Experience at UNC Leads to New Job

While training at UNC, Cheng Wang met many faculty including Myron Cohen, MD, director of the UNC Institute for Global Health & Infectious Diseases.

While training at UNC, Cheng Wang met many faculty including Myron Cohen, MD, director of the UNC Institute for Global Health & Infectious Diseases.

Cheng Wang came to UNC as a Visiting Scholar from China. In this blog post, he reflects on how the year-long training gave him the skills he needed to return to China and land a new job.

As a young researcher focusing on STD/HIV prevention in China, studying at UNC for the past year, which was funded by the D43 training program, has undoubtedly been one of the best learning and training experiences in my life for both personal and professional development.

During this one year, I was so lucky to work with three excellent professors including Michael Hudgens, PhD; Barry Bayus, PhD; and Joseph Tucker, MD, PhD, and other experienced researchers like Katie Mollan, MS, and Gabi Stein on two HIV related studies. One of the two studies examined the generalizability of results of online randomized control trials with inverse probability of sampling weights and G-formula, which concluded that the results of online randomized control trials can be generalized to a larger population of interest. The other was a meta-analysis which intended to explore the application of crowdsourcing methods in the medical and health fields. I am now writing the manuscript about this research.

This yearlong learning experience at UNC was eye-opening and inspiring, and is invaluable in shaping my future career. First, I became familiar with the whole process of doing a study – from literature review, proposal writing, data collection, statistical analysis, manuscript preparation and submission. I gained a better understanding of how to efficiently and effectively conduct a research study. Secondly, the experience of attending many different kinds of seminars and international conferences, and communicating with experienced researchers greatly broadened my academic vision and knowledge of the STD/HIV prevention work.

Thanks to the D43 training program, I will be transferred to a new job when I go back to China that is responsible for all STD control work in Guangdong. Without a doubt, this experience has been the highlight part of my research career. I also want to thank everybody I met during this one year who helped me and became my friend.

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Ethics of Ebola, Zika Clinical Trials Focus of Oxford Conference

Karine Dubé, DrPH, shares  key messages from the Consortium of Universities for Global Health's annual meeting.

Karine Dubé, DrPH, is a research assistant professor in the UNC Gillings School for Global Public Health.

Karine Dubé, DrPH, shares highlights from the Oxford Global Health and Bioethics International Conference.

The second Global Health and Bioethics International Conference was held at Keble College in Oxford on July 17 – 18, 2017. The aim of the conference was to examine ethical issues in global health and foster interdisciplinary thinking in policy, practice and research. The meeting focused on recent infectious diseases outbreaks of Ebola and Zika and on the role of sustainability and solidarity in global health. Trends in global health ethics were also highlighted.

Ethical Considerations in Infectious Diseases Outbreaks: Ebola and Zika

  • Liza Dawson, research ethics team leader at the Division of AIDS (DAIDS), National Institutes of Health (NIH), and Annette Rid, Senior Lecturer of Bioethics and Society at King’s College London provided an ethical framework for conducting clinical trials in public health emergencies and prioritizing research during epidemics. Considerations such as a clear justification for clinical research design and coordination with local authorities were discussed. The role of humanitarian ethics and trust with local communities were predominant themes.
  • Carleigh Krubiner, research scholar at the Johns Hopkins Berman Institute of Bioethics, examined ethical considerations for Zika virus (ZIKV) vaccine research and development, including responsiveness to the needs of pregnant women. With over 40 Zika vaccine candidates in the translational research pipeline, there is a need for concrete guidance on future ZIKV vaccines. Three imperatives were mentioned: 1) development of ZIKV vaccines that are acceptable for use by pregnant women; 2) development of ZIKV vaccines targeted to women of childbearing potential, and 3) fair access to participation in ZIKV vaccine trials that carry the prospect of direct benefit.
  • New World Health Organization (WHO) guidance on managing ethical issues in infectious diseases outbreaks can be found here.

Sustainability and Solidarity as Key Ethical Values in Global Health

  • Professor Angus Dawson, professor of bioethics at the University of Sydney, discussed the role of sustainability in global bioethics. Sustainability was defined as ‘the preservation of goods so that today’s needs are not prioritized in such a way that future needs will not be met.’ Sustainability requires ensuring the just distribution of goods through maintenance of that good across time. Antimicrobial resistance provided a great case study to discuss sustainability issues.
  • Dr. Peter West-Oram, political philosopher and bioethicist, examined achieving solidarity and justice in the context of refugee and migrant health. Recognizing solidarity as a foundation to global health ethics means sharing the ‘costs’ of assisting others. Solidarity encourages a more equitable and effective response to public health challenges, and requires a recognition of common threats to health.

Trends in Global Health Ethics

  • Jeffrey Kahn from the Johns Hopkins Berman Institute of Bioethics gave a plenary lecture on emerging trends in global health ethics. Factors such as increasing pressures on the environment, climate change, conflict and migration will continue to affect global health. The need for greater inter-disciplinarity in solving complex global health challenges was emphasized – including borrowing from disciplines such as economics, political science, engineering and psychology, among others.
  • The WHO published new guidelines on ethical issues in public health surveillance here.

The full program of the 2017 Global Health and Bioethics International Conference is available here.

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Contest Asks Chinese to Define a Healthy City

A screenshot from the winning video depicts air pollution in China.

A screenshot from the winning video depicts air pollution in China.

Air pollution contributes to the deaths of nearly 1.6 million people a year or 4,400 a day die in China, according to a 2015 study. Just this year, environmental inspectors found that 14,000 companies in China failed to meet standards for controlling air pollution.

Pollution and poor urban health in China are often framed as intractable, private problems. However, the Chinese public is increasingly identifying actionable, smart and local ways to improve urban public health. Recognizing this growing capacity, clinician-researchers at UNC Project-China, based in Guangzhou, organized an open contest to solicit contributions about what makes a healthy city and strategies for achieving a healthy city in China.

“There is growing public interest in the environment and how that impacts health in China today,” said Joseph Tucker, MD, PhD, director of UNC Project-China. “Not only academic groups, but also citizens are thinking about how to improve the health of local cities.”

Individuals submitted texts, images and videos over a five-week period. Each contribution was evaluated by at least four people, with the first phase consisting of crowd evaluation and final decisions made by a multi-sectoral panel. The panel included distinguished experts and local citizens, in partnership with the scientific journal The Lancet and Tsinghua University. Contributions were judged on capacity to create change, feasibility and innovation.

The contest drew 449 submissions from 142 cities in China. Fifty-nine contributions were deemed exceptional by the panel and will be recognized on July 11, which is World Population Day.

“Our website nearly buckled under the weight of 45,160 unique individuals,” said Tucker. “These contest submissions provide a point of reference for Chinese perspectives on healthy cities. But more importantly, they hint at a new model for mass community engagement in healthy cities. We hope this will inspire others to solicit community feedback on healthy cities.”

Finalists’ submissions and more details about the contest are available here.

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Friend’s Death Inspires Med Student to Apply for Research Fellowships

Flick, right, with his colleague Adamson Munthali during a site visit in Dowa, Malawi.

Flick, right, with his colleague Adamson Munthali during a site visit in Dowa, Malawi.

Robert Flick is a student at the University of Colorado School of Medicine. He has completed both the Doris Duke International Clinical Research Fellowship and the UJMT Fogarty Global Health Fellowship. In this blog post, he shares how these fellowships allowed him to conduct operational research in Malawi and pay tribute to a friend and former colleague.

I used to avoid research. The word itself evoked images of beakers, pipettes and white coats – sterile places impossibly removed and irrelevant from the health inequities that drove me to pursue a career in medicine in the first place.

My friendship with Peter changed all of that. While we were roughly the same age, Peter grew up in a rural district of Malawi, a world apart from my childhood in a middle class suburb outside Baltimore. We met soon after I first arrived in Malawi in 2011, and were both assigned to help support logistics in the most distant corners of Neno, a remote and rugged district.

It was hot, dusty, exhausting work. The days were long, and usually began with a predawn frenzy of loading pick-up trucks and land rovers with supplies, followed by a morning spent rattling down rutted dirt roads. The health posts were often a single room under a tin roof, and by the time we arrived, the line would be several hundred patients long. The need was always overwhelming. The end of each day typically found us exhausted, covered in a film of sweat and dust.

Peter and I developed a strong friendship and I grew to depend on his unfailingly optimistic outlook in spite of the desperate straits we often found ourselves in. He was one of my first friends after arriving, and patiently helped me learn to navigate the culture and language of Malawi, a country I would grow to love.

It was while traveling outside of Malawi when I received the news that he had died. His clinical decline was swift and inexorable: massive ascites, drenching night sweats, a productive cough. His clinicians suspected tuberculosis, began empiric treatment and transferred him to a tertiary hospital in the nearest city. He died en route. While visiting his childhood home several months later, I was unable to offer even a firm diagnosis to his grieving mother.

Flick, right, presents an abstract at a local conference in Lilongwe, Malawi, with his colleagues Adamson Munthali and Mwelura Harawa.

Flick, right, presents an abstract at a local conference in Lilongwe, Malawi, with his colleagues Mwelura Harawa and Adamson Munthali.

I was outraged at our collective inability to save his life, and identified the systematic failure to equitably implement the fruits of modern medical science as a major contributor. It was through the lens of personal loss that I first began to understand the “implementation gap” of global health—the challenges of applying best practices gleaned from controlled studies to the gritty reality of places like Malawi. What systematic barriers prevented Peter from accessing high-quality screening, diagnostic and treatment services? I realized I had found my research niche, and channeled my outrage into operational research in Malawi.

Thanks to support from the Doris Duke International Clinical Research Fellowship and the UJMT Fogarty Global Health Fellowship, I was able to spend two consecutive years in Malawi cultivating this passion under the mentorship of Dr. Mina Hosseinipour and other experienced researchers. My research focused on strategies to improve routine tuberculosis screening, specifically through the use of community health workers. Through operational research, we were able to address import health inequities, describe critical gaps in the current health infrastructure and share our lessons with the global community.

The support of these fellowships proved invaluable in shaping my career for several reasons. Most importantly, it provided the opportunity to immerse myself in Malawi for two consecutive years. This allowed me to develop meaningful personal and professional relationships, to learn from my Malawian friends and colleagues, and to begin grasping the intangible lessons that are critical to pursuing research in this unique setting. Further, hands-on experience under the mentorship of experienced faculty members at UNC Chapel Hill provided critical lessons on all steps of the research process, from proposal writing, to quantitative analysis, to manuscript preparation. Together, these fellowships helped to both cultivate my understanding of how to conduct meaningful research, and helped me lay the groundwork for my own research career.

I used to avoid research. But the loss of Peter showed me my definition of the profession had been too narrow. Improving health care delivery can happen in the lab, but also in the field. As I return to medical school, I encourage other students to be open to the call to a research career and to consider applying for a fellowship to explore these opportunities to improve global health.

Posted in Africa, Clinical care, Malawi, Research | Tagged , , , , , | Leave a comment

Pandemics and Fake Medicines Focus of CUGH Meeting

Karine Dubé, DrPH, shares  key messages from the Consortium of Universities for Global Health's annual meeting.

Karine Dubé, DrPH, shares key messages from the Consortium of Universities for Global Health’s annual meeting.

Karine Dubé, DrPH, is a research assistant professor in the UNC Gillings School for Global Public Health. She shares highlights from the annual meeting of the Consortium of Universities for Global Health (CUGH).

The Consortium of Universities for Global Health (CUGH) is an organization of 145 academic institutions involved in global health that facilitates the sharing of best practices to address complex global health challenges. The 2017 CUGH meeting took place in Washington, D.C., from April 6 – 9. Three infectious diseases highlights include: 1) strengthening the global health security agenda, 2) examining potential infectious diseases pandemics and 3) uncovering fake medicines throughout the world.

Strengthening the Global Health Security Agenda (GHSA)
The GHSA is a partnership of nations and organizations to build capacity around infectious diseases. GHSA action packages include strategies for the prevention, detection, evaluation, and interventions to infectious diseases. Package topics range from antimicrobial resistance to zoonotic diseases and biosafety/biosecurity. Close to 50 countries have joined the GHSA since it was launched in 2014.

Examining Potential Infectious Diseases Pandemics
Emerging infectious diseases were a focus of the 2017 CUGH conference. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, shared his lessons advising the five past U.S. presidents on emerging infectious diseases emergencies. Examples of recent emerging infections include, under each U.S. administration:

  • Reagan – 1981-1989 (HIV/AIDS emergency),
  • George H. Bush – 1989-1993 (HIV/AIDS treatment),
  • Clinton – 1993-2001 (West Nile Virus),
  • George W. Bush – 2001-2009 (anthrax, H5N1, SARS) and
  • Obama – 2009-2016 (Ebola, Zika).

Fauci explained that emerging infections will continue to remain a perpetual challenge. To proactively identify emerging infectious diseases threats, the Global Virome Project was created to map out unknown viruses throughout the world that are likely to infect humans. Scientists estimate that less than one percent of global viral threats have been identified. The Global Virome Project would identify potential threats before outbreaks occur and build systems to more efficiently respond to them.

CUGH is an organization of 145 academic institutions involved in global health that facilitates the sharing of best practices to address complex global health challenges.

CUGH is an organization of 145 academic institutions involved in global health that facilitates the sharing of best practices to address complex global health challenges.

Uncovering Fake Medicines throughout the World
Fake medicines remain an unseen threat to global health and affect all types of therapeutics throughout the world. The World Health Organization (WHO) estimates that between 10-30 percent of medicines in the world are of poor quality. Fake therapeutics can cause prolonged illness, disability and death due to treatment failure and increased antimicrobial resistance. They also hurt the pharmaceutical and medical professions. The greatest burden falls on the poor in Africa and Asia with curable illnesses, such as malaria. One of the main factors that has given rise to fake medicines includes the proliferation of online pharmacies (96 percent of which are illegitimate). Tackling the problem of fake medicines requires a holistic approach, including ensuring proper regulations and legislations as well as law enforcement solutions and point-of-sale verification options are in place. Jim Herrington, executive director of the Gillings Global Gateway, chaired the CUGH session on fake medicines.

Additional Megatrends in Global Health
Additional megatrends in global health were highlighted during the 2017 CUGH meeting. These include the double burden of infectious diseases and non-communicable diseases in developing countries, the role of global climate change, the aging global population and the importance of harnessing innovation and technology to address global health challenges.

One of the key topics of the conference was the future role of the United States in global health. The National Academies of Sciences will soon release a new report on global health.

Talking points for CUGH’s global health advocacy efforts are available here.

Posted in Clinical care, Global Health Policy, Research, USA | Tagged , , , | Leave a comment

Blog: ID Clinic Director Answers Most Common Patient Questions


Claire Farel, MD, MPH, shares the questions she is most asked as medical director of the UNC Infectious Diseases Clinic.

Claire Farel, MD, MPH, is an assistant professor of medicine in the UNC School of Medicine and medical director of the UNC Infectious Diseases Clinic. In answering the most common questions she is asked as a clinician, Dr. Farel illustrates the vast prevention and treatment services available at the clinic, and how they can be accessed.

I love it when patients ask questions. Being able to partner with patients in their care keeps all of us in the UNC Infectious Diseases (ID) Clinic going. Asking questions shows that patients and their families are engaged in what all of us find most important: a healthier life, an understanding of illness and treatment, reliable information to pass along to others, support during stressful times, options for prevention of infection, maybe even a lasting contribution to science.

There are some questions I get more than others. The following are some of the perennial favorites:

“Aren’t you worried you’ll catch something?”
Infectious diseases encompasses all organisms that cause infection – like bacteria, viruses, fungi, etc. – but this doesn’t mean that the person with the infection is necessarily a danger to others. While some infections can certainly be transmitted from person to person, the ones we worry about are the most commonplace and easy to get, including influenza (“the flu”). We protect ourselves and our patients from many illnesses through immunizations and vaccinations (all of us get our flu shots to stay healthy!), lots and lots of handwashing, and education. If a patient or a family member has a cough, cold, or flu symptoms, we ask them to wear a mask when they check in to protect others. All in all, I would worry more about “catching something” in the grocery store, gas station, or other high traffic areas where we think less about protecting ourselves and others.

We take our role in preserving public health seriously and have a lot of educational materials on the topic of HIV and sexual health around our clinic. Talking about HIV and sexually transmitted infections is an important part of our work, as many people are afraid to ask questions or have misinformation. However, it’s important to remember that these infections are not spread by casual contact or even by sharing eating utensils, bathrooms, or hugging and kissing.

Katherine Barley works in the ID Clinic as a research screener, matching patients with study volunteer opportunities.

Katherine Barley works in the ID Clinic as a research screener, matching patients with study volunteer opportunities.

“I met the nicest lady in the waiting room. Does she have what I have?”
Thankfully, UNC has strict privacy rules, so it should come as no surprise that we can’t share this information. The important thing to know is that we see patients for a huge variety of reasons. Our waiting room is busy but we also help to care for many patients during and after a hospitalization. We see patients for infections of any type (for example, pneumonia, bone and joint infections, skin infections, etc), to rule out a particular infection, or to provide education and recommendations after a diagnosis.

“Why are there so many research flyers posted?”
UNC is a major center for HIV research, care, and prevention and we are proud of the work we do. The research that takes place at UNC has made huge contributions to the field and we continuously seek ways to make our patients’ lives better and healthier. If you are HIV-positive, we may offer you the opportunity to take part in a research study. We also have an increasing number of research opportunities for people with other infections, especially Hepatitis C. If you choose not to participate, our commitment to caring for you in our clinic will not change. We will continue to offer these opportunities whenever we have them unless you ask us not to!

“My significant other has HIV. What can I do to keep from getting it?”
We love to get the word out about HIV prevention resources. If your loved one is on HIV medications already and doing well with an “undetectable” amount of virus on blood tests, their risk of passing HIV on to anyone else is greatly reduced by somewhere between 92-100 percent. We call this “treatment as prevention,” but there are other ways to use HIV medications to keep from getting the virus. You can take a pill every day to prevent HIV before an exposure, known as pre-exposure prophylaxis, or PrEP. Using PrEP consistently creates a “shield” in your body against possible infection, dropping the risk of acquiring HIV by at least 90 percent. In an emergency situation (for example, if a condom breaks during sex or in cases of sexual assault), you can take a combination of medications called post-exposure prophylaxis (PEP) to prevent infection after an exposure. There’s a fixed window of time for PEP medications to have a benefit, however – so it’s important to start those emergency medications within three days of the exposure. Our emergency department has expertise in providing this care and our clinic team can assist in accessing preventative medicine if needed.

We are happy to see folks who are interested in HIV prevention in our clinic and can offer lots of resources to make taking preventative medicine manageable and affordable – as well as advice on protecting yourself in other ways.

Anita Holt and Tre Hankins work in the ID Clinic as a nurse and certified medical assistant respectively.

Anita Holt and Tre Hankins work in the ID Clinic as a nurse and certified medical assistant respectively.

“How can I arrange to be seen in your clinic?”
We have special programs for HIV-positive patients that allow self-referral – just give us a call (information is included below) to arrange an appointment. We require that most other patients get a referral from a medical provider (such as a primary care provider or another specialist). Having your medical records and the initial workup for your problem allows us to provide a focused, expert consultation. We advise that anyone at risk gets testing for HIV and hepatitis C as recommended by the CDC (Centers for Disease Control and Prevention), either through regular healthcare provider, free testing events, or local health departments. We take referrals from all of these sources and provide hepatitis C treatment through our clinic if you have a new or longstanding diagnosis.

Our contact information is below, or many practices can send referrals electronically.

UNC Infectious Diseases Clinic
101 Manning Drive, 1st floor Memorial Hospital
Chapel Hill, NC 27599
Phone: 984-974-7198
Fax: 984-974-4587

Our mission is to provide excellent clinical care and education for all of our patients, whatever their concern, and to offer them every advance and advantage in our field to keep them healthy. Keep asking questions!

Posted in Clinical care, North Carolina, Research, Service, UNC campus, Uncategorized, USA | Tagged , , , , , | Leave a comment

What World AIDS Day Means to Me

Steve Beagle is a Disease Intervention Specialist.

Steve Beagle is a Disease Intervention Specialist.

Steve Beagle is a UNC Field Coordinator and Disease Intervention Specialist for the North Carolina Department of Health and Human Services eHealth Services. He wrote the following blog post about World AIDS Day, which was Dec. 1,  for Adam4Adam, an online dating website designed for men to meet other men.

Most of my summer vacation days during elementary school were spent watching MTV (back when MTV played music videos). This was during the middle of the 1980s. And though my main interest was heavy metal, Michael Jackson, and Weird Al Yankovic, MTV was one of the first cable TV stations that promoted AIDS awareness.

This stuff sounded horrible. I envisioned AIDS being little, explosive spheres circulating throughout the bloodstreams of the infected- exploding, and causing them to die well before their time; all because they simply had sex. People would find out they had it, and within a few months or years- they would be dead.

I did not think of AIDS as a “gay disease” when I was 10-years-old. I don’t remember ever hearing the first term applied to it in the late 1970s/early 1980s: GRIDS (Gay Related Immunodeficiency Syndrome). I figured that most people were infected through sharing needles, and who in their right mind would want to stick a needle in their arm- on purpose?

MTV continued to publicize and talk about AIDS. I remember the passing of Pedro from “The Real World,” one of the first “reality” TV shows. I remember a video for a song whose lyrics went “People are still having sex, this ‘AIDS’ thing isn’t working,” as if someone or some group of people created AIDS to get people to stop having sex if they were gay, bisexual, or not having sex for the sole purpose of making babies.

Celebrities I had never heard of were also becoming infected: Rock Hudson, Arthur Ashe, Magic Johnson, and Freddie Mercury. Not really knowing any openly gay people in the early 1990s, I decided that I could accept Freddie Mercury having AIDS. I was sad that he was dying before I would have a chance to see him live and in concert with Queen. I decided that his sexual choices were alright with me since he made great music. Don’t worry- I have since outgrown homophobia.

When I was (finally) lucky enough to have sexual experiences of my own, I remember thinking that I wanted to be tested for STDs. I did not have any symptoms, but I had rarely used condoms and I was afraid that at the very least, I could have HPV or HSV-II and not know it.

I was not familiar with health departments and community health centers, so I called the local hospital for STD testing. The lady who answered the phone encouraged me to make an appointment with my family doctor. I could not do that. My family went to that doctor. What if he told them that I sought out STD testing? They might think I was “dirty” or “weak” for being open to such a thing, though I was fortunate that my mom had “The Talk” with me way back in second grade.

My ex-fiancé once told me that if I was too embarrassed to buy condoms, then I shouldn’t be having sex. Even though she was two years younger than I at the time, she was obviously more mature.

Fast forward to the 2000s and I had my first job as a Disease Intervention Specialist in public health. My mission was to interview people that tested positive for HIV, in an effort to ensure that their partners were informed, confidentially, that they may have been exposed and to provide free testing to those partners.

2000px-red_ribbon-svgIn the early 2000s, I talked mostly with commercial sex workers that used crack and their customers. A common question at the time was “How long do I have to live?”

Since around 2005, most of my clients have been MSM (men who have sex with men). These gentlemen have taught me a lot about life, LGBT culture, and how to assist other MSM that may not (initially) be open to discussing HIV, testing, care, and partner notification.

In 2016, instead of just giving people a list of phone numbers for case management, we make that first appointment with an HIV specialist for our clients (if they have not already themselves).

A Bridge Counselor or Bridging Case Manager can transport clients to their first appointment. Thanks to Ryan White, there is money to assist clients with expensive medication and lab tests necessary to manage the infection through ADAP, the AIDS Drug Assistance Program. Keep in mind that people do not have to be diagnosed with AIDS to receive this assistance, and case managers can assist with completing the paperwork.

As we remember those who have passed, those that lived in a time with fewer treatments, resources, and education about HIV, we can honor them by enjoying the lives that we are living!

If we know that we are infected, we can get treatment, which means a longer, healthier life (a normal life span) and prevents transmission to others.

If we are at an increased risk of becoming infected, we can seek PrEP in order to reduce the chance of becoming infected with HIV, thus, keeping anyone else from becoming infected.

If we are simply curious to see if this infection could be in our bodies and not causing symptoms, we can get tested for free.

Let’s look forward to a time in the near future when there will be no new infections, and “AIDS” disappears from our vocabulary and our world.

Posted in Uncategorized, USA | Leave a comment

Cohen Talks HIV Prevention, Learning Rules of Emerging Infections during China Visit

UNC professors Gail Henderson and Myron Cohen (center, front) working in China, c. 1980.

UNC professors Gail Henderson and Myron Cohen (center, front) working in China, c. 1980.

Our Director Myron Cohen, MD, began his research career in China more than 30 years ago. Although based in Chapel Hill now, he visits China annually and talks regularly with UNC Project-China Director Joseph Tucker, MD, PhD. In this blog post, Dr. Tucker and colleagues at UNC Project-China recount Dr. Cohen’s visit to the region in October 2016 during which he presented in three cities and was the keynote speaker of China’s National Conference on HIV/AIDS.

Guangdong Provincial STD Control Center in Guangzhou
By Alice Zhang, BS, UNC Doris Duke Fellow (2016-2017)
Dr. Cohen delivered a lecture at the Guangdong Provincial STD Control Center in Guangzhou on Oct. 25. His lecture focused on the ethical challenges encountered during the HIV Prevention Trials Network (HPTN) 052 trial, of which he was principal investigator. This multinational randomized clinical trial demonstrated the concept of “treatment as prevention” and resulted in the 2015 World Health Organization recommendations that antiretroviral treatment be offered to all people living with HIV (PLHIV), regardless of CD4+ count. During his Guangzhou visit, Dr. Cohen also visited the Number Eight People’s Hospital, which is a key infectious diseases hospital that treats the most people living with HIV in southern China.

From L to R: Shinaya Wong (Executive Assistant to Chairman Wang), Dr. Kumi Smith (UNC postdoctoral fellow), Weiming Tang (UNC Assistant Professor), Fazheng Group Chairman Guangfa Wang, Cohen, Fazheng Group Chief Executive Officer Jun Pan, Joseph D. Tucker (UNC Project-China Director), and Larry Han (UNC alumni and Schwarzmann Scholar).

From L to R: Shinaya Wong (Executive Assistant to Chairman Wang), Dr. Kumi Smith (UNC postdoctoral fellow), Weiming Tang (UNC Assistant Professor), Fazheng Group Chairman Guangfa Wang, Cohen, Fazheng Group Chief Executive Officer Jun Pan, Joseph D. Tucker (UNC Project-China Director), and Larry Han (UNC alumni and Schwarzmann Scholar).

National Conference on HIV/AIDS in Chengdu
By Kumi Smith, PhD, UJMT Fogarty Global Health Postdoctoral Fellow
Next, Dr. Cohen traveled to Chengdu to participate in the 2016 Chinese National Conference on HIV/AIDS as the keynote speaker. Addressing an audience of over 2,000, Dr. Cohen described the trajectory of HIV/AIDS research to date, and provided insights into future directions of inquiry in the areas of prevention, treatment and cure. Participants were made up of experts across many fields of HIV/AIDS research – from microbiology and immunology, clinical care, behavioral research, and epidemiology – and hailed from across China’s 31 provinces and autonomous regions as well as several international countries.

Stanford Center at Peking University in Beijing
By Joseph Tucker, MD, PhD, Director of UNC Project China
Dr. Cohen gave a seminar-style talk on Oct. 28, to the Stanford Center at Peking University. His talk there was for undergraduates, graduate students and faculty at Stanford’s Center. The center is the university’s hub for faculty and students engaged in research, teaching, training and outreach activities in China. Dr. Cohen was hosted by Jean C. Oi, MA, PhD, the William Haas Professor in Chinese Politics, and Andrew Walder, PhD, the Denise O’Leary & Kent Thiry Professor at the School of Humanities and Sciences. Dr. Cohen has known these two China experts since they trained together at the University of Michigan, and were all some of the first U.S. visitors to China during the post-reform period.

Dr. Cohen talks about the rules to fighting infections during the Lancet-CAMS health summit.

Dr. Cohen talks about the rules to fighting infections during the Lancet-CAMS health summit.

Lancet-CAMS in Beijing
By Weiming Tang, PhD, MD, MS, Assistant Director of UNC Project-China
As a keynote speaker for Lancet-Chinese Academy of Medical Sciences (CAMS) health summit, Dr. Cohen was invited to give a talk on “fighting infections” to an audience of about 500 people in different fields of medical research in China. Dr. Cohen mentioned that the number one thing we need to fight against infections is to know the rule of the infections. He briefly mentioned how we use these rules to deal with new emerging infectious diseases such as SARS and Zika in recent years. Take AIDS prevention and control as an example, he introduced what researches have been learning about the different stages of HIV transmission by studying people who are unexposed, exposed (precoital/coital), exposed (postcoital) and infected.

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Zika in Nicaragua: Racing to Understand the Unknown

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow at UNC and is studying Zika virus in Nicaragua.

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow at UNC and is studying Zika virus in Nicaragua.

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow in the Division of Infectious Diseases at the UNC School of Medicine. He is working with collaborators across UNC as well as colleagues in Leόn, Nicaragua, to define the epidemiology of Zika virus as it emerges in Nicaragua. A large portion of these studies are designed to answer questions surrounding the risk for in-utero transmission and adverse birth outcomes resulting from Zika infections in pregnant women. He traveled to Nicaragua in March and August of 2016. Below he shares the questions left to answer and why there is cause for optimism.

I woke up one morning in early March to a pleasantly warm tropical sun (read: hotter than 75○F at sunrise on the way to 97○F). After a breakfast of beans, plantains, and pineapple juice, I found myself at a small, wooden classroom desk. I was served potent indigenous coffee in a black mug bearing the unmistakable Playboy bunny icon, and scholarly men began to discuss with us in Spanish. . . what else? SEMEN. Semen and its role as a vehicle for transmission of viral infections. What the heck is going on and how did I get here?

It was March 2016, and a few weeks earlier, World Health Organization Director-General Margaret Chan had declared that the emerging Zika virus epidemic in Latin America was a public health emergency. We had come to León, Nicaragua, to meet collaborators and discuss the role our respective institutions may play in the international response to Zika.

A poster from the Ministry of Health in Nicaragua reminds residents to do their part to curb mosquito breeding, saying "prevention is in your hands."

A poster from the Ministry of Health in Nicaragua reminds residents to do their part to curb mosquito breeding, saying “prevention is in your hands.”

I sipped my scandalous café con leche and blinked hard. This was real, and I thought to myself, “I can do this job.”

Living the dream. It’s poor fodder for personal statements, but I never really dreamed of becoming a physician-scientist. Meeting several young, aspiring doctors and principal investigators on UNC’s campus reminds me what a privilege it is to partner with the sick or susceptible in improving their health, to identify critical questions and to set about building answers. It’s a mixed bag with Zika work. None of us hopes for tragedy or global health crisis, for such scourges to be disproportionately visited upon disadvantaged portions of the population as so often happens. But, as clinicians and researchers, we do find satisfaction in demand for our particular training and skills, and we typically seek to work on problems that pique our intellectual interest as well as offer some benefit to society. Immunology, foreign language, infectious diseases, travel – the focus of my fellowship is conveniently unfolding as an amalgam of my personal and professional interests. I love going to work (almost) every day, being around smart and caring people, and feeling like part of a team with a worthy mission. It is sometimes as if I’m living a dream.

However, the Zika epidemic is a nightmare for so many, particularly women of childbearing age – the burden placed on them and their partners cannot be overstated.

There had not been much Zika reported in Nicaragua yet prior to our initial visit in March, but it was definitely coming if not there already. By the time of our second trip at the beginning of August, hundreds of cases were known, including many in pregnant women, though no adverse fetal outcomes or Guillain-Barré syndrome, a neurological disorder, had been announced. The virus itself is not that scary on the surface, less severe than the common cold in the majority of cases – but the exceptions have come to define the epidemic, and it is the unknown that is always especially problematic for our race. Only a minority of infected individuals manifest any symptoms, a short-lived itchy rash, fever, and/or eye irritation. A smaller fraction still suffers the most concerning sequelae: neurologic conditions such as Guillain-Barré syndrome and birth defects like microcephaly. Why does it only happen to certain people? How often is a developing fetus affected when the mom is infected by Zika? What are the risk factors? All of these remain unclear.

consulta externa

The entrance to HEODRA Teaching Hospital in León, Nicaragua. The hospital is affiliated with the medical school at UNAN-León, UNC’s partner in Zika research.

Despite the gravity of the situation, there is also cause for encouragement. Researchers around the globe have begun to fill in large gaps in our understanding of Zika virus. At UNC, one can find movement on many fronts: basic virology, translational immunology, ethics, epidemiology, pathogenesis, pharmacology, and more. Our partners in Nicaragua are bringing their own insight, expertise and leadership to the greater effort.

As we left León, there were many banners celebrating Nicaragua’s national poet Ruben Dario, who famously wrote “you are a universe of universes, and your soul a fount of songs.“ There are so many possibilities. We may contribute to the development of a field-ready serodiagnostic, or discover a chink in the virus that can be targeted therapeutically. Ultimately, Zika is the current example in a pattern of emerging pathogens in an increasingly urbanized planet, and approaching Zika in a way that enhances systems for managing the spread of novel infectious diseases will only help for the next time around. Regardless, I’m happy join many at UNC, UNAN-León, and elsewhere to invest in meaningful and much-needed work. Hopefully the epidemic will be curbed, and those affected or at risk can more readily realize, all the worlds they are.

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International AIDS Conference Reveals Faces of HIV

Angela Wahl, PhD

Angela Wahl, PhD

Angela Wahl, PhD, is a Research Assistant Professor in the Division of Infectious Diseases at the UNC School of Medicine. She specializes in HIV research. She attended the International AIDS Society meeting in Durban, South Africa, in July and shares her reflections of the conference.

As a basic scientist in the HIV field, I am fully aware that young women living in resource poor countries like South Africa are at the center of the HIV epidemic. In sub-Saharan Africa, over half of all HIV-infected individuals are women and HIV/AIDS is the leading cause of death in young women. Young women in South Africa are particularly susceptible to HIV infection due to culture and gender inequalities. While I often cite these facts in manuscripts and grants, it’s not my everyday reality. I have been privileged to grow up and live in the United States, a country with laws that protect the rights of women and a culture that, for the most part, tries to treat women equally. For me, attending the International AIDS Society (IAS) AIDS 2016 conference in Durban, South Africa, this year was not only an opportunity to present my research, it was an opportunity to learn more about the young women that are at the forefront of the HIV epidemic.

IAS AIDS conferences are unlike any other conferences that I have attended. Usually the most provocative moments at conferences involve presentations of controversial data but at IAS AIDS conferences it’s not uncommon for protesters to take over the stage. This year, I was particularly struck by a group of young African women that took the stage as the Minister of Health of South Africa began to introduce a speaker. Their goal was to draw attention to the alarming number of young girls in South Africa that miss school every week because they don’t have access to sanitary napkins. In addition, they demanded increased access to condoms to help prevent the spread of HIV to young women. Another morning I sat in a large room with thousands of other conference attendees and when the speaker asked those who are taking antiretrovirals in the audience to raise their hand, both women sitting on either side of me raised their hands with tears in their eyes.

Protesters at the International AIDS Society meeting in Durban, South Africa.

Protesters at the International AIDS Society meeting in Durban, South Africa.

The concern for the young women of South Africa and their increased susceptibility to HIV infection was not lost outside of the conference center. After learning that I was attending the AIDS conference, my taxi driver explained to me how wealthier older men in Durban pressure young women into having condom-less sex after buying them gifts. This scenario was supported by data presented at the conference which revealed that young African women tend to acquire HIV from middle age men. He also told me about the young women from rural areas who move to large cities like Durban to become sex workers so that they can help feed their families back home.

Although this isn’t the first AIDS conference that I have attended, this year’s conference in Durban truly gave me a face for the HIV epidemic for the first time. It also gave me hope after seeing that there are young women in South Africa who are defying cultural norms and demanding reform that will help empower women to end the cycle of HIV infection and after meeting men who recognize the particular vulnerability of young African women to HIV.

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