I like how it was done (high level genetic analysis) and I like the potential of using GIS to track not only endemic diseases (such as malaria) but also contagious diseases. I think a similar map in Africa would be equally impressive–showing the spread of HIV through truck drivers or other highly transient populations.

[Image courtesy of The Shane H via Flickr.]

Recent news reports have cited a link between HIV and tuberculosis–the statistic often thrown around is that one in four TB deaths is due to HIV. While this is not new scientific fact, it is important and worthy of media attention.

However, the reason for this post is that it’s also a good example of a syndemic. Syndemic research focuses on two simultaneous epidemics within a population, which create even greater negative health outcomes than the sum of the individual parts alone. In this case, it is HIV and TB. However, syndemic theory reaches much further than opportunistic infections. Some research has been done on the interplay between substance abuse, violence, and AIDS (SAVA theory). Other research has found a reciprocal and self-perpetuating link between depression and malnutrition. Even the HIV-TB link has been associated with increased violence. Stress and obesity have also been linked. The list goes on and on, but the point is the same–problems (and solutions) are almost always much more complicated than we would like to think.

While I’m still pretty new to syndemic theory as a research tool, this idea of the complex interaction of various factors and additive risk is not new to me. In fact, it was this aspect of poverty and inequality that sparked my interest in public health. During one of my favorite undergrad courses, we had to read Development as Freedom. After that, I was hooked on Amartya Sen’s works and other books on development economics. In these books, the authors often described the nuanced interplay of social factors on poverty. Right now, I’m working with a research center at NYU that is about to launch into a study on HIV/AIDS in New York City using syndemic theory as the main framework. I’m also going to be running my own experiment in South Africa and am hoping to implement a bit of syndemics theory in that one as well.

Basic cause-effect reasoning of previous public health problems will soon be a thing of the past. Truly effective social/behavioral-based public health interventions have to take a more holistic approach. We’re going to have to start factoring in that thing called “life”.

The supporters of the bill say that decriminalization would improve the safety and health of sex workers by allowing them to come forward to the police with complaints of rape or assault without fear. The opponents say the measure would increase crime and allow the already problematic human trafficking in San Francisco to explode.

While I won’t get into the details of the bill or my own personal opinion, it certainly shows the moral dilemmas one might face in public health. Does your moral stance against prostitution outweigh your moral stance against abuse and assault? Do the sex workers “deserve” to get assaulted if they are doing something illegal? Are you more interested in the health of the population or the perpetuation of your personal morals?

What I found most intriguing is the Swedish model of prostution enforcemet. In 1999, Sweden passed the “Sex Purchase Law”, which effectively makes the sale of sex legal but the purchase of sex illegal. This allows the sex worker to come forward, report crimes, receive proper medical attention, and more accurately portrays the sex workers as a victim. Originally mocked, the law has seen a recent surge of interest. It’s hard to gauge the effectiveness of the law as the drop in prostitution may just be the result of pushing it underground.

It’d be interesting to do a formal study about the health of the sex workers, sexual health of the general Swedish population, and rate of prostitution. If anybody knows of one, I’d like to know about it.

[Image by gwalton1 via Flickr.]

AIDS has already killed more Americans than the combined total of combat deaths in World War I, World War II, Korea, and Vietnam. Despite treatment advances, the deaths keep coming. In 2006, the most recent year with good records, we lost 14,627 of our fellow citizens to this terrible disease.

And the scary part is: he is not wrong. In fact, it has gotten so bad in the US that if African-Americans were there own country, they would rank 16th in the world in the number of people living with AIDS according to a new article. This administration has tried and given plenty to countries abroad while ignoring the huge HIV problem at home. As Pollack says, “Our next President will inherit a badly deteriorated public health system.”

In general terms of HIV prevention, we are in bad shape. The article by Pollack is definitely worth a read. He also has an article in The New Republic which is more technical and verbose but equally engaging. Particularly this part:

… in 1985, President Reagan made his first speech on AIDS. Health authorities proposed that he say the following: “As far as our best scientists have been able to determine, AIDS virus is not spread through casual or routine contact.” These words were redacted by a young White House aide, future Chief Justice John Roberts. This story stings, not just because Roberts was wrong, but because the public health community was so casually over-ruled by a well-placed young lawyer who knew nothing about AIDS.

Since the beginning of public health as a governmental institution, politicians, lawyers, advisers and those with little to no medical knowledge have had overwhelming powers in determining law.

If HIV prevention, or any public health issue, is going to be seriously addressed, there needs to be serious reform within the government–here’s to hoping for something new in the coming election.

[Image mine.]

More than 100,000 people live in New York City with HIV and thousands more are unaware they carry the disease. There are more AIDS cases in NYC than in Los Angeles, San Francisco, Miami and Washington DC combined. There is also a large disparity; the brunt of the burden — 80% — is taken on by African-American and Latino populations. HIV is spreading in New York at three times the national average

That’s the bad news. However, it is even worse than we thought. In a story by the NYTimes, a new formula developed by the CDC estimates that 4,762 New Yorkers contracted HIV in 2006.

Because this was a new method of estimating, it is difficult to tell the direction of the trend. What is evident, however, is the social and geographical disparities. Though the rate of white males contracting HIV in New York is 4 times greater than the national average, the raw numbers show almost 80% of new infections are from black and Latinos. to combat AIDS has never worked for us domestically and why he believes it would ever work for other nations is beyond me. The simple fact of the matter is that certain issues of public health cannot be looked at on a international or even national scale. Certainly, the numbers show that HIV is one of those things. Even within the city, the data obviously shows points of particular interest — where educational programs, advertisements, awareness campaigns, etc — would be most effective and which demographics to target. What we need is legislation and funding free of strings and constraints and local nonprofits to run targeted and concentrated campaigns.

[Image is mine and under CC license.]