Course Summary

I am really glad I took this course and I believe that all students should take it. Because STI's are so prevalent in younger populations, young people such as college students should educate themselves to prevent the spread of STI's and other diseases so that they can remain healthy. It would be great if this subject material were covered more thoroughly in high schools as well so that by the time students get to college, where they are likely to become sexually active, they are aware of the health risks and can protect themselves better.
Some of the best information I received in this class was the statistical information on STI's. I was really shocked to learn that 3 out of 4 people will contract a form of HPV at some point. I was glad to see so much information on the various methods of prophylactics available and also information about resources on campus and in the community to obtain sexual healthcare. I would have liked to see more information about government funding for prevention and treatment of STI's, particularly through Planned Parenthood, which is a resource many young people use throughout the country. It would have been very interesting to incorporate information on how politics has influences such funding has changed throughout the years.

Bob Skinner's Lecture

Bob's lecture on his experiences with AIDS was very interesting and I was suprised at the high cost of the drugs necessary to treat AIDS. He said that the antiretroviral medications can cost thousands of dollars every month. This seems very high and is obviously out of reach of most patients. I learned that Medicaid and Medicare programs help cover the costs of such drugs but that most insurance companies do not.
I had hoped to learn more about Bob's personal experience with HIV/AIDS, such as how his family and friends reacted to his diagnosis and what kind of support he has found in the community. However, Bob focused his talk more on the politics of AIDS.
I think Bob's experience of living with AIDS is probably very different from most people dealing with the disease because unlike many people worldwide, he has had access to drugs which have extended his life and a network of community support for his condition. Most people worldwide, however, live with life-altering stigma and fear of those around them and do not have access to decent healthcare.
Bob talked about how HIV is transmitted mainly via hetersexual intercourse in rural regions and how the rights of women in many rural communities limit the prevention of this transmission route. Living in such rural areas also makes access to quality healthcare difficult, especially when finances and transportation are limited.

SIV/HIV Transmission to Humans

The history of a disease can provide valuable information for those trying to prevent or cure it, so I believe it is important to know where a disease came from, how it has changed over time, and the methods of transmission associated with it. By knowing these things, researchers will be able to have another piece of the puzzle with which they can form a more complete picture of how the disease interacts with our immune systems and how it can be stopped.
The theories presented for the possible transmission routes for SIV to humans (which then developed into HIV) are very interesting, but I think that the "hunter" theory probably is the most plausible. This theory postulates that chimpanzee SIV was passed to bushmeat hunters in Africa by either ingesting the infected chimpanzee meat or by accidentally getting infected chimpanzee blood on an open wound. Chimpanzee SIV then mutated in the new human hosts and became HIV. This theory makes sense to me because we know how HIV mutates and how similar it is to strains of SIV. The other theories in our reading focused on the spread of HIV rather than the development of it, except for the "conspiracy theory" which seems really ridiculous to me from a biological viewpoint.
Of the theories on the spread of HIV, I believe the contaminated needle theory is plausible as it is entirely possible that needles were reused, especially at that time in history before the widespread fear of contaminated needles became a reality. The oral polio vaccine theory seems unlikely because of the counterarguments described in the reading (macaque monkey instead of chimpanzee, the virus-killing acid in the stomach, and the appearance of HIV prior to the OPV trials).

The Knapsack

In her article, "White Privilege: Unpacking the Invisible Knapsack", Peggy McIntosh describes the unconscious domination over others that supports an oppressive system of power, felt and understood uniquely by those it oppresses, while those in positions of dominance remain ignorant of their privileged status. While she notes that this unconscious dominance is evident in the various privileges that some are able to enjoy, mainly white people in comparison to people of color, she also points out that men enjoy a disproportionate amount of domination over women, regardless of skin color.
I agree with most of the author's points and feel that she did a great job of summarizing the privileges that white people take for granted. I was especially glad to see the list of privileges, many of which I had never thought of before, which only proves her point - that we are so unaware of our privileges and the systemic ways in which privileges are conferred. Reading her article, I couldn't help but wonder what could be done to change this system, with the end result being that people of all color are comfortable in our society and are incorporated into it so thoroughly that skin color becomes as irrelevant as hair color. McIntosh's only suggestion is to become more aware of unearned privileges, but does not offer us anything else to answer my question. I agree that if all white men in the world realized they weren't entitled to their unearned power that the world would be a better place for everyone else, but how do we as a society go about deconstructing a system which reinforces domination based on appearances and the need for superiority over others?
Privilege in regards to the spread of diseases is obvious to me. Why are so many people with HIV/AIDS in developing countries having to go without antiretroviral drugs while we here in privileged America can expect them? Why are black women more likely to die from cervical and breast cancer than white women? Because of unequal access to healthcare and health information. Even within the U.S., we saw in class the charts showing the distribution of various STI's, with the highest proportion often being in the Southern states where the largest proportion of African Americans live.
I think larger systems of oppression should be addressed when talking about sexual health because these systems are barriers to sexual health. Understanding how such systems affect access to healthcare and health information will help public health officials understand how to improve the health of communities that are oppressed because of their race, sex, class, or some other social marker.

HIV/AIDS

Most of what I know about HIV/AIDS has come from sex education in school and from the media. I feel that I have a pretty good understanding of how the disease progresses, it's effects on the immune system, transmission routes, the social implications of the disease, and research efforts to find a cure. However, I was suprised to learn from the video on Wednesday that the most common rate of transmission is found in cases of hetersexual relationships, where married women are the fastest-growing group of people to acquire the disease. It is very unfortunate that they most often acquire the disease from their husbands.
I am very interested to learn about the cultural and social implications of the disease, in America and in other countries. As an anthropology student, it is very interesting to me to see how diseases influence and are influenced by culture, politics, economics, women's rights, and the media. I would also like to learn more about research efforts and the allocation of research funds throughout the various political administrations since the disease was first diagnosed. I would also like to learn more about international cooperative efforts to combat the disease, such as the International AIDS Society (http://www.iasociety.org/).

Global Disparity

From what I have learned in class and from readings, I believe that socioeconomic status is the most influential factor in the spread of diseases like STIs. A person's ability to protect their own safety and to acquire medical care is directly related to their income and class. For example, women in Sub-Saharan Africa are more at risk of acquiring AIDS because they often do not have the power to demand condom use from their partners or to seek the healthcare they need. In many low-income coutnries, healthcare is very limited and difficult to obtain, again placing those with a low socioeconomic status at a serious disadvantage. From the videos we have watched in class and from the textbook, it seems like the best way to combat the spread of STIs and other diseases is to reduce poverty and empower women, thereby raising individuals' socioeconomic status and thus their ability to protect themselves and improve their access to necessary healthcare.
As an American, I think it is difficult for us to imagine living in a world in which high-quality healthcare is not readily available. I think that as Americans, we tend to make ethnocentric judments about people from other countries and the diseases they are burdened with, without considering the reality of socioeconomic disparity. The relatively low cost of vaccines and prophylactics here in America is often unimaginably expensive for much of the rest of the world. Here in America, we hardly ever hear about diseases related to poor sanitary conditions or unsafe drinking water, let alone rampant STIs that have vaccines and treatments. The rest of the world is not so lucky, especially those living in Sub-Saharan Africa and Southeast Asia, where the highest disease burdens are found. It bothered me to hear in Wednesday's video about perceptions of AIDS victims in Africa being "sexually promiscuous" because it is such a hypocritical, baseless judgement, especially when considering that many of those victims acquired the disease in-utero.
Problems associated with global disparities cannot be solved by just handing out condoms and vaccines. Issues of women's rights and high rates of poverty must also be addressed. Only through a comprehensive, cooperative approach to global disparity will solutions be found.

STD Ad Campaign

These pictures are from a Canadian ad campaign which displays images of bacteria and viruses with gift tags attached.
I think this is a very interesting series of ads, and I think its effectiveness lies in its simplicity. They are accurate in that each image represents what each STD looks like at the cellular level, and I commend the creators for not adding goriness where non was needed. I'm not sure who the ads are targeting, but I think they would be effective for any age group that understood what they were looking at.

Clinton's Tuskegee Apology

The artical for this week's blog concerned the public apology offered to the unwilling participants of the Tuskegee Syphillis study and the greater African American community. This apology was necessary because of the dishonest and extremely unethical treatment of poor African Americans over a period of 40 years to study the effects of untreated syphillis, despite the availability of treatment.

Mr. Clinton made several very good points regarding the impropriety of the study itself, as well as the irresponsibility of the government officials and health care providers involved. I felt that it was very good that Mr. Clinton not only for the study itself, but also for the long wait for an apology. He mentioned the loss of faith by the African American community in our government and the consequential loss of participation and trust in the healthcare system as a whole. He also expressed the importance of remembering such unfortunate events in our country's history.

However, I feel that Mr. Clinton fell short of providing truly effective policies relevant to African Americans that could have repaired their trust of our government. A memorial in Tuskegee is great, but there was only a vague reference to "increasing community involvement" to restore trust and encourage minority involvement in medical research in a positive way. Increasing research training in bioethics is of course welcomed, but that is only a preventive measure to ensure that such a study does not take place again. These steps proposed by Mr. Clinton were very good ideas, but I feel that he could have done more to take responsibility for the government's actions. For example, I think he should have brought the doctors and other individuals responsible for this study to justice. I believe it also would have been very effective to extend the charter for the National Bioethics Advisory Commission indefinitely to ensure effective oversight and ethical practices in all human-subject research studies and projects.

MDR-TB Cases in United States

According to the podcast issued by the CDC regarding Multi-Drug Resistant Tuberculosis (MDR-TB), there are around 9 million cases reported annually worldwide and 130,000 deaths each year. The CDC officials discussed a recent importation of the disease, carried by Thai immigrants, despite pre-departure screening for TB in Thailand. Considering that drug-resistance is a call for alarm by itself as it erodes our ability to fight diseases, MDR-TB is especially alarming as this disease can be transmitted from person to person via breathing, allowing it to spread quickly. Furthermore, if one has a weakened immune system due to an illness or coinfection such as HIV-AIDS, the body's ability to fight off infection is even weaker than normal and MDR-TB could easily be fatal. In these cases, the increased duration of treatment and increased toxicity of the medications required to treat MDR-TB may further exacerbate the negative impact of any concurrent illnesses or infections.

An interesting point that was discussed on the podcast was the fact that misuse and/or mismanagement of antibiotics has promoted the development of drug-resistant strains of bacteria, including that which causes MDR-TB. Dr. Oldman discussed this misuse in foreign countries such as Thailand, but failed to mention that misuse and mismanagement can and does happen here in the U.S. as well. I know of many people who have been given antibiotics by a doctor and either not completed the scheduled regimen or have saved the pills for another time, when they would self-diagnose an illness, such as the flu, and mistakenly believed that the antibiotics would heal them. This is how bacteria develop resistance to our medical weaponry and pose such an enormous health threat worldwide, as MDR-TB now does.

So should we be worried about MDR-TB? Of course, but I believe it is a mistake to only look outside the US for the source of this disease or believe that we here in the U.S. are not equally capable of misusing and mismanaging our own antibiotics.