Book Report: The Invisible Cure

I read The Invisible Cure, by Helen Epstein, at least ten years ago when I was on a particularly fevered quest to learn as much as I could about HIV. I was so impressed by her work that I later went to a talk that she gave about her work.

Epstein moved to Uganda in 1993 to work on an HIV vaccine. She worked across sectors, with politicians, activists, researchers, doctors, economists, and so on.

She challenged the prevailing orthodoxy and the struggled to understand how politics and greed can infect and corrupt even the most honorably motivated humanitarian projects. For me, I am always impressed by stories, like those told in The Invisible Cure, about the power and potential of grassroots community organizing as the most effective solution to community problems. She offers insight into the thoughts of the Ugandans with whom she is working:

“As a woman living with HIV,” says Beatrice Were of Uganda, “I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives.”

The story that is told is one that focuses on the Ugandan solution to the Ugandan Problem. The story takes place in the Bush era (so prepared to be fired up about major failings due to political ideologies!) and focuses on the successful reduction of new infections that stem from, Epstein argues, not the billions of dollars from the West, but from the “collective efficacy” of a “shared calamity,” where people helped each other and talked openly about sex, sexuality, and HIV. The reduction of HIV incidence in Uganda focuses on the “B” of the old ABC prevention methods (abstinence, be faithful, condomize). The “A” was problematic as a huge portion of infections were happening in marriages. The “C” was problematic because there simply were not enough condoms to go around at that time. So, Uganda focused on the “B”. President Yoweri Museveni called for “Zero Grazing” as a means of limiting the numbers of concurrent partners that Ugandans (and other groups, too) had. And it worked. Dramatically. Before there were millions in funding for HIV prevention.

In reflecting on the ten years that have lapsed since I read this book…all I can think is “thank goodness”! Thank goodness that we have more in our HIV toolkit than A, B and C. Thank goodness treatment is now much more widely available. Thank goodness we have gotten from a place of encouraging “Zero Grazing” as national policy to a place where we are aiming for 90% of those taking drugs to be virologically suppressed—an HIV prevention tactic I was longing for in the 90s and early 2000s.

Of course, the dark lessons, of the bumbling western influence into the affairs of other countries continues.  “Everyone seems to know what Africa needs, but sometimes I think our minds are not really on it,” she writes. “Most of us see only Africa’s contours, and we use them to map out problems of our own. Africa is a career move, an adventure, an experiment. It fades into an idea. We aren’t really looking.”

Those lessons around the neo-colonization that is funding, aid, and imperialism are still ever present. While times have changed, I still recommend this book for you public health junkies out there. It offers a compelling look back and lessons around the importance of community involvement, questioning what we think we know, and challenging the status quo.

Book Report: The Betrayal of Trust

The Betrayal of Trust, by Laurie Garrett, is another must-read for those of you who have a deep interest in global public health and a deeper interest in wanting to see improvements in the practice of public health.

First, praise for Laurie Garrett as an author. Her writing is compelling. She weaves beautiful stories out of tragedy and paints a picture with her carefully chosen words. I have read other books by Garrett and will keep coming back for more. I did not mind the length of the book, coming in at a hefty 768 pages, but then again, I am an avid reader and this is my field of interest.

Garrett outlines how public health interventions, such as the public supply of clean water, have brought us this far. We are living longer than our ancestors and, arguably, we are living “better”. However, she posits that the world’s public health organizations are in a woeful state with disastrous preparation for “the BIG one”. Collectively and globally, she warns of a lack of preparedness of public health agencies. However, the public health agencies, as underfunded and resourced as they are, are our best defense against microbial threats (through efforts to vaccinate large swaths of the pubic, maintenance of sanitation systems, and responses to actual or perceived threats).

In each chapter, she dissects a different public health threat….

  • The first chapter investigates the pneumonic plague panic of 1994 in India.
  • The second chapter scrutinizes the Congolese Ebola epidemic of 1995.
  • The third chapter documents the collapse of Soviet/Russian public health, with particular attention to drug-resistant tuberculosis.
  • The fourth describes the decline of public health efforts in the US under its `managed care’ and `medicine for profit’ health system.
  • The fifth chapter is titled “Biowar”.
  • And the last chapter is Garrett’s epilogue.

She builds the case that we need public health not only to stay safe and healthy now, but to ensure that we are ready for a superbug, a biological threat, and even to ensure that our water supply stays clean. Public health so often functions in the shadows….we are the ones who count disease, who test the water, who make sure your food is safe, and who occasionally remind you to get vaccinated. It is the work that helps to build optimism around the elimination of polio or smallpox. And, importantly to me, that work, builds equality and cuts through some of the injustices we see in our world. So, the next time you hear about funding to the CDC being cut or funding to your local health department being diverted, pick up the phone and call your representative to protest. We need public health!

State of the Union: When Someone Shows You Who They Are, Believe Them

In last night’s State of the Union, 45 announced his administrations plan to end all new transmissions of HIV by 2030.

He said, “in recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America and beyond.”

I hope this comes true. It CAN come true. We have so many tools at our disposal that aren’t being used to their fullest potential.

Only about 1/2 of those living with HIV in the US are virologically suppressed. To be virologically suppressed means that the virus is literally undetectable in the blood. If there is no virus circulating, there is no virus to be transmitted. So, obviously, more people need to be on treatment, more people need better follow up, and more people need to get the help that they need to take their meds. Those who are affected by HIV are more likely to be marginalized in some way–predictors of people not taking their meds are what makes folks marginalized–homelessness, impoverishment, joblessness, etc. HIV prevention must take our social environment into consideration.

To give another example, PrEP, which can be given to someone who is at risk of contracting HIV works tremendously well. But, right now, very few people who need it most are getting it.

Color me skeptical for 45s actions speak louder than words. When someone shows you who they are, believe them.

Right now, more than 1 million Americans are currently living with HIV. The effort to end new infections by 2030 will require massive prevention efforts and better treatment for those living with HIV.

It would be amazing.

If successful, the United States will, “become a country where the spread of HIV has been effectively halted, because every American with HIV/AIDS is receiving treatment and every American at risk for HIV is engaged in the right, proven prevention strategy,” said US Health and Human Services Secretary, Alex Azar II.

If this is to come true, which, ohmygoodness, I hope for, it requires backpedaling on 45’s own policies, an end to his horrifically sexist, homophobic, and abusive policies.

It has long been shown that stigma and discrimination are connected to increased HIV rates. Right now, in this country a man between the ages of 13-29 who has sex with men gets infected every 44 minutes. Right now, in this country, 45’s has fueled the flames of discrimination against …45 said “I’m just not in favor of gay marriage”. His administration almost immediately removed all mention of LGBT issues from the White House website; his administration even removed an apology on the State Department website written by John Kerry about the discrimination against the LGBT population.

Right now, in this country trans people are already at high risk of HIV because of the stigma that they face. Stigma that comes from 45 is in the form of a ban of trans people serving in the military and an effort to peel back rights for trans kids in school.

45 has tried to repeal the Affordable Care Act and slash Medicaid. HOW do you improve the health care of 1 million HIV infected Americans so that they are virologically suppressed, healthy, and break the chain of infections without affordable and accessible health care?

He’s sought to put an end to fetal tissue research which could put an end to HIV and cancers. He allowed the AIDS czar position to be vacant for much of his time in office.

This post has become a rant, I fear. It is high time we put an end to HIV. To do so requires every tool we have, a supportive environment, and that we take care of each other.

To end, this is the picture of “the chief architects of the plan” who are advising 45 on the plan. Do you see someone who is missing? Do see anything problematic with this picture?

It is high time we all speak up…because we CAN put an end to HIV. I need to be heard, you need to be heard, and everyone who is affected (i.e. just about every single one of us) needs to be heard, respected, and validated.

OPTIMIZE project

I am thrilled to announce that training materials for health care workers on the introduction of DTG for the treatment of HIV are now online!

The OPTIMIZE project is a global consortium dedicated to rapidly improving treatment outcomes for people living with HIV by optimizing ARV drugs and formulations and accelerating their introduction in low- and middle-income countries.  I was proud to contribute to the impressive work of the consortium by writing the training materials for health care workers.

In recent years, there has been a powerful movement to test folks for HIV and immediately treat all who have a positive test. This is a shift from pervious recommendations of treating those who have low CD4 counts or who are pregnant, for example.  This is huge! It is a huge move towards equity and justice in health care.

Of course, there are challenges to a shift like this. One of the challenges that OPTIMIZE is addressing is around complicated treatment guidelines that include several different drug formulation for multiple populations. The introduction of DTG helps to simplify the treatments overall, harmonize treatment across populations, simplify the supply chain, and save money.

There have been several pivotal moments in the fight against AIDS and this one, an effort to get 90% of those living with HIV on treatment, is one of them! And DTG is a tool that will help achieve the goal.

As always, I am open to new contracts and to working together. Please let me know how I can help you to build effective, exciting, and practice-based trainings.

Good news round up!

From time to time, I seek out stories that inspire me and challenge me to think creatively about our work. I love learning about the work that other folks are doing out there. It challenges me to think about our work in new ways and challenges me to think creatively.

If you know me, you know how passionate I am about the need for young people to have accurate sexual health education (and resources and access to care and contraception and and and!!!).  I love it even more when young people are active participants in their own learning and design of their education.

So, it will come as NO surprise that I love this story! Young artists in Temeke District in Tanzania are designing katangas (the colorful wraps that are worn in much of Africa) to promote gender equality and to share reproductive health messaging.  The organizers trained 75 young people who then created their own designs.  You can see the top 20 designs here.

In a similar light, children can be given tools to help improve even the most desperate of situations.In Spain, an outdoor campaign has gone on for a few years now.  The ingenuity of it is that adults and children see the ad differently due to lenticular printing.  Adults see an image of a child with an awareness-based message: “Sometimes child abuse is only visible to the child suffering it”.  Children, or anyone under 4’3″ sees the same child but with facial bruising and an offer of help that says “If somebody hurts you, phone us and we’ll help you.” I found some data that the ads in combination with other activities that calls to their help line did increase. I’d be curious to see that data teased out to see just how many calls were driven by the street ads.

Next up–a good story out of Cameroon!  Tim Immaculate Bih is the first women to be an engineer in Cameroon! As an engineer, she now seeks to consider the unique needs of women and girls as she builds buildings.  She is also hiring women and seeking to improve education in engineering for girls. Amazing all around!

And, finally, a story about food sovereignty.  I am always delightfully amazed when cities, towns, and countries, and the Navajo Nation, are able to defeat big business and tax soda and junk food.  Well, Torba, a group of islands that comprise Vanuatu, a South Pacific country, is now banning all Western junk food! Beyond that, they are hoping to be the first all-organic island by 2020. Incredible.  This may prompt me to add Vanuatu to my travel list!