the CDC outlines results of a study examining heterosexual HIV in 25 metropolitan areas-- Philadelphia included. The study was done as an anonymous survey, asking people in areas with known high rates of HIV about various demographics facts and their HIV status. What they found were HIV rates:
- twice as high in those who hadn't completed high school (2.8% vs. 1.2%)
- twice as high in unemployed (2.6% vs. 1.0%)
-twice as high when living in poverty (2.3% vs. 1.0%)
-similar among men and women
-by race/ethnicity were not as different as it is in the general population
It was NOT associated with different levels of crack cocaine use, exchanging sex for drugs or money, or rates of STDs once the statistics were controlled for differences in poverty.
The editors, in tying together HIV and poverty as the most important factors noted that "Low SES and other adverse social conditions can increase the risk for HIV infection through sexual exploitation, marital instability, unstable sexual partnerships, poor mental health, substance abuse, and limited access to health care and preventive services. In addition, socioeconomic segregation confines low-SES persons to sexual networks with high underlying rates of HIV and other STDs, thereby further increasing their risk for HIV infection". Their conclusions were that future prevention efforts need to especially focus on those who live in poverty in areas with high rates of HIV.
Philadelphia's own, Dr. Kathleen Brady and Althea Kirkland, of AACO are cited at the end of the report as contributors.

August Star Employee - Marie Spencer

This month's star employee is Marie Spencer. Hailed by her colleagues as being: lovable, hard working, team player, helpful, always smiling, a breaker of barriers. Marie works at the DMC as an HIV tester. She is well known by staff at area homeless shelters in particular for her efforts in HIV testing there.

Summer Newsletter Now Available

Your summer newsletter should soon be in your email box. For a preview click here.

Treatment Impacts Prevention

In a New England Journal of Medicine article, published on July 18, 2011, Dr. Myron Cohen of the University of North Carolina, Chapel Hill and his colleagues make the case for "early" treatment of HIV as a means of HIV prevention. In their study, they looked at nearly 2000 serodiscordant couples (one partner HIV+, one HIV-), predominantly from Africa. HIV medication was given to half of the HIV positive partners while treatment was deferred in half until the CD4 count dropped or development of HIV related symptoms-- the standard of care in these areas without enough medication for everyone. The goal of the study was to see if this "early" treatment would result in fewer infections among their HIV negative partners (while also monitoring them to see if early treatment made a difference in the positive partners' health).
The result was that of the 28 infections that were proven to be transmitted from one partner to the other, only 1 was in the treatment group. Individuals on treatment also had fewer HIV related clinical problems.
In a companion editorial in the same issue, Dr. Scott Hammer of Columbia University makes the case for expanded access for medications, "this is precisely the wrong time to limit access to antiretroviral therapy in resource-limited settings, since we have the tools in hand to maintain or restore health in infected persons and reduce transmission to their sexual partners."

The DMC "Hearts" Dr. Laguerre

Dr. Roberta Laguerre is our July Star Employee of the Month. As the sign she is holding says, she is fabulous, dedicated, and beautiful. Chosen by popular vote of our staff, our employee of the month gets to enjoy a month's worth of honors.
Dr. Laguerre is the Clinical Director of the DMC so is no stranger to our patients and is becoming increasingly well known by physicians in the area as she travels for her infamous lunch discussions about the importance of routine HIV testing for teens.

Our Video Now Available on Vimeo

The documentary video about the DMC, produced for our opening reception is now available on Vimeo here. For those of you who may have tried to view it in the past, the technical issues have been resolved. In the video, Dorothy Mann talks about her first experience with the program at St. Chris and with families affected by HIV. Also interviewed are Dr. Sue Willard, now at the Elizabeth Glaser Pediatric AIDS Foundation, Carol Treston, RN MPH now the Executive Director of the AIDS Alliance for Families and Children, Dr. Ellen Tedaldi of Temple University School of Medicine, and staff and family from the DMC. The video was directed by Alfredo Sosa of Mighty Head Entertainment.

First Ever National Prevention Strategy Unveiled

On June 15th, the US Department of Health and Human Services unveiled its first ever National Prevention Strategy. The prevention strategy is a required component of the implementation of the Affordable Health Care Act, aka Health Reform. Underlying the strategy is a plan that reducing illness will ultimately pay off not only in quality of life, but in less money being spent on disease care. Why should we in the HIV care about this?
Key points put forth by Maria Alvarez, the Director of Health Policy in the Office of Health Policy Reform at DHHS here at HealthCare.gov's blog :
1) Making healthy choices easy and affordable will result in more Americans having access to prevention services such as HIV testing, breast exams, blood pressure checks, etc. Having health care providers focus on prevention in general should result in broader prevention efforts in general.
2) Access to health care in underserved communities will be improved -- having a large impact on illnesses with health disparities such as hypertension, heart disease, and HIV. This will be for both HIV care and for issues around primary care as well.
3) Programs will be better targeted through advance scientific knowledge and innovation through creation of electronic systems to better monitor what is working and what isn't-- we already do this in Ryan White funded clinics through CAREWare.
4) Create a fairer and easier way to understand the health care system - by 2014, insurance will be easier to obtain and there legally cannot be any discrimination against anyone with a pre-existing condition-- opening many options for those with HIV.