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Fall 2015 HIV/AIDS

The Fall 2015 Quarterly Conversations in Global Health focused on the spectrum of issues that surround and stem from H IV/AIDS. Topics discussed include current research being done in the field, HIV/AIDS as a global health concern, and the social effects of stigma related to HIV/AIDS.

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The 1st Inaugural Quarterly Conversations in Global Health commenced on November 16th at the Great Hall at UC San Diego. The event brought in community resources who focus on HIV/AIDS prevention, education and awareness, as well as featured a photo booth, a faculty panelists and Q&A session. The Fall 2015 Quarterly Conversations in Global Health focused on the spectrum of issues that surround and stem from H IV/AIDS. Topics discussed include current research being done in the field, HIV/AIDS as a global health concern, and the social effects of stigma related to HIV/AIDS.

Global Health Program Director, Dr. Thomas Csordas opened the event and introduced our inspiring speakers where we heard from:

Members of San Ysidro Health Center “Our Place” spoke about their personal experience being HIV positive.

Take away: Despite the greater awareness, people are still being affected by HIV/AIDS at an enormous rate.

Ways of coming into contact with the virus: blood, semen, vaginal fluids, breast milk but it is 100% preventable. There are resources, so people must use them!

Things have changed, like there are better medications, but people still get infected and many don’t know they have it because they feel “fine.” There are disproportionate stats among groups of people like African Americans and Latinos. The pandemic in San Diego is still going­ on and there is still work that needs to be done.

Panel Recap

Dr. Steffanie Strathdee, Ph.D,  Chief of the Division of Global Public Health in the Department of Medicine at the University of California San Diego School of Medicine spoke about the HIV and AIDS crisis in Tijuana, specifically focusing  on the River canal next to the border where many people live. San Diego and Tijuana both share the issue of HIV/AIDS. Sexual workers who use drugs or have partners that use drugs are affected by STDs (including HIV) more often. Barriers to HIV prevention in Tijuana include police malpractice and lack of access to health care, so she is working with the police in Mexico to prevent needle accidents and she has started programs toward HIV prevention in Mexico.

Many of the issues are rooted in social, political, and economic realities in the Mexico, San Diego border.

Dr. Radhika Sundararajan, Assistant Professor of Emergency Medicine at UC San Diego spoke about the role of traditional healers for HIV. Traditional healers (TH) include herbalism, spiritual treatment, bone setting, and birth attendants (most use a combination of these). About 80% of people use traditional healers in some countries in Africa and Asia (but some use it rarely).

Beyond the need for traditional healers, people prefer to use traditional healers because they provides holistic care, aid for “possession/curses,” people have mistrust of bio medicine, and healers are respected members of the community. Traditional healers are the first point of contact when people get sick (not the doctors). HIV diagnosis is delayed when people visit TH. But there is lack of data for people who don’t have access to bio medical medicine.

To improve care, there needs to be collaborations between healers and bio medical providers, a better understanding of the needs and concerns of stakeholders, and formative research to understand how to best help people.

Dr. Robert Schooley, Chief, Division of Infectious Diseases and Academic Vice Chair, Department of Medicine, spoke about his research regarding HCV, influenza and HIV pathogenesis. He describes the advent of HIV in the early 1980’s and the stigmas surrounding HIV infections (especially towards gay men). Doctors didn’t accept gay men socially and thus did not want to treat them and they were also afraid of getting the disease if they helped them.

Bigotry allowed for a continuation of the epidemic. Clinical trials were done to provide drugs to HIV patients but the FDA did not want to approve initially, setting back access to aid for patients.

He began a study that had the people in other countries like India and Zimbabwe learn more about aid for HIV and persuade their governments to make drugs available to constituents.

However, most of the initiative is made by western countries since eastern nations don’t have as quality education for medicine. Therefore we need to work towards helping develop health care education in other countries.

The event ended with a speaker Q&A:

What common misconception should be cleared up?

Dr. Schooley: global health is more than medicine. Also, people in other countries with

limited resources do not lack knowledge, they just lack resources.

Dr. Sundararajan: there is so much more to global health than going and helping out- they already have the people for that. It’s about lending support intellectually and financially. It’s also about helping build infrastructure. Although it’s a slow process, it is lasting and is effective.

Dr. Strathdee: it’s also about social, political, and economic factors as well. You can’t just tell people to “not do something” that is deeply rooted in their lifestyles or culture.

How do you help women in particular?:

Dr. Strathdee: for example, sex working women are not doing their jobs because they want to, they are doing it because they need to support their families. We need to move upstream instead of saying “you shouldn’t do that.” Women should be given alternatives like micro­loans for example.

Dr. Sundararajan: there are different cultures and reasonings for why women do certain things. We need to understand why and not just make assumptions. For example, why do women use traditional healers more than biomedical aid. The more we engage with people, the more we can move away from making assumptions and actually learn more about people. There are many differences between different communities and we must learn about what makes each community unique by engaging with its people.

Dr. Schooley: when women are the leaders in the projects, they are able to help other women better. He agrees with Dr. Sundararajan in that people need to communicate with patients better about shortcomings and challenges and ways to open up.

Audience Question: What is the interaction between allopathic and biomedical medicine and are those interactions are impeding care?:

Dr. Sundararajan: most people discount allopathic medicine. For example, people in India visit healers because they didn’t know if they are cursed or actually infected with malaria. But doctors or practitioners of biomedical treatments claim healers are stupid and conducting malpractice. However, community members themselves respect healers more. Doctors and healers have the same goal but collaboration is lacking which impedes care.

Is it difficult to convince traditional healers that they are dealing with “western” problems/diseases as opposed to “possessions/curses?”:

Dr. Sundararajan: No because most of TH are knowledgeable. They hear the messages and have the knowledge of AIDS, for example, though the treatments aren’t perfect. It’s about respecting what they do and making suggestions nicely since they don’t often get positive reinforcement.

What would you say is the biggest barrier on the U.S. side?

Dr. Strathdee: The mind­set that “it is their fault.” It is about creating international partnerships and see the HIV epidemic as a shared responsibility. We have held Mexico back and now it’s coming back to us and affecting people in San Diego. Therefore, we need to make sure we are helping people, not blaming them.

Dr. Schooley: it has become more about the agencies like USAID and CDC as opposed to actually helping the people. USAID for example, monopolizes care over certain areas and prevents other groups from the CDC from working with the people in those areas.

We should let ourselves listen a little more and make sure money is being spent the right way.

Final Thoughts and Announcements:

The 3rd annual Horizons Global Health Conference focusing on global mental health will be held on May 3, 2016.

The next Quarterly Conversations in Global Health will be focusing on gun violence, so stay tuned for updates with more information!

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