Combating HIV by zip code

Minority neighborhoods in the U.S. are hit as hard by HIV as gay enclaves

From Healthline.com

HIV rates in some urban American neighborhoods rival those of Haiti and Ethiopia, according to a researcher at Brown University in Providence, R.I.

And while affected communities include big-city gay enclaves, such as New York’s Chelsea district, minority neighborhoods in the Bronx and Harlem make the list, too. The difference is that those in mostly white neighborhoods are more likely to be tested and treated than those in minority neighborhoods.They are also less likely to die of AIDS.

In an era of Internet targeting, Dr. Amy Nunn’s approach of going door-to-door if necessary to reach people with HIV may seem old-fashioned. But in areas with limited access to health care, employment, and education, HIV experts agree that a new model is needed to reach at-risk groups of black and Hispanic Americans.

Of the 50,000 new HIV infections in the U.S. in 2010, gay and bisexual men accounted for two-thirds of them, according to the U.S. Centers for Disease Control and Prevention (CDC). Black men and women are eight times more likely to become infected than whites, based on population size. Of all groups, white men who had sex with men comprised the largest segment of new infections, at 11,200. Black men who had sex with men were second, with 10,600 new infections.

Dr. Nunn, an assistant professor of medicine at Brown, told Healthline that more money must be targeted toward poor and minority neighborhoods. “If this were happening to white people there would be protests,” she said. “It’s so easy to overlook poor people.”

Of the more than 1.1 million people in the U.S. living with HIV, almost 16 percent don’t know they have it, according to the CDC. Powerful antiretroviral medications available to most everyone in the U.S. can suppress viral loads to the point that transmission is unlikely. But they will only work if they are taken regularly.

“We’ve got to get these people into treatment come hell or high water,” Nunn said.

Continue reading on Healthline.com.

Weekly clinic geared toward LGBTQ clients in Pittsburgh

research pageFrom The Pittsburgh Post Gazette… 

The first weekly Community Clinic for lesbian, gay and transgender people will be held Thursday in downtown Pittsburgh. The clinic, with physician Stacy Lane, is the only one targeting LGBTQIA individuals with no age limits or income requirements. It will be held on the eighth floor at 810 Penn Ave. from 2 to 5:30 p.m. During the clinic hours, the Garden of Peace Project will supply testing for sexually transmitted diseases and Project Silk will provide HIV testing.

Charmaine Turner, founder and director of Step Up 2 Step Out, will host a hip-hop dance class at 4 p.m. The Garden of Peace Project and Project Silk, which are the hosts, invite other providers to host their own dance classes or other health-related group activities such as yoga, meditation and self-esteem workshops.

STD prevention is a part of HIV prevention: STD Awareness Month 

A message from Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention (from AIDS.gov)

Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention

Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention

April marks the annual observance of STD Awareness Month. And for this month, I’d like to focus on the link between STD prevention and HIV prevention.

The Centers for Disease Control and Prevention (CDC) has been invested in exploring the intersection of HIV and other STDs. Every year, 20 million new STDs occur including 50,000 new HIV infections. We know that people who have STDs such as gonorrhea, herpes, and syphilis are more likely to get HIV compared to people who do not. In fact, being infected with genital herpes makes you 3 times more likely to get infected with HIV, if exposed. And data collected from several major U.S. cities indicate that nearly 45% of gay and bisexual men with syphilis are also infected with HIV.

So this STD Awareness Month, I encourage the public, health care providers, and community-based organizations to bring a renewed sense of enthusiasm and focus to their STD awareness and prevention efforts. Individuals should know that the same behaviors that put you at risk for acquiring STDs can put you at risk for getting HIV. Physicians should follow recommended screening and treatment guidelines. And community-based organizations should support local STD and HIV prevention efforts.

The link between STDs and HIV is real. By educating yourself on ways to lower your risk, you can take action to protect your health. Not having sex is the most effective way to prevent STDs and HIV, but if you are sexually active, you can lower your risk of STDs and HIV by

  • Choosing one partner and agreeing to be sexually active only with each other. It is still important that you and your partner get tested for STDs and HIV and share your test results with one another.
  • Limiting the number of people you have sex with if you have more than one partner.
  • Using latex condoms or dental dams the right way every time you have sex.

STD and HIV testing is a critical part of preventing the spread of disease. I am urging providers to educate patients on their risk for STDs and HIV, and make taking a sexual history a priority. The behaviors and circumstances that put people at risk for STDs also put them at risk for HIV; take the opportunity to offer HIV testing to all patients who are tested for an STD. With 20% of new HIV cases being detected in STD clinics, it’s clear that a continued merging of STD and HIV prevention efforts is needed. As well, patients diagnosed with HIV at STD clinics have been found to have less-advanced disease.

You can go to the CDC Website to find out more about STD Awareness Month.

New gay epidemic — and what you can do to end it

From the Huffington Post… 

(by Jimmy LaSalvia)

quit-smoking-man-largeThe new gay epidemic is an old one. It’s killing your gay friends and family, and it’s totally preventable. No, it’s not what you may be thinking. It’s not HIV/AIDS. I’m talking about smoking. Last week was LGBT Health Awareness Week, so this is good time to bring up a LGBT health crisis that many ignore or minimize. According to the American Lung Association, gay men are approximately 2.5 times more likely to smoke, and lesbians are about twice as likely as their straight counterparts. Most everyone knows that smoking is the leading preventable cause of death. That’s true for everyone, including LGBT Americans.

There’s not a physical reason why gay people smoke more, but there are some unique factors that contribute to the higher rate of smoking. For decades, the gay community has socialized and interacted in smoking venues such as bars. For a long time, gay bars were the only place for LGBT people to find others like them. It’s still a big part of gay culture and socialization. The American Lung Association also says that stress from social stigma and discrimination because of their sexual orientation is frequently cited as a reason that LGBT people start smoking. That’s especially the case with young people, who have a much higher rate of smoking than their straight peers.

It’s important for all of us, no matter who we are, to combat this epidemic within our own families and circles of friends. Understanding these unique pressures and risk factors can help us to urge our gay friends and family who are still smoking to stop. Quitting smoking is hard. Everyone knows that. While giving it up “cold turkey” (ideally with some advice from a doctor) is the best and most effective way, it’s just not possible for everyone. A wide range of pharmaceutical products — everything from over-the-counter nicotine gum to prescription medicine — can also help some people some of the time but also have very high failure rates particularly over the long term. Nicotine is addictive and quitting it is very, very hard.

For those who simply can’t quit or don’t want to there are products such as e-cigarettes and dissolvable smokeless tobacco that can help people with their addiction to nicotine without carrying the risks of smoking. These products are still addictive and certainly aren’t “safe” overall. But they are still safer than smoking. It’s the smoke that’s the real killer.

Continue reading on the Huffington Post.

HIV-infected men at increased risk for heart disease, large study finds

NIH-Supported Research Also Identifies Predictors of Heart Disease Risk In This Group
Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine. In addition, blockage in a coronary artery was most common among HIV-infected men whose immune health had declined the most over the course of their infection and who had taken anti-HIV drugs the longest, the scientists found, placing these men at even higher risk for a heart attack. “These findings from the largest study of its kind tell us that men with HIV infection are at increased risk for the development of coronary artery disease and should discuss with a care provider the potential need for cardiovascular risk factor screening and appropriate risk reduction strategies,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. “Thanks to effective treatments, many people with HIV infection are living into their 50s and well beyond and are dying of non-AIDS-related causes¬—frequently, heart disease,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), also part of NIH. “Consequently, the prevention and treatment of non-infectious chronic diseases in people with HIV infection has become an increasingly important focus of our research.”

NIAID and NHLBI funded the study with additional support from the National Center for Advancing Translational Sciences, part of NIH. Past studies of the association between heart disease and HIV infection have reached inconsistent conclusions. To help clarify whether an association exists, the current investigation drew participants from the Multicenter AIDS Cohort Study (MACS), a study of HIV/AIDS in gay and bisexual men established by NIAID nearly 30 years ago. “One advantage of the MACS is that it includes HIV-uninfected men who are similar to the HIV-infected men in the study in their sexual orientation, lifestyle, socioeconomic status and risk behavior, which makes for a good comparison group,” said Wendy S. Post, M.D., who led the study. Dr. Post is a professor of medicine and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Another advantage was the MACS’ size, with nearly 7,000 men cumulatively enrolled, 1,001 of whom participated in the new study. The participants included 618 men who were HIV-infected and 383 who were not. All were 40 to 70 years of age, weighed less than 200 pounds, and had had no prior surgery to restore blood flow to the coronary arteries. Dr. Post and colleagues investigated whether the prevalence and extent of plaque buildup in coronary arteries, a condition called coronary atherosclerosis, is greater in HIV-infected men than HIV-uninfected men and whether that plaque is soft or hard. Coronary atherosclerosis, especially soft plaque, is more likely to be a precursor of heart attack than hard plaque.

The scientists found coronary atherosclerosis due to soft plaque in 63 percent of the HIV-infected men and 53 percent of the HIV-uninfected men. After adjusting for cardiovascular disease risk factors, including high blood pressure, diabetes, high cholesterol, high body mass index and smoking, the presence of soft plaque and the cumulative size of individual soft plaques were significantly greater in men with HIV infection.

In addition, by examining a subgroup of HIV-infected men, the scientists discovered two predictors of advanced atherosclerosis in this population. The first predictor deals with white blood cells called CD4+ T cells, which are the primary target of HIV and whose level, or count, is a measure of immune health. The researchers found that for every 100 cells per cubic millimeter decrease in a man’s lowest CD4+ T cell count, his risk of coronary artery blockage rose by 20 percent. The scientists also found that for every year a man had taken anti-HIV drugs, his risk of coronary artery blockage rose by 9 percent.

Because the investigators examined coronary artery plaque at a single point in time, further research is needed to determine whether coronary artery plaque in HIV-infected men is less likely to harden over time, or whether these men simply develop greater amounts of soft plaque, according to Dr. Post. In addition, she said, studies on therapies and behavioral changes to reduce risk for cardiovascular disease in men and women infected with HIV are needed to determine how best to prevent progression of atherosclerosis in this population.

 

How Yoga helped me choose to live with HIV, instead of dying of AIDS

Alexander Smith

Alexander Smith

Alexander Smith explains his own viral mindfulness and how doing yoga’s corpse pose helped him appreciate his own life (from HIVplusmag.com) …

Difficult poses (asana) are expected in life and on the yoga mat. Hatha yoga is a style of yoga common in the West that focuses on poses and breathing. As we pose, we learn to sit with the pain and discomfort that arises in our bodies, and we become aware of the suffering in our minds that is attached to our thoughts and story. In a place of discomfort, we often let go of the breath (pranayama), which is there to strengthen and sustain us.

It is taught that shavasana — best known as the corpse pose or dead man’s pose — is the most difficult of all the poses. To assume the posture, lie down on your back, allow your feet to fall outward, rest your arms at your sides with palms facing upward, and let your breath follow its inherent inhaling and exhaling pattern. At the end of our practice we traditionally assume this pose. In the giant metaphor of sitting like a corpse, we have an empty space to release all effort in mind and body. Do nothing. Completely surrender. And experience the sweet spot of shavasana.

Yoga, meditation, and mindfulness drive us toward a strength that rises when we surrender everything. It reminds us that the happiness we seek is already here.

At the end of summer a couple of years ago I posed in my own version of a dead man. Facing the fact that my strain of HIV had mutated and developed a resistance to my current cocktail of antiretrovirals, I stood at a crossroads. After a decade I could stop taking pills and lean toward my own corpse pose. Set down the worry and frustration and struggle I experience in posing with this virus. Develop AIDS, catch an opportunistic infection or two, and be dead within a year.

As I surrendered in this pose I noticed that by focusing so much on my death I had distracted myself from stories of life. In a place of complete honesty and reproach, I made a decision to build me a life. I recommitted myself to regular practice of meditation and yoga — with compassion — and I started by cleaning my entire house, doing the laundry and dishes, feeding my body, and taking my medications.

When I checked the online schedule of yoga classes I saw a picture of a beautiful man and yogi. Posing. I recognized him from years earlier. We had shared a neutral greeting when I attended a class at his studio in Laguna Beach, Calif. I was super excited to think he would be teaching class that day. Perhaps he is my future husband, I thought hopefully. When I looked deeper for class details I realized the picture was in honor and memory of his life. My future husband was dead, but somehow I found comfort in the eerie coincidence — and I marveled at the beauty and strength in his pose.

Continue reading on HIVplusmag.com.