HIV Awareness: Progress and Challenges

Authors: Lauren Richey, MD, MPH, FIDSA and Sadie Beckett, MPH

Scientists and researchers have shown through multiple studies that when people living with HIV take their medicines as prescribed and as a result have no detectable virus in their blood on blood tests that they cannot transmit HIV to their sexual partners.

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This knowledge allows people living with HIV to lead full, unrestricted lives that allows them to safely have sex without condoms.  This also allows both men and women living with HIV to have children without the concern of transmitting the infection to their child.

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HIV still remains an important health issue in 2018. While HIV is easy to test for with a simple blood test, many people do not routinely get tested, either because they do not access healthcare or because their provider does not offer them testing.

In 2016, according to the Louisiana Office of Public Health, Louisiana had the third highest HIV diagnosis rate in the United States, with the New Orleans region being the region in Louisiana with the highest diagnosis rate.

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Diagnosis is important because once diagnosed, people will know whether or not they have HIV.  If they learn that they are living with HIV they can access lifesaving medications that improve their health and help them to achieve viral suppression.  When they achieve viral suppression, the virus is then undetectable in their blood and therefore can no longer be transmitted to partners

 University Medical Center New Orleans offers testing in the Infectious Disease Center (Clinic building, Zone C). There is also routine HIV testing in our Emergency Department. So if a medical condition or any risk of exposure to HIV brings you to the ED, you can get tested.

To find other testing centers near you, you can enter your zip code into: gettested.cdc.gov. Other places include your primary medical doctor, OB/GYN , or at a community testing event.

HIV and Stigma

One of the greatest challenges for many people living with aids is still the stigma that goes along with the disease.

The Merriam-Webster definition of stigma is “an identifying mark or characteristic.” In the case of HIV and stigma, HIV is the identifying characteristic, and it reduces a person from being whole and usual to tainted and discounted. The effects of HIV stigma on people living with HIV can be deadly.

People living with HIV are less likely to attend their medical appointments, less likely to be adherent to their medication regimens, and are more likely to suffer from mental health conditions.

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HIV stigma historically stems from a fear of the unknown. It began in the early 1980s when there were numerous cases of rare cancers, pneumonia and deaths of our patients. No one knew how HIV was transmitted which led to transmission myths creating a negative connotation of the infection.

Some of the more “popular” stigmatizing phrases were (and still are) that it is a “gay man’s disease” or HIV is only associated with sex workers and drug users. Anyone who is sexually active is at risk for contracting HIV. It is important to get tested and practice safe sex.

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In 2018, we now have over 40 medications that are used to treat HIV.   We now know that if people living with aids begin their antiretroviral therapy (ART) shortly after their diagnosis they substantially reduce the risk of their partners contracting HIV- indicating the need to start ART as soon as possible.

It is very important for individuals to receive accurate information so that HIV transmission can be prevented or effectively treated if someone is infected.  Without HIV stigma, more people would get into care and stay in care; the rate of HIV infections would decrease; there would be a substantial decrease in AIDS cases; there would be full participation in HIV testing and, most importantly, everyone would know their status.

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HIV and Stigma Discussion

On December 5, join us for a talk on HIV basics, the history of HIV and stigma and what we can do to end stigma. The talks will be at 7 a.m. and 3 p.m. in the UMC Conference Center, located on the first floor of the hospital, 2000 Canal Street. Refreshments will be served.

Lauren Richey, MD, MPH, FIDSA, is an Infectious Disease Specialist and LSU Health Sciences Center Associate Professor of Medicine.

Sadie Beckett, MPH, is a Clinical Educator in the UMC Infectious Disease Center/HIV Outpatient Clinic.

Pain Care: Prevention Before Treatment

Author: Harry J. Gould, III, MD, PhD

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When a patient says, “Doctor, it hurts when I do this,” the immediate thought in response to the implied request is “Don’t do that.”  Unfortunately, in today’s society, this seems to be the best and most effective advice that a physician can provide for their patients in pain.

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The United States is in the midst of what the Centers for Disease Control describes as “The worst public health crisis in American history.”

There are reports, almost daily, to enlighten us about the fact that the over-prescribing of prescription painkillers has led to countless overdose deaths and serious consequences associated with misuse, abuse, addiction, and diversion that plague society in epidemic proportions.

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As a result, there has been a strong push by the community and regulatory agencies to limit the prescribing and dispensing of opioid analgesics across the board, while paying little attention to the underlying cause.

Pain is often under-treated or over-treated, but mostly it is poorly treated.

The system’s response has precipitated a reluctance on the part of many physicians to provide pain care for many in need, further exacerbating the primary cause of the problem.

A frequent response is to change clinical focus and redirect efforts to offer one-dimensional assessment and management that relies on interventional modalities.  Unfortunately, not all patients are identical and interventions, if ordered inappropriately or too often, can be costly and have problems of their own.

The observations and policies have mandated change and have heightened the efforts of healthcare providers to find ways to “do no harm” in their efforts to help those in need.

How then can we improve pain care and overall quality of life?  Perhaps it is time to return to basics.

As a starting point, we should consider some important truths about pain.

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The Truth About Pain

  • Pain is subjective and is different for everyone based on culture, situation, experience, genetics, age and gender.
  • Pain is a modality that is essential for survival. It warns us of present and potential tissue injury so that we can respond and minimize damage.
  • The most important reason that chronic pain is so debilitating is less the uncomfortable sensation that is experienced and more the fact that pain robs us of our ability to control of own lives. Unfortunately, many chronic pain conditions are present for a lifetime.  Thus, the realistic goal should be to minimize the effect of the underlying condition causing the pain and reclaim control of our lives rather than to eliminate pain.

Too often, patients surrender responsibility for controlling their pain to friends, physicians, physicians, drugs or procedures.

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Taking Responsibility for Your Pain

As a patient, it is essential for you to take responsibility for your pain and to participate in your own care. This process can begin by considering and implementing some obvious positive behavior changes that can maximize pain control and minimize both physical and fiscal cost.

Things You Can Do to Control Pain

  • Eat a regular healthy diet, avoiding excess, with a goal to optimize body mass index (BMI).
  • Exercise daily — regular activity from baseline to 30-60 min/day tailored to the patient’s ability to tolerate activity without a backward slide. “No pain, no gain” is not always the best approach.
  • Be sure to get enough restorative sleep.
  • Balance life experiences and schedule time for yourself that allows for participation in hobbies and enjoyable leisure activities.
  • Be aware of habitual activities and positions that add undo ergonomic stress, e.g., poor posture, wearing high heels, wearing shoes that lack adequate support, sleeping on an old or non-supportive mattress or pillow, using inadequately supportive chairs and car seats. Tailor work and living environments to minimize but not necessarily eliminate stressors and eliminate high-risk conditions.
  • Learn and take advantage of alternative forms of coping and pain control, e.g., meditation, guided imagery, self-hypnosis and relaxation.

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With proper perspective and attention to basics, one is likely to realize improved general conditioning that enhances:

  • Healing and the immune system’s ability to fight off infection and disease
  • Improved cardiovascular, pulmonary and gastrointestinal health
  • Reduced stress
  • Improved mental health
  • Increased sense of self and well-being and an overall improved quality of life
  • Reduction in pain at any level

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When setbacks occur, first consider the use of topical heat, cooling or massage and prudent physical activity to improve strength, range of motion and endurance and seek counsel for a comprehensive pain assessment early when the basics have not provided adequate results.

Suicide Prevention: Know the Signs and Where to Get Help

Author: David Fein, MD, Medical Director of  Behavioral Health Emergency Room Services

Suicide rates have been on the rise, now standing as the 10th leading cause of death in the U.S. and the 2nd leading cause of death in teens. Now more than ever, it’s critical to know the signs that might indicate a person is considering suicide, where to go for help, and how to provide appropriate support and interventions.

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Risk Factors

While there are known risk factors for suicide, such as being older, male, or single, there are additional risk factors to be mindful of as well. These include dramatic changes in behavior, such as getting one’s affairs in order, giving away possessions, increasing substance use, and expressing feelings of being trapped, a sense of hopelessness, or the belief that there is no purpose or meaning to life.

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Many suicides occur during moments of extreme anxiety and hopelessness about the future. In fact, interviews of people who attempted suicide reveal that, oftentimes, they experienced profound regret about their decision almost immediately.

We should strive to never let temporary feelings of hopelessness drive us or a loved one to a permanent act like suicide. If you feel you are trapped with no way out and think the only solution is death, know that many resources are available to help you through the crisis.

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Where to Find Help

Each parish has a community mental health center and a mobile crisis unit that are available 24/7 to provide support for people in a behavioral health crisis. Calling the crisis unit does not necessarily mean you will be brought to the E.R. They are there to provide support to you – sometimes over the phone, sometimes in person.

Metropolitan Human Services District serves Orleans, St Bernard, and Plaquemines parishes. Call (504) 568-3130 for their clinic, and (504) 826-2675 for their mobile crisis unit. Jefferson Parish Human Services Authority serves Jefferson Parish. Call (504) 838-5257 for their clinic and (504) 832-5123 for their mobile crisis unit.

If a friend or loved one is in crisis and unwilling to seek help, another option is an Order of Protective Custody, which is signed off by the parish’s coroner and gives the police legal authority to bring the person to the hospital for an evaluation. To  request for an Order of Protective Custody in Orleans Parish,  call (504) 658-9660; in Jefferson Parish, call (504) 365-9100; in St. Tammany Parish, call (985) 781-1150.  

There are also national services such as the Suicide Hotline (1-800-273-8255) and the National Alliance on Mental Illness (NAMI) (1-800-950-6264) which also has a Crisis Text Line (just text NAMI to 741-741). As always, emergency rooms and 911 are available 24/7 in case of an emergency.

Dr. Fein is an Assistant Professor of Psychiatry and Associate Director of the LSU-Ochsner Psychiatry Residency Training Program, LSU Health New Orleans School of Medicine.

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Essential Immunizations for Adults

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You want to pass on certain things like family traditions, a grandmother’s quilt or dad’s love of books—but no one wants to pass on a serious illness. Take charge of your health and help protect those around you by asking about vaccines at your next doctor’s visit.

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Vaccines

Vaccinating our children is commonplace in the United States. But many adults don’t know which vaccines they need, and even fewer are fully vaccinated. Every year, thousands of adults in the U.S. become needlessly ill from infectious diseases. Many adults are hospitalized and some even die from diseases that could be prevented by vaccines.

Not only can vaccine-preventable diseases make you very sick, but if you get sick, you may risk spreading certain diseases to others. That’s a risk most of us do not want to take.

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Babies, older adults and people with weakened immune systems (like those undergoing cancer treatment) are especially vulnerable to infectious diseases. They are also more likely to have severe illness and complications if they do get sick.

You can help protect your health and the health of your loved ones by getting your recommended vaccines.

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The good news is that getting vaccinated is easier than you think. Adults can get vaccinated at their primary care doctor’s office, pharmacies, workplaces, health clinics and health departments.

Most health insurance plans cover the cost of recommended vaccines—a call to your insurance provider can give you the details.

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What vaccines do you need?

All adults should get:

  • Annual flu vaccine to protect against seasonal flu
  • Td/Tdap to protect against tetanus, diphtheria and pertussis (whooping cough)

Some additional vaccines you may need (depending on your age, health conditions and other factors) include:

  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus (HPV)
  • Meningococcal
  • Pneumococcal
  • Shingles

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Traveling overseas?

There may be additional vaccines you need depending on the location. Find out here. 

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Still not sure what vaccines you may need?

Take this short quiz.