Tuesday, September 29, 2015

Political Adversity and Eradicating Polio: The Common Denominator

by Olivia Fletcher and Happy Ghosh

Before the appearance of AIDS, the United States was plagued by fear of another prominent and terrifying disease – a disease that had been infecting humans and leaving many of them incredibly disabled since early written history. Early in the 20th century, Poliomyelitis was responsible for paralyzing thousands of children annually and the American people were terrified. The first polio epidemic in the US hit in 1894 but it wasn’t until 1908 that the idea of this illness being caused by a virus surfaced. Soon after, another epidemic hit in Brooklyn, New York during the summer of 1916. Polio continued to instill fear in the public. Over the next few decades, the iron lung was invented, the March of Dimes was born, and scientists were beginning to make headway on growing and culturing the poliovirus. In 1952, nearly 60,000 polio cases were reported in the US and more than a third of them were paralytic. This event further heightened the awareness of the need for a vaccine. However, while we seemed to be making progress in the fight against polio, we were continuing to stagnate in the fight for civil rights.

Notice that these dates mentioned above coincide with so much of the instability and unrest that defined the American 20th century – specifically World War I and the Civil Rights Movement. There seemed to be a notion that polio was a “white disease” as it did not infect an equal number of blacks proportionate to the population, and various treatment centers – most notably the Georgia Warm Springs polio rehabilitation center – maintained a whites-only policy. The Tuskegee Institute eventually opened a polio center as black health professionals and black polio survivors alike demanded that health care be provided without regard for color. Then the polio vaccine was released in 1954 and by 1980, the United States had seen its last case of polio. Is it a coincidence that polio reared its head during a time of such social and political instability? Though wars fought during this time were not on American soil, there is no doubt that the consequences were deeply felt by the American people. Was the civil rights movement not a type of war in itself? And is it just chance that the only three countries with polio left on this planet are countries that have been plagued by so much unrest?

As Dr. Pate mentioned in his lecture, the complexities of its social and political structure made it difficult to implement, and particularly, to enforce health policy in Nigeria. The fight to eradicate polio was faced with much political backlash and even acts of terrorism, often hindering any advancement . Pakistan, too, came close to eliminating Polio in 2012, but vaccination bans and attacks on fieldworkers by the Pakistani Taliban reversed the progress. Similarly, Afghanistan registered only 25 cases of polio in 2010, yet was also confronted by setbacks due to the resistance of militants and the death of yet another polio worker. It may feel like déjà vu, but the multitude of underlying causes for political dissension and fears regarding the role of the West in the polio campaign have manifested themselves in the same way.

Perhaps the parallels between the problems defining the polio battle in the U.S. and those of Nigeria, Pakistan, and Afghanistan today are coincidence, but it is difficult to argue that this common denominator shows no correlation. One solution will not meet the needs of all countries, but Dr. Pate's successful efforts prove the importance of persistence and starting from the ground up. The time he spent travelling to individual communities and making personal connections makes it clear that his investment was personal. Will Afghanistan and Pakistan achieve success by finding their own Muhammad Pate? How can Nigeria retain its momentum and finish out the race? Though the future holds no certainty, I am confident that the end to polio is near.

Note the overlap between Boko Haram activity and low immunization rates.

Monday, September 28, 2015

Heart Disease – The Silent Killer

By Kaboni Gondwe and Shaoqing Ge

The heart is an interesting organ in the body; it beats continuously even when asleep. Such a simple thing that signals the presence of life during embryonic period, signals the end of life at its cessation. While important to our survival, cardiovascular disease remains a silent killer. We have come through decades where heart disease was thought to be an issue for people who were overweight and obese or a problem for people with high socio-economic status. However, the burden of heart disease in global affecting people from all walks of life.

Heart disease has thus been described as the number one killer globally. And it is the 2nd leading cause of death in developing countries.

Dr. Bloomfield mentioned how developing countries are challenged by the dual burden of communicable and non-communicable diseases. The epidemic of non-communicable diseases such as cardiovascular/heart diseases has dramatically increased in recent years. In countries where resources are limited and are unaware of their risks for heart disease the people die without understanding why someone who looked perfectly normal could just collapse one day and die. In Malawi, most sudden deaths in the rural areas are usually thought of as witchcraft and gaining weight was for a long time viewed as a sign of wealth and peace. There was an incident where a man in the urban area felt a sharp pain in his chest while driving, he rushed to the hospital and he was in time to get the best treatment. This man was educated and was aware of the signs and symptoms, thus he knew he needed to seek medical attention and he survived. Other cases form the rural start with complaints of chest pain and headaches. People eventually die in their sleep with blood coming through their nose. “zitheka bwanji munthu oti anali bwino bwino dzuro lero muziti watisiya, ufiti” (How could someone who was fine yesterday die today, this is witchcraft). This lack of sensitization of the signs and symptoms is bound to result into more deaths that could have been prevented.

The problem of increasing cases of cardiovascular disease has equally affected developed countries like China. In China, the prevalence of diabetes among Chinese adult population has increased from less than 1% in 1980 to 11.6% in 2010 (Xu, Wang, He, & et al., 2013). China has the largest population in the world, with an estimated 113.9 million diabetic adults (Yang et al., 2010). Cardiovascular disease has also become a chronic problem for Chinese population and a challenge for older adults whose health is already diminishing. Shaoqing’s grandmother, an 80 year old Chinese lady, has lived with hypertension for 30 years, had stroke around 20 years ago and developed atrial fibrillation around 5 years ago. She now controls her situation with medicines and exercise regularly. However this was not the case when she initially diagnosed with hypertension, she was a regular smoker back then and she absolutely had no idea of self-management. The only thing she knew was she would not die soon only with hypertension. This situation was not changed until she had that stroke tragedy; she then realized the importance of self-management, such as diet, exercise and medicine. However, as age grows, the situation kept deteriorates to arterial fibrillation but just slower.

These stories reveal that behavior change will not happen suddenly; it is highly related to education and self-awareness. Strengthening education is especially valuable for countries with limited resources, which is the case for most developing countries. Back 30 or more years, people were not aware of the relationship between smoking, salty diet and cardiovascular diseases, now even though this can be a common sense to some people but can still be unfamiliar to people in certain lower-income countries and areas.  We believe this is both a challenge and opportunity for stakeholders, practitioners and global health researchers, to provide information, technology, and treatment.

Xu, Y., Wang, L., He, J., & et al. (2013). Prevalence and control of diabetes in chinese adults. JAMA, 310(9), 948-959. doi:10.1001/jama.2013.168118
Yang, W., Lu, J., Weng, J., Jia, W., Ji, L., Xiao, J., . . . He, J. (2010). Prevalence of Diabetes among Men and Women in China. New England Journal of Medicine, 362(12), 1090-1101. doi:doi:10.1056/NEJMoa0908292

Tuesday, September 22, 2015

Maternal Health

By Deena El-Gabri

I want to start with my perspective of maternal and child health in the developing world, before the lecture at FHI360.

My cousin has come to the United States from Egypt, for a very particular reason: not to gossip with her American relatives, not to see how numb her extremities get in the Chicago winters, and not to admire the country that made the Kardashians famous. She comes as a medical tourist to have her children.  Controversy surrounding the logistics of this aside (yes this makes them all US citizens- added bonus) she does this because she does not feel safe and does not feel her babies would be safe being born in an Egyptian hospital.

The thing I would like to highlight here is that my cousin is obviously not impoverished she is spending thousands of dollars to come to United States to have her children, this means that she has the means to access to best medical care in Egypt, and even that is not dependable—or in a western mindset—up to a developed country’s standard.  The things that she fears and the issues her friends and family members’ have faced all surround pre and post-opp care. There are trained obstetricians that she has access to, but the hospitals do not have the means to prevent and fight possible infections or complications post childbirth.

With this I look to the research Emily, Caleb, and Seth are conducting, and the similar model of research conducted in Ethiopia.  While we cannot make direct comparisons between developing countries’ medical infrastructure to support women and children, we can compare them to predict and understand issues that keep these women and children unsafe  (note that as we saw in the countdown to 2015 decade report, Egypt had 3 times the amount of caesarian sections Ethiopia and Mozambique have, suggesting that Egypt is a country with more access to high function medical care).   

Do you think that this stretch is reasonable and that such comparisons are telling of what issues should be highlighted? Basically, do you agree that this comparison is one worth making or do you think I’m throwing the wrong information in the wrong places? 

Current status (Model 0) of Tier B catchment areas by 2-hour transfer time to a Tier A facility

We saw through Seth’s GIS model of Mozambique and the article on Ethiopian access to care that there are certain regions that are lacking access to a high functioning medical facility, and both Emily and Seth referenced the long-term idea that if access is increased, this may encourage more women to have their babies in a medical facility. Off the basis of what my cousin has witnessed in Egypt, I think there might have to be particular emphasis on post-operative care, not just medical resources.  Even if more regions of Ethiopia and Mozambique are in reasonable proximity to a high resource facility, risk of infection is reason enough to stay away.

I recognize that maybe the first hurdle for these countries is to have these greater resources, but maybe this post-op care and lowered risk of infection can happen hand-in-hand instead of struggling to retroactively establish strict anti-infection protocol into a running system.

What are people’s thoughts on the feasibility of incorporating both of these qualities into health facilities in Ethiopia? There has to be a reason why they’re not already in place, do we think these obstacles are too great to expect high functioning, infection free facilities? 

Affects of the Negative Stigma Surrounding Cancer

By Elizabeth Monahan

One of the most interesting things that I learned from Dr. Zafar’s lecture was that around the world, cancer has a stigma.  This was something that I had never thought of before because everyone who I have ever known who has had cancer was incredibly supported economically, emotionally, and physically by the surrounding community.  Nobody was looked down upon or ostracized because they had been diagnosed with cancer.  Of all the reasons to fear being diagnosed with cancer, facing a negative stigma is something that I never would have considered.

After listening to Dr. Zafar’s lecture, I began to think of all the downstream effects of a communal negative stigma surrounding cancer.   We know that one of the best ways to increase somebody’s chance of survival is to diagnose their cancer early.  If there is a negative stigma regarding cancer, the chances that somebody is going to go to a clinic or the hospital to take part in early detection measures, or even go in when they start to suspect that something is wrong, is probably lower than in areas where there is not a negative communal stigma regarding cancer.  This results in cancer being caught in much later stages, and results in lower survival chances.  This means that a negative stigma is potentially contributing to higher rates of mortality due to cancer.  However, this stigma can also affect the lives of patients as they fight cancer and the lives of their families.

A negative stigma surrounding cancer is going to affect people economically.  I’ve seen communities rally around people who have been diagnosed with cancer to help support them economically by hosting fundraisers and making meals for the patient and their families to help with the economic burden of cancer treatments.  If a community finds having cancer shameful, they will not be inclined to help the individual with cancer or their family economically if the family needs economic support.  If a family or patient cannot afford cancer treatment, both the family and the patient suffer from both not receiving the necessary treatment and from knowing that there is nothing that they can do to get the treatment if they cannot afford it, which leads to another aspect of the fight against cancer that a negative stigma can affect.

A negative perception of cancer is also going to affect the person with cancer and their family emotionally.  A friend of mine said that the support that he received from friends and family when he was diagnosed with leukemia played a huge role in helping him get through his toughest days, and that he could not imagine having to go through his cancer treatments without the support of all the people around him.  As humans, we draw strength from each other; and positivity, kindness, and words of encouragement are infectious and desperately needed in all situations and especially valuable in our toughest moments.  While feeling supported will not cure cancer, positivity and support, even in a small amount, can never hurt.  A negative stigma surround cancer negates the chance of the person with cancer receiving the support that they need from the people around them, and unfortunately could leave them feeling incredibly alone.

Another aspect of the fight against cancer that a negative stigma can affect is research.  If people have a negative perception about cancer, they are not going to want to donate to cancer organizations or even listen to what these organizations are saying.  Organizations that support cancer research will not receive the support that they need to function, and cancer research will not be adequately funded. Furthermore, governments may feel less inclined to help fund cancer research if they fear losing the support of their people, or even a small portion of their supporters, over this issue.  Cancer research is extremely expensive and multifaceted because not all cancers can be treated the same way so many drugs and therapies are needed.  This means that strong funding is absolutely necessary to continue to make advances towards finding a cure for cancer.

Finding a cure for cancer has not and will not be easy, and neither will changing the negative stigma surrounding.  I’m sure that there are many areas of life that this negative stigma can affect for cancer patients and their families, but the above mentioned areas were what I immediately thought of during Dr. Zafar’s lecture.  After thinking about these areas, I believe that in order to truly find a cure for cancer, we also need to work to change this negative stigma surrounding cancer in order to give people fighting cancer the support that they need and deserve.

Global Cancer

by Adam Olson

Dr. Zafar’s excellent presentation on cancer at the global level stimulated a vigorous and appropriate
conversation about the impact of cancer care delivery on the public health infrastructure of resource-limited settings. As Devon mentioned, there are facilities in Kenya that are considering installation of a radiation therapy center when basic medical supplies – IV tubing, intubation materials, etc. – are only intermittently available. I agree that this does not make sense, but I respectfully challenge the unspoken assumption that radiotherapy does not have a role in a cancer control program in a resource-limited setting.

The assumption that radiation therapy is not a cost effective treatment in a resource-limited setting is quite understandable. Radiation therapy in the US is expensive, technologically advanced particularly over the past 10-20 years), and it requires a combination of technical, human, and capacity resources that rivals any other medical specialty. Indeed, you can ask anyone in my department how many times our machines require maintenance to appreciate how hard it is to keep a linear accelerator functioning!

To attempt to replicate a radiotherapy department like Duke’s in a resource-limited setting would be folly for practical and financial purposes. Radiotherapy requires a significant upfront investment, which covers the construction of the treatment vault, the treatment machine, and the costs of installation, commissioning, and quality assurance. Unlike other medical treatments, the cost of “consumables” (such as the IV tubing that Devon frequently lacks) for radiotherapy is actually quite low. Thus, if a radiotherapy machine is installed and can treat patients for several years with minimal downtime (not a trivial matter), then a radiotherapy center is likely a cost effective treatment. There are older models of radiotherapy units that are reasonably priced and available with partial subsidies from the International Atomic Energy Agency. If you factor in the potential benefits of treating childhood malignancies (e.g., Wilms tumors, neuroblastoma, lymphoma) and malignancies affecting young women (e.g., breast and cervix), then you can begin to appreciate how radiotherapy access can translate into a public health benefit using DALYs as we learned about in class.

Investigators from the Union for International Cancer Control have performed a cost-effectiveness analysis of radiotherapy installation in low- and middle-income countries. Their analysis is eagerly anticipated and should be published this fall (I heard in the Lancet Oncology). In the interim, there have been a number of publications describing the potential role of radiation therapy expansion in resource-limited settings. See Pubmed IDs 24929155, 24929154, 24751411, to name a few.

Monday, September 14, 2015

Mosquitoes, misguiding labels, and poverty

By Emily Esmaili and Daniel Evans

When you go to the grocery store, how can you trust you are getting what you pay for? How confident are you that that the box of Oreos you buy will in fact contain those delicious cream-filled cookies? When you go to the drug store, do you question if the bottle of Tylenol you are buying might actually be a bottle of sugar pills? Most of us in the US would answer no: most consumers are confident that regulatory bodies such as the FDA will ensure the quality of Tylenol sold in pharmacies, and – perhaps more importantly – the quality of Oreos sold in stores. If however, you lived in a developing country, you might not be so confident.

The problem of false advertising and counterfeit drugs in the developing world is a shamefully well-known issue. Pharmaceutical companies lack the close surveillance and regulatory boards necessary to ensure quality products. As a result, drugs with very little (or adulterated) active ingredients will be mass-produced and sold cheaply. This has devastating repercussions in the health care world: serious diseases are left partially or inadequately treated. The unknowing consumer is the victim – and often a fatality – of these capital-driven enterprises. One such disease with a flourishing counterfeit drug industry is malaria.

While it is true that we have made great strides in reducing the global burden of this terrible disease, malaria continues to cause a considerable amount of death and disability – much of which is preventable or avoidable. It is estimated that over one-third of all antimalarials on the market in Southeast Asia and Sub-Saharan Africa are fake, or substandard. To make a bad problem worse, these deceptive industries pray upon the world’s poorest, most vulnerable populations. A family may travel long distances and spend hard-earned wages on treatments that are essentially ineffective. An additional problem is the emerging artemisinin resistance that results from these false or partially effective treatments. Soon, even our genuine first-line treatments may no longer be effective.

In response to this serious problem, a scientist working with the FDA named Nicola Ranieri proposed a solution: CD-3. Though it may sound like a robot name or something you remember from immunology class, CD-3 (Counterfeit Detection Device, Version 3) is our best shot at cracking down on the trouble-makers, in a quick and easy way:

While CD-3 makes its way around the globe, cleaning up the streets of pharma industries in the world’s poorest neighborhoods, perhaps we can ponder why these poor neighborhoods are the hardest hit by malaria. Is there a link between poverty and malaria? Sonia Shah in her book The Fever which investigates the different facets of malaria, says that it does.

Malaria is rampant in poor and developing nations such as sub Saharan Africa and Asia. There are a combination of factors that increase malaria risk: inadequate housing that cannot protect against mosquitos, more time spent outside and exposed to mosquitoes, and poor sanitation that creates breeding grounds. All these factors are prevalent in the poor areas and slums of these countries. This means that the poorer someone is, the higher the likelihood they are going to contract malaria.

Not only does poverty increase the risk of malaria, but malaria also causes greater poverty. Sonia Shah explains this in her TED talk.

“What we also know now is that malaria itself causes poverty. For one thing, it strikes hardest during harvest season, so exactly when farmers need to be out in the fields collecting their crops, they're home sick with a fever. But it also predisposes people to death from all other causes. So this has happened historically. We've been able to take malaria out of a society. Everything else stays the same, so we still have bad food, bad water, bad sanitation, all the things that make people sick. But just if you take malaria out, deaths from everything else go down. And the economist Jeff Sachs has actually quantified what this means for a society. What it means is, if you have malaria in your society, your economic growth is depressed by 1.3 percent every year, year after year after year, just this one disease alone.”

Malaria and poverty are directly linked: Eradicate one and you will deal a crushing blow to the other. However, this is not possible if people are out to take advantage of the poor. Dirty pharmaceutical companies pumping out fake or tampered drugs are only furthering this problem. If we want to take on the problem of malaria, we need to tackle poverty and the problems surrounding it as well in order to make a meaningful difference.

Saturday, September 12, 2015

The Burden of Tuberculosis

By Brittney Sullivan and Laura Pulscher

Dr. John Bartlett’s presentation last week was a great introduction to Dr. Carol Hamilton’s TB lecture today, emphasizing challenges of TB/HIV co-infections and growing drug-resistance, both causing individual and structural (e.g. systemic) barriers to global TB control.  Although TB is a major challenge in India and China (accounting for 35% of the global burden in just those two countries alone), a lot of Dr. Hamilton’s lecture focused on the concentration of TB/HIV co-infection in sub-Saharan Africa as well as drug-resistant TB.  Brittney just returned from five weeks working in multi-drug resistant tuberculosis (MDR-TB) hospitals in South Africa (in the KwaZulu-Natal and Eastern Cape provinces) where 70% of MDR-TB patients are co-infected with HIV. We think Dr. Hamilton’s points about current TB treatment being problematic were well stated and cannot be under scored enough – especially within certain populations such as children or those co-infected with HIV.  The treatment burden can be immense; for those infected with MDR-TB daily treatment consists of approximately 15-20 pills per day along with a daily injection for up to six months during the intensive phase of treatment. 

For individuals co-infected with HIV, pill burden and drug interactions may be increased.  Despite this, initiation of antiretroviral therapy (ART) is recommended in all patients co-infected.  Attached is a recent meta-analysis measuring “The Effect of Early Initiation of Antiretroviral Therapy in TB/HIV Coinfected Patients: A Systematic Review and Meta-Analysis” which assessed 2,272 study participants from 6 trials where early ART initiation (2-4 weeks versus 8-12 weeks) was conclusively found to reduce all-cause mortality in TB/HIV co-infected patients (Abay, et al. 2015).  This evidence strengthens many national TB control program guidelines, although implementation of recommendations surely will be a challenge.  In settings where lack of reliable supply chains exist, access to care and poverty are daily concerns, and poor diagnostics and/or lack of provider awareness of proper protocols is common; dual therapy for TB and HIV is, and will continue to be, challenging.  Translating this dilemma to the pediatric population only adds complexity.  The photo (from the TB Alliance) below illustrates just how demanding of a regimen we ask patients to accept. 

As a final thought, story telling is another way in which to raise awareness to global health challenges in a unique way.  In order to get grants funded or manuscripts published we need decent data.  We all know that.  However; the human connection and the stories behind the numbers are what call most of us into this field, and what bring us satisfaction after arduous days in the field, or sleepless nights writing, reading, and interpreting our data.  These are a few more stories worth highlighting the impact and burden of TB in addition to Thembi Jakiwe’s story of strength we shared earlier.
  • Dalene von Delft – a physician from South Africa tells her battle with MDR-TB
  • Dr. Lucica Ditiu (Executive Secretary of the Stop TB Partnership) talks about the stigmatizing language surrounding TB.
  • Phumeza Tisile: HearNo Evil – a South African woman who survived XDR yet suffers from permanent hearing loss due to kanamycin (causing severe ototoxicity) discusses her journey through treatment and life after TB.
  • Thato Mosidi - a physician in South Africa tells her story of being diagnosed with XDR and the isolation it caused her from her husband and 3-year-old daughter. 

*Footnote: the photo that  Brittney could not post in her reply comment to the HIV blogpost from Shengjie is shown here:

Tuesday, September 8, 2015

To Vaccinate, or not to vaccinate? That is not the question…in developing countries.

by Tom Moore

Jokes aside, many of us remember reading in the news about the breakout of measles at Disneyland in early 2015. I was working at a primary care clinic in Colorado at the time of the breakout and watching several of our patients rushing in with kids in arm, demanding vaccinations. ‘Why aren’t your kids vaccinated already?’ is all that I wanted to say. I knew the answer already though. Measles is not an imminent threat in the United States (unless you’re going to Disneyland apparently). Measles is a threat to many other parts of the world though. If people understand the dangers of these diseases then perhaps the general consensus would be for vaccinations. Fortunately (or unfortunately depending on how you view it), the general population of the United States and many other developed countries, it’s citizens have the choice to vaccinate or not to vaccinate. However, that is not even a question for many people of developing countries. What is being done about this?

During his lecture, Dr. Chris Woods discussed the efforts being made to give the rest of the world access to vaccines for diseases such as measles and pneumococcal. There are many organizations public and private that are working toward the spread of vaccinations and eradication of disease. This includes research, development, and distribution of vaccines. What are some of these organizations you may ask? Meet GAVI The Vaccine Alliance.

Funded through the Gates foundation and the desire to bring vaccinations to the children of the world, an international immunization organisation was born. If you would like to know what GAVI is involved with or the efforts they have made, you can simply go to their website and they provide everything from the countries they are contributing, the progress reports for each year, and even the goals set for the following years to come.

Recently in March 2015, the CEO of GAVI, Dr. Seth Berkley, spoke at a TED conference and discussed the market realities of vaccinations. Research, development, and distribution of vaccinations are risky financial decisions for pharmaceutical companies and governments. There are even diseases that have limited vaccination research and trial because of undesired financial marketing. For more about Dr. Berkley's TED talk you can click on the link below:

Today we often hear the question in developed countries, “To vaccinate or not to vaccinate?” This is not a question that developing countries have the luxury of making, because many people do not have access to vaccines. Fortunately, there are organizations such as GAVI that are making it possible for people in the whole world to have access to vaccines. 

Monday, September 7, 2015

HIV - Not a Monster

by Shengjie Xu

Several months ago I received a phone call from a friend who expressed her panic about having had a dinner with a friend who MAY have a seropositive partner. She was considering stopping contacting her friend because of that. I was shocked.

30 years ago when HIV was first identified among homosexual men, because of ignorance people were scared. It was believed to be a punishment to gay people since it was mostly prevalent among the homosexual community. As we know now the method of transmission is through blood, blood-contaminated body fluids and mucosal contact as the virus can breach through the mucosal membranes. However even though we know about the science behind the nature of the virus, there’s still a big hurdle that prevents the society from accepting HIV seropositive people.

I spent hours try to comfort her, telling her that there’re many unknown factors that will lower the possibility of her being infected by dining with her friend. My arguing point is that physical contact and saliva are not the method where virus gets passed among people. I’m sure my friend knows about all the science, but when there’s a slight chance that she may get contact with “HIV” this word, she couldn’t pick up her mind to think rationally.

There are probably many people that still panic when hearing the word HIV even in a well-developed country. The social stigma and isolation of seropositive people remains a big problem of this battle. We have the resources to prevent and control viral spread, diagnose, and also treat patients for free. We know the science behind this sneaky virus. We know how to prevent and treat it. We even have research studies going on constantly to test for prophylaxis and vaccines. But why panic? The reason I used the title “not a monster” is because when we don’t know about a threatening creature, we call it “monster”. But when we start to know the nature of the unknown species, we start to face it calmly and start to call it “shark” or “lion” or “tiger”. HIV is like it: small amounts of people know the nature of HIV thoroughly and fight against it at the front line fearlessly. But the vast majority still sees HIV as a “monster” and even refuses to get contact with the warriors who risk their life helping the ones in need.

Educating the public should be an ongoing program of this campaign. The focus of the education part was on prevention. As the prevention part has done great jobs in reducing the incidence quite a lot in the past decades, maybe we should start bring our attentions to those underrepresented population who live with HIV in our society.

As Dr. Bartlett pointed out in his lecture about the antiretroviral study HPT 052, the use of antiretroviral therapy can reduce the sexual transmission of HIV-1 in serodiscordant couple by 96%. When the viral load of patient is minimally detectable, the risk of transmission is much reduced. This stunning number indicates that even as a HIV carrier, it is possible to live a normal life not passing the virus to their loved partner. There are also effective pre-exposure prophylaxis and post-exposure prophylaxis available for people who are at high risk of exposing to HIV. Science has also made it possible for HIV seropositive people to have healthy children. With the right treatment, living with HIV is not impossible. As we have good control and treatment methods, we may want to reconsider our unconscious discrimination against HIV+ population because of our ignorance.