Men In New York Research Articles

Mental health correlates of HIV-related resilience among older gay men living with HIV/AIDS in New York City: The GOLD studies

Introduction: Older adults represent the greatest proportion of people living with HIV/AIDS (PLWHA) in the U.S. and sexual minority men continue to be disproportionally impacted. As PLWHA age, they face multiple mental and psychosocial health challenges that may impact their overall health and well-being. Resilience may act as a buffer against these challenges. Method: Associations between HIV-related resilience and mental health endorsements were examined among older HIV-positive gay men in New York City. Result: Multivariate analyses indicate those with higher levels of HIV-related resilience were more likely to have lower levels of PTSD and substance dependence and were also more likely to feel financially secure. Conclusion: While further research will help better understand the role resilience has on overall health and well-being of older gay PLWHA, utilizing this perspective can yield important insights that can be used to shift toward strengths-based service and programmatic approaches for this population.

A History of Latinx Immigrant Activism

A History of Latinx Immigrant Activism

Broaching the Topic of HIV Self-testing with Potential Sexual Partners Among Men and Transgender Women Who Have Sex with Men in New York and Puerto Rico.

Men who have sex with men (MSM) and transgender women (TGW) are highly affected by HIV and need novel prevention strategies. Using HIV self-testing (HIVST) kits to screen sexual partners may represent a viable risk-reduction alternative; however, more research is needed on effective strategies for broaching HIVST with partners. In the ISUM study, 136 MSM and TGW were given ten HIVST kits for self- and partner-testing. After 3 months, they returned for a follow-up assessment; thirty participants were also selected for in-depth interviews about their experiences initiating HIVST with partners. Most found proposing HIVST to a diverse array of partners relatively easy. They employed strategies such as joint testing and integrating HIVST into larger discussions about protection and sexual health, with moderate success. Nonetheless, real or anticipated negative partner reactions were a significant barrier. Future research can inform best practices for safely and successfully broaching HIVST with sexual partners.

Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study.

ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance(p=.08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.

Black and White Differences in Life Expectancy in 4 US States, 1969-2013.

Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance.

Bastard Mentors

Bastard Mentors Jacob Weber (bio) Outside is the Ocean Matthew Lansburgh University of Iowa Press www.uipress.uiowa.edu 192 Pages; Print, $17.00 Society nearly fetishizes the role of the mentor. In any corporation in America, an employee can make up for a near total lack of productivity if that employee can convince his managers that he is a mentor to newer employees. In a way, this makes sense: if you are contributing to the future productivity of a whole generation of workers, isn't that more important than being a good worker today? Matthew Lansburgh's series of linked short stories, Outside is the Ocean, demonstrates a healthy skepticism toward would-be mentors. For every person who gives of herself because she cares, there are ten more self-serving advisors in it for their own reasons. Indeed, the relationship between mother Heike and her son Stewart is so toxic, the first comparisons it brings to mind are to Augusten Burrows' memoir Running with Scissors (2002). Heike uses advice to shame her son into complying with her wishes, as she manipulates nearly everyone in her life. She moves through three husbands in her life, with each, advancing in her ability to get what she needs out of them. Heike, however, is desperately in need of advice herself. Outside depicts her receiving both gratuitous and asked-for advice about one of her obvious areas for improvement. Her English is not perfect, as she arrived from Germany at age twenty. Her first husband, Raymond, the only less sympathetic character in the book than Heike, forces language help upon her: "In school, English was always her best subject, but here in America people talk quickly and sometimes—often—she still makes mistakes. Raymond likes to correct her. 'Adverbs end in l-y,' he instructs." His instruction is unwanted, but Heike knows she needs to improve, so she pays the girl down the street to tutor her. "Even if it is a small thing, please correct me," she asks the girl. Once her son, Stewart, is old enough to be embarrassed by his mother's freeness towards showing her body in public and sharing details about her love life with him in private, he rejects advice from his mother. This includes even some good advice. After ignoring his mother's caution about contracting AIDS, he himself wonders if he is playing with fire by running around with too many men in New York in the 1980s. Much as his mother overcompensates for rejecting Raymond's advice by asking the neighbor girl to correct even small mistakes, Stewart seeks out men who will be forceful telling him what to do. At the exact moment Stewart, while exasperated about mess his mother had created by taking a neighbor's dog for a walk without permission and then allowing the dog to get skunked, is wondering how he will "get from point A to point B," he finds himself reminiscing about a man who had "made it clear who was boss, who was going to do the fucking." Perhaps not coincidentally, soon after thinking of this man who forced himself upon Stewart, Stewart realizes that his own mother may need some direction from him: "He wanted to say something else, felt he ought to say more." But if Heike's weakness is giving her son too much advice, his is that he gives her too little: "He knew what his mother wanted to hear, but, instead of comforting her, he sat in the car next to her, unable, unwilling to respond." While Stewart and Heike seem caught in a cycle of damaging one another through advice that is forced, ignored, and withheld, the one character who escapes the cycle is the one most vulnerable to it: Heike's adopted daughter Galina. On the surface, adopting a Russian girl who lost an arm through suspicious circumstances might be Heike's most selfless act, but there are dark hints Heike might have also been motivated by a desire to make her grown son, who now ignores her, jealous: "For years, she'd been threatening to adopt one of the children she sponsored . . . so she would have...

The Huntsman

The Huntsman Lisa Taddeo (bio) It was the early aughts, and she was working with a group of married men on Forty-Seventh and Ninth. They were transferring newspaper stories onto the internet. Her coworkers' wives were long-nailed and harmless back in Long Island and New Jersey. These men couldn't wrap their heads around city girls, who didn't crave houses but parties. They wanted for women more now that they were married. Their faces keened with middling greed. In the end they were satisfied with free drinks. The regulars sat on their regular stools. They stared at their well drinks and the bartender's hands in that habit that regulars have of looking at something and nothing and owning the real estate in between. One vaporized accountant was eating chocolate ice cream. It melted in a silver cup while he sipped whisky. He reminded her of Christmases past. There were some underage Australian girls. Some Irishmen who should have beards and some young men who shouldn't. [End Page 629] Her coworkers stood in a loose circle by the dart board. At twenty-four, she was wiser than them, with their mini bagels and their gray pants. They talked about public golf courses and never touched the jukebox. When she got bored, she slipped out for cigarettes. Her friends wanted to know where she went on Thursdays. She could not say, Midtown. She felt it was more restful to hang with encrusted men than with a bottleneck of girls her own age, most with nicer hair and clothes. That it was advantageous, even, to be with these guys. Especially Mac. Mac was the new boss. He was fat and balding. His pate shone like a frog. In Montclair he had a wife and a slow son and a skinny daughter. She spied pictures of them on his credenza. He talked about the girl, about her riding horses. Mentioned hunters and dressage as if they weren't any different. He wore expensive ties and smoked only when she did, to ride the elevator with her and go through the revolving door behind her. The coders feared him. All week they affixed the right tag to a certain story with doggedness. They had done it sloppily for years, but when Mac was hired it became poetry. He made them feel like sons. She sensed his infatuation at the first meeting. It came across the kidney-shaped table. She wore a vintage peasant top and blue jeans. Her shoulders were young and pointed unreliably towards heaven. Mac looked at her and couldn't thereafter look at anything else. Forty minutes or however long it lasted. She accepted the gaze. She didn't put it in her pocket but let it hover in the air around her forehead. She was weekendly in love with someone at the time, some thin boy inside her phone. Being cherished by a kind, fat man in New York, in the middle of all the loathing and long lines, is like Popeyeing spinach. [End Page 630] For several months she received the usual favors. Coming in late without consequence, leaving a meeting early. She took her lunches in the museum, lingering ten, fifteen minutes past the hour. When September came, she enjoyed glasses of crisp white wine at outdoor tables, reading books and magazines. In turn the work she produced was golden. Being teacher's pet will do that. Girls her age had Labor Day plans, Montauk and heartless. She had Mac. She didn't have to do anything to maintain his reverence besides exist. She had to keep being pretty, but even if she had a breakout, or chopped her hair too short, she would still retain the early effulgence. A man must only see a woman as beautiful once. For one minute she must impress him and thereafter, nevermore. ________ Mac's hiring had coincided with nightly happy hours for the group. He always paid for the first few rounds. He used the company card but occasionally slid across his own. The men drank beers; she drank Merlot, at seven dollars a glass, out of plastic goblets. Generally the wine tasted of puke. He...

If I Marry a Man in New York, Could I Marry a Woman in Kentucky?: The Problem of the Fundamental Right to (Straight) Marriage

The Supreme Court's recent decisions on the status of those who are validly married to a member of the same sex leave many questions about the interstate recognition of such marriages unanswered. The law on status in the several states varies so widely that it is hard to determine what even the fundamental right to marry a member of the opposite sex looks like under the current law. This paper attempts to examine whether the states' constrained ability to abridge the fundamental right to opposite-sex marriage extends to interferences based on their seemingly broad right to refuse to recognize marriages between members of the same sex. Walking through the analysis, using the author's legal status as a factual foundation, this paper demonstrates how non-recognition among the states creates needless legal gray areas and implicates some of the most basic assumptions about the extent to which the state may regulate marriage. Unlike other papers in the area, it makes no assumptions, thoroughly investigating the question from several angles. While the question might seem silly, it goes to the heart of the issue of what it means to be married in America in 2013: Could a man, validly married to a man in New York, marry a woman in Kentucky?

Teens, Adults With Autism Need More Support

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessTeens, Adults With Autism Need More SupportAaron LevinAaron LevinSearch for more papers by this authorPublished Online:8 Nov 2013https://doi.org/10.1176/appi.pn.2013.11b12AbstractMore must be learned about the effects and care of the transition from adolescence to adulthood among people with autism, says psychiatrist Fred Volkmar, M.D.Fred Volkmar, M.D., says that adolescents being prepared for the transition to adulthold must be explicity taught adaptive skills.Ellen DallagerIn the past, autism was seen as a disorder of very young children. But children grow up, and far too little is known about autism in adults, said Fred Volkmar, M.D., at APA’s 2013 Institute on Psychiatric Services in Philadelphia in October.“Autism is a disorder of variability, and it has a tremendous range within the person, across populations, and across time,” said Volkmar, a professor of psychiatry, pediatrics, and psychology at the Yale School of Medicine and director of the Yale Child Study Center.The social difficulties experienced by people with autism affect how they learn, he pointed out. “A typically developing child takes cues from other people—what they’re looking at, how they respond, how they are feeling as shown by the expression on their faces—and integrates those observations with the context,” he said. “However, children with autism are more interested in things and prefer consistency and stability and have a gestalt learning style and difficulties in multitasking.”Transitions at each stage of life present challenges for everyone, but adolescents with autism need additional support to cope with new social demands and an awareness of sexuality in themselves and others.“Outcome studies suggest that some individuals make gains, while others exhibit a decline in function” at this stage, he said.Preparing adolescents for transition to an adult world requires more than using interventions originally tailored for children, Volkmar maintained. “Adaptive skills must be taught explicitly,” he said, recounting the case of one patient who could do complex mathematics in his head but could not order a hamburger and count the change.Educational transitions take additional effort. College students are not covered by the same laws as elementary and high school students. If college students self-identify as autistic under the Americans With Disabilities Act, they can receive services and accommodations. But many don’t do that and may behave in socially transgressive ways that get them expelled from school.However, colleges also can be havens for people with autism. They offer a structured, predictable environment in which a student can control his or her level of social isolation or interaction. Several universities now have supportive programs for students with autism, and others refer students to supports in surrounding towns.Once youth with autism reach adulthood, additional issues come into play. Adults with autism have an increased risk of being perpetrators or victims of crime or accidents because of their poor judgment, social isolation, literality, and narrowly focused interests, Volkmar noted, like a man in New York who liked to steal buses and subway trains.Adults with autism may also develop both physical and psychiatric problems as they age, said Volkmar. A sedentary lifestyle (and some medications) may increase risk of obesity. Anxiety and depression are increasingly prevalent as well.Life after school or college also calls for careful preparation. Ask adults with autism what they want and they will say they’d like safe, secure, quiet places to live and work. However, for more impaired individuals, living and working independently may increase stress and worsen outcomes, he pointed out.“There are various paths to adult independence and support,” he said. “You need a realistic assessment of the individual, covering more than academic factors and extending to functional, social, and vocational matters.”Much more research focused specifically on this cohort is needed to provide the evidence base for their lifelong care, Volkmar stated.Of the approximately 14,000 papers published on autism, only 23 cover interventions for adults. “We need more and better research on the aging process among people with autism, on services, and on outcome measures,” said Volkmar. “Then we need to translate research results into practical applications and disseminate high-quality and understandable information to parents, schools, students, and the public.” ■Information about the Yale Child Study Center is posted at http://www.childstudycenter.yale.edu/index.aspx. To watch an interview of Volkmar, go to http://www.youtube.com/watch?v=vjJVumJSlKE&feature=c4-overview&list=UUAPLZ4LG-XJgNSB43MbCLRg. ISSUES NewArchived

Alcohol and Drug Abuse Issues in Older Persons as Revealed Through the Comprehensive Drug, Alcohol, and Mental Health Treatment Systems

A substantial and growing percentage of older adults misuse alcohol, prescription drugs, or other substances. The number of older adults in need of substance abuse treatment is expected to more than double from 1.7 million in 2000 and 2001 to 4.4 million in 2020. One in four older adults has a significant mental disorder. Among the most common mental health problems in older persons are depression, anxiety disorders, and dementia (Bartels, Blow, Brockmann, & Van Citters, 2005). Saint Vincent Catholic Medical Centers' (New York) Department of Community Medicine operated a comprehensive ambulatory substance abuse/mental health program at the Barbara S. Kleiman (BSK) shelter for homeless men in New York from October 2006 through May 2010. This shelter was the site of the described study that was approved by the New York City Department of Homeless Services (DHS). The analyses and interpretations expressed herein do not necessarily reflect the opinions of DHS or its staff. The study concerns homeless men of all ages but the relevance to older homeless persons is evident. This is particularly so when it is recognized that chronic homelessness causes marked decline in age of survival. At BSK, shelter care, medical care, substance abuse, and mental health care were integrated in a single setting-a large urban homeless shelter. By using a continuum of addiction and mental health services, it promoted a flexible, supportive, and noncoercive environment for clients. We used the principles set forth in the Improvement Protocol (TIP) Series 35: Enhancing Motivation for Change in Substance Abuse Treatment as our evidence-based practice. We were able to incorporate the transtheoretical model of change that facilitated positive outcomes in the patient population. Other elements used in our daily activities included individual counseling, small group interactions, and facility or community-level interventions. Little or no adaptation/ modification was necessary to create the proposed treatment initiative at BSK. The project's goal was for clients to achieve sobriety and a positive drug-free social life, develop life skills and educational/ vocational training, and obtain and maintain independent living and employment. TARGET POPULATION Prior to full program implementation, a focus group was conducted using prospective candidates who met our admissions criteria. These persons were referred to us by the staff at the New York City DHS. The results of the focus group indicated that 53.6% would be Black or African American, 1.8% Asian, 26.8% White, 3.6% multiracial, and 14.2% from other racial population. By ethnicity, 21.4% self-reported to be Hispanic. Alcohol would be the primary drug of choice (46.4%); marijuana (19.6%); cocaine/crack (14.3%); heroin (5.4%); other opiates including benzodiazepines, percocet, and codeine (9.0%). The men averaged at least 6-12 months of homelessness each year. New York City was the target population's service area. RECRUITMENT Recruitment of clients for the program evaluation was done via the DHS assessment shelter system. Employed or employable clients with a reported substance abuse and/or mental health condition were referred to BSK. At intake, they received a biopsychosocial, psychiatric, comprehensive medical, and a drug screen using Drug Abuse Screening Test (DAST-10). A BSK case manager assessed clients for other unmet needs. INCLUSION CRITERIA All persons were admitted who, based on a thorough clinical evaluation, were judged to benefit from ongoing treatment for substance abuse in a program of several weekly group treatments. EXCLUSION CRITERIA Potential clients without a Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Review (DSM IV-TR) Axis I diagnosis of a substance abuse disorder or both a substance abuse and a psychiatric disorder were excluded. Target Enrollment Number targeted for enrollment (5-year target): 390. …

My Stevens: A Titling Hero

My Stevens:A Titling Hero Matthea Harvey Stevens is my titling hero. I can't think of any poet who doesn't wish they had thought of titles like "Hymn from a Watermelon Pavilion" or "The Revolutionists Stop for Orangeade" or "Le Monocle de Mon Oncle." In a letter of 1935, Stevens writes: Titles with me are, of course, of the highest importance. Some years ago a student of Wesleyan came up to the office. Apparently he had been given the job of writing a paper on Harmonium. He was under the impression that there was no relation whatever between the titles and the poems. Possibly the relation is not as direct and as literal as it ought to be. Very often the title occurs to me before anything else occurs to me. This is not uncommon; I knew a man in New York who ought to know who once told me that many more people have written the first chapters of novels than have written the rest of them, and that still more people have given their novels titles without having given them any bodies. (L 297) I have a little test with which I have come up for myself to explain the relations of poems to their titles and Stevens provides wonderful examples of all of them (except for the untitled category because he seems to have loved titles too much to ever use that). The five categories are: license-plate titles, spotlight titles, helium titles, greased-pig titles, and untitled or not wearing a tie. The license-plate titles give important identifying information: who is speaking, who is being addressed, the setting—for example, "Tea at the Palaz of Hoon." The untitled category is self-explanatory. But I would like to talk here about three Stevens poems that sport a spotlight title, a greased-pig title, and a helium title. Spotlight titles are titles that highlight a phrase or an image in the poem. One of Stevens' most interesting spotlight titles is "So-and-So Reclining on Her Couch." This is a coy and complicated spotlight, one that hops from name to name. The name "So-and-So" makes a point of its anonymity, so that each renaming in the poem is highlighted. First the painted woman who is being described is called "Projection A." Then she is decorated by a crown called "Projection B." And finally she becomes "Projection C" (CPP [End Page 112] 262-63). None of these names comes any closer to specificity. Instead the painter is showing that he is projecting layers and layers onto the blank face of So-and-So. Projection C is described as half the woman herself and half the artist's projection. So when her name is so suddenly Mrs. Pappadopoulos in the final line, we experience a bumpy ride back into reality. Interestingly, the minute she is given her name back, she is also dismissed. Abstraction is what keeps the painter interested. However, the reverse is true for the reader. We have been set up with the spotlight of So-and-So, jumping from Projection A to B to C to be very attuned to the moment her name is revealed. The next category of titling is the greased-pig title. In greased-pig contests, participants try to catch a young pig covered in cooking oil. It's apparently very difficult. Greased-pig titles, like their namesakes, evade connection with the poem. In these titles, the reader can grasp only a tiny point of tangible intersection between the title and the poem, like two lines that intersect in one spot and then go on to infinity in their separate directions. Greased pigs are able to glancingly touch the poem's content, but it is a brush by, not an embrace, as in the title, "Frogs Eat Butterflies. Snakes Eat Frogs. Hogs Eat Snakes. Men Eat Hogs." The only truly explicit connection between the title and the poem here is the last word of the title, "hogs," and the word "swine" in the first, second, and final stanzas of the poem (CPP 62). The title's construction sets you up to think about food chains, so phrases that...

Does HIV/AIDS Have a Biological Impact on the Risk of Human Papillomavirus–Related Cancers?

HIV-related immunosuppression is a well-accepted, strong biological risk factor for two virus-associated cancers: Kaposi’s sarcoma, which is associated with Kaposi’s sarcoma – associated herpesvirus, and non-Hodgkin lymphoma, which is associated with Epstein – Barr virus. In fact, recognition of an extraordinarily high rate of Kaposi’s sarcoma among men who have sex with men in New York and California during the early 1980s was one of the first indications of the existence of a human immunodeficiency virus ( 1 – 3 ). Soon thereafter, high rates of non-Hodgkin lymphoma in men who have sex with men were also recognized ( 4 , 5 ), and both Kaposi’s sarcoma and non-Hodgkin lymphoma became designated as AIDS-defining malignancies in HIV-positive patients ( 6 – 8 ). It was not until the 1990s though that formal linkages between population-based AIDS registries and cancer registries were initiated ( 9 , 10 ). The AIDS – cancer match registry study in the United States ( 11 , 12 ), and similar studies in other countries ( 13 – 15 ), found that the risks for both Kaposi’s sarcoma and non-Hodgkin lymphoma were increased by at least 100-fold in persons who developed AIDS compared with the general population ( 11 , 12 ). Furthermore, there were indications of a biological gradient—one of several criteria used to assess a possible causal relationship. Specifically, the risks for both Kaposi’s sarcoma and non-Hodgkin lymphoma increased, and with lower CD4 T-cell count at time of AIDS onset ( 16 ) with increasing time after AIDS diagnosis (which is thought to be a surrogate indicator

Coping with the HIV epidemic 1982–2007: 25‐year outcomes of the Hershey Haemophilia Cohort

Coping with the HIV epidemic 1982–2007: 25‐year outcomes of the Hershey Haemophilia Cohort

Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility

Avian H7 influenza viruses from both the Eurasian and North American lineage have caused outbreaks in poultry since 2002, with confirmed human infection occurring during outbreaks in The Netherlands, British Columbia, and the United Kingdom. The majority of H7 infections have resulted in self-limiting conjunctivitis, whereas probable human-to-human transmission has been rare. Here, we used glycan microarray technology to determine the receptor-binding preference of Eurasian and North American lineage H7 influenza viruses and their transmissibility in the ferret model. We found that highly pathogenic H7N7 viruses from The Netherlands in 2003 maintained the classic avian-binding preference for alpha2-3-linked sialic acids (SA) and are not readily transmissible in ferrets, as observed previously for highly pathogenic H5N1 viruses. However, H7N3 viruses isolated from Canada in 2004 and H7N2 viruses from the northeastern United States isolated in 2002-2003 possessed an HA with increased affinity toward alpha2-6-linked SA, the linkage type found prominently on human tracheal epithelial cells. We identified a low pathogenic H7N2 virus isolated from a man in New York in 2003, A/NY/107/03, which replicated efficiently in the upper respiratory tract of ferrets and was capable of transmission in this species by direct contact. These results indicate that H7 influenza viruses from the North American lineage have acquired sialic acid-binding properties that more closely resemble those of human influenza viruses and have the potential to spread to naïve animals.

Twenty-Five Years of HIV/AIDS

![Figure][1] CREDIT: NIH On 5 June 1981, a report in the Morbidity and Mortality Weekly Report ( MMWR ) described five young and previously healthy gay men with Pneumocystis carinii pneumonia (PCP) in Los Angeles. One month later, a second report in MMWR described 26 men in New York and California with Kaposi's sarcoma and 10 more PCP cases in California. No one who read those reports, certainly not this author, could have imagined that this was the first glimpse of a historic era in the annals of global health. Twenty-five years later, the human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), has reached virtually every corner of the globe, infecting more than 65 million people. Of these, 25 million have died. The resources devoted to AIDS research over the past quarter-century have been unprecedented; $30 billion has been spent by the U.S. National Institutes of Health (NIH) alone. Investigators throughout the world rapidly discovered the etiologic agent and established the direct relationship between HIV and AIDS, developed a blood test, and delineated important aspects of HIV pathogenesis, natural history, and epidemiology. Treatment was initially confined to palliative care and management of opportunistic infections, but soon grew to include an arsenal of antiretroviral drugs (ARVs). These drugs have dramatically reduced HIV-related morbidity and mortality wherever they have been deployed. The risk factors associated with HIV transmission have been well defined. Even without a vaccine, HIV remains an entirely preventable disease in adults; and behavior modification, condom use, and other approaches have slowed HIV incidence in many rich countries and a growing number of poor ones. With most pathogens, this narrative would sound like an unqualified success story. Yet it is very clear that scientific advances, although necessary for the ultimate control of HIV/AIDS, are not sufficient. Many important challenges remain, and in several of these the global effort is failing. New infections in 2005 still outstripped deaths by 4.1 to 2.8 million: The pandemic continues to expand. Despite substantial progress, only 20% of individuals in low- and middle-income countries who need ARVs are receiving them. Worldwide, fewer than one in five people who are at risk of becoming infected with HIV has access to basic prevention services, which even when available are confounded by complex societal and cultural issues. Stigma and discrimination associated with HIV/AIDS, and sometimes community or even governmental denial of the disease, too often dissuade individuals from getting tested or receiving medical care. Women's rights remain elusive at best in many cultures. Worldwide, thousands of women and girls are infected with HIV daily in settings where saying no to sex or insisting on condom use is not an option because of cultural factors, lack of financial independence, and even the threat of violence. ![Figure][1] CREDIT: MALCOLM LINTON In the laboratory and the clinic, HIV continues to resist our efforts to find a cure (eradication of the virus from an infected individual) or a vaccine. In 25 years, there has not been a single well-documented report of a person whose immune system has completely cleared the virus, with or without the help of ARVs. This is a formidable obstacle to the development of an effective vaccine, for we will need to do better than nature rather than merely mimic natural infection, an approach that has worked well with many other microbes. The development of next-generation therapies and prevention tools, including topical microbicides that can empower women to directly protect themselves, will require a robust and sustained commitment to funding the best science. Meanwhile, as we enter the second quarter-century of AIDS, we know that existing HIV treatments and prevention modalities, when appropriately applied, can be enormously effective. Programs such as President Bush's Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the efforts of philanthropies and nongovernmental organizations have clearly shown that HIV services can indeed be delivered in the poorest of settings, despite prior skepticism. We cannot lose sight of the fact that these programs must be sustained. As we commemorate the first 25 years of HIV/AIDS and celebrate our many successes, we are sobered by the enormous challenges that remain. Let us not forget that history will judge us as a global society by how well we address the next 25 years of HIV/AIDS as much as by what we have done in the first 25 years. [1]: pending:yes

Michael S. Gottlieb and the Identification of AIDS

Michael S. Gottlieb and the Identification of AIDS

Semen quality in fertile US men in relation to geographical area and pesticide exposure

We conducted the first US study to compare semen quality among study centres using standardized methods and strict quality control. We present data on semen quality in partners of 493 pregnant women recruited through prenatal clinics in four US cities during 1999-2001. Sperm concentration, semen volume and motility were determined at the centres and morphology was assessed at a central laboratory. While between-centre differences in sperm morphology and sample volume were small, sperm concentration and motility were significantly reduced in Columbia, MO (MO) relative to men in New York, NY, Minneapolis, MN and Los Angeles, CA; total number of motile sperm was 113 x 10(6) in MO and 162, 201 and 196 x 10(6) in CA, MN and NY respectively. Differences among centres remained significant in multivariate models that controlled for abstinence time, semen analysis time, age, race, smoking, history of sexually transmitted disease and recent fever (all p-values <0.01). We hypothesized that poorer sperm concentration and motility in MO men relative to other centres might be related to agricultural pesticides that are commonly used in the mid-west. We investigated this hypothesis by conducting a nested case-control study within the MO cohort. We selected 25 men in this cohort for whom all semen parameters (concentration, % normal morphology and % motile) were low as cases and an equal number of men for whom all semen parameters were within normal limits as controls. We measured metabolites of eight non-persistent, current-use pesticides in urine samples the men had provided at the time of semen collection. Pesticide metabolite levels were elevated in cases compared with controls for the herbicides alachlor and atrazine, and for the insecticide diazinon (2-isopropoxy-4-methyl-pyrimidinol) (p-values for Wilcoxon rank test = 0.0007, 0.012, and 0.0004 for alachlor, atrazine and diazinon respectively). Men with higher levels of alachlor or diazinon were significantly more likely to be cases than men with low levels [odds ratios (OR) = 30.0, 16.7 for alachlor and diazinon respectively], as were men with atrazine over the limit of detection (OR = 11.3). These associations between current-use pesticides and reduced semen quality suggest that agricultural chemicals may have contributed to the reduced semen quality seen in fertile men from mid-Missouri.

Reflections on AIDS: Lessons for the Future

On June 4, 1981, a report of five cases of Pneumocystis carinii pneumonia (PCP) inhomosexual men in Los Angeles appeared in CDC’s Morbidity and Mortality Weekly Report (MMWR), representing the first publication about acquired immunodeficiency syndrome (AIDS). Within 1 month, additional reports of PCP, other fatal opportunistic infections and a rare cancer (Kaposi's sarcoma) were reported among gay men in New York as well as California. Thanks to a highly specific case definition (which was adopted worldwide) and strong support from local health departments and concerned physicians, it was established that the syndrome was new and increasing rapidly. By the end of 1982, the epidemiologic patterns strongly suggested that AIDS was caused by an agent that could be transmitted sexually between men and between men and women and transmitted by blood among injecting drug-users and recipients of blood and blood products. Cases were also identified among infants born to women with AIDS. It was also clear that AIDS cases represented only the “tip of the iceberg” of an epidemic with persons in high-risk populations noting an increased frequency of generalized lymphadepathy, idiopathic thrombocytopenia, lymphomas and other conditions. Though the virus causing AIDS was not yet discovered, in 1983 the U.S. Public Health Service issued recommendations to prevent transmission of AIDS through sexual contact and blood donation. Within the next year, isolation of the causal virus (now known as HIV) facilitated development of assays to diagnose the infection and protect the blood supply. Very unfortunately, HIV proved to be a chronic infection with lifelong persistence and variable but inexorable progression. As it does in individuals, so also in communities and countries, HIV precedes AIDS by many years, causing an insidious epidemic of suffering and death. It is estimated that more than 250,000 Americans had already been infected with HIV by the time of the June, 1981, report of five cases of PCP. In the decades following the early 1980s, advances in monitoring and treating patients with HIV have greatly lengthened and improved the quality of life for hundreds of thousands of persons with HIV, mostly in high-income countries. In these same countries, perinatal transmission of HIV has been reduced by over 80%. Despite this scientific progress, HIV remains incurable and no vaccine has been proven effective. Meanwhile, HIV has progressed to infect over 60 million, now becoming the world’s fourth leading cause of death. The global impact of AIDS has yet to peak with estimates of new infections still exceeding deaths by millions per year. Despite recent impressive donor commitments in the world, the vast majority of persons with HIV are unaware of their own infection status and have little or no access to lifesaving therapy. Some lessons from the past can guide us in preventing HIV and providing care for those infected in both the United States and throughout the world. First, we must beware of complacency and of the tendency to underestimate the power of HIV to spread among vulnerable populations—especially adolescents and young adults in all nations. Continued education and motivation will be needed to overcome individual and community ignorance and denial. Second, HIV and its modes of transmission will continue to bear stigma, which fosters shame, secrecy and mistrust. Effective HIV prevention and care approaches need to see this as a barrier and attempt to overcome it. Third, successful leaders will build consensus around science-based approaches to HIV prevention. Concerns about saving lives must overcome political and religious differences in dealing with scientifically proven approaches to prevention such as condom availability and adequately funded programs for injecting drug users (including treatment and needle-and-syringe exchanges). Fourth, successful partnerships from the past must be re-energized. When most effective, persons with HIV and other advocates, government officials and caregivers worked together to combat the epidemic. This fosters trust and can assure that HIV treatment and prevention are linked and both receive attention. Fifth, HIV/AIDS and behavioral risk factor surveillance approaches need revamping in the era of effective HIV therapy. In the 1980’s, AIDS surveillance and mortality was highly accurate, and frequent reports were the “conscience” of the epidemic in the United States and the world. Twenty first century surveillance of HIV and risk behaviors must closely monitor the epidemic and risk behaviors while continuing to address privacy concerns. Sixth, resources committed to science for vaccines, therapies and other tools must be enhanced and continued. Finally, the global HIV epidemic demands a global response—with expertise and resources shared with populations in greatest need. We must work together to decrease suffering and death due to AIDS and stop the spread of HIV infection.

Bringing HIV/STI testing programmes to high-risk men

The aim of this study was to examine the meaning of significantly higher proportions of positive test results through outreach HIV/sexually transmitted infection testing programmes at gay bathhouses compared with clinic programmes among high-risk men who have sex with men. We conducted a random digit dial survey of men who have sex with men in New York, Los Angeles, Chicago, and San Francisco. Half of the men in the sample did not test in the past year. Among those who did not test, a sizeable minority (17%) reported engaging in high-risk sexual behaviour with a casual or secondary partner. Over half of these non-testing, high-risk men went to bathhouses. These findings strongly support the potential value of locating outreach-testing programmes in bathhouses. Although further studies are necessary, such programmes have the potential to increase testing among the high-risk segment of the population. This is particularly noteworthy given that many men among those who do not test regularly engage in high-risk behaviours.

Dermatophilus Infection in Nigeria: A Mini-Review

Dermatophilosis in Nigeria is reviewed. Dermatophilosis, a chronic dermatitis that damages the skin of cattle, is caused by Dermatophilus congolensis . The organism requires existing skin lesions to establish infection. An association between ticks bites and dermatophilosis has been established. 12% prevalence of infection in Nigeria's estimated 10.8 million cattle, and 10% prevalence in draught cattle may account for the loss of nearly 50.81% of annual revenue expected from hides. Infected cattle, which are retarded in growth, are culled early thereby contributing indirectly to the nation's shortfall of about 43.75% in meat expected from domesticated ruminants. 20% drop in milk yield has been observed in lactating cows unwilling to be milked due to painful lesions of dermatophilosis on their udders and teats. Systemic antibiotic chemotherapy is uneconomically feasible, and there is no immunity to re-infection. Control of tick infestation in cattle may help to reduce the incidence of dermatophilosis, but the emergence of resistant strains has rendered most of the available acaricides ineffective for field use in Nigeria. Dermatophilosis has been diagnosed in man in New York, and surveillance is necessary to establish the zoonotic status of the infection in Nigeria. Search for a safe and effective vaccine for immune-prophylaxis should be a priority in current bioresearch in Africa. Key Words: Dermatophilosis, Nigeria, Cattle, Economy, Control, and Public Health. Bio-Research Vol.2(2) 2004: 37-41