The United States HIV/AIDS Strategy

The afternoon session, Developing and Implementing the National HIV/AIDS Strategy, led by UNC SPH alum Greg Millett, detailed the features of the country’s first national strategy addressing prevention and treatment of HIV. The purpose of this strategy is to refocus attention on domestic the epidemic and identify a few key steps that will make the biggest impact. Key goals include: (1) reduce HIV incidence; (2) increase access to care for people living with HIV and optimize their health outcomes; and (3) reduce HIV related disparities.

The United States has invested millions of dollars in HIV/AIDS prevention and treatment programs in developing countries through PEPFAR. It seems odd we are just now putting together our own HIV/AIDS Strategy. Still, the momentum for putting this strategy into action is positive. In the budget released last week, President Obama innovatively allocated $60 million to specifically take forward our HIV/AIDS Strategy. Perhaps other governments will follow in specifically adding a line item to their budgets to take forward a strategy. A document is only as good as its implementation and I am interested to follow this creative move enacted by our nation’s leader.

For me personally, this was one of the most interesting domestic sessions I’ve ever attended at a conference. My focus has always been global public health but this one struck a chord with me. Perhaps it was Greg’s fabulous presentation and insightful yet astounding anecdotes – did you know that 1/3 of Americans believe HIV can be transmitted by sharing a glass of water, using public toilet seats, or swimming in public pools? This statistic has not changed since 1987! From a health workforce perspective, I appreciate Greg’s attention to addressing the shortage of health care providers, especially highlighting our need to have “culturally grounded” providers to provide HIV care.

You can and you should learn more about our National HIV/AIDS strategy at http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf.

Reflections from First Session: The Health of Aging Americans: New Perspectives on Health Disparities and Social Inequities Research

Reflections from First Session: The Health of Aging Americans: New Perspectives on Health Disparities and Social Inequities Research

The Missing Boxes

When you fill out your census form, do you feel your ethnic group or race is missing from the standard checklist? Have you ever considered who is really in that “Non-Hispanic White” category? Florence Dallo led a relevant discussion on the “missing” category of Arab-Americans, a group that has grown from around 660,000 in 1980, to over 2 million in 2007. Without specific data on Arab-Americans, variations in health disparities for this group are lost preventing meaningful public health interventions for Arab-Americans.

In case you are wondering, the Non-Hispanic white category includes Europeans, North Africans and populations from the Middle East.

Linking Aging and Health in Americans

No one will dispute the growth in the “senior” population in the United States. The “baby boomers” are aging, people are living longer and these seniors are living with often multiple chronic diseases. The 2050 Census projects the over 65 population to account for 87% of the country’s population – a substantial increase. As these huge shifts in demographics are taking place, we are facing shortages in primary health care workers and geriatricians who are able to care seniors. The presenter of this section, Nina Parikh, said there are approximately 7500 geriatricians currently in the United States, a % decrease from 2000.

Parikh spoke about interventions at senior health centers in New York City to address diabetes and depression care. There are many questions that arose: Can senior centers make a difference? Are senior centers a viable alternative for traditional health care centers for health promotion and senior self care management programs? Are these centers cost effective? Are they band-aids? We’ll have to pay close attention to care for seniors in the United States and the disparities affecting these populations.

The Keynote: 32nd Annual Minority Health Conference at UNC

Today, I had the distinct pleasure to attend my first Minority Health Conference sponsored by the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and the UNC Minority Student Caucus. This conference is the largest and longest running student led conference in the United States. The theme for 2011 is “The Promise of Health Equity: Advancing the Discussion to Eliminate Disparities in the 21^st Century. Conference co-chair Kristin Black set the tone for the day by urging attendees and students to use “data as our fuel” to put in place effective policies and successful interventions to eliminate health disparities.

Terri Houston, the interim Chief Diversity Officer and Executive Director of the University’s Office of Diversity and Multicultural Affairs, recognized the University’s commitment to work together to dispel myths and restore the disconnect in health disparities. Houston called for the audience to hold ourselves accountable to our commitments in addressing health disparities in minority populations. Also speaking was the UNC School of Public Health Dean, Dr. Barbara Rimer, who acknowledged the progress we have made in addressing health disparities in areas such as breast cancer screening. Still, Dean Rimer reminded us that we need to intensify our efforts especially in areas such as mortality and morbidities, diabetes, smoking and other areas that continue to persist.

The keynote speaker for the event Dr. Bonnie M. Duran, led a rich cultural presentation about the development of indigenous knowledge, modernity and socialization and the health of indigenous Indian populations. The audience was treated with a video about indigenous health disparities, indigenous wellness, delving into the “stories” of the Native American communities in the Western United States. During her speech, Dr. Duran focused on epistemenic diversity as an essential component of health equity. Her questions and objectives were thought provoking: Has Western knowledge contributed to health inequities in indigenous populations? How can we mobilize public health advocates and partnerships to foster opportunities to reduce disparities in the health of indigenous populations?

I was interested in this word “Episteme”, a term not used in my everyday public health language. What is indigenous episteme? I gather it is a socio-cultural “philosophy” of knowledge. Dr. Duran mentioned globalization, Western knowledge’s worldview of human development and other socio-cultural factors as contributors to health disparities in indigenous populations. I felt very much a participant in a history lesson as Dr. Duran walked the audience through some of the narration of socialization and health of indigenous populations. She said it is important to understand histories and the local communities in order to understand socialization and indigenous episteme today.

I was also quite interested by the “World System’s Theory” mentioned by Dr. Duran. She positioned this theory in that society is moving in the direction of the West and if you are not moving in that direction, you are not progressing. I goggled this theory and it would take quite a while to really dissect its inter-workings but can public health professionals really ignore these claims? Do we not go into communities and introduce what, we claim, is the best way implement health prevention and treatment?

Of the plethora of highlights Dr. Duran gave today, her comments on the truth and impacts of historical trauma affecting minority populations evoked nods and understanding from the crowd. This audience is well versed on the effects that weathering has on minority populations’ health. When asked what motivated her to research and focus her career in this direction, Dr. Duran said, “I work for an institution that believes in diversity but hasn’t figured out how to diversify.” These are strong words that we may all need to reflect on as we move forward in our studies and careers.

Love

Happy Valentine's Day! Today I am reflecting on love and my own "labour of love" - myself. For the past 19 months I have put a lot of work into myself and my future. And, I have been able to succeed without completely loosing my head by having the strong support of so many loved ones. Right before I started graduate school I had my heart broken. It is funny how some of the lowest points of your life can turn out to be the best thing that ever happened to you. Maybe it took someone falling out of love with me for me to truly fall in love with myself. And thank goodness for that - the world is mine!

School Management

Why is it important to improve health professional school management in developing countries and what is my project doing?

Check it out!

http://www.capacityplus.org/making-money-work-global-advisory-board

The most important blog post yet - My Mom's Cinderella Story

Where am I? I am in the shower and out of the blue a serendipitous thought invades my mind. I HAVE BECOME A REAL LIFE CINDERELLA. Now the best I remember, the storybook Cinderella had a fairy godmother that granted Cinderella's wish to go to the ball at the palace. The fairy godmother waved her magic and adorned Cinderella in a beautiful gown and stunning glass slippers. She even provided Cinderella with transportation to and from the ball. But, there was a catch. Cinderella had to be home from the ball by midnight, or else her dress would again become here customary rags, etc. Well' there's no need for me to elaborate. I’m sure you remember the rest. However, you are probably wondering by now why I feel like Cinderella. It’s because I well understand what it is like to participate in a life bound by a time limit. As an insulin dependent diabetic, my whole life revolves around time parameters. I don’t really have the luxury of being completely spontaneous when it comes to food or experiences. Actually if the aforementioned chronic disease followed precise rules, there would be no feelings of boundaries, but Type 1 diabetes is a very personalized entity. There is no one size fits all course of treatment. So, many variables affect it's path, making it impossible to predict what path it will actually take. As arduous as this sounds, it is possible to have a wonderful quality of life. All one has to do is test, test, test. God bless the inventor of glucose monitors. Constant testing is the key to enjoying life to its fullest. Why do I call Type 1 diabetes a very personalized disease? It is because of a host of variables that are unique to each individual. To name a few - diet, exercise, illness, stress, emotions, fear, anxiety, timing – the list goes on. Now, enough about all that. On to what is good. Living with Type 1 diabetes definitely has its positive sides. When first diagnosed, I felt so deprived in terms of food, but after taking a 3 day nutrition class at Duke, I learned how all people should eat in relation to fats, carbohydrates, proteins, fruits, vegetables, and dairy products, not to mention proper portion sizes. As a result, my energy levels soared. I also really began to understand the benefits of regular exercise. My immune system is phenomenal. Yes, sometimes I fall off the wagon so to speak. I may inflate an insulin injection and eat some sinfully indulgent dessert. I don’t do it often, but when I do, I treat it as a celebration of all that I have learned and achieved. Okay, back to Cinderella. The fairy tale ended happily ever after, and I truly believe that my life has been enriched and lengthened as a result of my diagnosis. I am so grateful for all the positive developments I have seen since being diagnosed 17 years ago, and above all, I maintain hope that there will one day be a cure. For me, even if I were miraculously cured tomorrow, I wouldn't change a thing about the way diabetes has taught me to eat and exercise. I would continue those habits. For me, the freedom would come in the release of the effects high and low blood glucose levels render on my brain. Until that time comes, I am indebted to my real life fairy godmothers---Dr. Ann Brown and P.A. Kathy Peralta for all that they have taught me and monitored in terms of my health. Cinderella is fiction, but I am real, and so is diabetes; however it is not the nightmare so many people seem to think it is. I bestow my sincere thanks to all of the medical personnel that have, and continue to, transform living with diabetes from being a once upon a time true nightmare into a happily ever after reality.

Linda J. Puckett

Waffles and Ice Skating!

Yesterday my fellow "MCHers" and I put away the books and had a fun Saturday outing. We started the day at Ye Ole Waffle Shop on Franklin Street. Have you been? It's amazing and I'm a big fan of the pecan waffles.

Next up, we ventured out for some ice skating. We may not have landed triple axels but we had a blast!

For the past year and a half, we have been so busy studying and working that we have neglected spending as much time doing the fun things as we would have liked. In this, our last semester together, we have vowed to spend more time together having fun. Yesterday was a total success!