OK, vacation's over, and I'm back to blogging. This post is kind of a grad student/public health combo. The grad student aspect of the blog is this: one more semester to go. I have one more semester until I am supposedly qualified to diagnose and treat a wide variety of ailments. Yike. The summer semester of my program, which ended just before my last post, was frighteningly bereft of clinical information. I had a class on violence and ways it may come up in clinical practice, which did make some excellent points. I had another class on the logistics of being an NP. It was devoted to admin things like licensing, practice agreements, insurance, etc. Important stuff, but it didn't really feel like it should take priority over, say, more diagnosis and management. Finally, we had a seminar where we presented cases, and that was useful. But we only met for two hours every other week, so...Anyway, suffice it to say I've gone online and bought some review books to supplement my already expensive education.
Now to public health. The President and CEO of the Kaiser Family Foundation, Drew Altman, recently wrote one of his "Pulling It Together" columns about the state of HIV prevention funding in the US. He notes that NYS is the top funder of HIV prevention, spending $88 of the $600 million spent nationally. This is slightly less impressive than it sounds, since NY is home to 17.6% of the people in the US living with HIV, and $88 million is only 14.6% of the overall funding. Still, a good start. However, the column notes these figures are for FY07, and things are likely to have changed since then thanks to the economy's shenanigans. The column also links to one of previous columns about attitudes towards HIV nationally.
Showing posts with label HIV. Show all posts
Showing posts with label HIV. Show all posts
Monday, August 17, 2009
Saturday, June 20, 2009
staten island steps up
On Thursday the Staten Island Ryan White HIV CARE Network launched its "Staten Island HIV Status Check Campaign". The campaign is designed to promote HIV testing among residents of Staten Island, and features a snazzy postcard that has information about free local testing centers. The postcard is available in English and Spanish, and will be distributed by local businesses and organizations along with HIV-related education literature and condoms.
A coordinator for the campaign, Karina Ryan, noted that 56% of Staten Island residents have never been tested for HIV. She also notes that while Staten Island has the lowest rate of infection of the five boroughs, it also has the highest HIV-related mortality rates. As with everywhere, Hispanics and blacks are disproportionately affected by the disease, comprising 19% and 50% new diagnoses in 2007 respectively, despite representing only 12% and 10% of the Island population.
For the campaign, the CARE Network is working with the Black Leadership Commission on AIDS and the City Council's Communities of Color Faith Initiative.
A coordinator for the campaign, Karina Ryan, noted that 56% of Staten Island residents have never been tested for HIV. She also notes that while Staten Island has the lowest rate of infection of the five boroughs, it also has the highest HIV-related mortality rates. As with everywhere, Hispanics and blacks are disproportionately affected by the disease, comprising 19% and 50% new diagnoses in 2007 respectively, despite representing only 12% and 10% of the Island population.
For the campaign, the CARE Network is working with the Black Leadership Commission on AIDS and the City Council's Communities of Color Faith Initiative.
Wednesday, June 3, 2009
ny daily news op/ed
There was an interesting opinion piece in Sunday's Daily News. Errol Louis focused his discussion on the fact that HIV infected New Yorkers who receive housing assistance through the city's HIV/AIDS Service Administration often have to put large chunks of their income to rent; he quotes figures as high as 56, 59, and 70%. Since the percentage is so high, Louis claims, evictions are common. Louis suggests that Albany simply cap that figure at 30% of income.
Louis rightly points out that keeping people with HIV/AIDS in stable housing situations is beneficial to public health. He states that people who are homeless are less likely to take their HIV medications as prescribed than those in stable housing, and points out such people are can wind up in emergency rooms at taxpayer's expense. He also claims that "studies show they [presumably HIV positive people, possibly not] are more likely to turn to prostitution", which would pose an obvious public health risk. That said, I have never heard of such a study. That sentence also does not make clear to whom HIV positive people are being compared by these studies, or even who exactly "they" are. Does he mean HIV positive people generally, or just HIV positive people with nowhere to live? Hmmm...
Finally, there is one paragraph in the column I find a little worrying. With regards to the eviction of HIV positive people, Louis writes:
I am, perhaps, reading this ungenerously, but is he implying that it is "risky" for an uninfected person to live on the streets/share a bathroom/occupy the same room with an infected person? It seems that he is, which is disturbing. HIV can only be spread via infected needles or sex. Period.
Louis rightly points out that keeping people with HIV/AIDS in stable housing situations is beneficial to public health. He states that people who are homeless are less likely to take their HIV medications as prescribed than those in stable housing, and points out such people are can wind up in emergency rooms at taxpayer's expense. He also claims that "studies show they [presumably HIV positive people, possibly not] are more likely to turn to prostitution", which would pose an obvious public health risk. That said, I have never heard of such a study. That sentence also does not make clear to whom HIV positive people are being compared by these studies, or even who exactly "they" are. Does he mean HIV positive people generally, or just HIV positive people with nowhere to live? Hmmm...
Finally, there is one paragraph in the column I find a little worrying. With regards to the eviction of HIV positive people, Louis writes:
That's an expensive and risky proposition for our city. People with AIDS or advanced HIV who get evicted often wind up living on the streets or sharing bathrooms with noninfected neighbors in homeless shelters, single-room occupancy buildings and welfare hotels.
I am, perhaps, reading this ungenerously, but is he implying that it is "risky" for an uninfected person to live on the streets/share a bathroom/occupy the same room with an infected person? It seems that he is, which is disturbing. HIV can only be spread via infected needles or sex. Period.
Friday, May 22, 2009
exciting development
A new vaginal ring, which provides a combination of ART and contraception, has been shown in laboratory tests to prevent pregnancy and HIV transmission. The study, headed by Drs. Brij Saxena and Jeffrey Laurence, both of New York-Presbyterian Hospital, will be published in AIDS later this year.
The ring uses three ART drugs, released by the ring over a 28 day period, to prevent the transmission of HIV. The drugs are: AZT, the lesser known PMPA, and a new compound called Boc-lysinated betulonic acid, or dapivirine. "The combination of these antiviral drugs has proven to be potent agents that may block infection by the HIV virus," Dr. Saxena told the the Times of India. The contraception the ring provides, which is non-hormonal, prevents conception by raising the acidity of the vagina, thickening vaginal mucus, and diminishing sperm motility.
This is a huge step forward: a method to both prevent conception and the transmission of AIDS that depends only on female compliance has been a goal of researchers for a long time.
The ring uses three ART drugs, released by the ring over a 28 day period, to prevent the transmission of HIV. The drugs are: AZT, the lesser known PMPA, and a new compound called Boc-lysinated betulonic acid, or dapivirine. "The combination of these antiviral drugs has proven to be potent agents that may block infection by the HIV virus," Dr. Saxena told the the Times of India. The contraception the ring provides, which is non-hormonal, prevents conception by raising the acidity of the vagina, thickening vaginal mucus, and diminishing sperm motility.
This is a huge step forward: a method to both prevent conception and the transmission of AIDS that depends only on female compliance has been a goal of researchers for a long time.
Wednesday, April 22, 2009
new bill to try to change HIV testing practices in NYS
On April 16, 2009, a new bill was introduced into the NYS Assembly arguing for a new HIV testing MO in the state of New York. The bill would require that HIV testing "to be part of a signed general consent to medical care" signed by the patient. The bill would also require that all EDs, hospitals, and doctor's offices offer HIV tests to patients on a regular basis, with some very limited exceptions (ie, they are being treated for a life-threatening illness at the time of their visit.)
But what does it mean for the HIV test to be "part" of a "signed general consent"? In an article published April 12, The Albany Democrat and Chronicle interpreted it to mean that patients "would check a box on a general medical-consent form, which would remain in force."
Advocates say that this is still too much of a barrier. C. Virginia Fields, chief executive officer and president of the National Black Leadership Commission on AIDS, is quoted in the Democrat: "What we're saying is routine testing is when you go to a doctor and get a blood work-up, and HIV should be among those (illnesses) tested."
I'm all for lowering barriers to testing for HIV, and myself have recommended several HIV (and chlamydia and herpes and gonorrhea) tests to several patients during my NP clinicals. However, I have trouble picturing HIV being added to "routine testing" because there is no such thing. That is, when a patient turns up at a clinician's office, either perfectly healthy and there for their annual exam, or with a looong list of episodic complaints, the clinician decides what tests to order based on the patient's characteristics. Admittedly, there are some tests (complete/basal metabolic panel, complete blood count, urinalysis) that are ordered for basically everyone, but these are not for diseases as such; they test organ function and indicate disease if abnormal. All of this is to say: in the absence of true "routine tests" for disease, a bill like this one is the only way to improve testing rates via legislation. Unless of course, the legislature wants to mandate that clinicians verbally offer the test for HIV to everyone on every visit. (Come to think of it, that's not a bad idea.) In the meantime, get tested.
Finally, an editorial from the NYT advocating greater awareness of HIV in the US, and more frequent testing for the disease.
But what does it mean for the HIV test to be "part" of a "signed general consent"? In an article published April 12, The Albany Democrat and Chronicle interpreted it to mean that patients "would check a box on a general medical-consent form, which would remain in force."
Advocates say that this is still too much of a barrier. C. Virginia Fields, chief executive officer and president of the National Black Leadership Commission on AIDS, is quoted in the Democrat: "What we're saying is routine testing is when you go to a doctor and get a blood work-up, and HIV should be among those (illnesses) tested."
I'm all for lowering barriers to testing for HIV, and myself have recommended several HIV (and chlamydia and herpes and gonorrhea) tests to several patients during my NP clinicals. However, I have trouble picturing HIV being added to "routine testing" because there is no such thing. That is, when a patient turns up at a clinician's office, either perfectly healthy and there for their annual exam, or with a looong list of episodic complaints, the clinician decides what tests to order based on the patient's characteristics. Admittedly, there are some tests (complete/basal metabolic panel, complete blood count, urinalysis) that are ordered for basically everyone, but these are not for diseases as such; they test organ function and indicate disease if abnormal. All of this is to say: in the absence of true "routine tests" for disease, a bill like this one is the only way to improve testing rates via legislation. Unless of course, the legislature wants to mandate that clinicians verbally offer the test for HIV to everyone on every visit. (Come to think of it, that's not a bad idea.) In the meantime, get tested.
Finally, an editorial from the NYT advocating greater awareness of HIV in the US, and more frequent testing for the disease.
Wednesday, April 15, 2009
Thursday, February 12, 2009
facebook for condoms
Like social networking and sexual health? Then the NYC Department of Public Health's new Facebook page for condoms is made for you. The site, which aims to promote sexual health and to raise awarenesss of the city's HIV statistics, gives users the opportunity to send "e-condoms". Over 6500 condoms have been sent as of Thursday afternoon, although a ranking of the senders has revealed a bunch have been sent by employees of the health department's communications office. Facts listed on the site include that NYC has more HIV cases than LA, San Francisco, DC, and Miami combined, and that one in four MSM in Chelsea has HIV. The site also features health updates from the health department and lively short videos encouraging condom use.
For Valentine's Day 2007, the City's health department introduced the official "city condom"; since it's introduction, over 70 million have been given away.
For Valentine's Day 2007, the City's health department introduced the official "city condom"; since it's introduction, over 70 million have been given away.
Wednesday, January 28, 2009
new study on HIV trials in foster care
The Vera Institute of Justice released its report today on the participation of HIV positive NYC foster children in HIV drug trials from the last 1980s until 2005. The city's Administration for Children's services commissioned the report in 2005 when allegations arose concerning the participation of certain children in the study. These allegations included: that race was a factor in the selection of participants, that children were at times inappropriately removed from their homes and placed in foster care to facilitate their participation in the study, and that the trials themselves adversely affected the children's health.
First, the study found that no child died as a result of his or her participation in a study. Sadly, 80 of the 532 children enrolled in HIV trials over this period of time did die, but investigators could find no connection between these deaths and any clinical trial. The study also noted that while there were instances of side effects in the children, these side effects were consistent with the literature published about the drug at the time. The study also fond several instances in which physicians took note of these toxicities and made appropriate adjustments. Second, the study finds no evidence that children were removed from their homes to due parental refusal to allow children to participate in drug trials. The study notes that 3/4 of children enrolled in foster care were enrolled before they were one year old, and more than 1/2 were enrolled directly in the hospital from birth. Third, the study finds that the while the trials did predominantly involve black and Hispanic children, their representation in the trials was reflective of the demographics of the HIV epidemic at the time.
On the other hand, there were some findings of concern. A number of them centered around informed consent: in seven cases, consent was given by someone who had no legal right to do so, consent forms were often written in medical jargon, and consent was at times accepted in the form of handwritten notes or over the phone. Sixty four children were enrolled in trials that were never reviewed bu the city's own Medical Advisory Panel (MAP), which had been developed specifically for that purpose. Twenty one children were enrolled in trials that had been reviewed by MAP and were not recommended, although 13 of these had been enrolled prior to entering foster care.
The report concludes with a few concerns and recommendations, mostly centered around the need for clearer and more comprehensive policy around the participation of foster children in clinical trials.
Further coverage of the study can be found at the NYT website.
Finally, on a personal note, one of the study's seven authors is my roommate, Reena Gadhia, who used to work at Vera and is now an RN at the Allen Pavilion of Columbia Presbyterian. Reena worked on this project a lot while at Vera, and has since gone to DC to present her research at a conference. Congrats Reena!
First, the study found that no child died as a result of his or her participation in a study. Sadly, 80 of the 532 children enrolled in HIV trials over this period of time did die, but investigators could find no connection between these deaths and any clinical trial. The study also noted that while there were instances of side effects in the children, these side effects were consistent with the literature published about the drug at the time. The study also fond several instances in which physicians took note of these toxicities and made appropriate adjustments. Second, the study finds no evidence that children were removed from their homes to due parental refusal to allow children to participate in drug trials. The study notes that 3/4 of children enrolled in foster care were enrolled before they were one year old, and more than 1/2 were enrolled directly in the hospital from birth. Third, the study finds that the while the trials did predominantly involve black and Hispanic children, their representation in the trials was reflective of the demographics of the HIV epidemic at the time.
On the other hand, there were some findings of concern. A number of them centered around informed consent: in seven cases, consent was given by someone who had no legal right to do so, consent forms were often written in medical jargon, and consent was at times accepted in the form of handwritten notes or over the phone. Sixty four children were enrolled in trials that were never reviewed bu the city's own Medical Advisory Panel (MAP), which had been developed specifically for that purpose. Twenty one children were enrolled in trials that had been reviewed by MAP and were not recommended, although 13 of these had been enrolled prior to entering foster care.
The report concludes with a few concerns and recommendations, mostly centered around the need for clearer and more comprehensive policy around the participation of foster children in clinical trials.
Further coverage of the study can be found at the NYT website.
Finally, on a personal note, one of the study's seven authors is my roommate, Reena Gadhia, who used to work at Vera and is now an RN at the Allen Pavilion of Columbia Presbyterian. Reena worked on this project a lot while at Vera, and has since gone to DC to present her research at a conference. Congrats Reena!
Monday, January 12, 2009
mobile HIV testing
NYT today covered moible HIV testing units in Westchester county, which has the highest rate of HIV in the state outside of NYC. The testing uses a specimen obtained from a gum swab and takes about twenty minutes. The vans also offers counseling for anyone who needs it. This type of rapid response testing is the same offered in several EDs throughout NYC.
Thursday, January 8, 2009
Hello
My first post will be just a quick introduction. I am a registered nurse pursuing a Master's degree in Nursing. My BS in Nursing was my second undergraduate degree; it was a one year accelerated program designed for students who wanted to be nurses but who already had four year degrees in other fields. My BA was in the social sciences, and one of the only two science classes I took in college was nicknamed "Sex" by the student body. (The course guide opted for the more discreet title "The Evolution of Human Nature", but it obviously fooled no one.) So transitioning into classes that actually had right and wrong answers was not easy. However, I was lucky enough to take care of my prereqs quickly, and to begin my nursing degree almost exactly a year after finishing undergad.
I was also lucky enough to get into my first choice nursing school: Columbia University. Its medical campus is centered around Columbia-Presbyterian Hospital, in the Washington Heights area of New York. A year after starting my degree at Columbia, I finished the bachelor's portion of the program and became a registered nurse. Like most people in my class, I moved on immediately to my Master's in Nursing, which, combined with passing the state's nursing boards, will qualify me to practice as a Nurse Practitioner in New York. I will complete my degree in December 2009.
In addition to nursing , I'm interested in public health, particularly in New York and particularly as it pertains to HIV. I intend for this blog to discuss all three subjects, although the ratio is to be determined. To that end, an interesting study recently came out from the New York Department of Health exploring a link between binge drinking and HIV among MSM. You can download the full study at the end of the press release.
I was also lucky enough to get into my first choice nursing school: Columbia University. Its medical campus is centered around Columbia-Presbyterian Hospital, in the Washington Heights area of New York. A year after starting my degree at Columbia, I finished the bachelor's portion of the program and became a registered nurse. Like most people in my class, I moved on immediately to my Master's in Nursing, which, combined with passing the state's nursing boards, will qualify me to practice as a Nurse Practitioner in New York. I will complete my degree in December 2009.
In addition to nursing , I'm interested in public health, particularly in New York and particularly as it pertains to HIV. I intend for this blog to discuss all three subjects, although the ratio is to be determined. To that end, an interesting study recently came out from the New York Department of Health exploring a link between binge drinking and HIV among MSM. You can download the full study at the end of the press release.
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