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, 2010  •  Permalink
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Posted by john on March 19, 2010

http://john.mn/2010/03/how-long-have-we-known/

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, 2010  •  Permalink
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Posted by john on March 10, 2010

http://john.mn/2010/03/hiv-prevention-2-0/

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, 2010  •  Permalink
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Posted by john on March 1, 2010

http://john.mn/2010/03/a-case-for-monogamy/

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, 2010  •  Permalink
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Posted by john on February 27, 2010

http://john.mn/2010/02/drunk-and-horny/

Who said track lighting died in the 90s?

I completed my first home project: installing track lighting in my office area.  The lighting before looked like, as my agent said, “something from the suburbs or the projects.”  It was cheap overhead lighting that looked quite dated.

So, I went to IKEA, and bought the Radium light system.  I’ve been putting off installing it for a couple of months.  I’ve never done anything electrical, so it was a pretty daunting task.  I drilled a bunch of holes in the ceiling, mounted the track, and then shut the power off.  After an hour of playing around with the 6 different wires (remember, I’m a total novice), I turned the power on, and everything worked!

Here’s the before…

and after…

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by on February 14, 2010  •  Permalink
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Posted by john on February 14, 2010

http://john.mn/2010/02/who-said-track-lighting-died-in-the-90s/

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, 2010  •  Permalink
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Posted by john on February 10, 2010

http://john.mn/2010/02/minnesota-hiv-rates/

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, 2010  •  Permalink
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Posted by john on January 20, 2010

http://john.mn/2010/01/awareness-test/

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, 2010  •  Permalink
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Posted by john on January 16, 2010

http://john.mn/2010/01/grand-rounds/

High Schoolers on Twitter

One of the three high schools I attended (don’t ask) is apparently jumping on the Web 2.0 bandwagon with the help of the U of Mn. Roosevelt High School is somehow integrating Twitter and other social media websites with their English class to help engage students. Very interesting idea. Perhaps most interesting for me was seeing my Open English teacher, Delainia Haug, teaching the class. She’s probably one of the best and most enthusiastic teachers I had during my high school career.

I couldn’t find much about the DigMe program in particular, but here’s the video from the U:

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by on January 16, 2010  •  Permalink
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Posted by john on January 16, 2010

http://john.mn/2010/01/high-schoolers-on-twitter/

Moved In!

I’m successfully moved and settled.  Just for proof, here’s a few more photos…

My office area.  Beyond the magical curtains is my bedroom area.  It’s one room that’s about 20 feet long, so I divided it up into an office and bedroom.

My living room.  Complete with Sactional and wall mounted TV.

My dining room.  Pretty much everything you see is IKEA.  With the exception of the ceiling fan — I’m really hoping to replace that soon.

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by on November 9, 2009  •  Permalink
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Posted by john on November 9, 2009

http://john.mn/2009/11/moved-in/

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