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 Adamson Munthali and Mwelura Harawa.

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

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

Karine Dubé, PhD, 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

ClaireFarel

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
www.med.unc.edu/infdis/clinical-care/infectious-diseases-clinic

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.

Posted in Asia, China | Leave a comment

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.

Posted in Nicaragua, Research | Leave a comment

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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Confidential Partner Notification

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 confidential partner notification for Adam4Adam, an online dating website designed for men to meet other men.

I wanted to say “Hello” and introduce myself to The Community.

My name is Steve and I have worked in public health for almost 16 years.

I am a Disease Intervention Specialist (DIS) in Raleigh, NC. Other states have DIS, and other states may refer to their DIS as CDS (Communicable Disease Specialists), PHAs (Public Health Advisors), or PHRs (Public Health Representatives). A running joke is that we are the “Sex Police.” I hope I can convince you that we are not.

When I applied for this job, I did not know that this job existed. I was not surprised, as I understood the need for the job. The job description mentioned educating people about STDs and drawing blood. I figured since my degree was in education and I had learned how to draw blood on dogs and cats (during my time as a veterinary technician) that I could do this job.

The job centers around confidential partner notification, that is, notifying individuals of their exposure to Syphilis and HIV, though some DIS also do confidential partner notification for Gonorrhea and Chlamydia exposures. You may see partner notification referred to as “partner services” or “contact tracing” within the literature.

The way the process works is when someone tests positive for an STD/STI (Sexually Transmitted Infection is the more modern term for Sexually Transmitted Disease), a DIS meets with them to ensure that they received adequate treatment for the infection, to answer any questions about the infection, and to ensure that the sex and needle sharing partners of the person are informed about the exposure, since one of the partners transmitted the infection to the person with the infection, and the person with the infection may have unknowingly transmitted the infection to their partner(s).

Some believe the person that tested positive for the infection has a moral and ethical obligation as a human being to inform their partner(s) about the exposure. Others believe that we are all responsible for ourselves and that the assumption is we are aware of what could happen as it relates to our health following a sexual encounter. Feel free to read a detailed discussion about this topic.

There are three ways in which partner notification may occur. The first way is when the person that has the STI informs their partner themselves. A partner may be more likely to get tested following an exposure if the person with the STI informs their partner. The DIS in this case makes a cooperative effort to ensure that the partner receives adequate testing and treatment depending upon the type of exposure based on CDC Guidelines.

The second way is when the person that has the STI prefers that the DIS informs the partner of the exposure, confidentially. This means that the DIS cannot tell the partner who gave them the partner’s identifying and locating information. People who test positive for STIs often feel embarrassed or guilty when they have been diagnosed with an STI. To preserve their anonymity, they choose not to inform the partner themselves but still understand that the partner should know about their exposure and have an opportunity to receive free testing and treatment following the exposure.

The third way is when the person that tested positive for the STI meets with their partner and the DIS together. The person or the DIS can inform the partner about the exposure, and the DIS can be on hand to answer any questions the partner may have about the infection or exposure. The DIS may also be able to offer testing immediately, on the spot, to the partner, or transport the partner to a health department or clinic for testing and treatment whenever necessary.

DIS acknowledge that there are times when people do not know the names of their partners, or may only know a screen name for their partner. Since 1999, certain states and areas across the US have decided to try and reach those partners as well. Adam4Adam.com was one of the first sites to devote profiles to Health Counselors (some of which are DIS) for this purpose.

In closing, I hope that I have been successful in convincing you that DIS are not “Sex Police.” We understand that infections are transmitted when people have sex (even when they are using protection). DIS realize that we must not focus on “who gave it to who,” rather, the health and well-being of everyone within The Community.

For free, confidential testing near you, click here.

For HIV care and related services, click here.

Be well.

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Blog: Semester Abroad Allows UNC Junior to Launch Social Media Health Campaigns in London

Ben Lineberger is a junior at UNC majoring in journalism and public relations. He is also a web consultant for UNC’s IGHID. This past fall semester, Ben studied in London and interned with National AIDS Trust or NAT. NAT is the United Kingdom’s leading charity dedicated to transforming society’s response to HIV through fresh thinking, expertise and practical resources. Ben spent the semester working with NAT on a number of educational campaigns, including having a kissing Booth in Soho Square on Dec. 1 for World AIDS Day in response to NAT research that shows 16 percent of people wrongly think you can get HIV from kissing, up from 4 percent 10 years ago. Below, Ben shares his thoughts on how far the UK has come in HIV prevention and treatment and where it still needs to focus.

During my time interning at NAT (National AIDS Trust) in London, I’ve learned so much about the whole HIV sector and seen a glimpse of what it’s like to live with HIV. I’ve been the communications intern at NAT this past semester and the whole experience has taught me more than I ever expected. I’ve not only gotten to do more for an organization in just a few months than I have in any previous internship, but as an intern I’ve participated in meetings with top ad and PR agencies, helped build a campaign, and performed research that’s informed our press releases and blogs. But what I’ve been most surprised by is how wrapped up in the fight against HIV and HIV stigma I’ve become. Here’s a bit about what I’ve learned about HIV in the UK:

UNC Journalism and Public Relations Major Ben Lineberger, third from right, with NAT staff and volunteers at a fundraising event on Bonfire Night in London.

UNC Journalism and Public Relations Major Ben Lineberger, third from right, with NAT staff and volunteers at a fundraising event on Bonfire Night in London.

Quality of life with HIV in the UK has seen marginal improvements in the past few years. Though it’s come quite a ways from the 1980s and 90s, there’s still a lot of work to do in terms of making life better for people living with HIV. In regards to social climate and public attitude toward HIV, though there have been recent improvements in policies concerning healthcare workers with HIV, a stigma still exists that makes it hard for folks to be open about their status. People face misunderstanding about their status, with a lot of people still thinking they can get it from kissing or sharing food. In addition, only recently have healthcare workers with HIV been able to perform exposure-prone procedures provided they’re on treatment. This policy is actually safer for patients, as undiagnosed HIV is actually more dangerous than when someone knows they have it and are on treatment. Discrimination, both overt and subtle, minimizes HIV as a serious issue and makes it difficult for people to get the facts about transmission and sexual health. This contributes to the growing problem of late diagnoses, as last year saw 40 percent of adults diagnosed at a late stage, after treatment should have begun. And with 72 percent of new diagnoses last year being among gay and bisexual men and black African heterosexuals, it’s evident that both prevention and testing efforts must be ramped up in the UK.

Clinically, more efforts must be made to strengthen prevention measures. PrEP, which stands for pre-exposure prophylaxis, has been found to almost always be effective at preventing uninfected individuals from contracting HIV if taken correctly. But in the UK, it’s unavailable on the National Health Service (NHS), which means almost no one can get it unless they have enough money to order it from overseas. Though treatment for those who already have HIV is made widely available in the form of ART (antiretroviral therapy), there is still a serious problem with the way HIV prevention care is managed, as the NHS is essentially failing those most at risk of contraction.

Another side of the issue with HIV care in the UK is lack of knowledge, stemming not only from discrimination in society, but also from the way sexual health is taught in UK schools. The curriculum for sex and relationship education, or SRE, doesn’t include any compulsory lessons on same-sex relationships. This means young people who identify as anything other than heterosexual aren’t getting vital, reliable information about their bodies and sexual health, which is leading to ignorance surrounding HIV, not to mention other risks that come from sex. This is another type of prevention that the UK is failing to ensure is working properly, and can only be corrected if SRE is free from discrimination as well.

Ben participating in the social media component of NAT's World AIDS Day campaign #RethinkHIV by painting a red ribbon on his lips.

Ben participating in the social media component of NAT’s World AIDS Day campaign #RethinkHIV by painting a red ribbon on his lips.

Not all is going badly, however, as there are many HIV-related successes. The UK is world-leading on treatment, as anyone living with HIV can access ART for free on the NHS, meaning that there’s an extremely low death rate from HIV and people can manage their health and have full life expectancies. ART can also help people achieve undetectable viral loads, which enables them to have sex with their partner without risk, and to reproduce without risk of passing it on to their children as well. Additionally, as the population of people living with HIV is aging – one in four are over 50 – NAT has developed new guidance for healthcare workers. Unfortunately, some parts of the health care sector don’t have up-to-date information on HIV and how it’s transmitted, which can lead to discrimination and insensitive treatment for the aging population. The new guidelines advise on how to be receptive and judgement-free, as well as maintaining confidentiality. There have been a great number of improvements, but much more has to happen before people living with HIV have the best quality of life possible.

My experience at NAT has been especially educational because I’ve gotten to work alongside a brilliant policy team that helped the communications team be fully informed for all the decisions leading up to our campaign. Being updated on all the policy related to HIV has elevated my knowledge on the subject and helped me really understand all sides of the issue. I didn’t expect to be so moved by all the negative things said about people living with HIV, but once I realized how harmful the stigma still is I became really invested in fighting it. I’m lucky that I’ve gotten to be a part of a team that’s so focused on combatting unfair and uninformed stigma and discrimination, and I’m grateful that each part of the internship has taught me something. And though there are still faults in the UK’s policies and attitudes regarding HIV, London has been an amazing place to live and study for a semester and I’m really happy I got to be here.

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Students Reflect on Training with Top Faculty from the US and UK to Improve Sexual Health in China

Bill Miller, MD, PhD, MPH, leads a training in manuscript writing.

Bill Miller, MD, PhD, MPH, leads a training in manuscript writing.

Friday, Sept. 18, 2015
Jessica Mao is a medical student at UCLA, where she just completed her third year of medical school. She is spending a year in Guangzhou, China, as part of the Doris Duke International Clinical Research Fellowship to work with UNC Project-China under the direction of Joe Tucker, MD, PhD. She will spend her year working with the Social Entrepreneurship for Sexual Health (SESH) group promoting HIV prevention and awareness.

Today was the kickoff of our South China-UNC STI Training Course & Research Workshop (try saying that 10 times fast!) This event has several purposes: 1) to bring together the researchers in China with the mentors from the US and the UK 2) to provide some training for the Chinese researchers 3) learn about the research being conducted overseas and 4) to update the mentors regarding our progress and future directions.

We started out the morning with a session by two UNC librarians, Jennifer Walker and Mellanye Lackey, where we learned how to better search medical literature databases and how to use Endnote. You would think that after four years of college at Johns Hopkins and three years of medical school, I would know how to search a database, but I still picked up some useful tips and tricks that will make my life so much easier in the future. Speaking to some of my Chinese colleagues, it seems that they are not always taught how to search English databases, and have been muddling along as best they could. This session was immensely helpful for them. I only wish that there had been a similar session regarding searching Chinese databases! I suppose there though, my biggest hurdle is the fact that everything is in Chinese…

Our next session was an informative session by William Miller, MD, PhD, MPH, regarding manuscript writing. We went over the basics – what goes into the introduction, methods, results, and discussion sections. While this was a topic I know well, it made me happy to think about the scientific method that I had been learning since 4th grade (If I add vinegar and baking soda into a papier-mâché volcano, then it will explode).

We took a break for lunch and for a rest. In China, it is customary that the hours of 12-2 p.m. be taken as a rest. The majority of people will take a nap (not unlike a Spanish siesta) after eating lunch. As an American, this is new for me, but even if I do not sleep it is nice to just have some time for myself.

We continued on in the afternoon with more manuscript writing. In this session, we talked about actual writing style rather than just the content. We discussed common grammar mistakes, editing out unneeded words and phrases, and rules for clearer writing. I am fairly confident I have neglected several of these in writing this post, so my apologies Dr. Miller! This was then followed by some practice using an actual work-in-progress by members of our group here. While I like to think that I am not a bad writer, the truth is that my degree is in engineering and the last time I wrote anything literary was probably high school. This was a good chance to practice only writing skills in an interactive and engaging way.

All in all, day one of our workshop was a success. During an initial cursory glance through the schedule, I felt that many of the activities were more geared towards my Chinese co-workers rather than towards myself. I was pleasantly mistaken though, and I think this just goes to show that there is always something to learn and some way to better myself. My colleagues, too, found the workshop immensely useful for their work. Our thanks to the UNC librarians and Dr. Miller for their time!

Coming up next, day two of the conference!

Saturday, Sept. 19, 2015
Krystal Zhang is the research assistant from SESH RO1 research team. It has been six months since she came on board with SESH. She has been involved in the qualitative research on contest evaluation as well as helping out some of the SESH organizational work. Krystal came from a background of anthropology, which often offers the team some unique ways of seeing things. As one of the “seniors” in the team (some of the members just newly arrived), she is very proud of what SESH has been working for while eager to learn more from the experts in the workshop.

It is the 7th day of work in a row for some of us because we have been busy preparing for the SESH STD Workshop, which JUST started today! The morning session was kicked off with a series of amazing talks given by renowned public health professionals from China, UK and US. Myron Cohen, MD, the Associate Vice Chancellor of Global Health at UNC Chapel Hill, who has been working for China HIV/STD projects for years, gave a presentation on current HIV prevention and cure worldwide. He made a joke saying that he was recording for VOA special English by speaking very slowly, but clearly in order to make the lecture more approachable to the Chinese audience. We all broke into laughter because it did sound like an audio from VOA Special English Health Report. His idea about cures should serve as the fundamental way of preventing HIV really got me thinking: for the SESH team, our current goal is to cut the transmission through increasing condom use and screening. Does that mean we still have a long way to go?

Kevin Fenton, MD, is the Director of Health and Wellbeing at Public Health England.

Kevin Fenton, MD, is the Director of Health and Wellbeing at Public Health England.

Kevin Fenton, MD, is the last speaker in the morning session; however, I can resonate with his talk the most. In his talk, he showed us some of the methods that his team and other health care providers have been using, with the help of mobile apps. When I was still going to school in the UK, I noticed that the UK has an amazing National Health System (unfortunately the government has cut down the budget for health lately). Although Britain is a country that has a long history, they are really good at cultivating innovations and incorporating different sectors in the society. Dr. Fenton demonstrated some of the programs they have combining health and mobile apps, which was truly inspiring and intriguing. In his talk, I found out that the clinic Bupa at the corner of my apartment back then has opened their own mobile app to connect people you know and engage them in a healthy life style.

The SESH team would give presentations on our work for the afternoon session. We already gave presentations once for the World Health Organization TDR meeting two weeks ago, but in front of all these professors? I couldn’t help but feel nervous. Fortunately all the presentations went very well, during which intense, but thought-provoking discussions highlighted the event. It is genuinely lucky to have all the professors here to reflect on SESH’s previous work and explore potential projects with us. Having been involved in the condom contest and photo contest, we received some awesome ideas on how we could improve our contests from the perspective of the audience while the professors gave us comments based on a wider spectrum – the general public health. I hope with all this feedback our next contest will be even more successful!

It is the second day of the workshop, and I already miss everyone and the intense discussion!

Sunday, Sept. 20, 2015
Lulu Qin is a medical student at Case Western Reserve University, where she just completed her third year of medical school. She is spending a year in Guangzhou, China, as part of the Fulbright-Fogarty fellowship to investigate HIV self-testing under the direction of Joe Tucker MD, PhD.

JessicaMaoSESHConfCohenWEB

Joseph Tucker, MD, PhD, seated second from the left, leads UNC Project-China. Myron Cohen, MD, standing, is the Director of UNC’s Institute for Global Health & Infectious Diseases, and he first began working in China in 1989.

During the third and final day of the South China-UNC STI Training Course & Research Workshop, we saw presentations about various projects. First, from the SESH collaborators from the Shandong CDC (Wei Ma) introduced some SESH projects that were happening in their city, as well as hopes for the future with SESH’s research support. Their city is the site from which a marketing-derived (rather than crowdsourced) video about condom use was made. Conference attendees debated about their thoughts regarding the differences between a professional video and a crowdsourced video, will this new approach work?

Next, Professor Kevin Fenton from Public Health England presented his most recent project, Health X. As Director of Health of Wellbeing, Dr. Fenton is responsible for the design and delivery of national health and wellbeing programs – a hefty charge to say the least. Towards this end, he piloted a nationwide contest to create a mobile app that promotes public health – be it eating better, exercising, or managing chronic diseases. The ultimate winner, by a group called Fee Fi Fo Fit, was an app that promoted family’s to walk around the neighborhood together in search of certain landmarks that earned them rewards.

Finally, the morning ended with Dr. Joe Tucker providing an overview of SESH’s future directions. Namely, after pilot testing the concept of using crowdsourcing to create relevant public health messages, the next step would be to conduct randomized control trials to evaluate the effect of such an intervention. Conference attendees generated lots of feedback and discussion about how best to proceed next. The end goal is to create an efficacious and cost-effective tool that has the potential to have lasting impact on sexual health in China.

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