from WTF to talk of a cure in 30-ish years

Today I wrote a long post about HIV for my Global Heath class. I'm reposting it here because the links I found are great. I realized that one of the reasons why looking at the timeline of this disease is so interesting to me is that we are almost the same age--my life has run its course alongside much of the lifetime of HIV and it's amazing to me to see how this disease has progressed in our shared lifetime. 

My post was in response to a classmate of mine's posting of this article from The Telegrah that talks about the possibility of a cure in the next few years and already this year we've seen several stories in the news about a baby being "cured" and other people who's viral load is so low it's virtually non-existent. We've come along way fast. My health post is below.

It's amazing to me the medical and social progress that has happened around HIV since the early 1980s. 

In the 1990s, I was pretty heavily involved in an HIV/AIDS youth peer education program that the American Red Cross was piloting in a few areas around the country. Unfortunately, it never took off nationally, but I personally thought it was a great and effective preventative intervention. 

I was teaching not long after Magic Johnson announced that he was HIV positive and had directed a ton of his personal wealth to HIV research/education. Around that time, the HIV phenomenon was just coming out of the really, really dark days of the late 1980s and early 1990s when institutional and general public lack of knowledge and understanding about the biology of the disease as well as the social implications of the disease left everyone of a certain age or of various social groups feeling unanchored and that the act of loving someone or being lazy about condoms could mean death or severe illness. 

This was when the entertainment industry was maybe the most human I've seen it be in my lifetime and I'd highly recommend watching these movies and tv shows if you have time (like over the summer) to get a sense of how far we've come both medically and culturally in the discussion around HIV. It will be interesting to see how HIV as a disease is treated and how people who are HIV positive are treated in this country today versus how these were addressed in the 1980s and 1990s, and how addressed in other, developing countries, with different social and development contexts.

1. And The Band Played On -- HBO film about the early days of HIV and the social and medical responses to the disease. This was the first film I ever saw about HIV and it's heartbreaking and eye-opening. Watch the full film here: http://www.youtube.com/watch?v=DIHy4_31Db4
2. MTV's Real World: San Francisco (the first time) -- Pedro Zamora was the first openly HIV positive gay man to be featured on national television. The Real World television reality show was a totally different animal in its early days compared to what it turned into in its later years and Pedro and his story is one of the reasons why. I was talking to Sarah about Pedro's story a few weeks ago and it made me choke up just thinking about how important he was in changing a generation's perceptions of people with HIV specifically and maybe even people's empathy toward other diseases, racial or socio-economic differences, etc. (to relate it to today's lab). The entire season is available for viewing here: http://www.mtv.com/shows/realworld-season3/video.jhtml (ps there's also lots of other crazy, more typical "Real World" stuff that makes the show fun for summer viewing [esp. crazy Puck]... and, hello, the clothes! It was the '90s!!!). He was 22 when he died shortly after the final episode aired in 1994. MTV put together a tribute to Pedro: http://www.youtube.com/watch?v=KA4ZZImS4Qs.
3. Philadephia -- Probably the most famous of the HIV-story offerings. Tom Hanks won an Oscar for his performance in this film as an HIV positive man and watching the process that Denzel Washington's character (as Hanks' lawyer) goes through in terms of his personal beliefs about homosexuality, HIV, human rights, etc., is powerful. 

In the 1980s, it seemed like HIV was as contagious and deadly as ebola, so many people were dying. Then they figured out ARV therapy, but it was expensive.

In the 1990s, it seemed like affordable, accessible treatment would never arrive. Then it did and people across the developed and developing world were able to live with some measure of disease management, but it still seemed like an incurable disease--after all, illnesses that had been around for much longer and that are politically less sensitive still didn't have cures, why should HIV be any different?

In the 2000s, we've seen the costs and unwieldy aspect of HIV meds decrease considerably and in 2013 there has been a lot of talk around cures and vaccines--even if we're still 5+ years out from a "cure," it's still incredible to me the medical and social changes we've seen around this disease. Although it seems like a long time since HIV came on the scene, the character of the (medical/social) treatment around it has progressed, in my opinion, very quickly considering that we've seen significant changes/advances across countries and cultures in HIV-related personal behavior, personal perceptions, research, medicine, patient-doctor communication, education, etc. 

the world is watching us

Dear Boston and the rest of America, 

The world is watching us and how we handle our reactions to the events of this week. Please don't make this horrible week any worse than it has already been. The majority of Bostonians and Americans are open-minded, reasonable, kind, wonderful people--let's make sure the world sees this side of us.

The Post-Boston Islamophobic Hate Crimes Have Begun

"On Wednesday, a white man harassed and punched a Palestinian woman in Medford, Massachusetts, calling her a “terrorist” and blaming her for the deadly bombing attack at the Boston Marathon."

http://colorlines.com/archives/2013/04/the_post-boston_islamophobic_hate_crimes_have_begun.html

food rations in refugee camps in Mali... not as easy as a PB&J sandwich

I wrote a super long post for the Google group of my Global Health class, so I'm going to multitask my mulitsectoral writing by posting it here.

***********************************

This article from Stanford's B-school is all about the financing behind ready-to-use-foods (RUTFs) based on a Norwegian study just released that basically advocates an "all-or-nothing" approach to RUTF distribution. Apparently, the common practice for humanitarian relief agencies is to try to spread out the RUTFs they have as much as possible, meaning that many kids are not getting a full serving. The new study says that if relief workers are forced (by constrained resources) to practice a "triage" approach, they should target the kids "on deaths door" first and to give them full rations. The study says that, ultimately, more lives will be saved with this approach. This approach, however, obviously raises questions about who determines which children are most undernourished and how to actually make this type of potentially heartbreaking distribution happen where you have to actively say to someone, "No, your child isn't starving to death enough, so we aren't giving them these more beneficial RUTFs at all" (they distribute "less powerful" RUTFs to children who are less malnourished).

Here's the summary (from the article) of how they ran the study and their findings:

"The team based its findings on mathematical analysis of data on thousands of undernourished children aged 5 or younger in the Democratic Republic of Congo and in Niger. Their conclusion: An "all-or-nothing" approach, combined with a more comprehensive measure of undernourishment, could reduce deaths and life-limiting disabilities by 9%, compared with current policies. Alternatively, they estimate, relief groups could get the same health results as today but reduce the cost by 61%."

One of this week's articles (De Pee and Bloem) mentions that one of the current "downsides" of RUTFs is their cost and how that limits the production capacity. I also noticed that77% of PlumpyNut RUTFs are produced in France and the remaining 23% is produced by only 10 other countries, mostly in Africa (here's a map of where PlumpyNut is produced). 

PlumpyNut has a high peanut content. Nine of the top 10 peanut producers in the world are in developing or transitioning economies (see table below [from Wikipedia... Editor Me would totally not accept this as a valid source... luckily, right now, that chick is unemployed, so she can't say anything). Two of them are in Africa. Even for countries who are not among the top 10 producers, peanuts (aka groundnuts) are a major crop for many African countries (especially in Sub-Saharan Africa). Labor in developing countries is A LOT less expensive than labor in France. The French company that invented PlumpyNut has even waived licensing fees for producers in developing countries. So, the next question is, why not produce RUTFs more in Africa (where a lot of RUTFs are destined anyway)?

A thousand responses probably come to mind:

- poor infrastructure (roads!) = expensive/difficult distribution

- lack of legal/regulatory capacity that favors large-scale production ventures

- lack of skilled workers

- rising food prices (peanuts commodities trades over the last 30yrs: http://www.indexmundi.com/commodities/?commodity=peanuts&months=360) 

- etc etc etc

The list goes on and on and the "systems" problem just becomes more and more obvious the more you think about it where poor education/economic/governance indicators lead to missed market opportunities which means missed opportunities for making money/economic growth which means lack of funding for education/health/governance capacity building, etc.

The main point of this post was to share the article since it's a timely story related to this week's readings and topic. But the article also got me thinking about all the connections I'm seeing between our Global Health, Global Food Systems, micro/macroeconomics, and even my security and social enterprise electives (the Stanford article even mentions advanced multiple regression, so, add stats to that list as well, check!). Despite the harrowing prospects of our econ/stats/health exams, the big picture makes it all a little more tolerable to get through (good luck with midterms!).

Link to main article: http://www.gsb.stanford.edu/news/research/tough-math-behind-humanitarian-aid

Top ten producers of peanuts in 2008/2009

Country Production

(Million Metric Tons)

 People's Republic of China 14.30

 India 6.25

 United States 2.34

 Nigeria 1.55

 Indonesia 1.25

 Myanmar 1.00

 Sudan 0.85

 Senegal 0.71

 Argentina 0.58

 Vietnam 0.50

 World 34.43

Source: USDA Foreign Agricultural Service: Table 13 Peanut Area, Yield, and Production

 

believe it or not, gender equality is something they've gotten right in Afghanistan...

This is adapted from a chat conversation I had with a friend of mine in December. Obviously, the message in the title of this post is relative to where the country was politically 10-20 years ago and where it is now. Women are present in the parliament even if they were included initially only as tokens for gender equality, they have staked their claim in the legislature and will not give it up without a fight.

At the time of this chat, I was neck-deep in research about Rwanda's post-conflict development and security and the role women's political participation has played in the country's thus far stable and ongoing progress. The paper was my final assignment for an amazing class I took about conflict and reconstruction using Afghanistan as a case study, but which featured no specific discussion of women's roles and rights in post-2001 Afghanistan. My paper was my effort to bring women and security into the conversation about long-term peace and development in post-conflict areas.

Friend: To a certain extent, isn't Afghanistan kind of an exceptional conflict?

Me: It is, but it isn't. It's had like every version of conflict around. So, if you look at the history and the pockets of conflict, it's useful for studying other types of conflict, though I think it's mostly a lesson of "what not to do"... Like see what we did in Afghanistan? Now do the opposite.

EXCEPT... incredibly... how they've incorporated women politically...

The fact that there is a woman who has already announced her intention to run for president in 2014 is amazing... 

even if nothing else happens
even if she doesn't run
even if she doesn't win
even if she turns out to be a big fraud and corrupt and horrible (which I don't think she is, she's pretty inspiring). 

The fact that it would even be conceivable for a woman to joke about running for president of Afghanistan considering where the country was 10 years ago and what most Afghan women's daily lives look like today...

It's like going from the Declaration of Independence to landing on the moon in a decade instead of two centuries. 

And, btw, she's not joking.

Lola Bunny is *actually* crazy and Bugs Bunny is totally sane

Today, a friend of mine innocently sent me a video of Kirsten Wiig's Lola Bunny character on the new Looney Tunes cartoon series crazily serenading the calm and reasonable seeming Bugs Bunny (WTF, Bugs is the one that is supposed to be nuts!).

My friend overheard the song in the background when her 6 year old son was watching the new series and had two reactions: 1) this is so inappropriate to be showing on a kids' show and 2) this is hilarious.

Here's the link she sent me:
http://www.vulture.com/2011/07/kristen_wigg_bugs_bunny_looney.html

Where she found humor--and I could see the humor the writers were trying to appeal to--I was super annoyed. I hesitated and then went ahead and replied:

OMG that was horrible! I know I'm getting on my misogyny soap box, but how is it okay to feed kids the message that women expressing emotion are automatically crazy!

"Bitch be crazy" is a phrase that every girl or woman has to worry about every time she disagrees with someone. Women who are assertive = bitch be crazy. Women who are aggressive = bitch be crazy. Women who are actually crazy = bitch be crazy. In practice, all these varying types of personalities/mental states are made equal with the shorthand "bitch be crazy."

Lola Bunny is actually crazy in this video, as in, out of the norm, not mentally stable, not representative of how the vast majority of women behave and think. There are as many if not more guys who are way crazier (and more violent and dangerous and actually need restraining orders against them) than there are women; yet, will we see a crazy stalker bugs bunny video? Probably not. 

As an aside: http://www.guardian.co.uk/business/2013/jan/25/facebook-sheryl-sandberg-gender-stereotypes

p.s. I love the concept of the re-imagined looney tunes, but the message of this song made me sad. :( Also sad that no one else in the comments section seemed bothered by this.

p.p.s. My first instincts when writing this email was to temper my language/reaction because I was worried that my "assertive" response would be taken simply as "bitch be crazy." sigh. :/ And yet I still felt the need to apologize for pointing out misogyny... 

p.p.p.s. Today is the 200th birthday of the original assertive funny lady, Jane Austen (her humor is subtle, but a riot once you put it in context). http://msmagazine.com/blog/2012/12/16/happy-birthday-jane-austen-five-feminist-footnotes/

a price too high

I didn't grow up around guns and I'm not from an area with lots of hunting that might have made me more familiar with guns even if they weren't in my house. In fact, my father is from one of the most, if not the most, gun averse country among developed countries, which surely had some influence on my opinions. I admit to my bias or, at the very least, ignorance, around gun culture in America.

What I do understand is words, reasoning, and legislation. I am not going to argue with the 2nd Amendment of the US constitution that says I have the right to bear arms--the right is there, enshrined in the Bill of Rights for hundreds of years, and repeatedly supported by US Supreme Court decisions. It's there to stay, at least for the foreseeable future.

What the 2nd Amendment does not say is that I have the right to fatally wound dozens of people (including children) on a psychotic whim.

Children from Sandy Hook Elementary School being led by police after the Newtown shooting. These kids are the same age, size, cuteness, maturity, adeptness of throwing embarrassing tantrums, and humanness as the 6- and 7- year old victims of Friday's shooting.

Off the top of my head, I can recall at least 6 other mass shootings committed by people who were mentally unstable with access to legally purchased weaponry: Columbine, Virginia Tech, the DC Sniper, the shooting of Rep. Gifford, the Colorado movie theatre shooting, and this one in Newtown. I don't even want to do the total on the number of victims in all of these; if it's more than 1 (and it is), it's too many.

The price for the right to bear arms as it exists in practice in our daily lives is TOO HIGH: I am not willing to trade the life of a child (or any human being, for that matter) for my right to shoot at a hypothetical future intruder or attacker.

Because that's what this is, a trade. For every gun that's legally purchased and in the public sphere for no other reason than just because it can be is a trade of one or more innocent lives against the chance to shoot a hypothetical future intruder or attacker in an effort to save myself. I would not trade my own life for a beloved neighbor or friend or relative to have that right, so why should any gun owner feel at liberty (I choose that word intentionally) to trade the lives of twenty children for that right?

Maybe that makes me a dirty hippie, tree-hugging liberal. (Liberal? Guilty. Tree-hugger? Guilty! Dirty? Not guilty!) Maybe that makes me economical--what was the earning potential and social contribution that those 20 children and 6 adult victims could have made to our society? Maybe that makes me risk averse--I'm betting that the odds of me getting attacked are much lower than me not getting attacked. Maybe that makes me human. Maybe that makes me cheap on "liberty" or "freedom" that I'm not willing to sacrifice lives for a constitutionally-mandated right--would I not sacrifice lives for the right to freedom of speech? (I would.)

It definitely does not make me un-American--how much more American is it than to want to prevent the unnecessary and senseless deaths of the most vulnerable among us? Or even the least vulnerable--hell, I don't want anyone shot!! How much freer can we be than to live without fear of such senseless and wasteful death and sadness?

The assault rifle and handguns that were used on Friday were not meant for hunting--at least, not for hunting animals. I won't get into what I think about hunting (though it's probably not what you'd expect). This is about basic safety and sanity--that is, the sanity and reason among those of us who are fully mentally capable and in charge of shaping legislation and regulating, manufacturing, selling, and distributing guns.

There are people in my life that I love, that are part of my family either by blood or experience, for whom I would literally trade my life to protect their right to speak freely and live without fear of retribution for who they are or what they believe, people who I know to be absolutely, unquestionably responsible enough, smart enough, mentally stable enough, trained enough, and valuing of human life enough to entrust with gun ownership. These are not the people I am worried about having their access to guns coincide with their access to suburban strip malls and elementary schools.

Regardless, I am not willing to trade the life of any innocent person for these responsible and sane people who I love and trust's right to own a gun as easily as they can now.

"Firearms regulation" does not mean "firearms ban." It does, admittedly and, in my opinion, rightly, mean making it very difficult for everyone and impossible for the people who should not have access to get access.

POTUS has taken flack for not using strong enough words in his statement on Friday. But I think he was putting everyone on notice: "meaningful action... regardless of the politics" means the human lobby is stronger than the gun lobby, and things are about to change.

To close (because, aptly, I have to get back to writing a paper about post-conflict security...), here is the email I sent my parents after I learned of the shooting on Friday:

I have my Econ final in a few hours and have been pretty calm about it ever since I had that freak out a few weeks ago. I'm definitely not going to do well on the test,* but, more importantly, I understand the general concepts from the semester and, frankly, at the end of the day, it's just really not that big a deal. I've been saying that to people all week--just calm down, at the end of your life, you're not going to look back and be like, if only I'd gotten a B+ instead of a C+ on the microeconomics final. 

I've been working calmly all morning just preparing my cheat sheet and working through practice problems. Some time between when I last listened to NPR this morning while getting ready for school and about an hour ago, some maniac went into a school an hour's drive from NYC and shot and killed at least 27 people, including 18 children. Literally, while people around me spent those hours freaking out about some relatively inconsequential grade on a relatively inconsequential test, children in a place we could drive to within an hour were having their opportunity to flake out on studying or do badly on a test taken away from them forever. 

Thanks, mom and dad, for raising me to (sometimes) remember to keep things in perspective and for being the ones to remind me of this when I'm being ridiculous and freaking out about stuff that in the long run just isn't that big a deal. 

Love
Miki

I want to engage in this discussion with perspective, civility, reason, and respect, and get to a place where everyone can be safe.

So, can we talk?

 Children in Karachi, Pakistan light candles early in the evening in memory of the Sandy Hook Elementary School shooting victims. 

This is all close to home which is why it's easy (and lazy) of me (all of us) to get so worked up about these deaths over ones that take place in other places, but maybe this is the place where this conversation will be able to take its next step and will help Americans be better friends with our global neighbors and their children.

* In case you're wondering, I think it actually went pretty well, much to my relief and surprise. Even more reason to not freak out about things that just aren't that big a deal... sometimes they turn out to be just fine.