Dr. Bill Jenkins, one of the people instrumental in ending the Tuskegee syphilis experiment, gave an opening keynote address. Racism, he argued, is the only example of a condition where we study the symptom and not the cause. There’s not a race problem in the US, there’s a racism problem. We need to broach the uncomfortable to start addressing actual determinants of health. And, like Martin Luther King, Jr did, we need to move from being a corporate leader to being a servant leader — and this means putting people before papers.

Dr. Cornel West closed the opening ceremony, in one of the most inspirational, energetic, and entertaining public health speeches I’ve ever heard (I can only hope APHA posts the video for free online). “Justice is what love is called in public [...] Love is a steadfast commitment to the wellbeing of others.”

So, this is my first national conference. My first day really reflected this, as I left the opening ceremony, and immediately tried to do everything. It was an apt twitter user that pointed out that APHA is a marathon and not a spring. However, I’m still glad I managed to meet and chat with other public health people, and learn about interesting topics…

I met the founders of The Positive Project, a Colorado-based organization working to share the stories of people living with HIV/AIDS. They are two therapists working with HIV+ clients who began noticing that many of their clients were experiencing similar situations. But, bound by confidentiality, there was no way for them to share stories. So, they created a website and posted interviews with consented people living with HIV/AIDS. It’s a simple, yet brilliant, idea — this way, people can privately hear the stories of all kinds of individuals living with HIV.

I talked with the a member of the Houston Public Health Department about their use of almost real-time data in responding to a syphilis outbreak.  In 2007, they were 2nd in the nation for Syphilis.  They mapped syphilis cases, clinics/services, and various determinants of health.  This, in turn, influenced where their mobile clinic went.  The clinic ended up serving 1,489 clients that year, and Houston managed to relinquish their position of second highest syphilis incidence in the country.  A true success story for data-driven practice.

I also learned that alcohol outlet density is associated with crime, but not gonorrhea cases.  Medical students like the idea of a Personal Health Record, but not necessarily for them personally.  And the gold standard of lab-confirmed STD cases may underreport compared to self-reported cases in public health research.

I really didn’t know what to expect coming to APHA.  But, I’ve learned that it’s important to focus and plan what you want to do (including planning your wandering time through the Expo).  There are so many passionate people here.  I’m amazed that I can stop at a poster that looks really boring, ask the person what they did, and just through their brief speech I can become energized and excited about their research.  It’s revitalizing, and I can’t believe I haven’t come here before.

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…