Full Circle

So, it's been a little over a month since my last post...I apologize! Happy new year!! 

It's been a crazy few weeks, but I do have some good news! I successfully finished off the semester with a 3.94 GPA (my best grades, ever!) and managed to get most of my stuff back to California all at the same time.

Over Thanksgiving break, I found an amazing little piece of paper in my closet. I wanted to blog about it right then and there, but I figured I'd wait and share it once all my coursework was completed. So, here it is: a letter written to my best friend, Heather, back in high school (no date, but based on context clues, I'd say it was either freshman or sophomore year).

For those of you who can't read my funky teenage handwriting, it says "some of the things that are goin on in the world are so sad! i wish i could do something about it. like whats going on w/ AIDS & Africa - that really sux! ...... i wish i could do something about whats happening. if i could get paid for it, i'd totally get a masters and work to change what's gon on but i denno if that is is only like non-profit so i guess that means I wouldn't get paid."

I found this funny, coincidental, and extremely touching because I went through so many potential careers between the time this letter was written and now (makeup artist, TV chef, psychologist, psychiatrist, plastic surgeon, etc.), yet my heart was in public health the entire time. I'm sure at the time I didn't even know what public health meant or what an MPH was, yet I ended up here. Things really do come full circle in life, and this is proof.

With that being said, I am excited to have officially completed my MPH coursework. Only a thesis paper stands between myself and my Masters degree at this point! I'm also happy to report that my job search is going relatively well (just started a few days ago) and I have come across many perfect positions. I will keep you posted on what happens next, and now that I am on an "extended vacation," I hope to update more frequently!

Late Post: World AIDS Day

Fact: There are 34 million people worldwide living with HIV/AIDS. Of those 34 million people, 1.2 million live in the United States.

So, as you may or may not know, yesterday - December 1st - was World AIDS Day. Although AIDS may seem like an "out of sight, out of mind" thing here in the USA, it is still very much a global health issue. In the health world, a lot of attention [read: money] goes to AIDS prevention and treatment. It's a pretty big deal. At Boston University School of Public Health, AIDS is important enough to get it's own class (I'm in it right now).


AIDS: A public health primer

Shall we start with a little AIDS history? No one really knows where AIDS came from, but there are several theories. Most people think it came from chimps, and most believe it came from Africa. It started to appear in the form of strange opportunistic infections in gay men in the 1980's, and for a while it was believe to be a gay disease. 1996 is the accepted "peak" of AIDS globally - it's complicated because of the classification of HIV (early stage) vs AIDS (late stage).

The most common ways that HIV is transmitted are:

• Unprotected sex
• Sharing of needles among injecting drug users (or other needles)
• Childbirth and breast milk
• Infected blood (blood transfusions)

HIV cannot be transmitted by:

• Mosquito bites
• Saliva
• Scratches
• Using the same toilet as a person who is HIV+
• The air

Click here for more information about transmission. 

Nowadays, there are lots of options for treatment. Here in the US, it's pretty much readily available for the most who need it. Treatment (called anti-retroviral therapy - ART) is pretty expensive. So in the developing world the cost is more of a problem, but with subsidization and generic drugs, it's becoming more readily available. Luckily, due to all the publicity and attention focused on AIDS, there are a lot of resources [again, read: money] going into the cause. Of the 14.8 million people who are eligible for treatment, 8 million people worldwide are getting it. The incidence - or rate of new HIV infections - is rapidly decreasing, thanks to prevention efforts. Common ways to prevent HIV infection include condom use, needle exchange programs, and of course monitoring of bloody supply.

In the field of public health, most of the ways to prevent AIDS have pretty much been figured out. There are a lot of controversial methods, especially for issues more common in the developing world. Prevention efforts are mainly focused on MARPS (see definitions below), which include FSWs, MSMs, and IDUs. I recently wrote a policy memo about HIV/AIDS in FSWs in India. One of the controversial issues in that population is giving out condoms to these women; some would argue that it's supporting prostitution. Another interesting intervention is needle exchange programs for people who inject drugs. Some believe that giving drug users clean needles is enabling them - but what would happen if we didn't? My guess is that they'd continue to use drugs and probably share needles with other people, increasing their risk for HIV. A really hot topic right now within the field of HIV/AIDS is stigma and discrimination. In a lot of places, HIV is so stigmatized that people won't get medical care for fear of having their status revealed, they won't take their pills at work for fear of being discovered, and they won't even tell their loved ones. So public health people are trying to find a way to minimize stigma and eliminate discrimination.

In sum, the outlook for AIDS is positive. Rates of transmission are going way down. Vaccine(s) are in the works. We know how to prevent it and we are now trying to figure out how to help people who have HIV by mitigating the impact the disease has on their lives. Here in the US, you can live a pretty normal life while being HIV positive (i.e. Magic Johnson). Hopefully we can roll out an AIDS vaccine soon, and in a few decades, HIV will be like other infectious diseases that have come and gone.

If you're interested in learning more about the global HIV/AIDS epidemic, check out this awesome report by UNAIDS .. it's really easy to read and has lots of figures and cool graphics!

Glossary: AIDS abbreviations

AIDS: Acquired Immunodeficiency Syndrome (this develops after being infected with HIV)
HIV: Human Immunodeficiency Syndrome
MARP: Most At-Risk Populations [for being infected with HIV]
IDU: Injecting drug user
MSM: Men who have sex with men
FSW: Female sex worker
PLHIV: People living with HIV
ART: Anti-retroviral therapy
PMTCT: Prevention of Mother to Child Transmission 

Preconception Health...What the heck is that??

Did you know that infant mortality (death) rates among African Americans are twice that of the general population? In other words, compared with everyone else in the US, African American babies are twice as likely to die. There are a lot of different factors that play into the phenomenon that ultimately produces this jaw-dropping statistic, like stress and health behaviors. Normally people who are poorer and have less education have poorer health outcomes, but with African Americans, this is not the case. That means someone like me - with an (almost!!!) Masters degree - is just as likely as a high school dropout to have my baby pass away. Check out this short video clip for more information about why it's important to start taking care of yourself now, not just when [if] you become pregnant! Also, men, you're not off the hook! This applies to you too.

Cassidy Goodson - Evidence of a Huge Public Health Problem?

Cassidy Goodson, a 14-year-old girl from Florida who recently strangled her newborn son to death, may seem like just another crazy American woman who killed her kid(s). These stories of women killing their children are all too common in the news. Some women suffer from biological ailments related to their pregnancies, but a lot of them have real motivations for taking the lives of their children. According to various news agencies, Cassidy gave birth to her son in the bathroom of her home and then killed the baby there. He was discovered a few days later by Cassidy’s mom, at which time she alerted the police.

No one knew Cassidy was pregnant. People suspected it, but she had been hiding her pregnancy by wearing baggy clothes and presumably making excuses for other signs and symptoms as they came along. But why was she hiding this pregnancy in the first place? We live in a society where teen pregnancy has become a normal thing. Approximately half of all pregnancies are unplanned, along with 80% of all teen pregnancies. The stigma that comes along with unplanned pregnancies, and unwed mothers causes young women (who are often too immature to make these types of decisions on their own) to take drastic measures. I’ve had personal experiences with the matter. My best friend got pregnant when she was 18 and gave birth to her baby girl at 19 years old. Whenever we went places together during her pregnancy and even after she had the baby, people would stare. Some strangers even had the nerve to tell her what she should and shouldn’t be doing with her child, as though they have that authority because they are older than her. Whether we want to admit it or not, America is not as progressive as we think it is, and the way that young mothers are treated is clear evidence of that.

But what does this have to do with public health? The answer to that question is – everything. Stigma and discrimination play huge roles in the way humans behave, and our behaviors are largely responsible for health outcomes. Stigma around sexual sexually active young women in Africa plays a large role in the spread of AIDS – women are afraid to buy condoms because they will be stigmatized and voila! AIDS is spread. It’s the same thing that’s happening here, just a different end result. Young women are afraid of how they will  be viewed if they become pregnant and/or have babies at a young age or when they are unmarried and as a result of this fear they have unsafe abortions or worse. While I am certainly not defending the barbaric actions of Cassidy Goodson, her actions are a direct result of the pressures of society, which are ultimately derived from religious values – ironically in the land of  “religious freedom.”  In order to prevent more Cassidy Goodsons, we must support young women [and men] of reproductive age by educating them, providing them with tools to prevent pregnancy, support services if they do become pregnant, and most importantly, ending stigma and discrimination against young mothers. 

I'm still alive if you were wondering

So, I’ve been back almost two weeks and haven’t found any time to write. Shame, I know. But in my defense, school started three days after I got back, I had two job interviews last week, my mom was here helping me get acclimated, and I went out of town to visit my boyfriend this past weekend. So I've been quite the busy bee. 

Things have been hectic and I miss my life in India that involved working hard but also enjoying the environment, exploring, and discovering. I’m already planning my next trip (I’m thinking Brazil or Switzerland…ideas, anybody?).

Getting adjusted to America has been easy but I have definitely noticed a lot of differences. Everything here seems so nice and clean. I didn’t really notice it while I was in India but now that I’m back here, I realized that there wasn’t a lot of grass there – well at least where I was living. People didn’t have lawns or anything like that and what is growing is not kept nearly as nice and manicured as the greenery here. Also, toilets are shaped different, which is just an interesting little tidbit. But every time I look at a toilet here I am surprised because they’re different. Not sure whose toilets I like better.

It’s really nice to have access to food and water and all the products that keep me comfortable here at home. I must say, however, that I forgot how to use my washing machine. It felt so foreign at first but after a couple seconds of staring at the dials my memory came flooding back. Now that I remember how to operate the machine, it's such a joy to throw some clothes in there and then 60 minutes later they're clean! And I just throw them into the dryer. Love that. 

                                                 

On another note, classes are going really well. This is my last semester of coursework and thanks to my summer work experience, I feel like I have a lot more to contribute in terms of group work, class discussions, etc. Additionally, I did a lot of things that I’m actually (just now) learning about in class so it’s helpful to learn the technical names and methods since I was pretty much winging it in India. A lot of my work involves projects and now that I’ve gotten some real-world experience, its becoming a lot easier for me to think of topics and things like that. Overall I’d really say my time there enhanced my education and my career path.

I was really sad to leave India (I got a little teary-eyed, not gonna lie) but I’m so grateful for the experience. I  really loved the people I worked with and I hope that our paths cross again – personally or professionally.

I’m in between classes now and I’ve got to cram and read for homework (still getting adjusted…sue me!) but I will continue to update. I start a new job next week working on a research study for Harvard so hopefully I’ll have an interesting tale or epiphany or something like that.