John Schrom

Epidemiologist and political junkie

More HIV Prevention…

A little over a week ago, a letter I co-authored ended up in the Star Tribune. As a follow-up to that letter, the strib wrote an editorial endorsing the need to utilize new, online methods as part of HIV prevention programs. The editorial was well written, and made a good point. Of course, I’m probably a little biased…

The editorial (intentionally) does not spell out any details about what kinds of programs should be done. That’s simply too much detail to fit into the space allotted. Since it couldn’t be done there, I’d like to share a few ideas and examples of ways to truly utilize social media and the internet:

  • Advertise online. That seems stupid and simple, but when was the last time you saw a HIV prevention message online? Red door has done this… but I haven’t heard of or seen any other Minnesotan organization doing HIV prevention through online advertising.
  • Video contest. The Ryan White program unsuccessfully tried this. One of their major failures was that they viewed the intervention as the end product and not the process. By having a video contest that’s graded by peers, the peers are also receiving the prevention messages. That’s the social aspect of social media :p
  • Midwest Teen Sex Show. It’s not a naughty website. It is, however, an example of a way to step away from the overly-sterile messages that sometimes come out of health organizations.
  • DC FUK!T. This is a dirty website. But that’s also what makes it so great. It’s essentially a sex ed video you can jack off to. And, there’s some evidence to suggest this kind of approach is effective in certain populations.

Ultimately, my issue is that it doesn’t feel like prevention is evolving to keep up with the epidemic. Prevention workers are already over worked, and there isn’t new money coming in. The internet is still relatively new, and many people that have been working in HIV prevention don’t comfortable on facebook, twitter, youtube, etc. So, in some ways it makes sense that new programs are slow to emerge.

However, we won’t know what works until we try. There’s a group of young people interested in stopping this recent epidemic that has started to meet. The idea is that among this group, we have the skills and resources to develop and execute pilot projects. And, hopefully, we can do things that will raise awareness about this problem. So, if you’re under 30 and interested in finding out more, send me a message.

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by on July 7, 2010No Comments
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Modernize HIV Prevention

I co-authored a letter to the editor that ran in the Star Tribune yesterday regarding the urgent need to modernize HIV prevention efforts. This sparked a handfull of comments on the strib website about how preventable HIV is (just like the flu, which kills ~36k people per year), and how we’re wasting money on AID’s[sic] education because people already know about it.

I continue to hear rumors that newly diagnosed cases of HIV among young men are not abating in 2010, and I continue to not see much of a response from the government regarding this increase. I don’t think anyone has answers about how to solve this problem, and that’s ok. It’s the lack of effort to try to find solutions that really bothers me. Anyway, here’s what ran in the strib:

As Pride weekend arrives once again, we remember the shocking news that came out of last year: The Hennepin County Public Health Clinic identified six new HIV-positive people, five of whom were under 30. This was a number that hadn’t been seen in years.

A few months later, the Minnesota Department of Health (MDH) issued a startling letter to service providers identifying a large increase in newly diagnosed HIV cases, with a bulk of them in the metro area. MDH then released preliminary 2009 data to much media fanfare.

HIV in men under 25 increased 83 percent in the last year and 300 percent since 2001, to a level not seen since 1986.

The story came and went.

Locally, Hennepin County’s Ryan White Program answered this startling news by organizing just a few sparsely attended youth events.

Its use of this dated and financially wasteful tactic was against the strong and early advice from those of us who work within these affected communities. MDH points to the Internet as a cause of the increase in HIV, yet none of this funding was spent online.

Now we’re back to the same HIV-prevention activities from the past decade; politically safe and of apparent decreasing effectiveness. Yet, with few exceptions, HIV-prevention activities have yet to truly utilize the Internet.

So what’s the impact? In the last five years, 222 young men have been infected with HIV in Minnesota. This is 132 young men beyond our endemic 2001 levels. It translates to $137 million dollars in lifetime medical costs, much of which will be paid for by state and federal programs.

For every $1 spent on HIV prevention, $7 are saved in future medical costs. It is imperative from both a fiscal and humanitarian standpoint that we take immediate action.

Increased funding alone is not going to solve this problem. Rather, we need to support new and innovative ideas, critically reevaluate our current prevention activities, support culturally competent partner services staff and meet youths where they are. That’s something that the governmental leadership in the HIV community has refused to do.

It’s time to talk prevention in the 21st century. It’s time to stop playing politics on the backs of our youth. And it’s time for new leadership.

CURT PRINS AND JOHN SCHROM

Prins is executive director of District 202, a Minneapolis-based organization for gay, lesbian, bisexual and transgender youths. Schrom is a member of the Minnesota HIV Services Planning Council.

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by on June 27, 2010No Comments
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Don’t Eat the Gravy!

There was a recent outbreak of Salmonella subspecies IV among attendees of a scout troupe potluck in Minnesota. Human cases of Salmonella are normally caused by subspecies I… this type is typically associated with contact with reptiles.

This led the investigators to the home of the potluck’s gravy-preparer:

She reported having two pet bearded dragons at home. The gravy was never brought to a boil and drippings were added over several days. We visited her home and took environmental swabs. We found multiple swabs positive for Salmonella Labada, a rare serotype, including inside and outside the dragons’ terrarium, a dragon’s stool sample, a cloacal swab from a dragon (a fun activity!), bathroom sink, and kitchen sink.

I don’t really have anything else to say about this, other than it struck me as oddly funny.

Regardless, the moral of the story is don’t let your bearded dragons roam your kitchen countertop while you leisurely prepare mashed potatoes and gravy. Oh, and you should probably wash your hands too.

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by on April 5, 2010No Comments
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How long have we known?

As I’m sure you’re well aware, Minnesota saw an 83% increase in HIV cases among young men who have sex with men (YMSM) in 2009. This prompted the Department of Health, Hennepin County (Part A), and the Department of Human Services (Part B) to plan a YMSM Provider’s Summit.

Someone at the summit made a comment to the effect of, “if we only knew sooner, we could have done more.” This got me thinking… how could we have not known?

I went to the Minnesota AIDS Project’s (MAP) annual reports. It seems that we’ve known about this for quite a while, but weren’t able to effectively address it. Pointing fingers doesn’t do any good (i.e., it’s not just a MAP or MDH failure) … but this is, nonetheless, disappointing and deeply concerning.

2004:
“Over two-thirds of the new [syphilis] cases were among gay and bisexual men, with nearly one-half of these cases involving co-infection with HIV. These patterns raise concerns about a potential surge in new HIV infections among gay and bisexual men.”

2005:
“Also, over the past three years, there has been a gradual increase in the rate of infections among young people age 13 to 24, with 17 percent of new infections in 2005 reported in this group.”

2006:
“[...] an alarming growth in infections among minority women and young people, MAP’s challenges in prevention, education, and services have expanded exponentially.”

2007:
“Disturbing increase in young gay and bisexual men.
There has been a steady increase in new cases occurring within the population of young gay and bisexual men (under the age of 24) since 2001. Of newly reported cases of HIV in 2007, 15 percent occurred in young men ages 13–24. In 2005–2007, virtually all of these cases (98 percent) are estimated to have male-to-male sex as their risk.”

2008:
“RAPID INCREASE IN YOUNG GAY & BISEXUAL MEN
Since 2001, there has been a steady increase in new cases occurring within the population of young gay and bisexual men (under the age of 24). In 2008, there was approximately double the number of newly reported cases in this demographic as compared to 2001 reports. For the 117 young men who tested HIV-positive during the three year period of 2006—2008, all of the young men, who reported risk, indicated same sex contact.”

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by on March 19, 2010No Comments
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HIV Prevention 2.0

There’s a definite and urgent need to adapt our HIV prevention strategy to reflect the needs and styles of adolescents and young adults. This is clear from the 9 year history of increasing newly diagnosed HIV cases among young men who have sex with men (YMSM), including the 83% increase in the last year.

I think one of the major adaptations is going to be moving towards user generated prevention. This is beneficial for three reasons: the population is most adept at communicating with each other (i.e., 16 year olds speak “teenager” better than most 40 year olds), there’s an innate prevention activity in developing the message, and these types of media campaigns can be dirt cheap.

There are a couple of agencies that are already doing this. The Minnesota Organization on Adolescent Pregnancy, Prevention & Parenting is having a video contest (PDF) regarding general adolescent health. MTV and funny or die recently had a crazy sex advice contest called Say What. The Minnesota AIDS Project/Pride Alive is collecting 10,000 messages, and trying to distribute them to 1,000,000 people. And, of course, Hennepin County and MDH are moving forward on a video contest (it technically ended, but stay tuned for a few announcements).

I think this is the right way to move. We’ve been living in a Web 2.0 world for half a decade, and we’re all getting used to sharing everything we’re thinking and telling other people what we think about what they’re thinking (this would be a good time to encourage you to follow me on twitter…). So, it seems logical that young adults should want to have input into what messages they think are appropriate, and what HIV prevention strategies they think are reasonable.

So, since these contests seem to be a good idea, I want to ensure we’re doing this appropriately… it sometimes feels like these contests are being run by people that aren’t familiar with technology or social media. Submissions should be made online — having to email someone is just annoying. Ideally, a website should post submissions for ranking and comments by other users, as this would fully capitalize on the potential of internet technologies. Campaigns need to be appropriately incentivized; just because YouTube is free, doesn’t mean a $20 gift card is sufficient. Don’t be too restrictive or too quick to censor. The most effective messages may make you squirm:

So despite my few critiques, I’m hopeful this style of health promotion is effective and am excited about what kinds of messages will be generated!

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by on March 10, 2010No Comments
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A Case for Monogamy?

A new study, set to be released in the March issue of Social Psychology Quarterly, suggests that people with higher IQs are more likely to favor atheism, liberalism, and monogamy (at least among males). “Smart” people are also more likely to align with unconventional philosophies, and demonstrate elitism. Go figure.

These beliefs don’t have a traditional evolutionary advantage, but as we progress there’s less evolutionary pressure to support the status quo. George Washington professor James Bailey says:

“The adoption of some evolutionarily novel ideas makes some sense in terms of moving the species forward [...] It also makes perfect sense that more intelligent people — people with, sort of, more intellectual firepower — are likely to be the ones to do that.”

The difference in IQs wasn’t great — ranging from 6 to 11 points (standard deviations is typically 15). Participants who identified themselves as “very conservative” had an average IQ of 95, compared with 106 among the “very liberal.”

I’m patiently awaiting the release of the full article, to gain a better grasp of their methods and results. Until then, I can make myself seem smarter (and more elitist) by affirming my belief of liberalism and sexual exclusivity.

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by on March 1, 2010No Comments
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Drunk and Horny

I attended the Minnesota YMSM Provider Summit yesterday, and that (alcohol, hormones) emerged as one theme partially attributable to the increase in HIV infections in men under 24. Honestly, I’m just trying hard to find a legitimate and professional excuse to say “horny” in a blog title…

We received an epidemiology update, with additional information from the disease investigator (DI) interviews. The DIs managed to interview about 50% of newly diagnosed cases to obtain additional information about risk factors relating to their infection and recent partners. I’m not sure if that’s a high/low/average rate, and we certainly don’t know if the responding population was different than the non-responders (e.g., were non-responders at higher risk than the responders?).

Minnesota saw 35 more cases of newly diagnosed YMSM in 2009 compared to 2008. That increase was driven largely by African American and white youth. About 20% report only having sex with one person in the last year or since their last negative (whichever is shorter?), and about 50% report having sex with 3-4 in that time period. Approximately 20% of young men had sex with BOTH men and women during that time period. 64% reported anonymous sex, 30% reported meeting partners online, ~60% report infrequent condom use, 13% report non-injection drug use (mostly marijuana, some meth), and 25% report alcohol use.

Additionally, MDH and Hennepin County put together a couple of small focus groups for HIV+ and college-aged guys. I’ll eventually post the results of the focus groups, but there were a couple of comments that stuck out to me:
“People are dying with HIV, not from it. Honestly I couldn’t care less if I keeled over and died tomorrow, I’ve had a fun run, people have nine lives… and I’m running out.”
“HIV meds or car payment — good campaign message.”
“When you’re 5 years old you start to experiment too, it’s just human sexuality. We’re here to procreate or to get off basically.”
“A lot of people don’t want to hear about [HIV] and right now a big trend is barebacking.”
“A lot of younger people are sluts.”
“I never had unprotected sex and just recently got really drunk and got date raped and am now poz.”

I don’t think any of this information is earth-shattering. However, it does provide a little data around the situation we’re in. We spent the remainder of the day listening to speeches and breakout panels. Ultimately, it was a good day for networking, but there weren’t many (any?) concrete next steps. Personally, I’m still trying to process the conversations that I had yesterday, and am waiting for clear direction and need to emerge. Any guidance or thoughts would be greatly appreciated…

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by on February 27, 2010No Comments
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Minnesota HIV Rates

The Minnesota Department of Health released initial 2009 HIV epidemiology data last week — something that they normally wait until April to do. MDH saw an urgent need to release the information due to the dramatic rise in incidence over the past year, particularly the 83% increase in young men who have sex with men (YMSM).

In response to this spike in incidence, the Department of Health, Department of Human Services (Ryan White Part B Grantee), and Hennepin County (Ryan White Part A Grantee) brought together a group to start raising awareness around this issue and start thinking about new solutions. This group, which I am a part of, has been meeting since November in preparation for a series of events happening at the end of February (not coincidentally the end of Part A’s fiscal year). This includes YMSM focus groups, a provider summit (open to all youth workers), and a youth PSA contest.

Obviously, this increase has been all over the blogs and newspapers in the past weeks. The response from many providers has been: youth like risky behavior, the interwebs gives you AIDS, and USE CONDOMS DAMMIT. Maybe I’m being a little overdramatic.

My point is that I don’t think this is a productive conversation. Adolescents are risky, but not necessarily intentionally so. I doubt any 17 year old is thinking, “if I have sex tonight, I might get HIV … that’s so risky.” No, they’re thinking, “Gee golly, that’s a really hot person that I’d like to touch inappropriately.” The internet doesn’t promote unsafe sex, it provides a medium for people to pursue something they’re pursuing anyway. This goes both ways — there are dating-oriented websites that connect people who may not have otherwise met.

And then there’s condoms. Yes, they’re effective, but they’re only effective if they’re being consistently used. The problem is that it’s really hard to tell a teenager that they need to use condoms for the rest of their life. We can put millions of dollars into education and advertising, but it doesn’t make it any easier to carry out.

I don’t have the solution, but I know we have a problem. We can’t blame the internet for this increase, we can’t blame the youth, and we can’t expect condoms to continue to be the solution. We, as a society, need to figure out a reasonable, life-long prevention plan for not just gay/bi men, but for everyone. I really wish I had a magical answer for this one…

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by on February 10, 20102 Comments
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Awareness Test

I started my new job yesterday, so I’ve spent yesterday and today in the new employee orientation (also known as “on-boarding”). This involves leaders from just about every administrative department coming to talk about what they do.

The patient safety person showed us a video that I thought was interesting. When you watch it, count the number of passes the white team makes. You should probably do that before reading any more of this entry.

So, when I watched it, I counted seventeen. The only problem is that I missed the giant gorilla that dances through the middle of the screen. People, apparently, only look for what they want to see. This becomes a problem when it comes to patient safety — if you’re looking for a certain drug to give to a patient, you might grab one that looks similar and actually read the “correct” drug’s name. This kind of mistake plays a part in many of the 98,000 deaths from medical errors every year.

Additionally, that exercise was used in a cyclist awareness campaign in the UK. Here’s one of the other ads that, perhaps, more dramatically demonstrates this effect (as if a dancing gorilla wasn’t dramatic enough):

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by on January 20, 2010No Comments
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Grand Rounds

Abdominal x-ray

You’re looking at an x-ray of the abdominal area, and there’s something in there that shouldn’t be…can you guess what it is?

I found this in a journal (Surgical Rounds) that we get at work. It details a case of an 85 year old man who showed up in the ER complaining of acute abdominal pain. They ended up taking a look, and finding a perforated colon. No explanation. They stitch him up, and he shows up again about 2 years later. This time, there’s a “bar of soap” stuck up there (the patient says it helps with his impacted stools). They could feel it when they push around on his tummy, and so they took that x-ray. Turns out, it wasn’t a bar of soap.

I don’t want to ruin the surprise. Feel free to guess, or if that’s too much work, you can read the case report (and other information about perforated colons and sexual activity).

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by on January 16, 2010No Comments
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