Fashion shows are pretty few and far between in Los Angeles, but when brands do decide to show on the West Coast, especially those with significant budgets, they make the most of it. That could mean taking over an entire beach in Malibu as Saint Laurent did Thursday, or perhaps the Universal …
Disability Rights California is criticizing San Francisco supervisors for approving a program that would force some people with serious mental illness and drug addiction into treatment ABC News: Health
SPECIAL NEWS BULLETIN:
http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News
Targeting a key gene before birth could someday help lead to a treatment for Down syndrome by reversing abnormal embryonic brain development and improving cognitive function after birth, according to a new study. Infant and Preschool Learning News — ScienceDaily
The current global health system treats chronic diseases with a pay-as-you-go model, spreading costs over months and years. It's unprepared to pay for a surge of new, single-treatment therapies with the potential to provide a lifetime of benefit. Health and Science
A new type of drug that targets a genetic weakness in an untreatable childhood brain cancer could become the first ever treatment designed to target the disease. The prototype treatment could also offer hope for patients with the rare and devastating ‘stone man syndrome’ — in which muscles and ligaments turn to bone. Child Development News — ScienceDaily
Of course, these highly-mocked caricatures only make up part of the story. The festival is also populated with an army of staffers who aren’t in Indio to party. This contingent includes security guards who work long days in high heat confiscating contraband, protecting talent, and generally attempting to ensure that everyone survives the weekend. It’s an important job, and an appealing one for fans and entertainment world-adjacent security professionals.
Antonio Cannady, a screenwriter based in Los Angeles, told The Daily Beast that he heard about a company based in Long Beach that was hiring security for Coachella. “So I went down there and applied and then we had this little quick orientation. It wasn’t much of an interview, it was like a cattle call, ‘cause we go inside this room and everybody’s standing up. It’s hot, we’re all sweating. But they talked it up like it’s Coachella, this big music festival. And they were like, yeah, it’s going to be like camping, so bring a tent and a sleeping bag or whatever.”
A new, 12-year longitudinal study, which monitored 6,830 children from early childhood into adolescence, has shown that consistent treatment with MPH-based medications during childhood increases the risk of antidepressant use during adolescence. The study is the first of its kind to examine the connection between children diagnosed with ADHD and prescribed MPH between the ages of six and eight, and future dispensed prescriptions of antidepressants. Parenting News — ScienceDaily
Teens and young adults who were exposed to HIV and antiretroviral therapy before birth but are HIV-negative themselves are at increased risk of obesity and asthma-like symptoms. Teen Health News — ScienceDaily
African-American men have the highest risk of being diagnosed with prostate cancer as well as dying from it compared to any other ethnic group in the U.S. This trend has remained unchanged for over four decades.
Although research has focused on identifying the biological differences that may lead to this difference, there’s growing evidence that distinct racial and ethnic disparities in prostate cancer treatment, and the quality of medical care in African-American men, contribute to this disparity.
Our multidisciplinary research program in cancer population science at the University of Virginia has been examining reasons for poor prostate cancer outcomes, especially in African-American patients. Recent, as yet unpublished research from our group highlights several issues related to medication challenges in elderly prostate cancer survivors. We found there is a clear link between improved use of these treatments and reduced mortality. In addition, both access and use of these life-saving treatments remains low among African-American survivors.
A history of gaps
African-American prostate cancer patients face unique challenges in the treatment decision-making process. These include lower rates of understanding of treatment options, less time and interaction with medical care professionals and, often, poorer quality of medical care. Those challenges particularly affect both their access and compliance to medications, and, in turn, outcomes in these patients.
For example, a 69-year-old African American man whom we interviewed for our research, Mr. Tyler (name changed), along with his wife, Mrs. Tyler, sat in an exam room while his doctor told him he had stage 4 prostate cancer. Stage 4 cancer is cancer that has spread from its original site to distant organs and, in prostate cancer, even the bone.
Mr. Tyler was shocked. He had not noticed any health issues besides getting up in the middle of the night to urinate and some hip pain. He thought that was normal as men age. When he went to the clinic, he thought he had arthritis in his hip and would be prescribed pain medications for that. He could not imagine hearing that he had cancer.
He had not been to see a health care provider in about 12 years. He was always so busy at work and did not really feel comfortable going to a health care provider, having heard stories from family members and friends that other African-Americans are not treated well at the hospital.
The doctor gave Mr. Tyler a few options such as surgery, radiation and androgen deprivation therapy, considering his age, ethnicity, comorbidities and other related factors. But Mr. Tyler and his wife did not know what treatment options to seriously consider.
The health care provider gave a recommendation, but his wife was unsure. They were confused and anxious about making such a big and complex decision. The couple relied on information they received from speaking to friends, church members and relatives and ultimately made a decision, but it was not easy. And, it was not free from some regrets. Ultimately they chose to receive the radiation treatment and start the androgen deprivation treatment, which Mr. Tyler stopped because of discomfort. Mr. Tyler unfortunately died shortly after he discontinued treatment.
Treatment decision process improvements may be paramount
This scenario of confusion and anxiety is not so uncommon. Cancer is a terrifying diagnosis, and making decisions about treatment can be overwhelming.
Studies have suggested that patients with cancer feel more comfortable expressing their concerns with their health care provider when there is a trusting and supportive relationship developed along with adequate time for treatment discussion. This in turn leads to more comfortable treatment decisions, which often works to improve patient outcomes.
Prostate cancer treatment in particular often brings harsh side effects that severely affect a man’s quality of life. These side effects include erectile dysfunction, hot flashes, muscle loss, hair loss and urinary issues such as incontinence. These may be short term, but they can last for years.
The matter is complicated because many of these harsh side effects stem from androgen deprivation therapies, which can improve survival. Because of the complicated nature of assessing the risk of side effects with the potential benefit of survival, the use of androgen deprivation therapies should carefully be considered by the patient and his doctor.
Research has shown that these treatment-related decisions are very different in African-American prostate cancer patients compared to white patients and those residing in urban and rural communities. Therefore, there is a need to study treatment decision-making in both settings to formulate effective educational interventions.
Aids that can help
In one of our recent studies, we found that decision aids may help. Decision aids are electronic or paper tools involving a set of questions and information related to treatments. They are used to assist patients and caregivers in making informed decisions about the types of treatments and procedures, or both, that are more suitable for their particular case.
Decision aids are effective in a shared decision-making process, in which the doctor or nurse navigator sits down with a patient and walks through the process. There is active participation between the patient, caregiver and health care provider.
Decision aids can help patients apply specific health information while actively participating in health-related decision-making. Primarily, decision aids that have been applied to prostate cancer have been focused on knowledge or treatment options only, which patients often complete themselves. These types of decision aids are quite limited and do not allow patients the time and true engagement with health care providers to really understand their disease and the options that are available, and ultimately become satisfied with that decision.
Decision aids are most effective when they are tailored to the individual patient, rather than being generic. For example, researchers have developed an individualized decision support system BreastHealthDecisions.org, which represents a new approach to breast cancer prevention care.
In our study that developed an interactive decision aid for treatment decisions among advanced prostate cancer patients, we found that not only did the decision aid enhance patients’ and their caregivers’ understanding of the options that they had for treatment, but it also built more trust and engagementbetween the patient and the health care provider, which is valuable. The study also revealed that by using the decision aid, patients were more concerned with the quality of their life after treatment than extending the number of years of life.
Developing decision support systems for prostate cancer is paramount as we move towards an era of precision medicine treatments, such as proton therapies, which are used only after decision support system plans are in place for the prostate cancer survivor.
Often, the conversations between health care providers and the patient are focused around the quantity of life. The patients in our study said they felt empowered enough through the use of the decision aid to discuss quality of life, and how that was a critical aspect within their conversations.
There is much work to do to provide optimal health care to patients with cancer, including African-Americans with cancer. Tailored decision aids that focus on the priorities of the patient and their caregivers and that promote trusting relationships with health care providers is key to helping patients feel satisfied with their health care decisions and have less regret.
Scientists have discovered that an existing therapy frequently used to treat Alzheimer’s disease might also work on patients with primary progressive aphasia (PPA), a type of dementia that destroys language and currently has no treatment. Child Development News — ScienceDaily
To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of pediatric critical care, neurosurgery and other pediatric experts today issued the third edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI. Child Development News — ScienceDaily
When it comes to mental health issues, black women are more likely to experience mental health-related issues due to lower income, poor health, multiple role strain, and the “double minority status” of race and gender according to a study conducted by psychologists who focused on the lack of support black women receive professionally.
More recently, the American Psychiatric Association recently published a study that revealed:
Only ⅓ of black Americans who need mental health care receive it
Physician-patient communication differs for African Americans and whites. Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with white patients.
Lack of culturally competent counseling deters folks from seeking care
We know that’s a lot of hardcore facts. So, take a deep breath with us… Now that you have the facts, we want to be sure that you have the tools that you need to take the steps toward your healing or be a resource for another powerful woman.
Speaking of powerful women, we spoke with Dr. LaVerne Collins, interim vice president of Foundation and Professional Services for the National Board for Certified Counselors, about the real on black women and mental health as we prepare for the Women of Power self-care and self-preservation workshop where women can ask our panel of experts anything. Yes, anything!
Black Women Mental Health Facts
When it comes down to the facts and figures, Dr. Collins says that there are a number of reasons why black women aren’t seeking professional help for their stress, anxiety, and other mental health issues. Stigma, pricing, and mistrust of both diagnoses and treatments to list a few.
“There’s stigma that’s still prevalent in the black community. Even a basic mental health issue like stress or anxiety because we as a people have been taught to be strong and we’ve been taught to rely on the inner strength of our ancestors and spiritual sources—all of which are good—however when we don’t seek the professional care that we need those resources don’t give us the complete package of care.”
There is also significant stigma associated with the language that some people use that keeps women from pursuing help.
“We’ve heard people say things like, ‘you know she’s not all the way there…’ or ‘you know she’s a little touched…’ We have very unfortunate labels and judgmental statements that we’ve heard our ancestors use because they didn’t have an accurate understanding of mental health,” says Dr. Collins. And that language only keeps women in hiding to live with their pain.
While the stigmas are very real for a lot of women, Dr. Collins urges women to pay attention to abnormal feelings and triggers that may arise.
“Pay attention to anything that is atypical for you; anything that is causing an interruption to your daily life such as your work or social life; and pay attention the degree of interference that you are experiencing.”
On your journey to wellness, it is important to seek culturally competent and responsive mental health professionals as well as consult with your doctor to rule out any medical conditions that could be contributing to any changes in your mood or brain chemistry. Here’s Dr. Collins’ formula for finding the right fit for your needs.
Secondly, prepare to speak to more than one counselor in the vetting process. You do not need to go with the services of the first counselor that you interview with or have a consultation
Look for a counselor who will give you a 15-minute consultation in person or by phone before you enter into an agreement with them.
Prepare yourself by taking notes of how you’re feeling so that you can tell your counselor what (i.e., if you’re having crying spells), your triggers are.
Remember that you are not alone
“Have confidants who you can share with that you trust and who will support you with their presence and their words,” adds Dr. Collins.
Know your limits. — Be able to set limits and don’t overload yourself. We live in an overload culture and it’s very easy to do more and take on more. Sometimes we find our significance in the amount of things that we do and we find ourselves wearing ourselves out
Take vacations or staycations. – Know how to step away and take a real vacation or staycation and do what reenergizes you and things that nourish your mind and body. If what you need is to be away from everyone, do that.
Watch what you eat. – Don’t give your taste buds over what your body really needs.
Maintain a regular cycle of 6 to 8 hours of sleep a night
Minimize or manage the amount of stress in your life—recognize what things are stressful to you and have a way to minimize them.
If you want to learn more about how you can protect your peace, join us at the Women of Power Summit in Vegas! Get your tickets here.
New research shows that an immersive virtual reality environment treats 45 percent of children with autism, freeing them from their fears and phobias — and that the treatment lasts. Child Development News — ScienceDaily
Lasers are now being used to zap everything from sun damage and skin cancers to acne scars and regrettable tattoos — and often with little to no downtime. Which ones are best for your particular skin type and issue? In this month’s Life in Plastic column, we tapped the country’s top laser gurus spell it out for us. Allure
Melanin is a beautiful gift from God that gives people of color added protection from UV rays, skin cancer, and signs of aging. Not to mention, it also glistens in the sun with a magical glow. However, on the flip side, those with pigmented skin are prone to hyperpigmentation — a skin condition that causes dark marks and acne scars when excessive melanin is produced. It can be triggered by anything from a rash, scratch, pimple, or inflammation. To make matters worse, this unsightly ailment can take anywhere from three months to two years to get rid of.
African Americans are most susceptible to hyperpigmentation because their melanin-rich skin tends to be more reactive than other people of color. Fortunately, there’s a treatment that can reduce the appearance of dark spots called dermalinfusion. According to Cheryl M. Medina, a physician assistant specializing in aesthetics, this treatment works wonders for those with brown skin. The New York-born Filipina has been working in skin care and practicing dermatology for seven years at Skin Deep Clinics, where she specializes in treating darker skin tones with a focus on acne, acne scarring, hyperpigmentation, and anti-aging. She also serves a range of influencers and rising stars, like fashion designer LaQuan Smith and DJ Natasha Diggs, at the Queens-based clinic.
In an interview with BLACK ENTERPRISE, Medina breaks down a popular dermalinfusion treatment as well as common myths about skincare.
Cheryl M. Medina, PA-C
BE: How does the Dermalinfusion treatment work?
One of the most popular and effective dermalinfusion treatments is called “The Silk Peel.” It’s a wonderful treatment that gets great results in treating acne, dark spots, acne scarring, and anti-aging. Similar to a microdermabrasion treatment, it breaks down the top layer of dead skin revealing newer skin and encouraging new skin cells to the surface, which gives you a nice glow and even skin texture.
As it is abrading your top layer, it forms a hyperbaric chamber with the skin allowing it to suction whatever can be manipulated out of your pore. So all the bacteria that is trapped in your skin gets eliminated and collected in a collection jar. After the treatment, you get to see all the wonderful things that was pulled out of your face.
Not only does it exfoliate and cleanse the skin, it also nourishes the skin. It is a wet microdermabrasion meaning, it delivers a solution back into the skin through the pores whilst they are engaged. Depending on what your skin is presenting, we are able to deliver back into the dermis nourishment and treatment in the form of hyaluronic acid, vitamin C, a brightening solution, as well as salicylic acid that helps prevent acne.
BE: Can you debunk a few skincare myths that you’ve heard?
MYTH: Greasy foods make me break out.
FACT: Sebaceous glands produce sebum or oil to coat our skin for protection and pH optimization. Greasy foods do not trigger these glands to produce more oil. In fact, it is the behavior whilst eating greasy foods that can add oil to the skin. For example, touching your face with greasy hands after eating greasy foods adds oil to the face and can lead to a breakout by clogging your pores. Be mindful of touching your face whilst eating and of the grease dribble on your chin when you take a bite! Sugar actually does ignite those sebaceous glands to produce more oil. So, what you should be mindful of is your sugar intake.
MYTH: I can use my body soap to wash my face in the shower. It cleanses all the same.
FACT: Soaps that foam have a foaming agent called a detergent. That’s right. The same agent you use to wash your clothes with. Detergents are drying agents so using foamy soaps will dry out your skin! That’s why after you wash your face it feels tight and super dry or “clean.” In doing so, you have stripped what’s called the natural acid mantle barrier, a light layer of oil meant to keep your skin at its proper pH level in order for it to function optimally, and throughout the day, you will notice that your skin will produce a lot more oil. It does so in order to compensate for the loss of oil that you stripped away with the foamy wash. Milky cream wash or gel wash is best!
MYTH: Black don’t crack. I don’t need sunscreen!
FACT: Although it is true, darker skin tones do age better; it is due to the oil that we produce that keeps our skin moist and supple so that our skin does not degrade as quickly. But sunscreen is used primarily to avoid skin cancer as well as aging. Darker skin tones are not invincible to skin cancer. It is imperative that you protect your skin from the UVA and UVB rays especially these days with our ozone layer depleting.
As far as aging, darker skin tones are susceptible to hyperpigmentation, dark spots, or age spots. Using an SPF 30-55 daily will prevent these spots from appearing or getting darker. Also, try putting sunscreen on the back of your hands daily as well. Your hands show age quickly due to its overexposure to the UV light.
Treat Your Skin Right
BE: What should people of color do on a daily basis to maintain healthy, clear skin?
It is important to have a proper skincare regimen, starting with a milky or gel-non foaming facial cleanser. You should cleanse your face daily and add a light moisturizer with a broad spectrum (that protects against UVA and UVB rays) SPF between 30-55 that contain antioxidants to nourish the skin.
The most important part of a skincare routine is being a member of exfoliation nation! You must exfoliate regularly. I tell patients, in the beginning, to start natural with a simple sugar and honey scrub that they can make at home with 1/4 cup sugar + 1-2 tbspns of honey. Mix into a puddy and scrub your face for 60sec. Wash off and apply nourishment to this skin in the form of a moisturizer with antioxidants. This should be done at night, three times per week. Then later to challenge the skin, you can start using chemicals like glycolic acid or retinol to exfoliate the skin.
Exfoliating allows your pores to breath, encourages new skin growth, gives your skin a healthy glow, and also prevents bacteria or acne to grow. Diet also plays a major role in skin health! You should eat foods that are high in antioxidants like deep greens, acai berries, pomegranate, etc. However, the most important part of your diet is drinking tons of water. Water helps your skin and body rids itself of toxins! Three water bottles a day should be your daily goal at the very least.
BE: What type of products do you recommend for people who suffer from hyper-pigmentation?
When dealing with hyperpigmentation, the process is twofold:
First, you must work out the skin. Meaning, you have to exfoliate regularly. Dark spots are a form of scar tissue. You can lighten it by exfoliating the dead skin off and encouraging new skin to come to the surface. Remember after you exfoliate you must, must, must wear sunscreen to protect the new skin from the sun’s damage. Otherwise, the dark spot will only get darker!
The second part is actually treating the hyperpigmentation with a topical. Products that contain hydroquinone 4%, bearberry, licorice, citric acid and kojic acid help to brighten or lighten the skin. At Skin Deep Clinics, we offer Skin Tone Pads that contain kojic acid, bearberry and hydroquinone to brighten the skin. They are easy to use and breed wonderful, safe results.
Hoping to earn its share of the $ 3.5 trillion health care market, the medical industry is pouring more money than ever into advertising its products — from high-priced prescriptions to do-it-yourself genetic tests and unapproved stem cell treatments.
Spending on health care marketing doubled from 1997 to 2016, soaring to at least $ 30 billion a year, according to a study published Tuesday in JAMA.
“Marketing drives more testing. It drives more treatments. It’s a big part of why health care is so expensive, because it’s the fancy, high-tech stuff things that get marketed,” said Steven Woloshin, co-director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice. His study captured only a portion of the many ways that drug companies, hospitals and labs promote themselves.
Advertising doesn’t just persuade people to pick one brand over another, said Woloshin. Sophisticated campaigns make people worry about diseases they don’t have and ask for drugs or exams they don’t need.
Consumer advocates say that taxpayers pay the real price, as seductive ads persuade doctors and patients alike to order pricey tests and brand-name pills.
“Whenever pharma or a hospital spends money on advertising, we the patients pay for it — through higher prices for drugs and hospital services,” said Shannon Brownlee, senior vice president of the Lown Institute, a Brookline, Mass., nonprofit that advocates for affordable care. “Marketing is built into the cost of care.”
High costs ultimately affect everyone, because they prompt insurance plans to raise premiums, said Diana Zuckerman, president of the National Center for Health Research, a nonprofit that provides medical information to consumers. And taxpayers foot the bill for publicly funded insurance programs, such as Medicare.
“These ads can be amazingly persuasive, and they can exploit desperate patients and family members,” said Zuckerman, who was not involved in the new study.
Drug companies spend the bulk of their money trying to influence doctors, showering them with free food, drinks and speaking fees, as well as paying for them to travel to conferences, according to the study.
Dr. Lisa Schwartz and Dr. Steven Woloshin(Courtesy of the Dartmouth Institute for Health Policy & Clinical Practice)
Yet marketers also increasingly target consumers, said Woloshin, who wrote the study with his wife and longtime research partner, Dartmouth’s Dr. Lisa Schwartz, who died of cancer in November.
The biggest increase in medical marketing over the past 20 years was in “direct-to-consumer” advertising, including the TV commercials that exhort viewers to “ask your doctor” about a particular drug. Spending on such ads jumped from $ 2.1 billion in 1997 to nearly $ 10 billion in 2016, according to the study.
A spokeswoman for the pharmaceutical industry group, PhRMA, said that its ads provide “scientifically accurate information to patients.” These ads “increase awareness of the benefits and risks of new medicines and encourage appropriate use of medicines,” said Holly Campbell, of PhRMA.
The makers of genetic tests — including those that allow people to learn their ancestry or disease risk —also bombard the public with advertising. The number of ads for genetic testing grew from 14,100 in 1997 to 255,300 in 2016, at a cost that year of $ 82.6 million, according to the study. AncestryDNA spends more than any other company of its kind, devoting $ 38 million to marketing in 2016 alone.
Some companies are touting stem cell treatments that haven’t been approved by federal regulators. The Food and Drug Administration has approved stem cell therapy for only a few specific uses — such as bone marrow transplants for people with leukemia. But hundreds of clinics claim to use these cells taken from umbilical cord blood to treat disease. Many patients have no idea that these stem cell therapies are unapproved, said Angie Botto-van Bemden, director of osteoarthritis programs at the Arthritis Foundation.
Stem cell clinics have boosted their marketing from $ 900,000 in 2012 to $ 11.3 million in 2016, according to the study.
Medical advertising today goes beyond TV and radio commercials. Some online campaigns encourage patients to diagnose themselves, Woloshin said.
The website for Restasis, which treats dry eyes, prompts patients to take a quiz to learn if they need the prescription eye drops, said Woloshin, who co-wrote a February study with Schwartz on the drug’s marketing strategy. The Restasis website also allows patients to “find an eye doctor near you.”
Many of the doctors included in the Restasis directory have taken gifts from its manufacturer, Allergan, Woloshin said. The doctor directory includes seven of the top 10 physicians paid by the company, his study says.
In a statement, Allergan spokeswoman Amy Rose said the company uses direct-to-consumer advertising “to support responsible disease awareness efforts.” The ads “do not displace the patient-physician relationship, but enhance them, helping to create well-informed and empowered consumer and patient communities.”
Drug sites don’t just lead patients to doctors. They also provide scripts for suggested conversations. For example, the website for Viagra, which treats erectile dysfunction, provides specific questions for patients to ask.
The website for Addyi, often called the “female Viagra,” goes even further. Patients who answer a number of medical questions online are offered a 10- to 15-minute phone consultation about the drug for $ 49. Patients who don’t immediately book an appointment receive an email reminder a few minutes later.
“This is more evidence,” Brownlee said, “that drug companies are not run by dummies.”
(The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.)
(THE CONVERSATION) I mentioned to a friend, a gay man nearing 60, that World AIDS Day, which has been observed on Dec. 1 since 1988, was almost upon us. He had no idea that World AIDS Day still exists.
This lack of knowledge is a testament to the great accomplishments that have occurred since World AIDS Day was created 30 years ago. It is also due to an accident in the timing of his birth that my friend escaped the devastation wreaked by AIDS among gay men in the U.S., before there was antiretroviral therapy.
Many people have forgotten AIDS, but there are consequences to forgetting. The fight against AIDS is at a tipping point. Increasingly, there are signs that we may be heading in the wrong direction.
Many successes, yet the grand prize is elusive
I am a social epidemiologist with more than 20 years of research experience in HIV and STD prevention. I am also the founder of The Basics with Dr. Mo, a sex health communications project that translates prevention science directly for people who need it most.
Most recently, Pre-Exposure Prophylaxis (PrEP) – the use of antiretrovial drugs to prevent HIV infection among those exposed – has proved to be a successful prevention approach.
Yet the prize – a vaccine that can prevent HIV infection – remains elusive, and makes impossible the use of the only known strategy to have ever eradicated an infectious disease: widespread vaccination. That disease was smallpox, in 1980.
The seeds of unease
Despite the lack of a vaccine, in 2016 United Nations member states adopted a political declaration on ending the AIDS epidemic by 2030.
Prominent scientists have already begun to question the ability to eradicate AIDS by the 2030 deadline, and concede that the situation has stagnated. The attainment of eradication looks bleak, without the aid of either an effective vaccine or the immediate large-scale promotion and utilization of existing prevention tools (i.e., condoms, voluntary circumcision and potentially PrEP). Given that the vast majority of new HIV infections are sexually transmitted and that condoms have played a decisive role in the global control of HIV transmission, ongoing condom availability and use will be essential to future eradication.
Condoms – both male and female – remain a highly effective mechanism of HIV/AIDS prevention, as well as of other sexually transmitted infections that greatly enhance the risk of HIV transmission.
Condom availability is a different matter and varies greatly from country to country. Countries with the highest levels of HIV often rely heavily on donor support. According to the most recent data, in sub-Saharan Africa in 2013, only 10 condoms were availableannually for every man aged 15 to 64 (as compared with the recommended 50 to 60), and, on average, there was one female condom available for every eight women. Funding required to maintain – let alone scale up – HIV commitments, particularly those dedicated to prevention, are increasingly uncertain.
The hydra, sprouting new heads
Even though condoms are an extremely effective barrier method, it is usage that makes condoms efficacious in preventing HIV transmission. Reported condom use varies considerably around the world, and ranges from 80 percent use by men in Namibia and Cambodia to less than 40 percent usage by men and women in other countries, including some highly affected by HIV such as Sierra Leone and Mozambique.
Age plays a role, too. Among young people aged 15 to 24, condom use at last sex variesfrom more than 80 percent in some Latin American and European countries to less than 30 percent in some West African countries. In the U.S., condom use is at the lower end of the spectrum: Only one-third of the population uses condoms, a number that has not changed significantly over the past two decades.
The majority – 66 percent – of the world’s HIV/AIDS cases are in sub-Saharan Africa, where there has been much progress, particularly with the provision of antiretroviral therapy.
However, there are worrying signs in other parts of the world. There has been little change in new HIV infections in countries outside of sub-Saharan Africa between 1990 and 2017.
In fact, six of the 10 most populous countries in the world have experienced 10 percent to 45 percent increases in new HIV infections since 2010: Russia, China, Brazil, Pakistan, Mexico and Bangladesh. Even in countries such as the U.S., where new HIV infections have decreased by 8 percent overall, the rates of change are unevenly distributed. For example, young African-American men who have sex with men show no decrease in new infections; African-American gay and bisexual men represent the largest percentage of new HIV infections: more than one-quarter.
The increased provision of antiretroviral therapy to people living with AIDS has had a huge impact on extending life and in preventing new HIV infections. However, there remains 25 percent of the population who live with HIV, about 9 million people, who do not know their status.
While we have been necessarily focused on the head of the hydra in sub-Saharan Africa, other hydra heads are beginning to make their presence known, many in countries ill-prepared to deal with increases in the number of new HIV infections.
In the absence of a vaccine, behavior change in the form of condom use promotion, acceptance and adoption, at a scale that many gay men utilized during the peak of the AIDS epidemic in the industrialized world, will need to occur. There are many challenges: continued stigma and gender inequality, not to mention issues of availability, distribution and proactive, nonjudgmental promotion.
We must not forget. Progress on reducing the rate of new HIV infection has been done before. It can be done again, but only if we take forceful, funded action now.
The chronic condition can feel overwhelming, so we asked some experts for their help and insight
Endometriosis affects one in 10 of us, and an estimated 1.5 million women in the UK alone. But despite it being so widespread, there’s little awareness of what the condition entails (it’s not just heavy, painful periods) and how it can be managed.
With this in mind, we grilled a couple of ‘endo experts’ to help you better understand the condition. So whether you think you may have endometriosis, have just been diagnosed or simply want to learn more, read on for an in-depth guide.
What is endometriosis?
‘Endometriosis is the growth of endometrial-like tissue (the lining of the womb/uterus) outside of the uterus,’ explains Dr Anita Mitra, aka the Gynae Geek. ‘This is commonly on the ovaries, bowel, bladder and – in rare cases – on the liver and lungs.
‘The tissue responds to female hormones throughout the menstrual cycle as it would if it were in the womb; it thickens and then begins to fall away as it would during a period. However, because it’s not inside the womb with an escape route, it causes irritation, inflammation and often excruciating pain.
‘Eventually, it can cause scar tissue to develop, which in turn causes the normally mobile internal organs of the pelvis to become stuck together, further adding to the pain. Endometriosis can be staged during surgery according to where it is, how much there is and how much scar tissue is present. Stage I – minimal, Stage II – mild, Stage III – moderate, and Stage IV severe.’
‘A lot of people think endometriosis is just heavy, painful periods; while that can be true, and it’s probably the most common symptom, it can be a whole lot more than that,’ explains Anita.
The most common symptoms include pain in your lower tummy or back, severe period pain that stops you doing normal activities and difficulty getting pregnant, according to the NHS.
‘Symptoms also depend on where exactly tissue is growing,’ Anita continues. ‘For example, excruciating pain on having your bowels open could be a sign that it’s growing on your bowel. Endometriosis also commonly causes bloating, diarrhoea and constipation, and the presence of scar tissue can make having sex painful.’
Diagnosing endometriosis can feel like a long process. After seeing your GP, you’ll be referred to a gynaecologist and will also need an ultrasound. ‘Endometriosis doesn’t show up on scans or blood tests, but it’s important to do a scan for other causes of pain,’ Anita explains. The scan can pick up other signs of the condition, such as a certain type of cyst with a classic appearance.
‘A normal scan doesn’t rule out the diagnosis however – the only definitive way to diagnose is endometriosis through a laparoscopy, keyhole surgery that involves putting a camera through your belly button to look directly inside your tummy.’
How to treat endometriosis
The good news is that the condition is completely treatable through medication and surgery. ‘Surgery will sometimes be performed at the time of diagnosis, and involves releasing adhesions [fibrous bands that form between organs and tissue] and removing or destroying deposits and cysts,’ Anita explains.
‘This should always be performed by a specialist in endometriosis surgery and, although many people will notice an improvement, there is a high rate of recurrence in symptoms post-surgery.
‘Many surgeons will advise some form of hormonal therapy, such as the contraceptive pill, Mirena coil, or injections of something called a GnRH analogue. This is also an option for people who don’t want or need surgery; the aim is to block the hormones that cause tissue to grow and shed every month, thus reducing the amount of pain and bleeding.’
Endometriosis pain management
Anita advises that painkillers can be used, but when endometriosis pain is at its worst they may not be that helpful. ‘But it’s definitely worth a try,’ she adds. ‘Hormonal medications are the next step because they stop the build up and shedding of endometriotic plaques, which is a cause of a lot of the pain.
‘One of the biggest problems I see is constipation, which is surprisingly common because a lot of us don’t drink enough water or eat enough fibre. Constipation can make endometriosis pain worse, as it can make your stomach quite bloated and pull on the scar tissue, but it also means you need to strain more to open your bowels – which for many women is already incredibly painful. So simple things like increasing fibre and fluid intake could see an improvement in symptoms.’
A very common worry is that there’s a link between endometriosis and cancer, or even that it is a type of cancer – possibly because pain is such a red flag for so many of us – but that’s not the case.
‘While there are a few small studies suggesting a possible link, there are no large, robust studies confirming a causal link between endometriosis and endometrial cancer,’ Anita says.
Endometriosis and diet
First things first: there is no need to eliminate entire food groups from your diet. ‘There are a lot of people who have read about cutting out dairy and gluten, although there’s no solid evidence that these worsen endometriosis’ Anita says.
‘But I think everyone should be treated as an individual – what might work for one person may not work for another. If you want to try it, by all means go ahead and try to keep a symptoms diary. But if this doesn’t improve your symptoms, there’s no need to cut things out of your diet for fear it’s making your endometriosis worse.’
Nutritionist Henrietta Norton is not only an expert in nutritional female health, but also on what it’s like to live with endometriosis, having been diagnosed in her twenties. After her laparotomy and laser treatment, she sought the help of a nutritional therapist, which she says changed her life.
‘Research continues to prove that nutrition and diet can be fundamental to managing the condition,’ she says. ‘Studies show that taking the right nutrients through supplements can reduce symptoms significantly – 98% of the women in one study experienced improvements.’
So, what is it worth trying to consume more of in your diet? ‘Zinc and magnesium are used in abundance during states of both physical and mental stress; as endometriosis is a state of physical stress, the demand is even greater than normal,’ Henrietta continues. ‘Women can actually lose up to half their magnesium supply during menstruation.
‘Endometriosis sufferers often experience heavy bleeding during their period, significantly reducing stores of iron. This, along with the trace mineral molybdenum, is required for the elimination of oestrogen (it’s thought that endometriosis is characterised by a dominance of oestrogen), and without adequate iron stores the pain management process can also be affected.’
‘Women with endometriosis have also been reported to have a lower intake of carotenoids (found in vegetables like carrots, kale and spinach) and D-glucarate (found in cruciferous vegetables, which blocks beta-glucoronidase) than women without endometriosis.’
Wild Nutrition’s Endometriosis Complex was created with the latest research in mind to use as part of a multi-disciplinary approach to managing the condition, Henrietta says. ‘Using natural forms of nutrients that are efficiently absorbed and used by the body in combination with organic herbs [magnesium, methionine, probiotics and more], the curated formulation addresses the complex condition affecting the immune and digestive systems and hormonal stability.’
Can you get pregnant with endometriosis?
A common worry is that an endometriosis diagnosis means pregnancy is unlikely or even impossible. But is this actually the case? ‘Not always,’ says Anita. ‘Generally it depends on the severity, but saying that, we do see a lot of women with severe endometriosis on the labour ward delivering their babies, so it’s not impossible.’
Case in point: Despite being told that she would never have children, Henrietta now has three sons, all of whom were natural conceptions and healthy pregnancies.
‘I also see a lot of patients being diagnosed with endometriosis during the investigative process for infertility,’ Anita continues. ‘On further questioning, the vast majority report a long-standing history of the common symptoms, which is saddening to hear as they often say they thought it was normal, or something they just had to tolerate as part of being a woman.
‘This is why we need to get more comfortable with talking to our friends and families about periods and women’s health – to know what is normal and what might require further investigation. And it’s also a reason we shouldn’t leave potential gynae issues right up until trying to get pregnant.’
As part of her mission to educate women everywhere about their reproductive health, Anita is about to publish her first book, which you can pre-order now. The Gynae Geek: Your No-Nonsense Guide to ‘Down There’ Healthcare tackles all of your burning gynae-related questions, from periods to smear tests to PCOS – it’s the definition of essential reading.
As with any condition, it’s important to listen to your body and know when it’s telling you to take it easy. ‘I have become acutely aware of how the foods I choose to eat and my lifestyle affect my symptoms,’ Henrietta says.
‘I understand the importance of slowing down, taking time to restore and just “be” in everyday life, which has a profound affect. I now use my symptoms as gentle reminders signalling me to slow down and to rest and digest.’
Things may feel very overwhelming – especially at first – but there are a number of support groups, helplines and online forums you can visit to get more advice and emotional support. Head to endometriosis-uk.org (Anita’s go-to patient resource) for more information.
Note that the purpose of this feature is to inform, not replace one-to-one medical consultations. For advice tailored specifically to you, always discuss your health with a doctor.