I know, I know -- you read that title and thought, "Grateful now? He must be out of his mind."
But with the (unsurprising) concession that I too felt that watching the election returns was akin to witnessing a slowly developing and incomprehensible train wreck, I remind you that the expression of gratitude is well known to make you happier. Plus, it's the season.
The morning after the election, my parents left on a road trip to Manzanar, the internment camp in central California where my family was imprisoned during World War II. My mother was born there. When I talked to them before they left, they were glad to be getting offline and out of range for a few days. They were going to scatter more origami cranes on the now empty, dusty block where my family was housed when my mother was a baby.
New person you're meeting: What to do you do?
ID Doc: I'm a doctor.
New person: Oh -- what kind?
ID Doc: A specialist in Infectious Diseases.
New person (making a face, or moving a few feet back, either to be humorous or truly frightened, or both): Yuck! Well I guess someone has to do it ...
We have not been here before. Over 50% of Americans with HIV are now over 50, and that number continues to grow. Mental health professionals treating older persons living with HIV are confronted with complex comorbidities that are just beginning to be documented and understood. When compounded by HIV, the routine medical, psychological and psychosocial stressors of aging grow more complex and present unique challenges to providers.
One of our medical school's most beloved teachers gives a wonderful lecture on how to give an effective presentation. He offers many invaluable tips for a successful talk, such as 1) Show up early; 2) Know your audience; 3) Don't read your slides; 4) Never include a slide that you need to preface by saying, "I know you can't read this, but ..."
This time, at least the "cure" news broke over the weekend, so I got to understand the science and anticipate the full range of responses and feelings before my week started.
In the late 1990s, a patient was admitted to our hospital with HIV-associated PCP. He had advanced AIDS, a CD4 cell count < 100, and was sick enough to require a temporary stay in our ICU.
Those clinical details aren't so remarkable -- "late" diagnoses of HIV still happen, and happened even more back then. What's remarkable is what happened to him before he got admitted.
I recall when a colleague told me in 2014 that some transgender women advocates were unhappy with iPrEx. I was surprised and disappointed. Since the study was conceived in 2004, I had struggled to include trans women for so many reasons and against so many objections.
A 28yo woman had a positive 4th gen +Ag/Ab assay, but a negative HIV-1/2 differentiation assay and negative HIV viral load. She had no signs of acute HIV, but is not using condoms with her partner, whose HIV status she doesn't know. We repeated the test yesterday and she is again Ag/Ab+, the remainder of the test is pending. If we get the same results again, would you try to get a Western blot?
The International AIDS Conference returned this year to Durban, South Africa, where it was famously first held in 2000. At that time the HIV epidemic was exploding in South Africa; funding for HIV treatment was essentially non-existent, and there was ongoing HIV denialism quite openly from some very influential figures in the South African government (including the President). Globally, fewer than 1 million people were receiving antiretroviral therapy, hardly any of them in Africa.
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