Tuesday, July 16, 2013

In Action To Combat HIV

Yesterday I had the honor of being invited to the White House for the 3 year anniversary celebration of the Obama administration’s National HIV AIDS Strategy (NHAS).  As part of this celebration, Secretary of Health and Human Services Kathleen Sebelius announced a new initiative, The HIV Care Continuum Initiative, focused on increasing the number of individuals who get tested for HIV, linked into care if and when they are diagnosed with HIV, started on treatment early and retained in care.  This strategy emphasizes that treatment is prevention.  (Details of the HIV Care Continuum Initiative can be found here.)
With Grant Colfax, M.D.,Director of the Office of
National AIDS Policy, at yesterday’s announcement.

Treatment as prevention means that if an individual with HIV gets diagnosed early and started on medication early, then the likelihood of having very low levels of the HIV virus in their body increases.  It’s imperative that people with HIV maintain low to negligible levels of the virus because that increases their chances of remaining healthy.  Beyond that, maintaining undetectable levels of virus (and practicing safe sex) makes it highly unlikely that they will transmit the virus to their sexual partners.  That’s how we get to “Treatment is Prevention.”

In Baltimore City we incorporated NHAS into Healthy Baltimore 2015, our city’s health policy agenda.  Our stated goal is to reduce the number of new HIV infections by 25%, but the reality is that our work is focused on helping to create an HIV/AIDS-free generation.  Nationally, roughly 20% of the people with HIV don’t know they are infected and only 2/3 of the ones who know get into care; another significant percentage drop off when it comes to starting medication.  By the time we get to the viral suppression bucket, we are left with only 25% of those we began with - 1 in 4 individuals.  The other 3 are destined to develop illnesses resulting from the virus and, for many of them, infecting sexual partners. 

It sounds difficult, but collectively we can achieve an AIDS-free generation.  Much of the work we do in collaboration with our clinical and community partners specifically targets increasing the number of individuals that travel through the continuum of care outlined above and live full lives free of debilitating illnesses. 

The new initiative announced today will provide much needed dollars for local health departments to partner with federally qualified health clinics. 

One of the ways in which we are focused on combating HIV / AIDS is through the city’s HIV/AIDS Commission.  The Baltimore City Health Department (BCHD) is accepting applications for appointments to the commission, whose mission will be to coordinate and enhance HIV prevention and care services and serve as the official HIV prevention planning body for the City.  If you are interested in being considered for appointment to serve in this Commission, please fill out the application.  

BCHD offers free HIV testing 6 days and 5 nights a week in our mobile van.  In addition, we will be at Artscape this weekend offering free confidential HIV testing, Friday and Saturday between 11 a.m. & 9 p.m. and on Sunday from 11 a.m. – 8 p.m.

Information on additional HIV / AIDS resources for Baltimore City is available on the Baltimore City Health Department website here.

We all have a role to play in ridding our city of HIV.  The first step is to get tested.

Take Care, B’More.

Friday, June 21, 2013

Consider Equity In Targeting Obesity

There is no doubt that reducing empty calorie consumption is a necessary component for eradicating the obesity epidemic.  In recent years, several approaches have been promoted as means of targeting large numbers of the American people who are either currently obese or at risk of becoming obese.  Some of these measures include restricting advertisement of junk foods to children, requiring calorie labeling on menus and restricting the size of sugar-sweetened beverages that are sold.  While there is not universal agreement on the appropriateness of these approaches, we can safely say that measures targeted towards promoting health and preventing obesity can and should be equally applied to all Americans regardless of their economic status. 

That is not the case with promoting the restriction of purchasing sugar-sweetened beverages with food stamps.  In order to qualify for SNAP benefits, individuals must have income that falls below 130% of the Federal Poverty Line; however, the income can go as high as 200% of the Federal Poverty Line for families receiving non-cash TANF services.  

As the argument goes, obesity is an epidemic that costs the healthcare system millions of dollars and a significant amount of federal dollars are being diverted from other important programs to underwrite treating this epidemic.  Therefore, the government should have greater discretion as to what it does and doesn’t subsidize within its food programs as a way to impact the obesity epidemic and bend the health care cost curve.   

It is not clear that restricting food purchase choices in a way that targets poor people will result in changed behaviors related to food choices and healthy eating.  However, if we accept the premise that targeting groups of individuals who receive federal dollars to purchase food is an effective way to decrease obesity, why stop at SNAP benefits?  There are more than 2 million federal employees and a growing number of elderly who use federal dollars to buy food for themselves and their families every day.  Both of these groups of individuals would benefit from decreased consumption of sugar-sweetened beverages and the potential savings accrued from their improved health would contribute additional health care savings.  These examples underscore the point that our perceptions of acceptable and reasonable restrictions on groups of individuals, especially if they are poor, are subjective.

One approach we at the Baltimore City Health Department have chosen to take to promote healthy food purchase and eating is evidenced through our Virtual Supermarket Program in which healthier food choices are incentivized at point of purchase.  The VSP is a program that is designed to improve food access for SNAP recipients who live in food deserts. Individuals get $10 health bucks every fourth order they make with the Virtual Supermarket to purchase fruits, vegetables, whole grains, and low-fat dairy products.

Ultimately, our approach respects an individual’s agency around health and wellness decisions and provides greater opportunities for sustainable behavioral change that can help turn the tide on obesity.

I'm curious to hear your take on the situation, Baltimore.  How are you impacted by this issue? Please share your comments below.

Take care, B’more.

Wednesday, February 13, 2013

Seniors and Hoarding

It was my pleasure to speak this morning to seniors, social workers, nurses and caregivers who attended our 3rd installment of Waxter Wisdom, a series of discussions covering some of the most challenging financial, medical and emotional issues facing aging adults and people with disabilities.

Since the program launched in December, we've already held frank conversations on end of life planning and healthy sex. Today’s discussion was on a topic that we once assumed was a rarity, but actually plagues as much as five percent of Baltimoreans: hoarding.

Thanks to the popularity of the A&E reality television show, hoarding has become quite a hot topic. By now, many of us have seen how cleaning crews are called in because the shame and sheer weight of accumulated papers, books, clothes and even trash has overwhelmed the person living inside and they need to literally dig their way out.

Physical challenges, dementia or Alzheimer’s, and difficulty managing years of accumulated memories all place seniors at much greater risk for hoarding. As we become less mobile or able to manage daily household chores, stacks of papers, books or treasures can quickly form  a dangerous obstacle course around the home, creating fire hazards and limiting the family’s movements – as well as hindering emergency workers’ ability to get inside in a crisis.

But we cannot ignore one additional, very important risk factor that compounds each of these challenges: social isolation.

As we age and physical or mental challenges arise, it’s quite easy to become depressed and isolated, losing interest in leaving home or inviting friends and family into our lives. And research shows that people who live alone – who are either widowed or never married – are overrepresented amongst those who suffer from hoarding.

It’s easier for seniors who are isolated to hide the confusion and feeling overwhelmed by a growing hoard – it’s also much tougher for them to get help.

And so, today, I urge us all to check on an elderly neighbor or relative. If someone in your life needs help sorting through collections, organizing memories, or just managing daily tasks, the following resources might be useful:

Also, our new directory of health and wellness resources for older adults, caregivers and the disabled in Baltimore City and County includes information on local mental health professionals and other support.

Some of us might know someone – or even be someone – who struggles with clutter and has trouble throwing things away.

But through forums like Waxter, we can learn about important resources and support to help our friends and loved ones before cherished memories become a hazard.

Take Care, B’More.