1 00:00:06,306 --> 00:00:07,240 >> WELCOME BACK. 2 00:00:07,307 --> 00:00:08,775 THANK YOU FOR JOINING US FOR 3 00:00:08,842 --> 00:00:15,915 DAY 2 OF THE NIH VIDEOCAST 4 00:00:15,982 --> 00:00:19,119 ON HIV AND WOMEN SCIENTIFIC 5 00:00:19,185 --> 00:00:19,919 WORKSHOP CENTERING THE 6 00:00:19,986 --> 00:00:22,322 HEALTH OF WOMEN IN HIV 7 00:00:22,389 --> 00:00:22,722 RESEARCH. 8 00:00:22,789 --> 00:00:27,460 I AM PROGRAM OFFICER AT NIAD 9 00:00:27,527 --> 00:00:32,031 AND COAUTHORING THE SESSION 10 00:00:32,098 --> 00:00:34,300 WITH Dr. TATIANA AND 11 00:00:34,367 --> 00:00:35,568 OTHERS. 12 00:00:35,635 --> 00:00:36,269 I WILL PROVIDE INTRODUCTION 13 00:00:36,336 --> 00:00:41,307 FOR ALL THE SPEAKERS OF THE 14 00:00:41,374 --> 00:00:45,712 SESSION AND TATIANA WILL 15 00:00:45,779 --> 00:00:46,946 MODERATE THE DISCUSSION. 16 00:00:47,013 --> 00:00:57,557 THIS IS PART OF THE HIV AND 17 00:00:59,592 --> 00:01:02,061 WOMEN SIGNATURE PROGRAM WITH 18 00:01:02,128 --> 00:01:08,735 THE INTENTION OF PREVENTING 19 00:01:08,802 --> 00:01:11,104 THE NEXT EPIDEMIC. 20 00:01:11,171 --> 00:01:14,507 WE WILL INCLUDE TODAY HOW TO 21 00:01:14,574 --> 00:01:15,942 IDENTIFY HIV RESEARCH. 22 00:01:16,009 --> 00:01:18,211 AS A REMINDER, YOU CAN 23 00:01:18,278 --> 00:01:22,115 PRESENT QUESTIONS USING THE 24 00:01:22,182 --> 00:01:24,951 LIVE FEEDBACK FORM AND VOICE 25 00:01:25,018 --> 00:01:28,054 THEM IF YOU ARE ABLE. 26 00:01:28,121 --> 00:01:35,261 YOU CAN ALSO SUBMIT 27 00:01:35,328 --> 00:01:41,768 QUESTIONS TO WOMENANDHIV AD 28 00:01:41,835 --> 00:01:43,470 OD.NIH.GOV. 29 00:01:43,536 --> 00:01:48,041 Dr. SHARON HILLIER IS A 30 00:01:48,107 --> 00:01:51,611 RESEARCHER DISCOVERING THE 31 00:01:51,678 --> 00:01:59,152 ORGANISM IN THE GENITAL 32 00:01:59,219 --> 00:02:06,960 TRACT INCLUDING HIV. 33 00:02:07,026 --> 00:02:12,499 Dr. HILLIER HEADED THE 34 00:02:12,565 --> 00:02:15,768 NETWORK FROM 2006 TO 2022, 35 00:02:15,835 --> 00:02:18,404 THE ORGANIZER OF THE CHILD'S 36 00:02:18,471 --> 00:02:22,375 NETWORK AND PART OF THE UAB 37 00:02:22,442 --> 00:02:25,445 FUNDED INITIATIVE TO PRESENT 38 00:02:25,512 --> 00:02:31,084 NEW HIV PREVENTION PRODUCTS. 39 00:02:31,150 --> 00:02:32,919 Dr. BRIANNA FURCH IS A 40 00:02:32,986 --> 00:02:35,688 SCIENTIST WHO FOCUSES ON 41 00:02:35,755 --> 00:02:39,192 WOMEN'S HEALTH, HIV 42 00:02:39,259 --> 00:02:40,660 PREVENTION AND INFECTIOUS 43 00:02:40,727 --> 00:02:41,160 DISEASE. 44 00:02:41,227 --> 00:02:44,998 AT THE FRED HUTCHINSON 45 00:02:45,064 --> 00:02:48,001 CANCER CENTER, Dr. FURCH 46 00:02:48,067 --> 00:02:50,036 PLAYS A KEY ROLE FOR 47 00:02:50,103 --> 00:02:52,672 OVERSIGHT AND DEVELOPMENT 48 00:02:52,739 --> 00:02:57,744 AND IMPLEMENTATION OF SARS 49 00:02:57,810 --> 00:03:02,649 COV2, HIV AND ASSOCIATED 50 00:03:02,715 --> 00:03:03,016 TRIALS. 51 00:03:03,082 --> 00:03:07,320 Dr. RASHEETA CHANDLER IS A 52 00:03:07,387 --> 00:03:10,056 PROFESSOR AT UNIVERSITY OF 53 00:03:10,123 --> 00:03:14,327 CALIFORNIA AND SCHOOL OF 54 00:03:14,394 --> 00:03:18,698 MEDICINE SAN FRANCISCO. 55 00:03:18,765 --> 00:03:20,300 AS A PRACTITIONER AT THE 56 00:03:20,366 --> 00:03:25,638 CENTER OF BLACK WOMEN'S 57 00:03:25,705 --> 00:03:28,641 HEALTH IN GEORGIA. 58 00:03:28,708 --> 00:03:30,944 Dr. CHANDLER LOOKS AT 59 00:03:31,010 --> 00:03:36,349 DISPARITIES IN CARE 60 00:03:36,416 --> 00:03:41,321 INCLUDING REPRODUCTIVE CARE 61 00:03:41,387 --> 00:03:49,662 INCLUDING CIS WOMEN. 62 00:03:49,729 --> 00:03:52,799 Dr. SINEAL DELANY-MORETIWE 63 00:03:52,865 --> 00:03:55,635 IS PROTOCOL CHAIR OF THE 64 00:03:55,702 --> 00:03:59,739 LANDMARK TRIALS AND 65 00:03:59,806 --> 00:04:01,674 INJECTABLE PREEXPOSURE PRO 66 00:04:01,741 --> 00:04:04,043 LACKED 'TIS WHICH LED TO -- 67 00:04:04,110 --> 00:04:07,113 [INDISCERNIBLE] 68 00:04:07,180 --> 00:04:12,919 IN SEVERAL COUNTRIES. 69 00:04:12,986 --> 00:04:15,088 JACQUELYNE ALESI HAS WORKED 70 00:04:15,154 --> 00:04:18,291 FOR THE WOMEN'S PREVENTION 71 00:04:18,358 --> 00:04:20,159 CAMPAIGN, GLOBAL COMMUNITY 72 00:04:20,226 --> 00:04:20,994 LEADERSHIP SINCE 73 00:04:21,060 --> 00:04:21,561 NOVEMBER 2021. 74 00:04:21,628 --> 00:04:26,666 IN THIS ROLE, SHE MOBILIZES 75 00:04:26,733 --> 00:04:30,937 THE GLOBAL COMMUNITY VOICE, 76 00:04:31,004 --> 00:04:32,538 A GLOBAL COLLABORATION FOR 77 00:04:32,605 --> 00:04:36,542 PEOPLE LIVING WITH HIV TO 78 00:04:36,609 --> 00:04:38,911 INCLUDE U EQUALS YOU IN THE 79 00:04:38,978 --> 00:04:42,515 COVID RESPONSE. 80 00:04:42,582 --> 00:04:44,450 SINCE JACQUELYNE WILL NOT BE 81 00:04:44,517 --> 00:04:49,088 ABLE TO JOIN THE 82 00:04:49,155 --> 00:04:49,656 PRESENTATION, DANIELLE 83 00:04:49,722 --> 00:04:51,791 CAMPBELL WILL BE ATTENDING 84 00:04:51,858 --> 00:04:52,759 THE DISCUSSION. 85 00:04:52,825 --> 00:04:57,397 DANIELLE IS A FOURTH-YEAR 86 00:04:57,463 --> 00:05:00,066 RESEARCH MANAGER FOR 87 00:05:00,133 --> 00:05:01,634 IMPLEMENTATION SCIENCE IN 88 00:05:01,701 --> 00:05:03,936 BIOBEHAVIORAL RESEARCH INTO 89 00:05:04,003 --> 00:05:05,138 HIV TREATMENT PREVENTION AND 90 00:05:05,204 --> 00:05:05,605 CURE RESEARCH. 91 00:05:05,672 --> 00:05:10,276 SHE IS A MEMBER OF THE 92 00:05:10,343 --> 00:05:12,679 FACULTY AT CHARLES R 93 00:05:12,745 --> 00:05:14,380 UNIVERSITY OF MEDICINE AND 94 00:05:14,447 --> 00:05:15,782 SCHOOL OF MEDICINE, 95 00:05:15,848 --> 00:05:17,350 PHYSICIANS OF PREVENTIVE AND 96 00:05:17,417 --> 00:05:19,686 SOCIAL MEDICINE. 97 00:05:19,752 --> 00:05:21,120 NEXT SLIDE, PLEASE. 98 00:05:21,187 --> 00:05:23,790 THE FIRST PRESENTATION IS 99 00:05:23,856 --> 00:05:24,824 FROM SHARON HILLIER. 100 00:05:24,891 --> 00:05:27,694 PLEASE GO AHEAD, Dr. 101 00:05:27,760 --> 00:05:28,094 HILLIER. 102 00:05:28,161 --> 00:05:29,328 >> THANKS SO MUCH AND IT IS 103 00:05:29,395 --> 00:05:31,297 A THRILL TO BE HERE TO GET 104 00:05:31,364 --> 00:05:33,366 TO SHARE SOME OF MY 105 00:05:33,433 --> 00:05:36,302 EXCITEMENT FOR ADVANCES IN 106 00:05:36,369 --> 00:05:39,605 MULTIPURPOSE PREVENTION. 107 00:05:39,672 --> 00:05:40,106 NEXT SLIDE. 108 00:05:40,173 --> 00:05:44,343 SIMPLY PUT, I DON'T REALLY 109 00:05:44,410 --> 00:05:47,380 LIKE THE TERM MPT VERY MUCH 110 00:05:47,447 --> 00:05:49,816 BECAUSE I DON'T THINK MOST 111 00:05:49,882 --> 00:05:50,850 WOMEN THOUGHT FIRST THING IN 112 00:05:50,917 --> 00:05:53,920 THE MORNING I WOULD LIKE TO 113 00:05:53,986 --> 00:05:56,589 PUT MPT IN MY VAGINA. 114 00:05:56,656 --> 00:05:58,324 WHAT THEY ARE IS PRODUCTS 115 00:05:58,391 --> 00:05:59,792 FOR DUAL PREVENTION AND 116 00:05:59,859 --> 00:06:01,060 REALLY GEARED TO PROTECT 117 00:06:01,127 --> 00:06:02,361 AGAINST MORE THAN ONE THING 118 00:06:02,428 --> 00:06:03,763 AT A TIME. 119 00:06:03,830 --> 00:06:06,799 WOMEN GET PREGNANT, STIS AND 120 00:06:06,866 --> 00:06:08,701 HIV ALL IN THE SAME WAY SO 121 00:06:08,768 --> 00:06:13,906 THE IDEA IS QUITE SIMPLY YOU 122 00:06:13,973 --> 00:06:17,477 COULD PREVENT HIV, SEXUALLY 123 00:06:17,543 --> 00:06:18,377 TRANSMITTED INFECTION AND 124 00:06:18,444 --> 00:06:19,912 PREGNANCY ALL FROM THE SAME 125 00:06:19,979 --> 00:06:21,514 EXACT PRODUCT. 126 00:06:21,581 --> 00:06:25,885 FROM A PERSPECTIVE OF WHAT 127 00:06:25,952 --> 00:06:27,954 THEY WANT, WE HAVE HEARD 128 00:06:28,020 --> 00:06:29,222 FROM MANY WOMEN THAT THEY 129 00:06:29,288 --> 00:06:32,992 HAVE A PURPOSE FOR 130 00:06:33,059 --> 00:06:33,760 MULTIPREVENTION PRODUCTS. 131 00:06:33,826 --> 00:06:38,698 58PERCENT 132 00:06:38,765 --> 00:06:40,333 8-- 85 PERCENT SAY THEY 133 00:06:40,399 --> 00:06:42,168 WOULD LIKE A PRODUCT THAT 134 00:06:42,235 --> 00:06:45,104 DOES MORE THAN ONE THING BUT 135 00:06:45,171 --> 00:06:47,874 THERE IS NO PRODUCT 136 00:06:47,940 --> 00:06:49,542 CURRENTLY AVAILABLE ASIDE 137 00:06:49,609 --> 00:06:51,511 FROM A FEMALE CONDOM. 138 00:06:51,577 --> 00:06:53,479 THEY FACE BARRIERS TO 139 00:06:53,546 --> 00:06:55,314 SUCCESS INCLUDING LACK OF 140 00:06:55,381 --> 00:06:57,683 INVESTMENT BY FUNDERS, A 141 00:06:57,750 --> 00:06:58,818 COMPLEX REGULATORY APPROVAL 142 00:06:58,885 --> 00:07:00,353 PATH AND PROGRAM SILOS THAT 143 00:07:00,419 --> 00:07:03,089 EXIST IN FAMILY PLANNING 144 00:07:03,156 --> 00:07:04,223 VERSUS HIV/STI PROGRAMS. 145 00:07:04,290 --> 00:07:04,624 NEXT SLIDE. 146 00:07:04,690 --> 00:07:07,160 SO I WILL GO THROUGH A FEW 147 00:07:07,226 --> 00:07:11,230 OF THOSE PRODUCTS AND ONE OF 148 00:07:11,297 --> 00:07:13,599 THE PRODUCTS THAT DO GO 149 00:07:13,666 --> 00:07:17,370 ALONG IS HERE ON THE 150 00:07:17,436 --> 00:07:18,838 RIGHTHAND SIDE TO SHOW HOW 151 00:07:18,905 --> 00:07:20,206 THIS WOULD BE PACKAGED. 152 00:07:20,273 --> 00:07:22,141 WHAT WE HAVE HEARD FROM MANY 153 00:07:22,208 --> 00:07:26,279 WOMEN IS THAT ORAL PREP 154 00:07:26,345 --> 00:07:31,050 ESSENTIALLY IS WHAT 155 00:07:31,117 --> 00:07:32,985 SIGMATIZED TO MAKE THOSE 156 00:07:33,052 --> 00:07:34,020 TABLETS LOOK EXACTLY LIKE 157 00:07:34,086 --> 00:07:37,657 TREATMENT SO THERE CAN BE 158 00:07:37,723 --> 00:07:39,358 STIGMA ASSOCIATED WITH USING 159 00:07:39,425 --> 00:07:41,694 PREVENTION WHEN ONE IS NOT 160 00:07:41,761 --> 00:07:43,062 LIVING WITH HIV. 161 00:07:43,129 --> 00:07:44,664 SO THE IDEA OF THE DUAL 162 00:07:44,730 --> 00:07:53,773 PREVENTION PILL IS THAT YOU 163 00:07:53,840 --> 00:08:00,079 WOULD COFORM LATE ALONG WITH 164 00:08:00,146 --> 00:08:01,914 THE ORAL CONTRACEPTIVE PILL 165 00:08:01,981 --> 00:08:04,750 AS ONE TABLET AND PACKAGED 166 00:08:04,817 --> 00:08:06,485 IN THE SNAP PACKAGE MANY OF 167 00:08:06,552 --> 00:08:08,855 US ARE FAMILIAR WITH ORAL 168 00:08:08,921 --> 00:08:09,388 CONTRACEPTIVES. 169 00:08:09,455 --> 00:08:12,291 THIS IS A STUDY THAT WILL BE 170 00:08:12,358 --> 00:08:16,429 PRESENTED BY THE HIV TRIAL 171 00:08:16,495 --> 00:08:18,264 PREVENTION NETWORK WITH THE 172 00:08:18,331 --> 00:08:19,031 LAUNCH IN 2024. 173 00:08:19,098 --> 00:08:21,467 AND IF THIS STUDY IS 174 00:08:21,534 --> 00:08:24,103 SUPPORTED, THAT IT REALLY 175 00:08:24,170 --> 00:08:25,338 DOES INCREASE ADHERENCE OR 176 00:08:25,404 --> 00:08:26,739 PREP AND WOMEN LIKE IT, I 177 00:08:26,806 --> 00:08:29,375 THINK IT IS A PATHWAY FOR 178 00:08:29,442 --> 00:08:33,012 HOW THIS COFORMULATION OF 179 00:08:33,079 --> 00:08:34,080 CONTRACEPTIVES AND PREP 180 00:08:34,146 --> 00:08:35,281 PRODUCTS COULD OCCUR. 181 00:08:35,348 --> 00:08:35,681 NEXT SLIDE. 182 00:08:35,748 --> 00:08:37,049 THE NEXT PRODUCT I WANT TO 183 00:08:37,116 --> 00:08:43,089 TELL YOU ABOUT IS A 90-DAY 184 00:08:43,155 --> 00:08:44,624 VAGINAL RING FOR 185 00:08:44,690 --> 00:08:45,791 CONTRACEPTION AND HIV. 186 00:08:45,858 --> 00:08:49,495 THIS WAS DEVELOPED BY THE 187 00:08:49,562 --> 00:08:53,032 INTERNATIONAL PARTNERSHIP 188 00:08:53,099 --> 00:08:55,101 FOR MICROBICIDES AND NOW 189 00:08:55,167 --> 00:08:57,103 HOUSED BY THE POPULATION 190 00:08:57,169 --> 00:08:57,436 COUNCIL. 191 00:08:57,503 --> 00:08:59,705 THIS IS SIMILAR TO THE VAL 192 00:08:59,772 --> 00:09:01,974 RING THAT WENT THROUGH 193 00:09:02,041 --> 00:09:04,610 CLINICAL TRIALS EXCEPT IT IS 194 00:09:04,677 --> 00:09:08,147 LOADED WITH DANNUAL PIVIRENE 195 00:09:08,214 --> 00:09:12,718 SO IT LASTS FOR 90 DAYS AS 196 00:09:12,785 --> 00:09:17,924 WELL AS LEAVING 197 00:09:17,990 --> 00:09:19,859 LEVONORGESTREL FOR 198 00:09:19,926 --> 00:09:20,293 CONTRACEPTION. 199 00:09:20,359 --> 00:09:22,895 THE PRODUCT WAS FOUND TO BE 200 00:09:22,962 --> 00:09:24,163 REALLY WELL TOLERATED WITH 201 00:09:24,230 --> 00:09:25,431 NO CONCERNS AND TWO DAYS 202 00:09:25,498 --> 00:09:26,933 AFTER YOU TAKE THE PRODUCT 203 00:09:26,999 --> 00:09:28,801 OUT OF THE ADVANTAGE FINE IN 204 00:09:28,868 --> 00:09:31,904 A -- SORRY, GO BACK ONE, 205 00:09:31,971 --> 00:09:32,705 PLEASE. 206 00:09:32,772 --> 00:09:35,241 TWO DAYS AFTER IT IS TAKEN 207 00:09:35,308 --> 00:09:37,843 OUT OF THE VAGINA YOU WOULD 208 00:09:37,910 --> 00:09:38,878 SEE THIS DECREASE IN THE 209 00:09:38,945 --> 00:09:41,681 DRUG SO IT DOESN'T HAVE A 210 00:09:41,747 --> 00:09:43,316 DRUG TAIL. 211 00:09:43,382 --> 00:09:44,617 THE PRODUCT WAS FORMULATED 212 00:09:44,684 --> 00:09:47,019 TO MAKE IT EASIER AND THE 213 00:09:47,086 --> 00:09:49,155 RING A LITTLE BIT LESS RIGID 214 00:09:49,221 --> 00:09:51,724 AND THAT STUDY IS ONGOING 215 00:09:51,791 --> 00:09:53,192 THROUGH THE CONTRACEPTIVE 216 00:09:53,259 --> 00:09:54,627 CLINICAL TRIALS, A NETWORK 217 00:09:54,694 --> 00:09:57,196 FUNDED BY THE INSTITUTE OF 218 00:09:57,263 --> 00:10:00,166 CHILD HEALTH WITH 30 TO 40 219 00:10:00,232 --> 00:10:01,667 PARTICIPANTS ENROLLED TO 220 00:10:01,734 --> 00:10:01,968 DATE. 221 00:10:02,034 --> 00:10:03,135 NEXT SLIDE. 222 00:10:03,202 --> 00:10:04,603 SO THE NEXT PRODUCT I WANT 223 00:10:04,670 --> 00:10:14,647 TO TELL YOU ABOUT IS ANOTHER 224 00:10:14,714 --> 00:10:15,948 DAPIVIRNE VAGINAL RING. 225 00:10:16,015 --> 00:10:18,084 THE IDEA OF THIS IS YOU CAN 226 00:10:18,150 --> 00:10:19,218 DELIVER DRUGS OVER A MONTH 227 00:10:19,285 --> 00:10:21,654 OF TIME BUT WITHOUT THE RING 228 00:10:21,721 --> 00:10:23,756 IN THE VAGINA WHICH MAKES IT 229 00:10:23,823 --> 00:10:25,624 MUCH MORE DISCREET, COULD BE 230 00:10:25,691 --> 00:10:26,492 DEFINITELY LOWER COST TO 231 00:10:26,559 --> 00:10:27,059 MANUFACTURE. 232 00:10:27,126 --> 00:10:33,165 SO THERE IS TWO VERSIONS OF 233 00:10:33,232 --> 00:10:38,671 THIS PILL, ONE THAT CONTAINS 234 00:10:38,738 --> 00:10:48,214 JUST DAPIVIRINE AND ONE THAT 235 00:10:48,280 --> 00:10:50,950 CONTAINS DAPIVIRINE AND 236 00:10:51,017 --> 00:10:51,417 PROGESTERONE. 237 00:10:51,484 --> 00:10:53,386 THIS IS IN PHASE 1 STUDY IN 238 00:10:53,452 --> 00:10:56,389 THE U.S., KENYA, ZIMBABWE 239 00:10:56,455 --> 00:10:57,256 AND SOUTH AFRICA. 240 00:10:57,323 --> 00:10:57,790 NEXT SLIDE. 241 00:10:57,857 --> 00:10:59,625 HOW DOES THIS WORK? 242 00:10:59,692 --> 00:11:00,326 NEXT SLIDE. 243 00:11:00,393 --> 00:11:05,197 THE IDEA IS THE IT IS PLACED 244 00:11:05,264 --> 00:11:06,966 IN THE VAGINA BY THE WOMAN, 245 00:11:07,033 --> 00:11:08,701 PRETTY EASY TO DO. 246 00:11:08,768 --> 00:11:11,537 IT IS WETTED BY VAGINAL 247 00:11:11,604 --> 00:11:14,373 FLUID AND AS IT SLOWLY 248 00:11:14,440 --> 00:11:16,208 DISSOLVES, IT SPREADS 249 00:11:16,275 --> 00:11:18,144 THROUGHOUT THE VAGINA AND IN 250 00:11:18,210 --> 00:11:20,246 THAT WAY, BLOCKS HIV AND 251 00:11:20,312 --> 00:11:20,846 PREGNANCY. 252 00:11:20,913 --> 00:11:22,615 AFTER 30 DAYS, THE FILM IS 253 00:11:22,681 --> 00:11:25,418 COMPLETELY GONE AND WOULD BE 254 00:11:25,484 --> 00:11:26,452 REPLACED BY ANOTHER FILM. 255 00:11:26,519 --> 00:11:30,022 SO THIS IS A REALLY EXCITING 256 00:11:30,089 --> 00:11:32,658 COMPLETELY NOVEL WAY OF 257 00:11:32,725 --> 00:11:34,293 DELIVERING A MPT AND WE'RE 258 00:11:34,360 --> 00:11:36,128 EXCITED TO SEE HOW THIS 259 00:11:36,195 --> 00:11:37,663 PROGRESSES IN THE MONTHS 260 00:11:37,730 --> 00:11:37,963 AHEAD. 261 00:11:38,030 --> 00:11:38,697 NEXT SLIDE. 262 00:11:38,764 --> 00:11:40,733 THE NEXT PROBLEM I WANT TO 263 00:11:40,800 --> 00:11:42,134 QUICKLY TELL YOU ABOUT IS 264 00:11:42,201 --> 00:11:43,736 SOMETHING CALLED THE ONE 265 00:11:43,803 --> 00:11:46,505 RING, A DUAL PURPOSE RING TO 266 00:11:46,572 --> 00:11:47,740 PREVENT HIV AND PREGNANCY 267 00:11:47,807 --> 00:11:49,241 AND THIS IS BEING DEVELOPED 268 00:11:49,308 --> 00:11:49,675 IN CALIFORNIA. 269 00:11:49,742 --> 00:11:51,811 THIS IS A RING THAT HAS, AS 270 00:11:51,877 --> 00:11:54,280 YOU CAN SEE THERE AT THE 271 00:11:54,346 --> 00:11:56,348 TOP, TWO LITTLE PODS. 272 00:11:56,415 --> 00:11:59,085 ONE CON PAINS THE ANTI-HIV 273 00:11:59,151 --> 00:12:01,687 AGENT AND THE OTHER CONTAINS 274 00:12:01,754 --> 00:12:02,788 THE CONTRACEPTIVE. 275 00:12:02,855 --> 00:12:04,356 WHAT IS REALLY NOVEL ABOUT 276 00:12:04,423 --> 00:12:08,394 THIS RING IS THAT IT IS A 277 00:12:08,461 --> 00:12:12,531 NONHORMONAL, NONE A RV-BASED 278 00:12:12,598 --> 00:12:13,799 CONTRACEPTIVE AND HIV RING. 279 00:12:13,866 --> 00:12:16,769 SO WHAT IS IT? 280 00:12:16,836 --> 00:12:19,205 THE ANTIVIRAL IS A ANTIVIRAL 281 00:12:19,271 --> 00:12:21,173 PEPTIDE WHICH IS UNIQUE AND 282 00:12:21,240 --> 00:12:24,143 HAS ACTIVITY AGAINST HERPES 283 00:12:24,210 --> 00:12:26,278 AND HPV AND THE 284 00:12:26,345 --> 00:12:30,449 CONTRACEPTIVE AGENT IS 285 00:12:30,516 --> 00:12:39,925 SOMETHING CALLED A SAC 286 00:12:39,992 --> 00:12:41,861 INHIBITOR WHICH BASICALLY 287 00:12:41,927 --> 00:12:44,597 INHIBITS SPERM MOTILITY. 288 00:12:44,663 --> 00:12:46,799 THE PRECLINICAL PLACEBEEN O 289 00:12:46,866 --> 00:12:48,400 RINGS, THIS CARRIER DEVICE, 290 00:12:48,467 --> 00:12:51,070 ARE NOW BEING EVALUATED IN 291 00:12:51,137 --> 00:12:52,671 CLINICAL TRIALS FOR 292 00:12:52,738 --> 00:12:53,572 ACCEPTABILITY AND FOR 293 00:12:53,639 --> 00:12:56,408 SELECTION OF THE STIFFNESS 294 00:12:56,475 --> 00:12:59,044 OF THE VAGINAL RINGS IN AN 295 00:12:59,111 --> 00:12:59,678 ONGOING CLINICAL TRIAL IN 296 00:12:59,745 --> 00:13:01,947 THE U.S. AND AFRICA. 297 00:13:02,014 --> 00:13:04,049 AND WE'RE EXCITED TO SEE THE 298 00:13:04,116 --> 00:13:05,317 ACTIVE VERSION OF THESE 299 00:13:05,384 --> 00:13:07,453 RINGS MOVING INTO CLINICAL 300 00:13:07,520 --> 00:13:10,523 TRIALS NEXT YEAR. 301 00:13:10,589 --> 00:13:11,223 NEXT SLIDE. 302 00:13:11,290 --> 00:13:12,892 SO ONE THAT I THINK WILL BE 303 00:13:12,958 --> 00:13:15,294 FAMILIAR TO MANY OF YOU IS 304 00:13:15,361 --> 00:13:18,264 HOW DO YOU MAKE AN 305 00:13:18,330 --> 00:13:20,799 INJECTABLE TAB THAT SINEAD 306 00:13:20,866 --> 00:13:23,102 IS GOING TO TALK ABOUT IN A 307 00:13:23,169 --> 00:13:24,203 LITTLE BIT, MAYBE A LITTLE 308 00:13:24,270 --> 00:13:24,837 BIT BETTER. 309 00:13:24,904 --> 00:13:29,508 AND THIS IS A PRODUCT CALLED 310 00:13:29,575 --> 00:13:30,910 CAB HYDROGEL INJECTABLE 311 00:13:30,976 --> 00:13:33,279 DEPOT WHICH IS BEING 312 00:13:33,345 --> 00:13:34,547 DEVELOPED IN VIRGINIA AND WE 313 00:13:34,613 --> 00:13:36,849 HOPE WILL BE STUDIED IN A 314 00:13:36,916 --> 00:13:39,285 CLINICAL TRIAL WITH THE 315 00:13:39,351 --> 00:13:39,985 ADOLESCENT TRIALS NETWORK. 316 00:13:40,052 --> 00:13:42,688 SO IT IS NOT EXACTLY LIKE 317 00:13:42,755 --> 00:13:44,857 THE CAB LA THAT HAS BEEN 318 00:13:44,924 --> 00:13:48,627 LICENSED BUT IT IS A NOVEL 319 00:13:48,694 --> 00:13:53,599 PRODUCT THAT CREATES A DEPOT 320 00:13:53,666 --> 00:13:56,635 UNDER THE SKIN BUT WILL 321 00:13:56,702 --> 00:14:00,072 PROVIDE SIX MONTHS OF 322 00:14:00,139 --> 00:14:02,141 PROTECTION FROM HIV ALONG 323 00:14:02,208 --> 00:14:03,809 WITH PROGESTERONE. 324 00:14:03,876 --> 00:14:04,343 WHY? 325 00:14:04,410 --> 00:14:07,146 THE CURRENT CAB LA IS NOT 326 00:14:07,213 --> 00:14:07,780 CURRENTLY FORMULATED SO I 327 00:14:07,846 --> 00:14:11,517 THINK WHAT WE WILL HAVE IS A 328 00:14:11,584 --> 00:14:14,053 3-MONTH PRODUCT WITH SMALLER 329 00:14:14,119 --> 00:14:19,558 MILS, THREE MONTHS OF 330 00:14:19,625 --> 00:14:20,426 INJECTION PROVIDED 331 00:14:20,492 --> 00:14:23,329 SUBCUTANEOUSLY SO LESS 332 00:14:23,395 --> 00:14:27,299 INJECTION PAIN, REDUCED 333 00:14:27,366 --> 00:14:28,367 INJECTION SITE REACTION, 334 00:14:28,434 --> 00:14:32,805 LOWER COST AND REDUCIBLE D 335 00:14:32,871 --> 00:14:34,707 HEALTH SYSTEM BURDEN. 336 00:14:34,773 --> 00:14:36,542 THIS IS IN PRECLINICAL 337 00:14:36,609 --> 00:14:38,611 DEVELOPMENT BUT THERE ARE 338 00:14:38,677 --> 00:14:40,713 PLANS UNDERWAY TO EVALUATE 339 00:14:40,779 --> 00:14:44,016 THIS CLINICALLY IN THE 340 00:14:44,083 --> 00:14:49,021 PHYSICAL 1 STUDY WITH THE 341 00:14:49,088 --> 00:14:49,321 NICHD. 342 00:14:49,388 --> 00:14:51,223 SO WHEN WE THINK ABOUT THE 343 00:14:51,290 --> 00:14:52,725 RINGS OF PRODUCT WE HAVE 344 00:14:52,791 --> 00:14:53,993 CURRENTLY IN DEVELOPMENT, IT 345 00:14:54,059 --> 00:14:55,628 LOOKS PRETTY GOOD BUT IT 346 00:14:55,694 --> 00:14:58,564 NEEDS TO BE A LOT BETTER. 347 00:14:58,631 --> 00:14:59,965 AND MY HEADLINE ON THIS ONE 348 00:15:00,032 --> 00:15:03,502 IS THAT THE FUNDING FOR MPT 349 00:15:03,569 --> 00:15:05,337 IS MODEST AND ACTUALLY 350 00:15:05,404 --> 00:15:06,605 GETTING SOMEWHAT SMALLER. 351 00:15:06,672 --> 00:15:10,042 WE SEE HERE IN THE MIDDLE IN 352 00:15:10,109 --> 00:15:12,111 THE BLUE TABLE A LIST OF THE 353 00:15:12,177 --> 00:15:14,380 WONDERFUL PROJECTS THAT ARE 354 00:15:14,446 --> 00:15:16,582 IN DEVELOPMENT AT NICHD 355 00:15:16,649 --> 00:15:18,284 WHICH HAS REALLY BEEN THE 356 00:15:18,350 --> 00:15:21,887 LEADER IN THIS SPACE AS MPTS 357 00:15:21,954 --> 00:15:23,222 OR POTENTIAL MPTS AND THESE 358 00:15:23,289 --> 00:15:27,493 ARE ALL, AS YOU CAN SEE ON 359 00:15:27,559 --> 00:15:33,399 THE FAR RIGHTHAND COLUMN IN 360 00:15:33,465 --> 00:15:34,433 VERY PRECLINICAL STAGES. 361 00:15:34,500 --> 00:15:35,401 LEAD DISCOVERY, STILL TRYING 362 00:15:35,467 --> 00:15:37,336 TO FIGURE OUT WHAT IS THE 363 00:15:37,403 --> 00:15:38,570 BEST PRODUCT, STILL 364 00:15:38,637 --> 00:15:39,405 SCREENING FOR PRODUCTS AND 365 00:15:39,471 --> 00:15:41,240 THERE IS ONLY ONE REALLY AT 366 00:15:41,307 --> 00:15:43,642 THE TOP THERE, THE PHASE 1 367 00:15:43,709 --> 00:15:46,378 STUDY OF A PRODUCT THAT IS 368 00:15:46,445 --> 00:15:48,647 BEING DEVELOPED BY DEBBIE 369 00:15:48,714 --> 00:15:50,382 ANDERSON AND KEVIN WHALEY 370 00:15:50,449 --> 00:15:57,356 WHICH IS A VAGINAL DEVICE 371 00:15:57,423 --> 00:16:01,226 THAT CONTAINS A ANTI-SPERM 372 00:16:01,293 --> 00:16:01,660 AND ANTIBODY. 373 00:16:01,727 --> 00:16:03,962 SO THIS IS A WONDERFUL 374 00:16:04,029 --> 00:16:05,264 PORTFOLIO OF PRODUCTS BUT 375 00:16:05,331 --> 00:16:06,565 ALL VERY, VERY EARLY. 376 00:16:06,632 --> 00:16:08,267 IN THE BOXES ON THE BOTTOM 377 00:16:08,334 --> 00:16:09,568 WHICH I HIGHLIGHTED IN RED, 378 00:16:09,635 --> 00:16:15,541 TWO THINGS YOU NEED TO KNOW. 379 00:16:15,607 --> 00:16:19,078 ONE, THE BILL AND MELINDA 380 00:16:19,144 --> 00:16:19,912 GATES FOUNDATION, ALTHOUGH 381 00:16:19,978 --> 00:16:21,213 SPIRITUALLY SUPPORTIVE OF 382 00:16:21,280 --> 00:16:24,383 THE DEVELOPMENT, HAS NOTED 383 00:16:24,450 --> 00:16:26,585 MPT IS NOT ON STRATEGY OR AS 384 00:16:26,652 --> 00:16:29,221 WE LIKE TO CALL A PARALLEL 385 00:16:29,288 --> 00:16:30,489 STRATEGY MEANING THEY ARE 386 00:16:30,556 --> 00:16:31,890 NOT MAKING A SIGNIFICANT 387 00:16:31,957 --> 00:16:35,194 INVESTMENT IN THIS AREA. 388 00:16:35,260 --> 00:16:39,531 NIAID WHICH HAS HAD THE NEXT 389 00:16:39,598 --> 00:16:40,699 GENERATION MULTIPURPOSE 390 00:16:40,766 --> 00:16:41,400 TECHNOLOGIES ANNOUNCEMENT 391 00:16:41,467 --> 00:16:43,402 FOR SEVERAL YEARS HAS NOTED 392 00:16:43,469 --> 00:16:44,303 THEIR ANNOUNCEMENT WILL 393 00:16:44,370 --> 00:16:45,437 EXPIRE IN DECEMBER OF THIS 394 00:16:45,504 --> 00:16:46,839 YEAR AND THERE WILL LIKELY 395 00:16:46,905 --> 00:16:47,573 BE A GAP. 396 00:16:47,639 --> 00:16:53,345 SO WE SEE TWO OF THE LARGER 397 00:16:53,412 --> 00:16:55,781 FUNDERS, NIAID AND THE BILL 398 00:16:55,848 --> 00:16:58,384 AND MELINDA GATES FOUNDATION 399 00:16:58,450 --> 00:17:00,586 REALLY NOT IN THIS SPACE YET 400 00:17:00,652 --> 00:17:03,689 THE WORK THAT HAS BEEN DONE 401 00:17:03,756 --> 00:17:06,492 BY NIAID IS CRITICAL, HIGHLY 402 00:17:06,558 --> 00:17:07,993 LAUDABLE BUT VERY EARLY. 403 00:17:08,060 --> 00:17:08,394 NEXT SLIDE. 404 00:17:08,460 --> 00:17:10,062 SO WHEN WE THINK ABOUT WHERE 405 00:17:10,129 --> 00:17:12,097 WE HAVE, THE PRODUCTS WE 406 00:17:12,164 --> 00:17:15,367 HAVE RIGHT NOW INCLUDE THE 407 00:17:15,434 --> 00:17:17,336 PREVENTIVE PILL WHICH WOULD 408 00:17:17,403 --> 00:17:20,539 BE EVALUATED BY MPT4 AND 409 00:17:20,606 --> 00:17:22,674 WILL TEACH US WHETHER ORAL 410 00:17:22,741 --> 00:17:25,744 PREP DRUGS AND ORAL 411 00:17:25,811 --> 00:17:26,812 CONTRACEPTIVE DRUGS 412 00:17:26,879 --> 00:17:28,180 INCREASES UPTAKE, ADHERENCE 413 00:17:28,247 --> 00:17:30,482 AND PERSISTENCE WITH PREP. 414 00:17:30,549 --> 00:17:31,650 IN THE CLINICAL DEVELOPMENT, 415 00:17:31,717 --> 00:17:36,722 WE HAVE THE TAV/EVG INSERT 416 00:17:36,789 --> 00:17:41,393 FOR PREP, A MPT-HIV 417 00:17:41,460 --> 00:17:47,966 CONTRACEPTIVE RING AND A 418 00:17:48,033 --> 00:17:50,803 NONHORMONAL NONARV RING AND 419 00:17:50,869 --> 00:17:51,703 A MONTHLY FILM. 420 00:17:51,770 --> 00:17:53,338 THEN IN A PRECLINICAL 421 00:17:53,405 --> 00:17:56,542 DEVELOPMENT, WE HAVE THE CAB 422 00:17:56,608 --> 00:17:58,477 PELLET IMPLANTS WITH OUR 423 00:17:58,544 --> 00:17:59,178 WITHOUT CONTRACEPTIVES WHICH 424 00:17:59,244 --> 00:18:02,481 I DIDN'T TALK ABOUT TODAY, A 425 00:18:02,548 --> 00:18:05,117 CAB DEPOT SUBQ INJECTABLE 426 00:18:05,184 --> 00:18:06,218 WITH OR WITHOUT 427 00:18:06,285 --> 00:18:07,719 CONTRACEPTIVE WHICH WILL BE 428 00:18:07,786 --> 00:18:08,987 GOING INTO TRIALS SOON AND 429 00:18:09,054 --> 00:18:10,856 THEN A NOVEL VAGINAL FILM 430 00:18:10,923 --> 00:18:13,859 AND RINGS BEING SUPPORTED BY 431 00:18:13,926 --> 00:18:14,159 NICHD. 432 00:18:14,226 --> 00:18:14,760 NEXT SLIDE. 433 00:18:14,827 --> 00:18:18,397 SO WHERE DOES THIS LEAVE US? 434 00:18:18,464 --> 00:18:21,667 IN A WOMAN WHO HAS WORKED IN 435 00:18:21,733 --> 00:18:22,768 HIV PREVENTION FOR 30 YEARS 436 00:18:22,835 --> 00:18:25,437 OR MORE, WHAT WE SEE IS THE 437 00:18:25,504 --> 00:18:26,605 DESIRE EXPRESSED BY WOMEN IN 438 00:18:26,672 --> 00:18:28,340 THE COMMUNITY FOR MPT AND 439 00:18:28,407 --> 00:18:30,509 WHAT WE SEE IS THE 440 00:18:30,576 --> 00:18:32,444 INVESTMENT HAS BEEN 441 00:18:32,511 --> 00:18:34,046 RELATIVELY MODEST. 442 00:18:34,112 --> 00:18:35,881 SO FOR ME, OUR CALL TO 443 00:18:35,948 --> 00:18:37,249 ACTION IS FOR GREATER 444 00:18:37,316 --> 00:18:39,518 FINANCIAL SUPPORT FOR 445 00:18:39,585 --> 00:18:40,552 DUAL-PREVENTION PRODUCTS. 446 00:18:40,619 --> 00:18:42,421 YOU KNOW, I LIKE TO SAY WE 447 00:18:42,488 --> 00:18:44,256 HAVE EVERYTHING WE NEED TO 448 00:18:44,323 --> 00:18:45,891 MAKE A MPT EXCEPT THE WILL 449 00:18:45,958 --> 00:18:49,061 AND THE MONEY SO WE REALLY 450 00:18:49,127 --> 00:18:50,195 NEED GREATER INVESTMENT 451 00:18:50,262 --> 00:18:53,599 BECAUSE THESE PRODUCTS ARE 452 00:18:53,665 --> 00:18:53,999 COMPLICATED. 453 00:18:54,066 --> 00:18:55,834 AND THAT LEADS US TO MY NEXT 454 00:18:55,901 --> 00:18:56,368 POINT. 455 00:18:56,435 --> 00:18:58,670 WE CURRENTLY HAVE NO 456 00:18:58,737 --> 00:19:01,440 REGULATORY PATH LAID OUT FOR 457 00:19:01,507 --> 00:19:02,107 MULTIPURPOSE TECHNOLOGIES. 458 00:19:02,174 --> 00:19:04,409 RIGHT NOW THE WAY IT WORKS 459 00:19:04,476 --> 00:19:14,186 WITH ANY REGULAR -- 460 00:19:14,253 --> 00:19:15,287 REGULATOR IN THE WORLD WHO 461 00:19:15,354 --> 00:19:16,555 SAYS THIS IS THE PRODUCT AND 462 00:19:16,622 --> 00:19:20,392 WHAT YOU NEED TO DO BUT THIS 463 00:19:20,459 --> 00:19:22,227 IS DIFFERENT BECAUSE THEY 464 00:19:22,294 --> 00:19:23,495 WILL REQUIRE CLINICAL TRIAL 465 00:19:23,562 --> 00:19:23,896 DESIGN. 466 00:19:23,962 --> 00:19:25,130 IF YOU THINK ABOUT THE ONE 467 00:19:25,197 --> 00:19:31,370 PRODUCT THAT I MENTIONED 468 00:19:31,436 --> 00:19:38,944 WITH A STAPH INHIBITOR AND 469 00:19:39,011 --> 00:19:43,048 HIV PREVENTION AND 470 00:19:43,115 --> 00:19:43,815 ANTIMICROBIAL, IT BECOMES 471 00:19:43,882 --> 00:19:45,384 IMPOSSIBLE TO MOVE SO WE 472 00:19:45,450 --> 00:19:46,752 NEED A REGULATORY PATHWAY 473 00:19:46,818 --> 00:19:49,154 FOR THESE PRODUCTS. 474 00:19:49,221 --> 00:19:51,657 AND FINALLY HIV PREVENTION 475 00:19:51,723 --> 00:19:54,860 AND FAMILY PLANNING LIVE IN 476 00:19:54,927 --> 00:19:57,262 DIFFERENT SILOS FROM R&D TO 477 00:19:57,329 --> 00:19:59,998 SCALE-UP AND WE NEED BETTER 478 00:20:00,065 --> 00:20:01,166 INTEGRATED SYSTEMS TO MAKE 479 00:20:01,233 --> 00:20:02,734 THIS POSSIBLE. 480 00:20:02,801 --> 00:20:05,037 I THINK MPT COULD EXPAND 481 00:20:05,103 --> 00:20:06,738 USE, COULD MEET THE UNMET 482 00:20:06,805 --> 00:20:08,273 NEEDS OF YOUNG WOMEN AND ONE 483 00:20:08,340 --> 00:20:11,310 OF THE THINGS I ALWAYS HEAR 484 00:20:11,376 --> 00:20:13,078 ARE THINGS THAT I CALL THE 485 00:20:13,145 --> 00:20:14,012 ENEMY OF THE GOOD. 486 00:20:14,079 --> 00:20:17,616 THAT IS PEOPLE SAYING WELL, 487 00:20:17,683 --> 00:20:20,819 IF SOMEONE HAS A REALLY 488 00:20:20,886 --> 00:20:21,720 EFFECTIVE CONTRACEPTIVE, WE 489 00:20:21,787 --> 00:20:23,956 DON'T WANT THEM TO USE A MPT 490 00:20:24,022 --> 00:20:25,324 BECAUSE THEN THEY MIGHT FALL 491 00:20:25,390 --> 00:20:25,691 PREGNANT. 492 00:20:25,757 --> 00:20:29,494 OR WE HAVE A PERFECTLY GOOD 493 00:20:29,561 --> 00:20:30,963 HIV PREVENTION PRODUCT AND 494 00:20:31,029 --> 00:20:32,831 SOMEONE SHOULD ALWAYS USE 495 00:20:32,898 --> 00:20:34,967 THAT, SO CAB LA IS ALMOST 496 00:20:35,033 --> 00:20:35,767 PERFECT, RIGHT? 497 00:20:35,834 --> 00:20:39,338 SO WE DON'T WANT TO OFFER 498 00:20:39,404 --> 00:20:40,806 THEM SOMETHING THAT MAY BE 499 00:20:40,872 --> 00:20:41,506 LESS EFFECTIVE. 500 00:20:41,573 --> 00:20:43,008 I HAVE A DIFFERENT VIEW. 501 00:20:43,075 --> 00:20:46,078 WHAT WE WANT TO DO IS CREATE 502 00:20:46,144 --> 00:20:47,813 MANY OPTIONS THAT ALLOWS 503 00:20:47,879 --> 00:20:48,647 WOMEN TO PICK SOMETHING THAT 504 00:20:48,714 --> 00:20:50,482 IS RIGHT FOR THEM. 505 00:20:50,549 --> 00:20:50,882 NEXT SLIDE. 506 00:20:50,949 --> 00:20:53,251 I WOULD LIKE TO ACKNOWLEDGE 507 00:20:53,318 --> 00:20:55,187 ALL THE PEOPLE AND GROUPS 508 00:20:55,253 --> 00:20:55,821 WHO SUPPORTED PROVIDING 509 00:20:55,887 --> 00:20:56,488 INFORMATION FOR THE 510 00:20:56,555 --> 00:20:58,056 PRESENTATION AND OF COURSE 511 00:20:58,123 --> 00:20:58,490 OUR FUNDERS. 512 00:20:58,557 --> 00:21:06,698 THANK YOU SO MUCH. 513 00:21:06,765 --> 00:21:09,101 >> THANK YOU SO MUCH, 514 00:21:09,167 --> 00:21:11,837 SHARON, AS A REMINDER TO THE 515 00:21:11,903 --> 00:21:16,008 AUDIENCE, PLEASE SUBMIT YOUR 516 00:21:16,074 --> 00:21:20,679 QUESTIONS IN THE CHAT OR 517 00:21:20,746 --> 00:21:21,046 FEEDBACK. 518 00:21:21,113 --> 00:21:22,180 Dr. HILLIER IS AVAILABLE 519 00:21:22,247 --> 00:21:24,416 TO ANSWER ANY QUESTIONS. 520 00:21:24,483 --> 00:21:28,954 >> GOOD MORNING, I AM 521 00:21:29,021 --> 00:21:31,390 BRIANA FURCH, I AM HERE 522 00:21:31,456 --> 00:21:33,225 REPRESENTING THE HIV VACCINE 523 00:21:33,291 --> 00:21:34,526 TRIALS NETWORK IN SEATTLE, 524 00:21:34,593 --> 00:21:35,193 WASHINGTON. 525 00:21:35,260 --> 00:21:37,162 THANK YOU FOR INVITING ME TO 526 00:21:37,229 --> 00:21:47,773 BE A PART OF THE -- PART OF 527 00:21:56,581 --> 00:22:02,187 THE NIH HIV PREVENTION 528 00:22:02,254 --> 00:22:02,688 WORKSHOP. 529 00:22:02,754 --> 00:22:04,589 A VACCINE SUBSTANCE CREATES 530 00:22:04,656 --> 00:22:06,892 AN IMMUNE RESPONSE IN A 531 00:22:06,958 --> 00:22:09,728 PERSON'S BODY SO IF YOU 532 00:22:09,795 --> 00:22:13,265 ENCOUNTER A SIMILAR 533 00:22:13,331 --> 00:22:14,966 SUBSTANCE, AN INVADER IN THE 534 00:22:15,033 --> 00:22:16,134 FUTURE, YOUR BODY WILL 535 00:22:16,201 --> 00:22:17,769 RECOGNIZE IT AND KNOW HOW TO 536 00:22:17,836 --> 00:22:20,439 FIGHT IT WITHOUT CAUSING THE 537 00:22:20,505 --> 00:22:23,875 DISEASE ITSELF. 538 00:22:23,942 --> 00:22:24,576 RESEARCHERS USE EPIDEMIOLOGY 539 00:22:24,643 --> 00:22:26,978 TO DESCRIBE WHO HAS HIV IN 540 00:22:27,045 --> 00:22:29,047 YOUR COMMUNITY AND DETERMINE 541 00:22:29,114 --> 00:22:32,350 RISK FACTORS ASSOCIATED WITH 542 00:22:32,417 --> 00:22:34,486 ACQUIRING HIV TO INITIATE 543 00:22:34,553 --> 00:22:35,420 CLINICAL TRIALS. 544 00:22:35,487 --> 00:22:37,289 WE WANT VACCINES TO TARGET 545 00:22:37,355 --> 00:22:43,361 VARIABLE AREAS OF THE HIV 546 00:22:43,428 --> 00:22:46,832 VIRUS AND SHOULD PROTECT 547 00:22:46,898 --> 00:22:49,167 AGAINST HIV-1 INFECTION BY 548 00:22:49,234 --> 00:22:51,770 SEX AND INJECTABLE DRUGS. 549 00:22:51,837 --> 00:22:54,473 THEY SHOULD BE AVAILABLE TO 550 00:22:54,539 --> 00:22:56,742 TAKE NO SIDE TEXTS AND 551 00:22:56,808 --> 00:22:59,711 AFFORDABLE BY ALL PEOPLE FOR 552 00:22:59,778 --> 00:23:02,347 SAFE EFFECTIVE VACCINE FOR 553 00:23:02,414 --> 00:23:06,184 HIV GLOBALLY. 554 00:23:06,251 --> 00:23:06,885 THE OVERALL RESEARCH 555 00:23:06,952 --> 00:23:08,620 INVOLVES WORK IN ALL PHASES 556 00:23:08,687 --> 00:23:10,822 OF THE DESIGN, DEVELOPMENT 557 00:23:10,889 --> 00:23:14,426 AND EVALUATION OF HIV 558 00:23:14,493 --> 00:23:14,826 VACCINATION. 559 00:23:14,893 --> 00:23:16,194 WHILE THE RESOURCES OF THE 560 00:23:16,261 --> 00:23:18,163 NETWORK ARE ALMOST ENTIRELY 561 00:23:18,230 --> 00:23:20,332 DEVOTED TO CLINICAL TRIAL 562 00:23:20,398 --> 00:23:21,933 EVALUATION FROM TEST TO 563 00:23:22,000 --> 00:23:24,703 HUMAN AND CONCEPT TO 564 00:23:24,770 --> 00:23:26,104 LICENSURE EFFICACY TRIALS, 565 00:23:26,171 --> 00:23:27,205 THE NETWORK AND 566 00:23:27,272 --> 00:23:29,474 INVESTIGATORS ARE ALSO 567 00:23:29,541 --> 00:23:34,546 INVOLVED IN PRECLINICAL 568 00:23:34,613 --> 00:23:35,947 ASPECTS OF VACCINE SIGNS AND 569 00:23:36,014 --> 00:23:36,581 DEVELOPMENT. 570 00:23:36,648 --> 00:23:38,517 SO WHAT IS A VACCINE? 571 00:23:38,583 --> 00:23:40,118 A VACCINE BASICALLY TEACHES 572 00:23:40,185 --> 00:23:45,257 YOUR BODY TO RECOGNIZE THE 573 00:23:45,323 --> 00:23:45,590 DISEASE. 574 00:23:45,657 --> 00:23:48,727 IT THEN WILL POST AN ALARM 575 00:23:48,794 --> 00:23:50,028 AND INSTRUCT YOUR CELLS TO 576 00:23:50,095 --> 00:23:51,696 GO TO WORK WITH THE IDEA 577 00:23:51,763 --> 00:23:54,466 THAT IT WILL BE KILLED OR 578 00:23:54,533 --> 00:23:54,866 CONTROLLED. 579 00:23:54,933 --> 00:23:59,070 SO VACCINES CAN BE 580 00:23:59,137 --> 00:23:59,871 PREVENTIVE IN HUMANS. 581 00:23:59,938 --> 00:24:02,507 PREVENTIVE VACCINES FOR THE 582 00:24:02,574 --> 00:24:04,142 HIV-NEGATIVE POPULATIONS ARE 583 00:24:04,209 --> 00:24:06,178 BEING DEVELOPED BY HVTN TO 584 00:24:06,244 --> 00:24:11,316 CONTROL THE SPREAD OF HIV BY 585 00:24:11,383 --> 00:24:12,617 PREVENTING INFECTION AND 586 00:24:12,684 --> 00:24:17,289 DECREASING THE LIKELIHOOD OF 587 00:24:17,355 --> 00:24:17,722 TRANSMISSION. 588 00:24:17,789 --> 00:24:20,258 IF INFECTION DOES OCCUR, A 589 00:24:20,325 --> 00:24:23,328 VACCINE CAN HELP PREVENT HIV 590 00:24:23,395 --> 00:24:25,363 PROGRESSION TO AIDS SO 591 00:24:25,430 --> 00:24:31,102 RESEARCHERS ARE ALSO 592 00:24:31,169 --> 00:24:31,670 EVALUATING THERAPEUTIC 593 00:24:31,736 --> 00:24:33,772 VACCINES TO TREAT PEOPLE 594 00:24:33,839 --> 00:24:36,341 ALREADY INFECTED WITH HIV OR 595 00:24:36,408 --> 00:24:36,741 AIDS. 596 00:24:36,808 --> 00:24:47,352 SO WHAT ARE THESE SYSTEMS WE 597 00:24:48,119 --> 00:24:49,454 TALK ABOUT? 598 00:24:49,521 --> 00:24:50,922 [INAUDIBLE] THE INNATE 599 00:24:50,989 --> 00:24:52,991 IMMUNITY RESULTS IN 600 00:24:53,058 --> 00:24:54,025 PREVENTING OR ELIMINATING 601 00:24:54,092 --> 00:24:55,427 INFECTION THROUGH THE 602 00:24:55,493 --> 00:24:56,695 PRODUCTION OF NATURAL BODY 603 00:24:56,761 --> 00:24:58,296 CHEMICALS OR THROUGH THE 604 00:24:58,363 --> 00:24:59,631 ACTION OF CELLS. 605 00:24:59,698 --> 00:25:02,133 SO THIS IS THE ONE THAT WHEN 606 00:25:02,200 --> 00:25:03,768 YOU HAVE NEVER BEEN EXPOSED 607 00:25:03,835 --> 00:25:09,941 TO ANYTHING BEFORE AND YOUR 608 00:25:10,008 --> 00:25:16,114 BODY ENCOUNTERS IT, IT 609 00:25:16,181 --> 00:25:19,551 STARTS RECRUITING CELLS TO 610 00:25:19,618 --> 00:25:22,454 FIGHT IT. 611 00:25:22,520 --> 00:25:27,192 THE OTHER IMMUNE CELLS 612 00:25:27,259 --> 00:25:28,326 THROUGH PRODUCTION THROUGH 613 00:25:28,393 --> 00:25:31,062 PRODUCTION OF THE SPECIFIC 614 00:25:31,129 --> 00:25:33,098 ANTIBODIES BY B CELLS OR 615 00:25:33,164 --> 00:25:40,338 THROUGH ACTIONS OF CD8 616 00:25:40,405 --> 00:25:41,273 LYMPHOCYTES FOLLOWING 617 00:25:41,339 --> 00:25:43,742 EXPOSURE TO THE PATHOGEN OR 618 00:25:43,808 --> 00:25:45,844 PARTS OF THE PATHOGEN. 619 00:25:45,911 --> 00:25:50,348 THE HELPER CELLS STRENGTHEN 620 00:25:50,415 --> 00:25:53,418 THESE RESPONSES AND VACCINE 621 00:25:53,485 --> 00:25:55,720 GIVE IT A PIECE OF THAT TO 622 00:25:55,787 --> 00:25:59,791 TELL THE BODY WHAT TO LOOK 623 00:25:59,858 --> 00:26:02,193 FOR TO PREVENT INFECTION. 624 00:26:02,260 --> 00:26:07,632 SO THE SYSTEM IS VERY BROAD, 625 00:26:07,699 --> 00:26:12,137 WILL PROGRAM THE IMMUNE 626 00:26:12,203 --> 00:26:16,174 SYSTEM TO START PRODUCING 627 00:26:16,241 --> 00:26:18,476 CLONES TO ATTACK AND THEN 628 00:26:18,543 --> 00:26:20,078 MAKE SPECIFIC ANTIBODIES TO 629 00:26:20,145 --> 00:26:25,050 DO THAT, SPECIFIC T CELLS TO 630 00:26:25,116 --> 00:26:26,885 COUNTER THAT TRIANGLE SHAPE. 631 00:26:26,952 --> 00:26:30,322 THIS IS HELPED ALONG BY T 632 00:26:30,388 --> 00:26:31,189 CELLS THAT STRENGTHEN THE 633 00:26:31,256 --> 00:26:32,958 RESPONSE AND WITH THE 634 00:26:33,024 --> 00:26:35,026 ULTIMATE GOAL IS FOR 635 00:26:35,093 --> 00:26:37,896 VACCINES TO STIMULATE AN 636 00:26:37,963 --> 00:26:40,165 ADAPTIVE IMMUNE RESPONSE, TO 637 00:26:40,231 --> 00:26:41,666 BE THE IMMUNE SOLDIERS AND 638 00:26:41,733 --> 00:26:43,768 HELP PROTECT THE HOST FROM 639 00:26:43,835 --> 00:26:45,003 INFECTION OR TO BLOCK THE 640 00:26:45,070 --> 00:26:48,073 OCCURRENCE OF THE DISEASE. 641 00:26:48,139 --> 00:26:51,142 SO WHY DO WE NEED AN HIV 642 00:26:51,209 --> 00:26:54,012 SPECIFIC VACCINE? 643 00:26:54,079 --> 00:26:56,381 WELL, ANTI-RETRO VIRAL 644 00:26:56,448 --> 00:26:58,650 TREATMENT IS ONE OF THE VIBE 645 00:26:58,717 --> 00:26:59,718 ABILITIES. 646 00:26:59,784 --> 00:27:06,458 95PERCENT OF PEOPLE WITH HIV 647 00:27:06,524 --> 00:27:09,627 LIVE IN DEVELOPING WORLD 648 00:27:09,694 --> 00:27:09,995 COUNTRIES. 649 00:27:10,061 --> 00:27:12,163 THE TREATMENT IS NOT A CURE 650 00:27:12,230 --> 00:27:13,431 AND HAS MANY SIDE EFFECTS. 651 00:27:13,498 --> 00:27:16,401 WE ALSO KNOW THE VIRUS IS 652 00:27:16,468 --> 00:27:17,802 BEING RESISTANCE TO CERTAIN 653 00:27:17,869 --> 00:27:19,871 DRUGS AND WE KNOW PREVENTION 654 00:27:19,938 --> 00:27:23,274 AND EDUCATION HAVE SLOWED 655 00:27:23,341 --> 00:27:24,776 THE EPIDEMIC BUT NOT STOP 656 00:27:24,843 --> 00:27:26,277 MASSIVE SPREAD SO WE NEED 657 00:27:26,344 --> 00:27:28,113 SOMETHING TO HELP COVER AND 658 00:27:28,179 --> 00:27:32,751 REACH AS MANY PEOPLE AS WE 659 00:27:32,817 --> 00:27:33,418 CAN. 660 00:27:33,485 --> 00:27:36,087 SO WHY AN HIV VACCINE? 661 00:27:36,154 --> 00:27:38,089 WELL, AS YOU CAN SEE FROM 662 00:27:38,156 --> 00:27:39,457 THE DIFFERENT COLORS ON THE 663 00:27:39,524 --> 00:27:48,199 MAP HERE, THEY REPRESENT THE 664 00:27:48,266 --> 00:27:49,401 DIFFERENT STRINGS OF THE 665 00:27:49,467 --> 00:27:49,701 VIRUS. 666 00:27:49,768 --> 00:27:50,835 IT IS LIKE A FAMILY. 667 00:27:50,902 --> 00:27:52,470 YOU KNOW YOU ARE ALL RELATED 668 00:27:52,537 --> 00:27:54,539 BUT YOU ARE NOT QUITE THE 669 00:27:54,606 --> 00:27:54,839 SAME. 670 00:27:54,906 --> 00:27:56,975 YOU ARE NOT CLONES OF EACH 671 00:27:57,042 --> 00:27:58,109 OTHER SO EVERYTHING WILL BE 672 00:27:58,176 --> 00:28:02,480 JUST A LITTLE BIT DIFFERENT 673 00:28:02,547 --> 00:28:04,816 AND ALMOST THE SAME. 674 00:28:04,883 --> 00:28:06,651 THE HIV CAN ESCAPE THE 675 00:28:06,718 --> 00:28:08,019 IMMUNE SYSTEM THROUGH VIRAL 676 00:28:08,086 --> 00:28:08,386 MUTATION. 677 00:28:08,453 --> 00:28:13,525 IT CAN HIDE IN LATENT 678 00:28:13,591 --> 00:28:14,559 RESERVOIRS LIKE ADIPOSE 679 00:28:14,626 --> 00:28:16,461 TISSUE OR MUSCLES, WE'RE 680 00:28:16,528 --> 00:28:17,228 FINDING OUT. 681 00:28:17,295 --> 00:28:18,596 IT TARGETS CELLS IN THE 682 00:28:18,663 --> 00:28:19,297 IMMUNE SYSTEM. 683 00:28:19,364 --> 00:28:21,933 IT HAS A HIGH SEQUENCE OF 684 00:28:22,000 --> 00:28:28,273 DIVERSITY AND HIV ALSO MASKS 685 00:28:28,339 --> 00:28:29,107 NEUTRALIZING EPITOPES WHICH 686 00:28:29,174 --> 00:28:31,476 ARE THE PLACES ON THE VIRUS 687 00:28:31,543 --> 00:28:33,778 THAT TARGET OUR TD 4 CELLS 688 00:28:33,845 --> 00:28:35,046 AND CONNECT AND BIND AND 689 00:28:35,113 --> 00:28:36,614 START THE PROCESS OF THE 690 00:28:36,681 --> 00:28:36,948 DISEASE. 691 00:28:37,015 --> 00:28:41,386 SO IT CAN MASK THESE AND 692 00:28:41,453 --> 00:28:43,755 THAT MAKES THINGS MORE 693 00:28:43,822 --> 00:28:44,355 DIFFICULT. 694 00:28:44,422 --> 00:28:45,657 THIS SLIDE DEMONSTRATES THE 695 00:28:45,723 --> 00:28:49,027 STRUCTURE OF THE VIRUS WHERE 696 00:28:49,094 --> 00:28:49,761 RESEARCHERS CAN TARGET 697 00:28:49,828 --> 00:28:51,429 DIFFERENT AREAS FOR A BETTER 698 00:28:51,496 --> 00:28:58,536 VACCINE WITH THE GOAL IT OF 699 00:28:58,603 --> 00:29:01,739 CREATING MULTICLONAL STRINGS 700 00:29:01,806 --> 00:29:03,908 THROUGHOUT GEOGRAPHIC AREAS, 701 00:29:03,975 --> 00:29:05,176 CREATING SEVERAL VACCINES 702 00:29:05,243 --> 00:29:06,811 TARGETING REGIONS THAT ARE 703 00:29:06,878 --> 00:29:11,382 SPECIFIC ON THE VIRUS ACROSS 704 00:29:11,449 --> 00:29:12,750 CLAVES, TO CREATE A VACCINE, 705 00:29:12,817 --> 00:29:16,521 A LITTLE OF THIS, LITTLE OF 706 00:29:16,588 --> 00:29:18,456 THAT TO KEEP NEUTRALIZING 707 00:29:18,523 --> 00:29:20,191 BODIES FROM PEOPLE LIVING 708 00:29:20,258 --> 00:29:22,160 WITH HIV AND FIRST ENGINEER 709 00:29:22,227 --> 00:29:23,728 THEM TO MAKE COMBINATION 710 00:29:23,795 --> 00:29:25,697 VACCINES THAT CAN BE THE 711 00:29:25,763 --> 00:29:30,869 SAME BODIES. ANTIBODIES. 712 00:29:30,935 --> 00:29:36,774 AND THIS WORK USING DNA 713 00:29:36,841 --> 00:29:38,810 PEPTIDE, RECOMBINANT 714 00:29:38,877 --> 00:29:49,154 PROTEIN, PARTICLES, VIRAL 715 00:29:49,220 --> 00:29:51,823 VECTORS AND ULTIMATELY 716 00:29:51,890 --> 00:29:52,790 CHYMERA. 717 00:29:52,857 --> 00:29:53,858 THERE ARE ADDITIONAL THINGS 718 00:29:53,925 --> 00:29:55,827 TO BOOST THE VIRUS AND THIS 719 00:29:55,894 --> 00:29:56,861 WILL AFFECT THE DOSE, HOW 720 00:29:56,928 --> 00:29:59,264 MUCH WE WILL NEED TO USE, 721 00:29:59,330 --> 00:30:02,800 HOW WILL IT ADMINISTER, WILL 722 00:30:02,867 --> 00:30:05,069 IT BE SHOT, INTRAVENOUS, 723 00:30:05,136 --> 00:30:08,173 WILL IT BE DONE 724 00:30:08,239 --> 00:30:09,340 SIMULTANEOUSLY, IT WILL 725 00:30:09,407 --> 00:30:12,243 AFFECT THE TIMING, HOW MANY 726 00:30:12,310 --> 00:30:14,612 INJECTIONS WE NEED, HOW FAR 727 00:30:14,679 --> 00:30:17,248 BETWEEN THEM AND THE METHOD, 728 00:30:17,315 --> 00:30:21,686 WILL WE USE JUST THE SYRINGE 729 00:30:21,753 --> 00:30:23,655 OR OTHER METHODS AND ALL OF 730 00:30:23,721 --> 00:30:25,690 THESE THINGS WE TAKE INTO 731 00:30:25,757 --> 00:30:31,896 CONSIDERATION WHEN WE THINK 732 00:30:31,963 --> 00:30:35,867 ABOUT VACCINES. 733 00:30:35,934 --> 00:30:37,268 IN ORDER TO DETERMINE 734 00:30:37,335 --> 00:30:38,336 WHETHER A VACCINE WORKS, IT 735 00:30:38,403 --> 00:30:46,010 WILL NEED TO BE TESTED. 736 00:30:46,077 --> 00:30:50,882 KNOWING THE RISK FOR 737 00:30:50,949 --> 00:30:55,553 ACQUIRING HIV ENABLES US TO 738 00:30:55,620 --> 00:30:58,723 BE ABLE TO RUN A TRIAL FOR 739 00:30:58,790 --> 00:30:59,257 HIV. 740 00:30:59,324 --> 00:31:01,492 BEING ABLE TO DESCRIBE WHO 741 00:31:01,559 --> 00:31:03,228 HAS HIV IN YOUR COMMUNITY 742 00:31:03,294 --> 00:31:06,431 WILL LEAD US TO DETERMINE 743 00:31:06,497 --> 00:31:09,434 RISK FACTORS ASSOCIATED WITH 744 00:31:09,500 --> 00:31:10,435 ACQUIRING HIV. 745 00:31:10,501 --> 00:31:12,403 THESE ARE ALL PERSISTENT AND 746 00:31:12,470 --> 00:31:14,606 EX VENT AND WE USE MODELS TO 747 00:31:14,672 --> 00:31:16,107 DETERMINE THESE RISK 748 00:31:16,174 --> 00:31:16,474 FACTORS. 749 00:31:16,541 --> 00:31:17,942 WITH THIS INFORMATION, WE 750 00:31:18,009 --> 00:31:25,550 CAN THEN DESIGN AND RECRUIT 751 00:31:25,617 --> 00:31:27,018 APPROPRIATE HIV VACCINE 752 00:31:27,085 --> 00:31:27,352 TRIALS. 753 00:31:27,418 --> 00:31:30,455 SO HOW DO WE TEST A 754 00:31:30,521 --> 00:31:31,723 POTENTIAL VACCINE CANDIDATE? 755 00:31:31,789 --> 00:31:33,992 WELL, THERE ARE PHASES FOR 756 00:31:34,058 --> 00:31:35,827 CLINICAL TRIALS. 757 00:31:35,893 --> 00:31:38,763 PHASE 1 REQUIRES A SMALL 758 00:31:38,830 --> 00:31:43,635 GROUP OF HEALTHY 759 00:31:43,701 --> 00:31:44,802 PARTICIPANTS WITHOUT HIV TO 760 00:31:44,869 --> 00:31:46,437 TEST SAFETY, DOSE AND 761 00:31:46,504 --> 00:31:47,372 SCHEDULE. 762 00:31:47,438 --> 00:31:50,642 IN PHASE 2, HUNDREDS OF 763 00:31:50,708 --> 00:31:52,477 PARTICIPANTS WITHOUT HIV TO 764 00:31:52,543 --> 00:31:54,345 TEST SAFETY AND IMMUNE 765 00:31:54,412 --> 00:31:54,712 RESPONSE. 766 00:31:54,779 --> 00:31:56,614 AND PHASE 3 WHICH IS 767 00:31:56,681 --> 00:31:57,982 THOUSANDS OF PARTICIPANTS 768 00:31:58,049 --> 00:31:59,150 FROM POPULATIONS OF INTEREST 769 00:31:59,217 --> 00:32:00,551 TO TEST SAFETY AND 770 00:32:00,618 --> 00:32:01,119 EFFECTIVENESS. 771 00:32:01,185 --> 00:32:03,321 AND AS YOU CAN SEE, EACH 772 00:32:03,388 --> 00:32:04,022 PHASE TAKES A DIFFERENT 773 00:32:04,088 --> 00:32:05,323 AMOUNT OF TIME SO BY THE 774 00:32:05,390 --> 00:32:08,660 TIME WE ARE FINISHED THE 775 00:32:08,726 --> 00:32:13,531 PHASE 3, WE'RE AT THE YEAR 4 776 00:32:13,598 --> 00:32:13,865 MARK. 777 00:32:13,931 --> 00:32:15,233 AND WE KEEP TRACK THROUGH 778 00:32:15,300 --> 00:32:16,968 EACH OF THE PHASES BECAUSE 779 00:32:17,035 --> 00:32:18,469 IT IS THE MOST IMPORTANT 780 00:32:18,536 --> 00:32:21,539 THING WHEN DOING ANY KIND OF 781 00:32:21,606 --> 00:32:22,807 VACCINE OR CLINICAL TRIAL, 782 00:32:22,874 --> 00:32:29,814 WE ALWAYS MAKE WE USE 783 00:32:29,881 --> 00:32:33,151 INFORMED CONSENT ON RISKS 784 00:32:33,217 --> 00:32:33,685 AND IMPLEMENTATION. 785 00:32:33,751 --> 00:32:34,986 IT IS REQUIRED FOR ALL 786 00:32:35,053 --> 00:32:35,420 VOLUNTEERS. 787 00:32:35,486 --> 00:32:38,923 WE MAKE SURE THEY UNDERSTAND 788 00:32:38,990 --> 00:32:42,126 AND CONSENT. 789 00:32:42,193 --> 00:32:45,997 SO WHEN WE FIND IT, JUST 790 00:32:46,064 --> 00:32:48,633 WHAT MIGHT A PREVENTIVE HIV 791 00:32:48,700 --> 00:32:49,434 VACCINE DO? 792 00:32:49,500 --> 00:32:51,903 THERE ARE SEVERAL WAYS WE 793 00:32:51,969 --> 00:32:53,504 BELIEVE A HIV VACCINE MIGHT 794 00:32:53,571 --> 00:32:53,938 WORK. 795 00:32:54,005 --> 00:32:56,140 FIRST WAY IT MIGHT WORK IS 796 00:32:56,207 --> 00:32:58,376 BY TRIGGERING A STRONG 797 00:32:58,443 --> 00:32:58,876 ANTIBODY RESPONSE. 798 00:32:58,943 --> 00:33:02,780 THAT WOULD BE THE GOAL TO 799 00:33:02,847 --> 00:33:03,314 COMPLETELY PREVENT 800 00:33:03,381 --> 00:33:03,748 INFECTION. 801 00:33:03,815 --> 00:33:05,183 BUT A VACCINE THAT CAN 802 00:33:05,249 --> 00:33:06,884 TRIGGER A REALLY STRONG T 803 00:33:06,951 --> 00:33:10,321 CELL RESPONSE MAY BE ABLE TO 804 00:33:10,388 --> 00:33:11,122 COMBAT INFECTION AND CLEAR 805 00:33:11,189 --> 00:33:12,657 IT FROM THE BODY TO FIGHT 806 00:33:12,724 --> 00:33:13,458 THE DISEASE. 807 00:33:13,524 --> 00:33:14,625 JUST LIKE WE'RE ABLE TO 808 00:33:14,692 --> 00:33:17,495 FIGHT BACK FROM THE COLD OR 809 00:33:17,562 --> 00:33:17,929 FLU. 810 00:33:17,995 --> 00:33:20,298 THIS WOULD BE THE SILVER 811 00:33:20,365 --> 00:33:20,598 MEDAL. 812 00:33:20,665 --> 00:33:23,101 AND THEN THE THIRD IDEA, 813 00:33:23,167 --> 00:33:24,602 PERHAPS WE COULDN'T 814 00:33:24,669 --> 00:33:26,771 COMPLETELY FIGHT OFF THAT 815 00:33:26,838 --> 00:33:28,539 INFECTION BUT ONLY PARTIALLY 816 00:33:28,606 --> 00:33:29,173 CONTROL IT? 817 00:33:29,240 --> 00:33:31,042 THIS COULD RESULT IN SLOWING 818 00:33:31,109 --> 00:33:32,543 IT DOWN, GIVING US THE TIME 819 00:33:32,610 --> 00:33:34,946 IT WOULD TAKE TO GO FROM 820 00:33:35,012 --> 00:33:45,189 INITIAL HIV TO DEVELOPING 821 00:33:45,256 --> 00:33:45,656 CLINICAL PIECE. 822 00:33:45,723 --> 00:33:49,494 THIS WOULD STRETCH OUT BY 823 00:33:49,560 --> 00:33:51,062 HELPING CONTROL THE VIRAL 824 00:33:51,129 --> 00:33:55,066 LOAD AND THIS IS THE GOLD 825 00:33:55,133 --> 00:33:56,234 MEDAL BECAUSE WE KNOW THEY 826 00:33:56,300 --> 00:33:58,970 WOULD BE LESS ABLE TO 827 00:33:59,036 --> 00:34:02,673 TRANSMIT INFECTION TO OTHERS 828 00:34:02,740 --> 00:34:06,911 AND LESS LIKELY TO DEVELOP 829 00:34:06,978 --> 00:34:10,148 THE DISEASE THEMSELVES. 830 00:34:10,214 --> 00:34:12,450 THEY COULD ALSO CREATE HERD 831 00:34:12,517 --> 00:34:16,521 IMMUNITY WITH THE IDEA THAT 832 00:34:16,587 --> 00:34:18,356 EVEN THOUGH SOME PEOPLE ONLY 833 00:34:18,423 --> 00:34:20,425 GET THE VACCINE MAKING THEM 834 00:34:20,491 --> 00:34:24,495 LESS ABLE TO TRANSMIT THE 835 00:34:24,562 --> 00:34:26,130 VIRUS TO OTHERS, THEN THERE 836 00:34:26,197 --> 00:34:28,733 IS FEWER CONNECTIONS WITH A 837 00:34:28,800 --> 00:34:30,067 GREATER RESULT. 838 00:34:30,134 --> 00:34:32,170 WITH FEWER PEOPLE 839 00:34:32,236 --> 00:34:34,772 TRANSMITTING, THE WIDER 840 00:34:34,839 --> 00:34:35,807 PUBLIC COULD STILL BENEFIT. 841 00:34:35,873 --> 00:34:39,377 SO THAT IS MY CALL TO 842 00:34:39,444 --> 00:34:39,710 ACTION. 843 00:34:39,777 --> 00:34:42,113 IF YOU SEE A CLINICAL TRIAL 844 00:34:42,180 --> 00:34:43,848 FOR A HIV VACCINE, READ UP 845 00:34:43,915 --> 00:34:44,782 ON IT. 846 00:34:44,849 --> 00:34:46,984 TALK TO THE RECRUITERS, TALK 847 00:34:47,051 --> 00:34:48,085 TO THE NURSES, THE 848 00:34:48,152 --> 00:34:49,187 PHYSICIANS, AND SEE IF THIS 849 00:34:49,253 --> 00:34:51,289 IS A GOOD TRIAL FOR YOU. 850 00:34:51,355 --> 00:34:52,223 READ THE INFORMED CONSENT 851 00:34:52,290 --> 00:34:54,459 AND IF YOU AGREE, SIGN UP. 852 00:34:54,525 --> 00:34:57,328 WE WOULD LOVE TO HAVE YOU. 853 00:34:57,395 --> 00:34:59,430 WE NEED HEALTHY 854 00:34:59,497 --> 00:35:00,131 PARTICIPANTS, HEALTHY 855 00:35:00,198 --> 00:35:01,699 VOLUNTEERS ALL AROUND THE 856 00:35:01,766 --> 00:35:04,001 WORLD TO HELP US FIGURE OUT 857 00:35:04,068 --> 00:35:05,036 WHICH VACCINES ARE GOING TO 858 00:35:05,102 --> 00:35:11,142 BE THE BEST VACCINES TO USE 859 00:35:11,209 --> 00:35:13,311 SO PEOPLE CAN DECREASE VIRAL 860 00:35:13,377 --> 00:35:14,612 LOSE, DECREASE TRANSMISSION 861 00:35:14,679 --> 00:35:16,848 EVERYWHERE AND HOPEFULLY IN 862 00:35:16,914 --> 00:35:17,415 THIS HIV EPIDEMIC. 863 00:35:17,482 --> 00:35:19,717 SO I WOULD LIKE TO THANK MY 864 00:35:19,784 --> 00:35:21,886 COLLEAGUES AT FRED HUTCH. 865 00:35:21,953 --> 00:35:28,526 LIKE TO THANK MY COLLEAGUES 866 00:35:28,593 --> 00:35:30,862 AT THE HIV TRIAD, THANK MY 867 00:35:30,928 --> 00:35:32,964 COLLEAGUES AT THE NIH FOR 868 00:35:33,030 --> 00:35:34,131 INVITING ME AND PLEASE LET 869 00:35:34,198 --> 00:35:35,800 ME KNOW IF YOU HAVE ANY 870 00:35:35,867 --> 00:35:36,367 QUESTIONS. 871 00:35:36,434 --> 00:35:36,734 THANK YOU. 872 00:35:36,801 --> 00:35:46,577 >> THANK YOU SO MUCH, Dr. 873 00:35:46,644 --> 00:35:46,878 FURCH. 874 00:35:46,944 --> 00:35:48,312 SOME OF YOU MAY NOT KNOW 875 00:35:48,379 --> 00:35:50,948 THAT SHE IS A NEW MOM AND 876 00:35:51,015 --> 00:35:52,984 YOU COULD HEAR HER BABY 877 00:35:53,050 --> 00:35:54,719 CRYING IN THE BACKGROUND. 878 00:35:54,785 --> 00:35:58,122 SO AS A REMINDER, PLEASE PUT 879 00:35:58,189 --> 00:36:00,424 YOUR QUESTIONS IN THE 880 00:36:00,491 --> 00:36:00,825 FEEDBACK. 881 00:36:00,892 --> 00:36:03,160 GO AHEAD, Dr. CHANDLER. 882 00:36:03,227 --> 00:36:04,128 >> I AM OVERVOID WITH THE 883 00:36:04,195 --> 00:36:05,463 PRESENTATION PRIOR TO MINE, 884 00:36:05,530 --> 00:36:07,465 VERY EXCITED ABOUT THE NEW 885 00:36:07,532 --> 00:36:09,300 DEVELOPMENT WITH MPT AND 886 00:36:09,367 --> 00:36:11,669 ALSO THE INTRODUCTION AND 887 00:36:11,736 --> 00:36:16,541 FUNDING SPECIFIC FOR THAT 888 00:36:16,607 --> 00:36:17,508 VACCINATION. 889 00:36:17,575 --> 00:36:20,778 IT'S VERY EXCITING SO THANK 890 00:36:20,845 --> 00:36:22,947 YOU TO MY PREVIOUS 891 00:36:23,014 --> 00:36:23,848 COLLEAGUES WHO PRESENTED 892 00:36:23,915 --> 00:36:24,382 THEIR INFORMATION. 893 00:36:24,448 --> 00:36:25,850 I AM GOING TO TAKE IT BACK 894 00:36:25,917 --> 00:36:27,318 TO THE BASICS WITH PREP IN 895 00:36:27,385 --> 00:36:30,121 USA AND I WANT TO 896 00:36:30,187 --> 00:36:31,289 SYMBOLICALLY REPRESENT AS 897 00:36:31,355 --> 00:36:33,558 YOU SAW ON ALL OUR SLIDES 898 00:36:33,624 --> 00:36:36,294 AND REMEMBERING NATIONAL 899 00:36:36,360 --> 00:36:38,729 WOMEN AND GIRLS ON HIV 900 00:36:38,796 --> 00:36:40,631 AWARENESS DAY THAT WAS ON 901 00:36:40,698 --> 00:36:42,066 MARCH 10TH. 902 00:36:42,133 --> 00:36:43,968 NEXT SLIDE, PLEASE. 903 00:36:44,035 --> 00:36:45,670 WE ARE GOING TO BREAK PREP 904 00:36:45,736 --> 00:36:47,672 DOWN HERE JUST A LITTLE BIT 905 00:36:47,738 --> 00:36:53,144 AND TALK ABOUT THE 906 00:36:53,210 --> 00:36:54,645 FORMULATION AND THEN SOME OF 907 00:36:54,712 --> 00:36:56,247 THE ISSUES THAT PERSIST. 908 00:36:56,314 --> 00:36:58,849 WE HAVE ALL THESE GREAT 909 00:36:58,916 --> 00:36:59,850 DISCOVERIES BUT WE HAVE TO 910 00:36:59,917 --> 00:37:01,419 GET IT TO THE POPULATION AND 911 00:37:01,485 --> 00:37:03,721 WE HAVE TO TRY TO ENCOURAGE 912 00:37:03,788 --> 00:37:05,856 YOU AND DO THAT EQUITABLY. 913 00:37:05,923 --> 00:37:07,625 SO I WILL START OUT BY 914 00:37:07,692 --> 00:37:08,793 SAYING PREP IS RECOMMENDED 915 00:37:08,859 --> 00:37:11,228 FOR PEOPLE WHO ARE HIV 916 00:37:11,295 --> 00:37:12,964 NEGATIVE AND AT RISK FOR 917 00:37:13,030 --> 00:37:16,634 GETTING THE VIRUS FROM SEX 918 00:37:16,701 --> 00:37:18,903 OR INJECTION DRUG USE. 919 00:37:18,970 --> 00:37:21,038 AND FOR SEXUAL TRANSMISSION, 920 00:37:21,105 --> 00:37:23,574 THIS INCLUDES PEOPLE WITHOUT 921 00:37:23,641 --> 00:37:25,876 HIV WHO HAVE HAD AGE OR 922 00:37:25,943 --> 00:37:27,478 VAGINAL SEX IN THE PAST 6 923 00:37:27,545 --> 00:37:33,818 MONTHS AND HAVE A SEXUAL 924 00:37:33,884 --> 00:37:35,086 PARTNER WITH HIV, ESPECIALLY 925 00:37:35,152 --> 00:37:37,855 IF THE PARTNER HAS AN 926 00:37:37,922 --> 00:37:40,558 UNKNOWN OR DETECTABLE VIRAL 927 00:37:40,625 --> 00:37:42,159 LOAD, OR HAVE NOT 928 00:37:42,226 --> 00:37:42,893 CONSISTENTLY USED A COULD 929 00:37:42,960 --> 00:37:43,995 NOT COME TO. 930 00:37:44,061 --> 00:37:47,465 OR HAVE BEEN DIAGNOSED WITH 931 00:37:47,531 --> 00:37:48,132 A SEXUALLY TRANSMITTED 932 00:37:48,199 --> 00:37:49,834 DISEASE IN THE PAST SIX 933 00:37:49,900 --> 00:37:50,167 MONTHS. 934 00:37:50,234 --> 00:37:52,303 FOR PEOPLE WHO INJECT DRUGS, 935 00:37:52,370 --> 00:37:55,640 THIS INCLUDES THOSE WHO HAVE 936 00:37:55,706 --> 00:37:58,109 AN INJECTION PARTNER WITH 937 00:37:58,175 --> 00:38:02,279 HIV OR HAVE SHARED WOULD 938 00:38:02,346 --> 00:38:04,348 NEEDLES, SYRINGES OR OTHER 939 00:38:04,415 --> 00:38:05,416 INJECTION EQUIPMENT. 940 00:38:05,483 --> 00:38:05,916 NEXT SLIDE PLEASE. 941 00:38:05,983 --> 00:38:07,918 I WANTED TO TALK A LITTLE 942 00:38:07,985 --> 00:38:10,454 BIT ABOUT PREP FORMULATION. 943 00:38:10,521 --> 00:38:12,423 I WON'T GO INTO THE 944 00:38:12,490 --> 00:38:15,126 SPECIFICS BUT WITH THE 945 00:38:15,192 --> 00:38:16,260 ALLOTTED TIMELINE, JUST SHOW 946 00:38:16,327 --> 00:38:18,129 HOW PREP CAME ALONG. 947 00:38:18,195 --> 00:38:23,801 SO IN 2012, WE HAD TRUVADA, 948 00:38:23,868 --> 00:38:25,603 THE BLUE PILL THAT IS TAKEN 949 00:38:25,670 --> 00:38:26,637 ONCE A DAY. 950 00:38:26,704 --> 00:38:29,306 THEN WE HAD DESCOVY AND I 951 00:38:29,373 --> 00:38:32,643 WANT TO -- YOU KNOW THAT 952 00:38:32,710 --> 00:38:35,146 DISCOVERY WAS IN -- WELL, 953 00:38:35,212 --> 00:38:35,980 MADE AVAILABLE IN 2019 BUT I 954 00:38:36,047 --> 00:38:42,653 WANT YOU TO KNOW IT IS NOT 955 00:38:42,720 --> 00:38:47,124 IN USE FOR FEMALES OR THOSE 956 00:38:47,191 --> 00:38:49,660 AT BIRTH TO PREVENT HIV 957 00:38:49,727 --> 00:38:52,530 BECAUSE THIS HAS NOT BEEN 958 00:38:52,596 --> 00:38:52,863 STUDIED. 959 00:38:52,930 --> 00:38:54,632 IN 2020, GENERIC PREP WAS 960 00:38:54,699 --> 00:39:02,873 MADE AVAILABLE AND IN 2021, 961 00:39:02,940 --> 00:39:05,142 APPRETUDE OR CABOTEGRAVIR 962 00:39:05,209 --> 00:39:08,112 WAS MADE AVAILABLE IN LONG 963 00:39:08,179 --> 00:39:10,548 ACTING FORM AND INJECTABLE 964 00:39:10,614 --> 00:39:11,215 FORM. 965 00:39:11,282 --> 00:39:12,383 NEXT SLIDE, PLEASE. 966 00:39:12,450 --> 00:39:14,518 WHAT I REALLY WANT TO GET 967 00:39:14,585 --> 00:39:15,486 INTO IS THE PREP CAB AND 968 00:39:15,553 --> 00:39:18,689 THAT IS WHAT I ALLUDED TO 969 00:39:18,756 --> 00:39:20,057 EARLIER, IS THAT WE HAVE 970 00:39:20,124 --> 00:39:21,025 THESE GREAT OPTIONS FOR 971 00:39:21,092 --> 00:39:23,294 INDIVIDUALS BUT WE NEED TO 972 00:39:23,360 --> 00:39:26,030 HOPEFULLY ENSURE THAT WE CAN 973 00:39:26,097 --> 00:39:27,798 GET THEM TO INDIVIDUALS 974 00:39:27,865 --> 00:39:29,767 EQUITABLY AND YOU WILL NOTE 975 00:39:29,834 --> 00:39:31,836 IN SOME OF THE SLIDES THAT I 976 00:39:31,902 --> 00:39:34,238 HAVE WHERE THOSE DISPARITIES 977 00:39:34,305 --> 00:39:35,272 OCCUR. 978 00:39:35,339 --> 00:39:38,375 SO LOOKING AT CDC MODELING 979 00:39:38,442 --> 00:39:41,846 AND INSURANCE CLAIM DATA, IT 980 00:39:41,912 --> 00:39:43,314 ESTIMATES 1.2 MILLION PEOPLE 981 00:39:43,380 --> 00:39:45,149 ARE LIKELY TO BENEFIT FROM 982 00:39:45,216 --> 00:39:48,519 PREP IN THE U.S. BUT THAT 983 00:39:48,586 --> 00:39:50,154 ONLY 30 PERCENT OF THOSE 984 00:39:50,221 --> 00:39:51,989 INDIVIDUALS WHO COULD 985 00:39:52,056 --> 00:39:53,724 BENEFIT FROM PREP WERE 986 00:39:53,791 --> 00:40:00,998 PRESCRIBED IT. 987 00:40:01,065 --> 00:40:03,634 AND SO WE NEED TO IMPROVE 988 00:40:03,701 --> 00:40:05,736 THAT AND UNFORTUNATELY THIS 989 00:40:05,803 --> 00:40:08,806 IS RACIALLY SIGNIFICANT AND 990 00:40:08,873 --> 00:40:09,573 RELATED TO RACE. 991 00:40:09,640 --> 00:40:10,975 SO I WILL DEMONSTRATE THAT 992 00:40:11,041 --> 00:40:16,814 AS WELL. 993 00:40:16,881 --> 00:40:19,216 AND SO IN ALL RACES, 994 00:40:19,283 --> 00:40:22,820 41 PERCENT OF MEN WHO WERE 995 00:40:22,887 --> 00:40:24,922 ELIGIBLE WERE DESCRIBED AS 996 00:40:24,989 --> 00:40:27,291 WHITE AND THEN 14.5 PERCENT 997 00:40:27,358 --> 00:40:29,193 OF WOMEN ELIGIBLE WERE 998 00:40:29,260 --> 00:40:30,928 PRESCRIBED SO WE HAVE SOME 999 00:40:30,995 --> 00:40:32,630 IMPROVEMENT WE NEED TO DO 1000 00:40:32,696 --> 00:40:32,963 THERE. 1001 00:40:33,030 --> 00:40:33,831 NEXT SLIDE, PLEASE. 1002 00:40:33,898 --> 00:40:36,700 AND AS YOU WILL NOTICE, AS 1003 00:40:36,767 --> 00:40:38,669 SHOWN HERE WHERE YOU SEE 1004 00:40:38,736 --> 00:40:41,872 THAT RACIAL BREAKDOWN SO IN 1005 00:40:41,939 --> 00:40:44,975 2021, LESS THAN 1/4 OF 1006 00:40:45,042 --> 00:40:46,677 PLAQUE, HISPANIC OR LATINO 1007 00:40:46,744 --> 00:40:48,646 PEOPLE WHO WERE ELIGIBLE FOR 1008 00:40:48,712 --> 00:40:51,348 PREP WERE PRESCRIBED IT 1009 00:40:51,415 --> 00:40:53,417 COMPARED TO 3/4 OF WHITE 1010 00:40:53,484 --> 00:40:56,220 PEOPLE SO THIS IS A VISUAL 1011 00:40:56,287 --> 00:40:57,721 TO ILLUSTRATE THAT. 1012 00:40:57,788 --> 00:40:58,589 NEXT SLIDE, PLEASE. 1013 00:40:58,656 --> 00:41:02,059 AND IN OUR EFFORT OF ENDING 1014 00:41:02,126 --> 00:41:03,294 THE HIV EPIDEMIC IN THE 1015 00:41:03,360 --> 00:41:04,495 UNITED STATES, HERE ARE SOME 1016 00:41:04,562 --> 00:41:05,629 OF THE GOALS. 1017 00:41:05,696 --> 00:41:09,633 SO THE GOAL IS FOR 1018 00:41:09,700 --> 00:41:14,171 75 PERCENT REDUCTION IN NEW 1019 00:41:14,238 --> 00:41:17,174 HIV DIAGNOSES IN FIVE YEARS 1020 00:41:17,241 --> 00:41:19,977 AND A 90 PERCENT REDUCTION 1021 00:41:20,044 --> 00:41:20,945 IN TEN YEARS. 1022 00:41:21,011 --> 00:41:22,646 SO THESE GOALS ARE SLATED 1023 00:41:22,713 --> 00:41:24,849 FOR 2030 SO WE'RE DILIGENTLY 1024 00:41:24,915 --> 00:41:26,951 TRYING TO GET TO THAT. 1025 00:41:27,017 --> 00:41:27,885 AGENCIES ACROSS THE U.S. 1026 00:41:27,952 --> 00:41:31,021 DEPARTMENT OF HEALTH AND 1027 00:41:31,088 --> 00:41:32,890 HUMAN SERVICES DEVELOP A 1028 00:41:32,957 --> 00:41:34,859 OPERATIONAL PLAN TO PURSUE 1029 00:41:34,925 --> 00:41:40,164 THAT GOAL ACCOMPANIED BY A 1030 00:41:40,231 --> 00:41:41,332 REQUEST FOR ADDITIONAL 1031 00:41:41,398 --> 00:41:44,635 ANGLED FUNDING TO DO SO. 1032 00:41:44,702 --> 00:41:46,503 THIS PLAN LEVERAGES CRITICAL 1033 00:41:46,570 --> 00:41:53,177 ADVANCES IN HIV PREVENTION, 1034 00:41:53,244 --> 00:41:57,581 DIAGNOSIS, TREATMENT AND 1035 00:41:57,648 --> 00:42:03,153 OUTBREAK BY LEVERAGING THE 1036 00:42:03,220 --> 00:42:04,755 INFRASTRUCTURE IN OFFICES. 1037 00:42:04,822 --> 00:42:09,326 INFECTIONS ARE HIGHLY 1038 00:42:09,393 --> 00:42:13,564 CONCENTRATED AMONG MEN, 1039 00:42:13,631 --> 00:42:16,367 MINORITIES, ESPECIALLY 1040 00:42:16,433 --> 00:42:16,867 AFRICAN-AMERICANS, 1041 00:42:16,934 --> 00:42:17,868 HISPANICS, LATINOS, AMERICAN 1042 00:42:17,935 --> 00:42:19,036 INDIANS AND ALASKA NATIVES 1043 00:42:19,103 --> 00:42:20,337 AND THOSE WHO LIVE IN THE 1044 00:42:20,404 --> 00:42:21,171 SOUTHERN UNITED STATES. 1045 00:42:21,238 --> 00:42:23,474 SO THOSE ARE THE AREAS OF 1046 00:42:23,540 --> 00:42:23,908 CONCENTRATION. 1047 00:42:23,974 --> 00:42:24,441 NEXT SLIDE, PLEASE. 1048 00:42:24,508 --> 00:42:26,310 YOU WILL SEE ON THE NEXT 1049 00:42:26,377 --> 00:42:29,947 SLIDE I HAVE ILLUSTRATED OR 1050 00:42:30,014 --> 00:42:32,082 SHOWN A MAP WHERE THERE IS 1051 00:42:32,149 --> 00:42:33,550 HIV EPIDEMIC IN THE UNITED 1052 00:42:33,617 --> 00:42:38,055 STATES. 1053 00:42:38,122 --> 00:42:40,991 IT IS CONCENTRATED. 1054 00:42:41,058 --> 00:42:43,360 THE INITIATIVE INITIALLY 1055 00:42:43,427 --> 00:42:44,995 FOCUSES EFFORTS IN 48 1056 00:42:45,062 --> 00:42:46,997 COUNTIES, WASHINGTON D.C. 1057 00:42:47,064 --> 00:42:49,133 AND SAN JUAN AND PUERTO RICO 1058 00:42:49,199 --> 00:42:52,369 WHERE MORE THAN 50 PERCENT 1059 00:42:52,436 --> 00:42:55,039 OF HIV DIAGNOSES OCCUR AND 1060 00:42:55,105 --> 00:42:57,041 AN ADDITIONAL 7 STATES WITH 1061 00:42:57,107 --> 00:42:59,643 A SUBSTANTIAL NUMBER OF HIV 1062 00:42:59,710 --> 00:43:01,078 DIAGNOSIS IN RURAL AREAS 1063 00:43:01,145 --> 00:43:04,248 BRINGING THE TOTAL NUMBER OF 1064 00:43:04,315 --> 00:43:06,884 PRIORITIZED TO A 1065 00:43:06,951 --> 00:43:11,488 JURISDICTION TO 57. 1066 00:43:11,555 --> 00:43:20,230 NEXT SLIDE, PLEASE. 1067 00:43:20,297 --> 00:43:22,232 SO ENDING THE HIV EPIDEMIC 1068 00:43:22,299 --> 00:43:24,768 IN THE UNITED STATES, I TRY 1069 00:43:24,835 --> 00:43:27,338 TO THINK OF A SOLUTION MAP 1070 00:43:27,404 --> 00:43:31,041 TO THINK OF SOME OF THE 1071 00:43:31,108 --> 00:43:32,876 OBSTACLES WE NEED TO 1072 00:43:32,943 --> 00:43:36,814 OVERCOME TO IMMEDIATE OUR 1073 00:43:36,880 --> 00:43:38,983 HIV GOALS. 1074 00:43:39,049 --> 00:43:41,618 THE FIRST ONE IS DYING ALL 1075 00:43:41,685 --> 00:43:45,789 PEOPLE WITH HIV AS EARLY AS 1076 00:43:45,856 --> 00:43:46,957 POSSIBLE, TREATMENT OF 1077 00:43:47,024 --> 00:43:49,026 PEOPLE WITH HIV RAPIDLY AND 1078 00:43:49,093 --> 00:43:53,263 EFFECTIVELY TO REACH 1079 00:43:53,330 --> 00:43:55,966 SUSTAINED VIRAL SUPPRESSION, 1080 00:43:56,033 --> 00:44:01,438 PREVENT NEW HIV 1081 00:44:01,505 --> 00:44:12,082 TRANSMISSIONS BY USING 1082 00:44:12,149 --> 00:44:12,816 PROVEN INTERVENTIONS 1083 00:44:12,883 --> 00:44:14,885 INCLUDING PREP AND SSPS AND 1084 00:44:14,952 --> 00:44:16,754 RESPOND QUICKLY TO POTENTIAL 1085 00:44:16,820 --> 00:44:18,589 PIV OUTBREAKS TO GET NEEDED 1086 00:44:18,655 --> 00:44:19,523 PREVENTION AND TREATMENT 1087 00:44:19,590 --> 00:44:21,358 SERVICES TO PEOPLE WHO NEED 1088 00:44:21,425 --> 00:44:23,527 THEM. 1089 00:44:23,594 --> 00:44:24,194 NEXT SLIDE, PLEASE. 1090 00:44:24,261 --> 00:44:29,166 ALSO I AM WANTING TO 1091 00:44:29,233 --> 00:44:30,667 HIGHLIGHT THE INFECTIONABLE 1092 00:44:30,734 --> 00:44:31,702 ISSUES TO PREP BECAUSE WE 1093 00:44:31,769 --> 00:44:35,105 WANT TO ADDRESS SOME OF 1094 00:44:35,172 --> 00:44:39,043 THESE SOCIAL ISSUES THAT 1095 00:44:39,109 --> 00:44:43,080 WILL HINDER INDIVIDUALS FROM 1096 00:44:43,147 --> 00:44:43,781 HAVING PREP. 1097 00:44:43,847 --> 00:44:45,282 SO ON THE INDIVIDUAL LEVEL, 1098 00:44:45,349 --> 00:44:48,419 THERE ARE LINKS LIKE MENTAL 1099 00:44:48,485 --> 00:44:52,790 HEALTH, POVERTY, UNSTABLE 1100 00:44:52,856 --> 00:44:54,625 HOUSING, SUBSTANTIAL USE, 1101 00:44:54,691 --> 00:44:55,893 CRIMINAL JUSTICE 1102 00:44:55,959 --> 00:44:57,694 INVOLVEMENT, SELF STIGMA, 1103 00:44:57,761 --> 00:44:59,196 AWARENESS OF RISK AND PREP 1104 00:44:59,263 --> 00:44:59,563 ADHERENCE. 1105 00:44:59,630 --> 00:45:01,632 AS FAR AS THE NETWORK IN 1106 00:45:01,698 --> 00:45:05,102 LEVEL 2, IT INCLUDES THINGS 1107 00:45:05,169 --> 00:45:06,804 SUCH AS MIV PREVALENCE IN 1108 00:45:06,870 --> 00:45:09,006 THE NETWORK, YOUNG AGE OF 1109 00:45:09,073 --> 00:45:10,140 NETWORK MEMBERS AND 1110 00:45:10,207 --> 00:45:11,642 COMMUNITY OF STIGMA IS 1111 00:45:11,708 --> 00:45:12,042 IDENTIFIED. 1112 00:45:12,109 --> 00:45:15,412 I THINK THAT WAS MENTIONED 1113 00:45:15,479 --> 00:45:17,347 BEFORE, POVERTY, RACISM, 1114 00:45:17,414 --> 00:45:18,916 TRANSPORTATION COULD BE AN 1115 00:45:18,982 --> 00:45:21,985 ISSUE BETWEEN PATIENTS AND 1116 00:45:22,052 --> 00:45:24,054 HEALTHCARE PROVIDERS AS 1117 00:45:24,121 --> 00:45:24,354 WELL. 1118 00:45:24,421 --> 00:45:28,792 AS FAR AS POLICY, MEDICAID 1119 00:45:28,859 --> 00:45:29,359 EXPANSION. 1120 00:45:29,426 --> 00:45:32,196 A LOT OF SOUTHERN STATES 1121 00:45:32,262 --> 00:45:36,366 UNFORTUNATELY DID NOT EXPAND 1122 00:45:36,433 --> 00:45:37,434 AND THEREFORE NOT COVERING 1123 00:45:37,501 --> 00:45:40,137 SOME OF THE COSTS ASSOCIATED 1124 00:45:40,204 --> 00:45:43,107 WITH PRESCRIPTIONS. 1125 00:45:43,173 --> 00:45:45,342 ILLICIT DRUG LAWS AND 1126 00:45:45,409 --> 00:45:47,744 POLICIES AS FAR AS THE 1127 00:45:47,811 --> 00:45:53,550 EPIDEMIC AND PREP 1128 00:45:53,617 --> 00:45:55,052 AVAILABILITY AND THEN LEVEL 1129 00:45:55,119 --> 00:45:58,922 5, PREVALENCE AND POPULATION 1130 00:45:58,989 --> 00:46:00,557 LEVEL OF VIREMIA. 1131 00:46:00,624 --> 00:46:02,793 NEXT SLIDE PLEASE. 1132 00:46:02,860 --> 00:46:07,798 SO SOME OF THE PREP 1133 00:46:07,865 --> 00:46:09,066 CHAMPIONS, SOLUTION TO 1134 00:46:09,133 --> 00:46:12,069 PROMOTE PREP UPTAKE AND 1135 00:46:12,136 --> 00:46:13,737 PERSISTENCE, SOME OF THE 1136 00:46:13,804 --> 00:46:17,040 CURRENT CHALLENGES, LACK OF 1137 00:46:17,107 --> 00:46:18,942 PERSONAL RESPONSIBLE FOR 1138 00:46:19,009 --> 00:46:19,843 PREP MANAGEMENT, 1139 00:46:19,910 --> 00:46:21,245 INCONSISTENT PREP SUPPORT 1140 00:46:21,311 --> 00:46:22,513 AND BUY-IN FROM CLINIC 1141 00:46:22,579 --> 00:46:23,614 LEADERSHIP. 1142 00:46:23,680 --> 00:46:24,715 AND SO SOME OF THE SOLUTIONS 1143 00:46:24,781 --> 00:46:26,316 WAS TO CREATE A PREP 1144 00:46:26,383 --> 00:46:29,119 CHAMPION AND I THINK THIS 1145 00:46:29,186 --> 00:46:31,522 KIND OF COMES FROM THE 1146 00:46:31,588 --> 00:46:34,491 NAVIGATOR -- SOME OF THE 1147 00:46:34,558 --> 00:46:37,227 NAVIGATOR PARADIGM WHERE YOU 1148 00:46:37,294 --> 00:46:38,495 TRAIN PROVIDERS AND PREP 1149 00:46:38,562 --> 00:46:39,630 COORDINATORS TO MEET WITH 1150 00:46:39,696 --> 00:46:42,633 PATIENTS AND MEET THEIR 1151 00:46:42,699 --> 00:46:42,933 NEEDS. 1152 00:46:43,000 --> 00:46:45,068 USE EVIDENCE TO STRENGTHEN 1153 00:46:45,135 --> 00:46:47,004 COMMUNICATION AND INCREASE 1154 00:46:47,070 --> 00:46:49,339 LEADERSHIP SUPPORT AND 1155 00:46:49,406 --> 00:46:50,374 MAXIMIZE PREP COORDINATOR 1156 00:46:50,440 --> 00:46:52,543 ROLE TO SUPPORT AND FOLLOW 1157 00:46:52,609 --> 00:46:54,878 UP TO IDENTIFY AND REDUCE 1158 00:46:54,945 --> 00:46:55,512 BARRIERS. 1159 00:46:55,579 --> 00:46:56,713 NEXT SLIDE, PLEASE. 1160 00:46:56,780 --> 00:47:00,684 OTHER THINGS TO HELP WITH, 1161 00:47:00,751 --> 00:47:04,755 EDUCATING PATIENTS AND 1162 00:47:04,821 --> 00:47:06,256 HEALTHCARE PROVIDERS ABOUT 1163 00:47:06,323 --> 00:47:13,497 CREATING CHANGE TO WELFARE 1164 00:47:13,564 --> 00:47:15,866 AND ENCOURAGING REVENUES, 1165 00:47:15,933 --> 00:47:19,436 COMMUNITY BASED EDUCATION TO 1166 00:47:19,503 --> 00:47:21,271 RAISE AWARENESS, COMBAT 1167 00:47:21,338 --> 00:47:23,540 IMPLICIT AND UNCONSCIOUS 1168 00:47:23,607 --> 00:47:26,777 BIAS, INSTILL TRUST IN 1169 00:47:26,843 --> 00:47:30,681 HEALTHCARE SYSTEM. 1170 00:47:30,747 --> 00:47:32,516 MORE BLACK HCPS AS TRUSTED 1171 00:47:32,583 --> 00:47:35,953 COMMUNITY SOURCES OF NO, 1172 00:47:36,019 --> 00:47:39,089 ALSO HISPANIC AND THOSE 1173 00:47:39,156 --> 00:47:41,258 CONDUCTING THE RESEARCH, 1174 00:47:41,325 --> 00:47:42,759 ADDRESS UNFOUNDED BELIEFS 1175 00:47:42,826 --> 00:47:45,362 ABOUT RISK COMPENSATION THAT 1176 00:47:45,429 --> 00:47:47,564 FEED RELUCTANCE TO RECEIVE 1177 00:47:47,631 --> 00:47:48,332 PREP. 1178 00:47:48,398 --> 00:47:49,399 POSITIVE MESSAGING TO 1179 00:47:49,466 --> 00:47:51,101 PATIENTS VIA SOCIAL NETWORKS 1180 00:47:51,168 --> 00:47:53,403 AND SOCIAL MEDIA TO IMPROVE 1181 00:47:53,470 --> 00:47:55,305 KNOWLEDGE AND ATTITUDES AND 1182 00:47:55,372 --> 00:47:56,540 REDUCE STIGMA. 1183 00:47:56,607 --> 00:47:58,041 SUPPORT PREVENTION MESSAGES 1184 00:47:58,108 --> 00:48:01,111 FOR HIV AND STIS THROUGH 1185 00:48:01,178 --> 00:48:02,613 MONITORING AND TESTING AND 1186 00:48:02,679 --> 00:48:06,416 DISCUSS ALL AVAILABLE PREP 1187 00:48:06,483 --> 00:48:08,352 OPTIONS TO GIVE PATIENTS 1188 00:48:08,418 --> 00:48:09,886 WHAT CAN AND WHAT MIGHT WORK 1189 00:48:09,953 --> 00:48:11,188 FOR THEM. 1190 00:48:11,255 --> 00:48:11,722 NEXT SLIDE, PLEASE. 1191 00:48:11,788 --> 00:48:15,025 I WOULD ALSO LIKE TO 1192 00:48:15,092 --> 00:48:16,059 ACKNOWLEDGE NIH SPECIAL MY 1193 00:48:16,126 --> 00:48:20,264 TEAM AND THANK YOU FOR THE 1194 00:48:20,330 --> 00:48:21,031 OPPORTUNITY TO PRESENT. 1195 00:48:21,098 --> 00:48:22,866 >> THANK YOU SO MUCH, Dr. 1196 00:48:22,933 --> 00:48:23,567 CHANDLER. 1197 00:48:23,634 --> 00:48:25,602 AS A REMINDER TO THE 1198 00:48:25,669 --> 00:48:27,304 AUDIENCE, PLEASE SUBMIT 1199 00:48:27,371 --> 00:48:30,140 QUESTIONS OR COMMENTS IN THE 1200 00:48:30,207 --> 00:48:31,642 LIVE FEEDBACK OPTION AT THE 1201 00:48:31,708 --> 00:48:33,043 BOTTOM OF THE VIDEOCAST. 1202 00:48:33,110 --> 00:48:40,751 WE WILL NOW HEAR FROM Dr. 1203 00:48:40,817 --> 00:48:41,418 DELANY-MORETIWE. 1204 00:48:41,485 --> 00:48:42,953 >> THANKS VERY MUCH, I WOULD 1205 00:48:43,020 --> 00:48:45,856 LIKE TO THANK THE WORKSHOP 1206 00:48:45,922 --> 00:48:46,890 ORGANIZERS FOR INVITING ME 1207 00:48:46,957 --> 00:48:49,493 TO SPEAK WITH ALL OF YOU FOR 1208 00:48:49,559 --> 00:48:51,028 THE HIV PREVENTION IN WOMEN. 1209 00:48:51,094 --> 00:48:52,796 NEXT SLIDE. 1210 00:48:52,863 --> 00:48:54,631 AND I WOULD ALSO LIKE TO 1211 00:48:54,698 --> 00:48:55,699 ACKNOWLEDGE THE MANY, MANY 1212 00:48:55,766 --> 00:48:57,200 PEOPLE WHO HAVE BEEN 1213 00:48:57,267 --> 00:49:02,606 INVOLVED IN THE CABOTEGRAVIR 1214 00:49:02,673 --> 00:49:11,948 PROGRAM INCLUDING FUNDERS, 1215 00:49:12,015 --> 00:49:16,720 HTPS, NIH AND ALL THOSE 1216 00:49:16,787 --> 00:49:20,957 INVOLVED IN AFRICA AND THE 1217 00:49:21,024 --> 00:49:21,325 AMERICAS. 1218 00:49:21,391 --> 00:49:22,059 NEXT SLIDE. 1219 00:49:22,125 --> 00:49:24,127 SO WOMEN STILL EXPERIENCE 1220 00:49:24,194 --> 00:49:26,797 MANY BARRIERS TO DAILY PILL 1221 00:49:26,863 --> 00:49:27,698 TAKING INCLUDING STIGMA, 1222 00:49:27,764 --> 00:49:29,333 JUDGMENT AND IN SOME CASES, 1223 00:49:29,399 --> 00:49:31,568 THE THREAT OF INTIMATE 1224 00:49:31,635 --> 00:49:32,069 PARTNER VIOLENCE. 1225 00:49:32,135 --> 00:49:36,039 SO THERE HAS BEEN A STRONG 1226 00:49:36,106 --> 00:49:38,075 INSTANCE ON WHETHER WE COULD 1227 00:49:38,141 --> 00:49:39,810 OVERCOME SOME OF THE 1228 00:49:39,876 --> 00:49:43,980 BARRIERS TO DAILY PILL 1229 00:49:44,047 --> 00:49:48,618 TAKING AND THE RECENT 1230 00:49:48,685 --> 00:49:50,687 COMPILED EVIDENCE REALLY 1231 00:49:50,754 --> 00:49:57,094 CONCLUDE THE POPULATIONS 1232 00:49:57,160 --> 00:49:58,595 THAT WORKERS AND EVEN 1233 00:49:58,662 --> 00:50:00,397 TRANSWOMEN PREFER THE 1234 00:50:00,464 --> 00:50:01,865 INJECTABLE AND THE MANY 1235 00:50:01,932 --> 00:50:03,400 REASONS THEY WANT THE PREP 1236 00:50:03,467 --> 00:50:06,737 AGENT IS THEY SEE IT COULD 1237 00:50:06,803 --> 00:50:07,938 BE CONVENIENT, CIRCUMSTANCE 1238 00:50:08,004 --> 00:50:09,339 COUPLE VENTS DAILY PILL 1239 00:50:09,406 --> 00:50:11,074 TAKING, COULD BE DISCREET 1240 00:50:11,141 --> 00:50:17,481 AND AVOID STIGMA AND IN SOME 1241 00:50:17,547 --> 00:50:20,450 CASES, IT RELIES ON SOME 1242 00:50:20,517 --> 00:50:26,189 PEOPLE'S EXPERIENCE WITH 1243 00:50:26,256 --> 00:50:27,257 CONTRACEPTION. 1244 00:50:27,324 --> 00:50:29,292 SO THIS IS ALLOWING IT TO BE 1245 00:50:29,359 --> 00:50:31,495 DEVELOPED AS ONE OF THE 1246 00:50:31,561 --> 00:50:34,865 FIRST INJECTABLE AGENTS. 1247 00:50:34,931 --> 00:50:36,133 NEXT SLIDE, PLEASE. 1248 00:50:36,199 --> 00:50:39,002 SO CAB WAS EVALUATED IN TWO 1249 00:50:39,069 --> 00:50:43,073 LARGE TRIALS IN CIS AND 1250 00:50:43,140 --> 00:50:53,683 TRANSWOMEN WHO HAVE SEX WITH 1251 00:51:01,792 --> 00:51:03,093 MEN, AND HIV PATIENTS. 1252 00:51:03,160 --> 00:51:06,696 AND IT WAS FOUND THAT CAB LA 1253 00:51:06,763 --> 00:51:10,367 WAS SUPERIOR TO ORAL PILLS 1254 00:51:10,434 --> 00:51:16,173 IN PREVENTING INFECTION IN 1255 00:51:16,239 --> 00:51:26,116 THE CAB GROUP IN HTP03 AND 1256 00:51:26,183 --> 00:51:29,019 HTP04 AND THESE SHOW THE 1257 00:51:29,085 --> 00:51:30,153 ADVANTAGE OVER THE DAILY 1258 00:51:30,220 --> 00:51:30,620 PILL TAKING. 1259 00:51:30,687 --> 00:51:33,123 WHAT IS IMPORTANT TO NOTE IS 1260 00:51:33,190 --> 00:51:34,624 THAT THESE RESULTS WERE 1261 00:51:34,691 --> 00:51:36,560 SUSTAINED OVER ONE YEAR AND 1262 00:51:36,626 --> 00:51:39,496 THAT THESE EFFECTS WERE ALSO 1263 00:51:39,563 --> 00:51:40,997 CONSISTENT ACROSS AGE 1264 00:51:41,064 --> 00:51:42,499 GROUPS, RACE, GENDER 1265 00:51:42,566 --> 00:51:43,400 IDENTITY AND REGION. 1266 00:51:43,467 --> 00:51:44,734 AND BECAUSE OF THESE 1267 00:51:44,801 --> 00:51:48,672 RESULTS, THE FDA AND EMA AND 1268 00:51:48,738 --> 00:51:50,674 MANY OTHER REGULATORY 1269 00:51:50,740 --> 00:51:52,309 AUTHORITIES WHERE THE CALLS 1270 00:51:52,375 --> 00:51:54,978 HAVE TAKEN PLACE INCLUDE THE 1271 00:51:55,045 --> 00:51:56,680 INJECTABLE CAB FOR PREP AND 1272 00:51:56,746 --> 00:52:01,117 TWO YEARS AGO, WHO INCLUDED 1273 00:52:01,184 --> 00:52:05,355 IT IN ITS PREP GUIDELINES. 1274 00:52:05,422 --> 00:52:06,223 NEXT SLIDE, PLEASE. 1275 00:52:06,289 --> 00:52:09,593 SO WHAT WE HAVE LEARNED FROM 1276 00:52:09,659 --> 00:52:11,228 THESE CABS AND ALMOST 8000 1277 00:52:11,294 --> 00:52:13,630 PEOPLE IS THAT LONG ACTING 1278 00:52:13,697 --> 00:52:15,232 INJECTABLE CAB IS GENERALLY 1279 00:52:15,298 --> 00:52:17,200 SAFE AND WELL TOLERATED AND 1280 00:52:17,267 --> 00:52:21,271 THIS INCLUDES EVEN IN HAD A 1281 00:52:21,338 --> 00:52:23,173 LESS SENSE UNDER THE AGE OF 1282 00:52:23,240 --> 00:52:23,440 18. 1283 00:52:23,507 --> 00:52:24,941 THE MOST COMMON SIDE EFFECT 1284 00:52:25,008 --> 00:52:26,643 THAT WAS OBSERVED IN THE 1285 00:52:26,710 --> 00:52:27,844 TRIALS THAT WAS DIFFERENT 1286 00:52:27,911 --> 00:52:30,113 BETWEEN THE TWO GROUPS IS 1287 00:52:30,180 --> 00:52:32,048 PEOPLE WHO RECEIVED CAB WERE 1288 00:52:32,115 --> 00:52:34,684 MORE LIKELY TO EXPERIENCE 1289 00:52:34,751 --> 00:52:37,287 INJECTION SITE REACTIONS. 1290 00:52:37,354 --> 00:52:38,688 THESE INJECTION SITES 1291 00:52:38,755 --> 00:52:39,623 REACTIONS WERE GENERALLY 1292 00:52:39,689 --> 00:52:41,491 MILD AND RESOLVED AFTER THE 1293 00:52:41,558 --> 00:52:42,826 FIRST INJECTION AND YOU CAN 1294 00:52:42,893 --> 00:52:45,028 SEE IN THE FIRST PANEL THAT 1295 00:52:45,095 --> 00:52:47,297 MOST PEOPLE EXPERIENCED AN 1296 00:52:47,364 --> 00:52:50,033 INITIAL INJECTION SITE 1297 00:52:50,100 --> 00:52:53,670 REACTION BUT VERY PEOPLE 1298 00:52:53,737 --> 00:52:54,604 EXPERIENCED SUBSEQUENT 1299 00:52:54,671 --> 00:52:55,839 INJECTION SIDE REACTION. 1300 00:52:55,906 --> 00:52:57,707 MOST OF THESE WERE 1301 00:52:57,774 --> 00:52:59,209 ASSOCIATED WITH PAIN AND 1302 00:52:59,276 --> 00:53:00,710 TENDERNESS AND IN WOMEN IN 1303 00:53:00,777 --> 00:53:03,313 PARTICULAR, WE DIDN'T SEE 1304 00:53:03,380 --> 00:53:04,314 ANY DISCONTINUATION 1305 00:53:04,381 --> 00:53:05,715 FOLLOWING THE INJECTION SITE 1306 00:53:05,782 --> 00:53:07,284 REACTION WHICH WAS SOMEWHAT 1307 00:53:07,350 --> 00:53:08,919 DIFFERENT THAN THE MEN'S 1308 00:53:08,985 --> 00:53:11,755 TRIAL AND EVEN IN ADOLESCENT 1309 00:53:11,821 --> 00:53:19,896 WOMEN, THERE WERE NO 1310 00:53:19,963 --> 00:53:22,732 DISCONTINUATION FROM ADVERSE 1311 00:53:22,799 --> 00:53:23,166 EVENTS. 1312 00:53:23,233 --> 00:53:28,972 THOSE TAKING THE INJECTION 1313 00:53:29,039 --> 00:53:30,307 FOR ANTIVIRAL THERAPY, WE 1314 00:53:30,373 --> 00:53:35,478 LOOKED AT CHANGES IN WEIGHT 1315 00:53:35,545 --> 00:53:37,881 IN THE TRIALS, AND ALTHOUGH 1316 00:53:37,948 --> 00:53:41,418 WE SAW AN INITIAL DIFFERENCE 1317 00:53:41,484 --> 00:53:46,957 OF ABOUT 1KG WHICH IS ABOUT 1318 00:53:47,023 --> 00:53:48,091 TWO POUNDS, BOTH GROUPS 1319 00:53:48,158 --> 00:53:50,293 GAINED WEIGHT AND THERE WAS 1320 00:53:50,360 --> 00:53:52,195 NO SUBSTANTIAL DIFFERENCE 1321 00:53:52,262 --> 00:53:55,165 BETWEEN THE TWO GROUPS 1322 00:53:55,231 --> 00:53:57,434 SHOWING VERY LITTLE 1323 00:53:57,500 --> 00:53:58,935 INFLUENCE ON CAB FROM WEIGHT 1324 00:53:59,002 --> 00:54:00,870 GAIN AND THERE ARE OTHER 1325 00:54:00,937 --> 00:54:04,474 ITEMS WE'RE REALLY EXPLORING 1326 00:54:04,541 --> 00:54:06,743 WITH CAB THROUGH ITS EFFECT 1327 00:54:06,810 --> 00:54:08,244 ON WEIGHT GAIN AND 1328 00:54:08,311 --> 00:54:08,979 HYPERTENSION. 1329 00:54:09,045 --> 00:54:13,750 SOME OF THESE RESULTS WERE 1330 00:54:13,817 --> 00:54:16,953 SUBMITTED FROM MEN IN LA KOI 1331 00:54:17,020 --> 00:54:20,090 AND THE ONE ON WOMEN IS 1332 00:54:20,156 --> 00:54:20,490 FORTHCOMING. 1333 00:54:20,557 --> 00:54:20,890 NEXT SLIDE. 1334 00:54:20,957 --> 00:54:23,126 SO ONE OF THE THINGS THAT WE 1335 00:54:23,193 --> 00:54:28,431 NEED TO REMEMBER IS THAT IN 1336 00:54:28,498 --> 00:54:33,336 THE TRIALS WE HAVE OBSERVED 1337 00:54:33,403 --> 00:54:36,640 VERY FEW HIV INFECTIONS 1338 00:54:36,706 --> 00:54:38,141 OVERALL AND PARTICULARLY IN 1339 00:54:38,208 --> 00:54:38,475 WOMEN. 1340 00:54:38,541 --> 00:54:48,985 AND THIS HAS MADE IT 1341 00:54:50,286 --> 00:54:56,660 DIFFICULT TO CONTROL IT IN 1342 00:54:56,726 --> 00:54:57,327 WOMEN. 1343 00:54:57,394 --> 00:54:59,362 SO THE INFECTIONS WERE 1344 00:54:59,429 --> 00:55:01,898 CUMULATIVE AND IN ONE CASE, 1345 00:55:01,965 --> 00:55:05,769 A WOMAN WHO ACQUIRED HIV 1346 00:55:05,835 --> 00:55:08,738 INFECTION WHILE TAKING DAILY 1347 00:55:08,805 --> 00:55:13,710 ORAL PILLS HIGHLIGHTING THE 1348 00:55:13,777 --> 00:55:15,679 LIMITATION FOR PEOPLE WHO 1349 00:55:15,745 --> 00:55:18,148 WANT A INJECTION AND WE HAVE 1350 00:55:18,214 --> 00:55:21,685 SEEN ONE CASE WHILE 1351 00:55:21,751 --> 00:55:23,119 RECEIVING INJECTIONS, 1352 00:55:23,186 --> 00:55:24,421 RECEIVED MULTIPLE INJECTION 1353 00:55:24,487 --> 00:55:24,788 DELAYS. 1354 00:55:24,854 --> 00:55:27,857 SO IT MAY BE BECAUSE OF THE 1355 00:55:27,924 --> 00:55:29,225 DOSING INTERVAL PLUS THE 1356 00:55:29,292 --> 00:55:32,862 FACT WE TEND TO SEE THE 1357 00:55:32,929 --> 00:55:34,464 CONCENTRATIONS IN THE FEMALE 1358 00:55:34,531 --> 00:55:37,200 COMPARTMENT COMPARED TO THE 1359 00:55:37,267 --> 00:55:38,234 RECTAL COMPARTMENT, THESE 1360 00:55:38,301 --> 00:55:42,772 MAY EXPLAIN WHY WE HAVE SEEN 1361 00:55:42,839 --> 00:55:45,675 SO FEW INFECTIONS IN WOMEN 1362 00:55:45,742 --> 00:55:48,745 WITH THE CAB INJECTION TO 1363 00:55:48,812 --> 00:55:49,045 DATE. 1364 00:55:49,112 --> 00:55:53,083 WHAT WE HAVE LEARNED IS THAT 1365 00:55:53,149 --> 00:55:55,518 LONG LASTING ANTIVIRALS LIKE 1366 00:55:55,585 --> 00:55:56,953 CAB ARE EXTREMELY POWERFUL 1367 00:55:57,020 --> 00:55:59,255 AND VERY GOOD AT REPLACING 1368 00:55:59,322 --> 00:56:01,091 VIRAL REPLICATION. 1369 00:56:01,157 --> 00:56:05,995 SO WHEN SOMEONE ACQUIRES HIV 1370 00:56:06,062 --> 00:56:13,670 INFECTION, THERE IS A 1371 00:56:13,737 --> 00:56:19,008 SUPPRESSED RESPONSE WHICH 1372 00:56:19,075 --> 00:56:20,477 MEANS THE INJECTABLES WORK 1373 00:56:20,543 --> 00:56:21,211 VERY WELL. 1374 00:56:21,277 --> 00:56:23,580 IN MEN AND WOMEN, THESE LAY 1375 00:56:23,646 --> 00:56:32,489 ITS LED TO EMERGENCE OF 1376 00:56:32,555 --> 00:56:36,326 RESISTANCE TO INS TI THERAPY 1377 00:56:36,392 --> 00:56:42,999 BUT WE HAVE NOT SEEN SIMILAR 1378 00:56:43,066 --> 00:56:44,934 RESISTANCE IN CIS WOMEN. 1379 00:56:45,001 --> 00:56:48,772 FORTUNATELY THOSE WHO DID 1380 00:56:48,838 --> 00:56:52,008 ACHIEVE SUPPRESSION RECEIVED 1381 00:56:52,075 --> 00:56:54,811 PI ON REGISTRATION. 1382 00:56:54,878 --> 00:57:04,420 BUT THESE REALLY HIGHLIGHT 1383 00:57:04,487 --> 00:57:06,022 THE RECOMMENDATION FOR THIS 1384 00:57:06,089 --> 00:57:08,758 IN WOMEN BUT IS NOT FEASIBLE 1385 00:57:08,825 --> 00:57:09,859 IN SOME COUNTRIES AND WE 1386 00:57:09,926 --> 00:57:13,663 LEARN MORE ABOUT THE VALUE 1387 00:57:13,730 --> 00:57:18,134 OF HIV TESTING THROUGH 1388 00:57:18,201 --> 00:57:19,169 HTPN03 AND 04. 1389 00:57:19,235 --> 00:57:19,569 NEXT SLIDE. 1390 00:57:19,636 --> 00:57:21,538 I JUST WANTED TO HIGHLIGHT 1391 00:57:21,604 --> 00:57:23,206 THAT ALTHOUGH PEOPLE WORRY 1392 00:57:23,273 --> 00:57:26,376 ABOUT THE INABILITY TO 1393 00:57:26,442 --> 00:57:27,777 DIAGNOSE HIV, IN FACT THE 1394 00:57:27,844 --> 00:57:29,112 BIGGER PROBLEM WE HAVE SEEN 1395 00:57:29,179 --> 00:57:31,614 AND ONE THAN CLINICIANS WILL 1396 00:57:31,681 --> 00:57:34,117 FACE IS WHEN YOU HAVE A HIV 1397 00:57:34,184 --> 00:57:35,151 POSITIVE TEST FOR SOMEONE 1398 00:57:35,218 --> 00:57:36,986 WHO HAS RECEIVED CAB AND YOU 1399 00:57:37,053 --> 00:57:41,391 NEED TO DECIDE WHETHER TO 1400 00:57:41,457 --> 00:57:43,326 INITIATE ANTIVIRAL RETRO 1401 00:57:43,393 --> 00:57:43,693 THERAPY. 1402 00:57:43,760 --> 00:57:46,763 AND THE ANALYSIS FROM 03 AND 1403 00:57:46,830 --> 00:57:49,933 04 PROVIDE US WITH 1404 00:57:49,999 --> 00:57:51,801 REASSURANCE THAT IF YOU HAVE 1405 00:57:51,868 --> 00:57:54,170 TWO HIGHLY EFFECTIVE CASES, 1406 00:57:54,237 --> 00:57:56,940 YOU COULD ADMIT THE PERSON 1407 00:57:57,006 --> 00:57:57,874 ON ANTIRETRO VIRAL THERAPY. 1408 00:57:57,941 --> 00:58:01,911 ONE OF THE THINGS WE SEE IS 1409 00:58:01,978 --> 00:58:03,179 A LOWER PREDICTOR VALUE FOR 1410 00:58:03,246 --> 00:58:06,683 PEOPLE WHO ARE ON CAP AND I 1411 00:58:06,749 --> 00:58:11,354 THINK THIS REFLECTS THE 1412 00:58:11,421 --> 00:58:12,288 POSITIVE PREDICTIVE VALUE 1413 00:58:12,355 --> 00:58:14,090 BEING VERY LOW. 1414 00:58:14,157 --> 00:58:16,159 BUT THE TAKEHOME MESSAGE FOR 1415 00:58:16,226 --> 00:58:17,660 YOU IS TO RECOGNIZE THE 1416 00:58:17,727 --> 00:58:20,096 EFFECTS WE SEE ON LONG 1417 00:58:20,163 --> 00:58:22,966 ACTING AGENTS ON HIV TESTS 1418 00:58:23,032 --> 00:58:25,501 IS NOT REFLECTIVE TO CAB AND 1419 00:58:25,568 --> 00:58:27,170 WILL LIKELY AFFECT THE OTHER 1420 00:58:27,237 --> 00:58:29,439 PATTERN WE SEE IN FUTURE 1421 00:58:29,505 --> 00:58:31,741 LONG AGENTS AND WE NEED TO 1422 00:58:31,808 --> 00:58:33,142 REFLECT ON OUR CURRENT 1423 00:58:33,209 --> 00:58:34,077 APPROACHES TO HIV AND 1424 00:58:34,143 --> 00:58:35,845 WHETHER WE NEED TO ADAPT 1425 00:58:35,912 --> 00:58:38,448 THEM IN THE CONTEXT OF LONG 1426 00:58:38,514 --> 00:58:39,782 ACTING PREP. 1427 00:58:39,849 --> 00:58:40,884 NEXT SLIDE, PLEASE. 1428 00:58:40,950 --> 00:58:43,386 SO ONE OF THE THINGS THAT -- 1429 00:58:43,453 --> 00:58:44,687 WELL, AN ONGOING QUESTION 1430 00:58:44,754 --> 00:58:47,190 PARTICULARLY FOR WOMEN IS 1431 00:58:47,257 --> 00:58:53,830 WHETHER WE COULD EXPAND THE 1432 00:58:53,897 --> 00:58:57,233 DOSING INTERVAL FOR CAB TO 1433 00:58:57,300 --> 00:59:00,303 12 WEEKS TO LINE UP WITH 1434 00:59:00,370 --> 00:59:01,638 CONTRACEPTION AGENTS. 1435 00:59:01,704 --> 00:59:07,076 AND WE EXPLORED THIS 1436 00:59:07,143 --> 00:59:08,444 QUESTION IN HTPN84 BECAUSE 1437 00:59:08,511 --> 00:59:14,450 WE HAD FEW TO THE COVID LEX, 1438 00:59:14,517 --> 00:59:17,854 EXPANDED THEM TO 12 WEEKS. 1439 00:59:17,921 --> 00:59:19,389 WHAT WE OBSERVED IS THAT 1440 00:59:19,455 --> 00:59:21,658 THERE'S PROBABLY SOME DOSE 1441 00:59:21,724 --> 00:59:24,394 FORGIVENESS WHEN PEOPLE MISS 1442 00:59:24,460 --> 00:59:25,828 A SINGLING JECTION BUT WE 1443 00:59:25,895 --> 00:59:28,631 DID HAVE ONE HIV INFECTION 1444 00:59:28,698 --> 00:59:32,535 IN SOMEBODY WHO HAD MULTIPLE 1445 00:59:32,602 --> 00:59:33,703 INJECTION DELAYS AND THIS IS 1446 00:59:33,770 --> 00:59:35,104 REALLY THE CONCERN WITH 1447 00:59:35,171 --> 00:59:37,273 EXTENDING THE DOSE INTERVAL. 1448 00:59:37,340 --> 00:59:38,441 THE MODELING HAS SUGGESTED 1449 00:59:38,508 --> 00:59:40,176 IT IS PROBABLY NOT POSSIBLE 1450 00:59:40,243 --> 00:59:42,545 TO ACHIEVE THE DRUG 1451 00:59:42,612 --> 00:59:45,815 CONCENTRATIONS WITH 1452 00:59:45,882 --> 00:59:50,453 QUARTERLY DOSING TO PROTECT 1453 00:59:50,520 --> 00:59:53,122 AGAINST HIV INFECTIONION SO 1454 00:59:53,189 --> 00:59:55,625 CURRENTLY EXTENDING THE DOSE 1455 00:59:55,692 --> 00:59:59,062 INTERVAL IS NOT RECOMMENDED 1456 00:59:59,128 --> 01:00:02,665 FOR WOMEN, CIS OR OTHER 1457 01:00:02,732 --> 01:00:03,066 POPULATIONS. 1458 01:00:03,132 --> 01:00:05,635 THOSE WHO MAKE CAB HAVE NOW 1459 01:00:05,702 --> 01:00:08,504 DETERMINED A LONG ACTING 1460 01:00:08,571 --> 01:00:13,977 FORMULATION THAT MAY ALLOW 1461 01:00:14,043 --> 01:00:15,545 FOR EXTENDIBLE DOSING IN THE 1462 01:00:15,611 --> 01:00:15,878 FUTURE. 1463 01:00:15,945 --> 01:00:17,213 NEXT SLIDE. 1464 01:00:17,280 --> 01:00:19,749 SO THE KEY FOR PARTICULARLY 1465 01:00:19,816 --> 01:00:22,452 TRANSWOMEN IS THAT THE 1466 01:00:22,518 --> 01:00:24,387 POTENTIAL FOR CAB 1467 01:00:24,454 --> 01:00:25,989 SURROUNDING HORMONE THERAPY 1468 01:00:26,055 --> 01:00:31,761 AND IN THE TPTN83 TRIAL, 1469 01:00:31,828 --> 01:00:35,498 THEY USED WOMEN USING 1470 01:00:35,565 --> 01:00:37,667 HORMONE THERAPY AND THOSE 1471 01:00:37,734 --> 01:00:39,469 NOT USING HORMONE THERAPY 1472 01:00:39,535 --> 01:00:41,971 AND THE CAB CONCENTRATIONS 1473 01:00:42,038 --> 01:00:44,240 WERE COMPARABLE BETWEEN THE 1474 01:00:44,307 --> 01:00:46,642 TWO GROUPS SUGGESTING THE 1475 01:00:46,709 --> 01:00:49,412 VARIOUS EFFECTS ON CAB ON 1476 01:00:49,479 --> 01:00:50,313 GENDER AFFIRMING HORMONES. 1477 01:00:50,380 --> 01:00:52,582 WE LACK DATA CURRENTLY ON 1478 01:00:52,648 --> 01:00:55,618 INTERACTIONS BETWEEN CAB AND 1479 01:00:55,685 --> 01:00:59,389 TESTOSTERONE THAT MAY BE 1480 01:00:59,455 --> 01:01:00,456 USED BY TRANSMEN. 1481 01:01:00,523 --> 01:01:03,159 AND GIVEN THE INTEREST IN 1482 01:01:03,226 --> 01:01:04,660 COMBINING CAB AND 1483 01:01:04,727 --> 01:01:06,562 CONTRACEPTION EITHER WITHIN 1484 01:01:06,629 --> 01:01:08,498 THE SAME SCHEDULE OR 1485 01:01:08,564 --> 01:01:11,300 FORMULATION AS Dr. HILLIER 1486 01:01:11,367 --> 01:01:12,668 ALLUDED TO EARLIER, THERE 1487 01:01:12,735 --> 01:01:14,370 ARE SEVERAL PRODUCTS IN VERY 1488 01:01:14,437 --> 01:01:15,304 EARLY DEVELOPMENT THAT MIGHT 1489 01:01:15,371 --> 01:01:16,606 OFFER THE POTENTIAL TO 1490 01:01:16,672 --> 01:01:18,541 COMBINE CAB WITH A 1491 01:01:18,608 --> 01:01:19,242 CONTRACEPTIVE AGENT. 1492 01:01:19,308 --> 01:01:23,513 AND TO DATE WE HAVE NOT SEEN 1493 01:01:23,579 --> 01:01:25,581 ANY SIGNIFICANT DRUG 1494 01:01:25,648 --> 01:01:27,350 INTERSECTIONS BETWEEN CAB 1495 01:01:27,417 --> 01:01:29,786 AND CONTRACEPTION. 1496 01:01:29,852 --> 01:01:31,020 NEXT SLIDE. 1497 01:01:31,087 --> 01:01:35,725 SO IN THE INITIAL SLIDE I 1498 01:01:35,792 --> 01:01:38,594 SHOWED YOU THE SUGGESTION 1499 01:01:38,661 --> 01:01:40,229 THAT INJECTABLE AGENTS WOULD 1500 01:01:40,296 --> 01:01:41,564 BE HIGHLY SUCCESSFUL IN 1501 01:01:41,631 --> 01:01:42,899 POPULATIONS BUT THIS WAS 1502 01:01:42,965 --> 01:01:44,600 REALLY A THEORY BECAUSE MANY 1503 01:01:44,667 --> 01:01:46,936 PEOPLE HAD NOT EXPERIENCE 1504 01:01:47,003 --> 01:01:52,508 WITH INJECTABLE PREP. 1505 01:01:52,575 --> 01:01:57,613 SO IT IS NICE TO SEE THAT IT 1506 01:01:57,680 --> 01:01:59,482 HAS ACCEPTABILITY AND WE SAW 1507 01:01:59,549 --> 01:02:01,117 IN ADULTS A STRONG 1508 01:02:01,184 --> 01:02:02,385 PREFERENCE FOR INJECTION 1509 01:02:02,452 --> 01:02:03,553 OVER PILLS PARTICULARLY 1510 01:02:03,619 --> 01:02:05,488 DURING THE PERIOD WHERE 1511 01:02:05,555 --> 01:02:06,856 PEOPLE WERE USING BOTH AND 1512 01:02:06,923 --> 01:02:08,458 WHEN PEOPLE WERE OFFERED THE 1513 01:02:08,524 --> 01:02:11,661 CHOICE TO EITHER TAKE CAB OR 1514 01:02:11,727 --> 01:02:13,362 ORAL PREP, ABOUT EIGHT OUT 1515 01:02:13,429 --> 01:02:15,798 OF TEN OF THEM CHOSE THE 1516 01:02:15,865 --> 01:02:17,166 INJECTABLE CAB FOR PREP. 1517 01:02:17,233 --> 01:02:20,369 AND WE ALSO SAW HIGH NUMBERS 1518 01:02:20,436 --> 01:02:22,772 OF UNDER 18S WHO OPTED TO 1519 01:02:22,839 --> 01:02:25,875 CONTINUE CAB INJECTIONS FROM 1520 01:02:25,942 --> 01:02:27,210 THE ADOLESCENT STUDY. 1521 01:02:27,276 --> 01:02:29,612 THE MAIN REASON PEOPLE GIVE 1522 01:02:29,679 --> 01:02:31,214 FOR CHOOSING CAB IS NOT 1523 01:02:31,280 --> 01:02:31,914 SURPRISING. 1524 01:02:31,981 --> 01:02:33,883 IT IS CONVENIENT, DISCREET 1525 01:02:33,950 --> 01:02:36,519 AND EASIER TO ADHERE TO BUT 1526 01:02:36,586 --> 01:02:38,020 WHAT HAS ALSO BEEN 1527 01:02:38,087 --> 01:02:39,722 INTERESTING TO SEE IS THAT 1528 01:02:39,789 --> 01:02:40,423 PEOPLE CHOOSING CAB APPEAR 1529 01:02:40,490 --> 01:02:44,360 TO BE AT HIGHER RISK FOR HIV 1530 01:02:44,427 --> 01:02:46,496 AND RECOGNIZE THAT RISK SO 1531 01:02:46,562 --> 01:02:47,997 PEOPLE WITH CAB ARE LESS 1532 01:02:48,064 --> 01:02:52,401 LIKELY TO LIVE WITH THEIR 1533 01:02:52,468 --> 01:02:55,171 PARTNERS, PORN PERHAPS OUT 1534 01:02:55,238 --> 01:02:56,639 OF RECENT PORT NEVER 1535 01:02:56,706 --> 01:02:58,007 VIOLENCE OR PAID FOR SEX. 1536 01:02:58,074 --> 01:03:01,811 THERE IS A POPULATION 1537 01:03:01,878 --> 01:03:03,179 DESPITE THE HTPN84 THAT 1538 01:03:03,246 --> 01:03:04,680 STILL OPTED FOR PILLS AND 1539 01:03:04,747 --> 01:03:06,315 THIS REMINDS US ALL THAT 1540 01:03:06,382 --> 01:03:07,783 PEOPLE NEED A CHOICE FOR 1541 01:03:07,850 --> 01:03:09,318 AGENTS THAT THEY CAN 1542 01:03:09,385 --> 01:03:19,295 INTEGRATE INTO THEIR LIVES. 1543 01:03:19,362 --> 01:03:20,263 NEXT SLIDE. 1544 01:03:20,329 --> 01:03:22,732 SO ONE OF THE ANSWERED 1545 01:03:22,798 --> 01:03:24,901 QUESTIONS IS REALLY ABOUT 1546 01:03:24,967 --> 01:03:26,369 THE SAFETY AND MOST OF THE 1547 01:03:26,435 --> 01:03:28,437 INFORMATION WE HAVE COMES 1548 01:03:28,504 --> 01:03:29,739 FROM PRECLICK CALL STUDIES. 1549 01:03:29,805 --> 01:03:34,143 SO WE HAVE NOT SEEN TOXICITY 1550 01:03:34,210 --> 01:03:35,278 CONCERNS PARTICULARLY AT 1551 01:03:35,344 --> 01:03:37,013 THOSE USED FOR HUMAN DOSES. 1552 01:03:37,079 --> 01:03:39,081 WE HAVE LEARNED FROM 1553 01:03:39,148 --> 01:03:40,116 PRECLINICAL STUDIES THAT 1554 01:03:40,183 --> 01:03:41,617 THERE IS TRANSFER BUT IT IS 1555 01:03:41,684 --> 01:03:44,921 VERY LOW AND SIMILARLY FOR 1556 01:03:44,987 --> 01:03:45,288 LACTATION. 1557 01:03:45,354 --> 01:03:46,989 THERE PROBABLY IS SOME 1558 01:03:47,056 --> 01:03:48,691 TRANSFER OF CAB IN BREAST 1559 01:03:48,758 --> 01:03:50,660 MILK BUT AGAIN THE 1560 01:03:50,726 --> 01:03:53,396 CONCENTRATIONS ARE LIKELY TO 1561 01:03:53,462 --> 01:03:54,063 BE VERY LOW. 1562 01:03:54,130 --> 01:03:55,331 WHAT WE HAVE LEARNED FROM 1563 01:03:55,398 --> 01:03:56,699 THE TRIALS IS THAT EVEN IN 1564 01:03:56,766 --> 01:03:59,001 PEOPLE WHO STOP TAKING 1565 01:03:59,068 --> 01:04:01,270 INJECTIONS ONCE THEY HAVE A 1566 01:04:01,337 --> 01:04:02,171 POSITIVE PREGNANCY TEST IS 1567 01:04:02,238 --> 01:04:03,105 THAT THEY WILL STILL 1568 01:04:03,172 --> 01:04:05,575 CONTINUE TO HAVE CAB 1569 01:04:05,641 --> 01:04:07,677 CONCENTRATIONS THROUGHOUT 1570 01:04:07,743 --> 01:04:08,444 PREGNANCY AND THAT IS WHAT 1571 01:04:08,511 --> 01:04:10,680 THE GRAPH IS TRYING TO SHOW 1572 01:04:10,746 --> 01:04:12,248 AND YOU THESE CONCENTRATIONS 1573 01:04:12,315 --> 01:04:14,717 ARE VERY SIMILAR IN PREGNANT 1574 01:04:14,784 --> 01:04:15,985 AND NONPREGNANT WOMEN SO 1575 01:04:16,052 --> 01:04:18,187 THAT MAY BE SOME REASSURANCE 1576 01:04:18,254 --> 01:04:20,823 THAT WE MAY NOT HAVE TO 1577 01:04:20,890 --> 01:04:22,625 ADJUST THE DOSE IN WOMEN WHO 1578 01:04:22,692 --> 01:04:23,626 ARE PREGNANT. 1579 01:04:23,693 --> 01:04:24,060 NEXT SLIDE. 1580 01:04:24,126 --> 01:04:25,561 ONE OF THE KEY QUESTIONS 1581 01:04:25,628 --> 01:04:27,630 THAT WE ARE BUSY ADDRESSING 1582 01:04:27,697 --> 01:04:31,601 IN THE OPEN LABEL EXTENSION 1583 01:04:31,667 --> 01:04:34,036 OF HTPM084 IS REALLY TO 1584 01:04:34,103 --> 01:04:36,806 PROVIDE SUPPORTIVE DATA 1585 01:04:36,872 --> 01:04:38,641 AROUND THE SAFETY OF CAB 1586 01:04:38,708 --> 01:04:41,043 WHEN PEOPLE CHOOSE TO TAKE 1587 01:04:41,110 --> 01:04:41,944 INJECTIONS DURING PREGNANCY 1588 01:04:42,011 --> 01:04:43,379 AND WHETHER OR NOT WE NEED 1589 01:04:43,446 --> 01:04:45,615 TO ADJUST THE DOSE IN 1590 01:04:45,681 --> 01:04:49,452 PREGNANCY GIVEN THE CHANGES 1591 01:04:49,518 --> 01:04:52,188 IN DRUG METABOLISM THAT 1592 01:04:52,255 --> 01:04:53,489 OCCUR DURING WOMEN IN 1593 01:04:53,556 --> 01:04:54,724 PREGNANCY AND ALSO WE WANT 1594 01:04:54,790 --> 01:04:57,727 TO BE ABLE TO TELL BOTHERS 1595 01:04:57,793 --> 01:05:00,096 ARE BREASTFEEDING IF THEY 1596 01:05:00,162 --> 01:05:01,497 ARE USING CAB 1 WHAT THE 1597 01:05:01,564 --> 01:05:04,000 RISK WOULD BE FOR THEIR 1598 01:05:04,066 --> 01:05:06,168 INFANTS SO THESE TRIALS ARE 1599 01:05:06,235 --> 01:05:09,138 ONGOING AS WE SPEAK AND HOPE 1600 01:05:09,205 --> 01:05:11,107 TO PROVIDE THESE RESULTS IN 1601 01:05:11,173 --> 01:05:11,574 2024. 1602 01:05:11,641 --> 01:05:13,409 HAVING SAID THAT, BASED ON 1603 01:05:13,476 --> 01:05:15,578 THE DATA ALREADY BEING 1604 01:05:15,645 --> 01:05:16,812 SUBMITTED TO REGULATIVE 1605 01:05:16,879 --> 01:05:20,583 AUTHORITY, WHAT WE HAVE SEEN 1606 01:05:20,650 --> 01:05:23,352 IS CURRENT APPROVALS ARE 1607 01:05:23,419 --> 01:05:25,054 PERMISSIVE FOR PREGNANCY AND 1608 01:05:25,121 --> 01:05:26,455 THIS IS BECAUSE OF THE 1609 01:05:26,522 --> 01:05:28,391 REALIZATION THAT PEOPLE ARE 1610 01:05:28,457 --> 01:05:31,060 BEING EXPOSED TO CAB EVEN IF 1611 01:05:31,127 --> 01:05:32,194 YOU STOP INJECTION. 1612 01:05:32,261 --> 01:05:36,499 NEXT SLIDE. 1613 01:05:36,565 --> 01:05:37,733 >> WE'RE AT TIME. 1614 01:05:37,800 --> 01:05:40,936 >> SO JUST TO SAY A COUPLE 1615 01:05:41,003 --> 01:05:42,672 OF NEXT STEPS WILL BE KEY TO 1616 01:05:42,738 --> 01:05:43,839 GETTING PREP TO PEOPLE WHO 1617 01:05:43,906 --> 01:05:45,541 NEED IT AND THERE ARE A 1618 01:05:45,608 --> 01:05:47,076 NUMBER OF IMPLEMENTATION 1619 01:05:47,143 --> 01:05:48,311 STUDIES THAT WILL RAISE A 1620 01:05:48,377 --> 01:05:50,179 NUMB OF THESE QUESTIONS 1621 01:05:50,246 --> 01:05:51,447 INCLUDING MODELS OF DELIVERY 1622 01:05:51,514 --> 01:05:53,282 AND WHAT PEOPLE IN THE REAL 1623 01:05:53,349 --> 01:05:55,818 WORLD WILL CHOOSE AS WELL AS 1624 01:05:55,885 --> 01:05:58,554 HOW TO BEST SUPPORT CHOICE. 1625 01:05:58,621 --> 01:05:59,889 NEXT SLIDE. 1626 01:05:59,955 --> 01:06:02,058 AND HERE REALLY IS A SUMMARY 1627 01:06:02,124 --> 01:06:04,794 OF WHAT I HAVE ARTICULATED, 1628 01:06:04,860 --> 01:06:06,662 THAT CAB IS GENERALLY SAFE 1629 01:06:06,729 --> 01:06:09,398 AND WELL TOLERATED AND 1630 01:06:09,465 --> 01:06:10,666 EFFECTIVE FOR HIV 1631 01:06:10,733 --> 01:06:13,336 IMPLEMENTATION AND REALLY 1632 01:06:13,402 --> 01:06:15,538 THAT THE INTERVENTION 1633 01:06:15,604 --> 01:06:24,814 PRODUCTS ARE CRITICAL TO 1634 01:06:24,880 --> 01:06:25,881 SUPPORT STRATEGIES FOR WOMEN 1635 01:06:25,948 --> 01:06:28,050 AND THOSE WHO NEED IT. 1636 01:06:28,117 --> 01:06:29,752 >> THANK YOU SO MUCH. 1637 01:06:29,819 --> 01:06:32,054 >> WE HAVE ONE MORE 1638 01:06:32,121 --> 01:06:32,488 PRESENTATION. 1639 01:06:32,555 --> 01:06:33,856 >> THANK YOU SO MUCH AND AS 1640 01:06:33,923 --> 01:06:38,194 A REMINDER TO THE AUDIENCE, 1641 01:06:38,260 --> 01:06:40,696 PLEASE SUBMIT QUESTIONS AND 1642 01:06:40,763 --> 01:06:41,731 COMMENTS VIA THE FEEDBACK 1643 01:06:41,797 --> 01:06:45,034 BUTTON AT THE BOTTOM OF THE 1644 01:06:45,101 --> 01:06:47,069 NEWSCAST. 1645 01:06:47,136 --> 01:06:57,680 AND SO NOW WE HAVE OUR NEXT 1646 01:07:01,350 --> 01:07:01,617 PRESENTATION. 1647 01:07:01,684 --> 01:07:11,827 >> WE'RE NOT HEARING IT, 1648 01:07:11,894 --> 01:07:12,161 MELISSA. 1649 01:07:12,228 --> 01:07:20,436 >> HI, EVERYONE, MY NAME IS 1650 01:07:20,503 --> 01:07:24,073 SUJATA -- 1651 01:07:24,140 --> 01:07:34,450 [ POOR AUDIO ] 1652 01:07:35,951 --> 01:07:46,128 [INAUDIBLE] 1653 01:09:50,386 --> 01:10:00,629 [INDISCERNIBLE] 1654 01:11:29,818 --> 01:11:31,754 >> THANK YOU EVERYBODY FOR 1655 01:11:31,820 --> 01:11:34,189 YOUR EXCELLENT 1656 01:11:34,256 --> 01:11:34,757 PRESENTATIONS. 1657 01:11:34,823 --> 01:11:36,291 WE DO HAVE VERY GOOD 1658 01:11:36,358 --> 01:11:37,926 QUESTIONS AND I INVITE ALL 1659 01:11:37,993 --> 01:11:42,264 OF THE SPEAKERS TO TURN ON 1660 01:11:42,331 --> 01:11:48,270 YOUR CAMERAS AGAIN AND AS A 1661 01:11:48,337 --> 01:11:50,773 REMINDER, IF YOU HAVE 1662 01:11:50,839 --> 01:11:52,808 QUESTIONS OR COMMENTS, 1663 01:11:52,875 --> 01:11:55,944 PLEASE ENTER THEM ON THE 1664 01:11:56,011 --> 01:12:05,387 LIVE FEEDBACK ON THE BOTTOM 1665 01:12:05,454 --> 01:12:06,055 OF THE SCREEN. 1666 01:12:06,121 --> 01:12:09,324 SO WHAT IS ACCEPTABLE FOR 1667 01:12:09,391 --> 01:12:10,826 PROVIDERS AND ALSO WOMEN SO 1668 01:12:10,893 --> 01:12:17,366 THIS QUESTION IS TO Dr. 1669 01:12:17,433 --> 01:12:17,933 HILLIER. 1670 01:12:18,000 --> 01:12:22,671 IT WAS INTERESTING TO HEAR 1671 01:12:22,738 --> 01:12:29,978 ABOUT THE DESIGN OF 1672 01:12:30,045 --> 01:12:40,589 NONHORMONAL AND NONHIV USE, 1673 01:12:49,164 --> 01:12:54,837 SO COULD YOU PROVIDE 1674 01:12:54,903 --> 01:12:56,905 INFORMATION ON CONNECTIVITY 1675 01:12:56,972 --> 01:12:58,607 AND WHETHER NONHORMONAL 1676 01:12:58,674 --> 01:13:01,009 PLAYS SOME ROLE WITH THIS 1677 01:13:01,076 --> 01:13:02,277 BEING MORE ACCEPTABLE TO 1678 01:13:02,344 --> 01:13:02,578 WOMEN. 1679 01:13:02,644 --> 01:13:03,545 >> THANKS FOR THE QUESTION 1680 01:13:03,612 --> 01:13:05,547 AND IT IS AN IMPORTANT ONE 1681 01:13:05,614 --> 01:13:08,117 AND BASICALLY I WANT TO 1682 01:13:08,183 --> 01:13:09,718 REMIND EVERYONE THAT IN THE, 1683 01:13:09,785 --> 01:13:12,154 FOR EXAMPLE THE STUDY OF 1684 01:13:12,221 --> 01:13:14,723 YOUNG WOMEN 16 TO 21 YEARS 1685 01:13:14,790 --> 01:13:16,658 OF AGE WHERE YOUNG WOMEN 1686 01:13:16,725 --> 01:13:19,361 WERE OFFERED THE VAGINAL 1687 01:13:19,428 --> 01:13:21,430 RINK AND ORAL PREP AND USED 1688 01:13:21,497 --> 01:13:24,199 BOTH FOR SIX MONTHS, AFTER 1689 01:13:24,266 --> 01:13:25,334 ONE YEAR, TWO-THIRDS OF 1690 01:13:25,400 --> 01:13:26,769 YOUNG WOMEN CHOSE THE RING. 1691 01:13:26,835 --> 01:13:29,505 SO WE ALREADY HAVE DATA THAT 1692 01:13:29,571 --> 01:13:31,440 VAGINAL RINGS ARE QUITE 1693 01:13:31,507 --> 01:13:33,642 ACCEPTABLE TO YOUNG WOMEN IN 1694 01:13:33,709 --> 01:13:37,679 AFRICA AND WE ALSO FOUND 1695 01:13:37,746 --> 01:13:39,081 HIGH ACCEPTABILITY IN THE 1696 01:13:39,148 --> 01:13:39,448 U.S. 1697 01:13:39,515 --> 01:13:41,950 SO ONE RING THAT I TALKED 1698 01:13:42,017 --> 01:13:45,954 ABOUT WHICH IS THE 1699 01:13:46,021 --> 01:13:48,357 NONHORMONAL, NONHIV RING HAS 1700 01:13:48,423 --> 01:13:51,560 JUST BEEN ACCEPTED IN A 1701 01:13:51,627 --> 01:13:53,095 TRIAL, 80 IN AFRICA AND 20 1702 01:13:53,162 --> 01:13:55,764 IN THE U.S. AND WE WILL 1703 01:13:55,831 --> 01:13:57,065 UNDERSTAND BETTER HOW THEY 1704 01:13:57,132 --> 01:13:58,133 FEEL ABOUT THIS PARTICULAR 1705 01:13:58,200 --> 01:13:59,601 RING BUT MANY WOMEN HAVE 1706 01:13:59,668 --> 01:14:02,504 TOLD US IN STAKEHOLDER 1707 01:14:02,571 --> 01:14:03,806 ENGAGEMENTS THAT THEY ARE 1708 01:14:03,872 --> 01:14:06,108 WHY INTERESTED IN A 1709 01:14:06,175 --> 01:14:07,976 NONHORMONAL OPTION SO WE 1710 01:14:08,043 --> 01:14:10,979 WILL FIND OUT. 1711 01:14:11,046 --> 01:14:13,048 >> THANK YOU, WE LOOK 1712 01:14:13,115 --> 01:14:16,118 FORWARD TO SEEING THE 1713 01:14:16,185 --> 01:14:18,120 STATUS. 1714 01:14:18,187 --> 01:14:28,664 NEXT QUESTION IS TO Dr. 1715 01:14:39,107 --> 01:14:39,775 DELANY-MORETIWE. 1716 01:14:39,842 --> 01:14:42,611 WHAT INJECTABLE IS INCLUDED 1717 01:14:42,678 --> 01:14:47,182 IN THE PORTFOLIO OF HIV 1718 01:14:47,249 --> 01:14:47,549 VACCINES? 1719 01:14:47,616 --> 01:14:48,817 >> THANK YOU FOR THE 1720 01:14:48,884 --> 01:14:49,184 QUESTION. 1721 01:14:49,251 --> 01:14:53,121 I DIDN'T REALLY GO THROUGH 1722 01:14:53,188 --> 01:14:54,156 MANY OF THEM. 1723 01:14:54,223 --> 01:14:57,459 PERSONS LIVING WITH HIV WHO 1724 01:14:57,526 --> 01:14:58,393 HAVE ALREADY MADE 1725 01:14:58,460 --> 01:15:03,832 ANTIBODIES, WE WILL USE SOME 1726 01:15:03,899 --> 01:15:04,833 OF THAT ANTIBODIES AND I 1727 01:15:04,900 --> 01:15:06,668 DON'T KNOW WHAT THEY DO WITH 1728 01:15:06,735 --> 01:15:10,873 IT AT THE LAB BUT CLEAN IT 1729 01:15:10,939 --> 01:15:14,877 UP AND VACUUM AND GIVE THAT 1730 01:15:14,943 --> 01:15:15,844 AS A PROFUSION TO 1731 01:15:15,911 --> 01:15:16,278 PARTICIPANTS. 1732 01:15:16,345 --> 01:15:17,880 THAT IS ONE WAY. 1733 01:15:17,946 --> 01:15:21,850 ANOTHER WAY IS TO ISOLATE 1734 01:15:21,917 --> 01:15:23,252 THE PARTICLES WHICH ARE 1735 01:15:23,318 --> 01:15:24,519 ATTACHED TO THE VACCINE 1736 01:15:24,586 --> 01:15:28,457 WHILE IN THE BODY SO THAT 1737 01:15:28,523 --> 01:15:32,060 WILL HELP TRIGGER A MORE 1738 01:15:32,127 --> 01:15:39,234 ROBUST T CELL RESPONSE AND 1739 01:15:39,301 --> 01:15:42,537 WE HAVE VACUUM IN THE 1740 01:15:42,604 --> 01:15:43,572 PIPELINE THAT INCORPORATES 1741 01:15:43,639 --> 01:15:48,076 DIFFERENT PLATFORMS SO WE 1742 01:15:48,143 --> 01:15:49,444 USE CERTAIN ADJUVANTS THAT 1743 01:15:49,511 --> 01:15:51,513 WILL HELP BOOST THE VACCINE 1744 01:15:51,580 --> 01:15:54,716 AND MAKE IT WORK BETTER AND 1745 01:15:54,783 --> 01:16:03,926 CONSIDERING PLATFORMS LIKE 1746 01:16:03,992 --> 01:16:06,361 MRNA OR PT S M.D., DIFFERENT 1747 01:16:06,428 --> 01:16:08,597 VIRUSES THAT WILL WORK AND 1748 01:16:08,664 --> 01:16:09,898 BE INCLUDED WITH THE 1749 01:16:09,965 --> 01:16:11,733 VACCINATION THAT WILL HELP 1750 01:16:11,800 --> 01:16:14,336 THE BODY RECOGNIZE AND 1751 01:16:14,403 --> 01:16:19,141 TRIGGER A RESPONSE AND MAKE 1752 01:16:19,207 --> 01:16:19,942 T-CELLS MUCH FASTER. 1753 01:16:20,008 --> 01:16:21,944 AND WE ALSO HAVE TRIAL SITES 1754 01:16:22,010 --> 01:16:24,646 ALL OVER THE WORLD, IN THE 1755 01:16:24,713 --> 01:16:27,015 AMERICA, ASIA AND AFRICA, TO 1756 01:16:27,082 --> 01:16:31,653 BE SPECIFIC, AND WE INCLUDE 1757 01:16:31,720 --> 01:16:37,059 VARIOUS POPULATIONS SO THESE 1758 01:16:37,125 --> 01:16:39,027 ARE EXPOSED AND USE HEALTHY 1759 01:16:39,094 --> 01:16:39,594 ADULTS. 1760 01:16:39,661 --> 01:16:41,997 WE WORK WITH VOLUNTEERS THAT 1761 01:16:42,064 --> 01:16:45,834 ARE TRANSAND ALSO WORK WITH 1762 01:16:45,901 --> 01:16:49,037 VOLUNTEERS THAT ARE ALREADY 1763 01:16:49,104 --> 01:16:50,272 ON CAB. 1764 01:16:50,339 --> 01:16:52,874 SO MANY, MANY TRIALS IN THE 1765 01:16:52,941 --> 01:16:54,943 PIPELINE WITH MANY 1766 01:16:55,010 --> 01:16:57,379 COLLABORATIONS AND JUST 1767 01:16:57,446 --> 01:16:58,780 SEEING WHAT WORKS AND HOPE 1768 01:16:58,847 --> 01:17:00,315 TO DEVELOP MORE PILES IN THE 1769 01:17:00,382 --> 01:17:02,484 FUTURE WITH OUR PARTNERS. 1770 01:17:02,551 --> 01:17:03,385 THANK YOU. 1771 01:17:03,452 --> 01:17:05,887 >> THANK YOU SO MUCH. 1772 01:17:05,954 --> 01:17:07,489 WE HAVE ANOTHER VERY 1773 01:17:07,556 --> 01:17:10,625 INTERESTING QUESTION. 1774 01:17:10,692 --> 01:17:13,061 IT IS FOR Dr. CHANDLER. 1775 01:17:13,128 --> 01:17:15,163 CAN YOU PLEASE SPEAK TO THE 1776 01:17:15,230 --> 01:17:17,032 FACTORS AS THERE IS A BIG 1777 01:17:17,099 --> 01:17:20,435 GAP BETWEEN BLACK AND WHITE 1778 01:17:20,502 --> 01:17:25,407 GROUPS AND LOOSE THE BIG GAP 1779 01:17:25,474 --> 01:17:26,108 BETWEEN DESCRIPTION OF GAP 1780 01:17:26,174 --> 01:17:34,449 FOR WOMEN AND MEN SO PLEASE 1781 01:17:34,516 --> 01:17:36,818 COMMENT AND -- 1782 01:17:36,885 --> 01:17:37,285 [INDISCERNIBLE] 1783 01:17:37,352 --> 01:17:38,787 -- BUT PLEASE ANSWER THE 1784 01:17:38,854 --> 01:17:39,154 QUESTION. 1785 01:17:39,221 --> 01:17:41,556 >> THANK YOU, I WILL BE VERY 1786 01:17:41,623 --> 01:17:41,957 QUICK. 1787 01:17:42,024 --> 01:17:44,292 I WOULD BE REMISS TO SAY 1788 01:17:44,359 --> 01:17:45,927 THERE ARE SOME STRUCTURAL 1789 01:17:45,994 --> 01:17:50,332 ISSUES THAT OCCUR, WHETHER 1790 01:17:50,399 --> 01:17:55,971 THAT IS RACISM, SOME OF WILL 1791 01:17:56,038 --> 01:17:59,541 THE ISMS THAT EXIST SO 1792 01:17:59,608 --> 01:18:01,109 UNFORTUNATELY WITH 1793 01:18:01,176 --> 01:18:01,777 STRUCTURAL ISSUES THAT ARISE 1794 01:18:01,843 --> 01:18:04,513 WITH REGARD TO PROVIDERS, 1795 01:18:04,579 --> 01:18:06,448 FOR INSTANCE, I WORK A LOT 1796 01:18:06,515 --> 01:18:08,517 WITH BLACK WOMEN IN CERTAIN 1797 01:18:08,583 --> 01:18:10,552 CARE SETTINGS AND IN MY 1798 01:18:10,619 --> 01:18:11,620 RESEARCH AND A LOT OF THE 1799 01:18:11,686 --> 01:18:14,456 ISSUES THAT HAVE COME UP 1800 01:18:14,523 --> 01:18:15,390 AROUND NOT BEING 1801 01:18:15,457 --> 01:18:16,324 PRESCRIBBLED PREP IN 1802 01:18:16,391 --> 01:18:18,126 PARTICULAR IS THAT THEY 1803 01:18:18,193 --> 01:18:19,861 DON'T EVEN GET OFFERED PREP 1804 01:18:19,928 --> 01:18:22,597 AND IF THEY INQUIRE, LIKE IF 1805 01:18:22,664 --> 01:18:24,466 THEY MAKE A CONSCIOUS EFFORT 1806 01:18:24,533 --> 01:18:26,868 TO INQUIRE, THEY ARE TOLD, 1807 01:18:26,935 --> 01:18:28,703 WELL, YOU DON'T SEEM TO NEED 1808 01:18:28,770 --> 01:18:30,205 IT, YOU ARE MARRIED, OR 1809 01:18:30,272 --> 01:18:32,607 THERE IS A ALLOTTED OF 1810 01:18:32,674 --> 01:18:34,910 HESITANCY AND MAYBE BECAUSE 1811 01:18:34,976 --> 01:18:37,345 OF THEM NOT NECESSARILY 1812 01:18:37,412 --> 01:18:39,114 BEING COMFORTABLE WITH PREP 1813 01:18:39,181 --> 01:18:41,183 AND KNOWING ENOUGH ABOUT IT, 1814 01:18:41,249 --> 01:18:43,151 TO FEEL LIKE THEY CAN 1815 01:18:43,218 --> 01:18:43,718 PRESCRIBE IT. 1816 01:18:43,785 --> 01:18:46,354 SO THOSE ARE SOME OF THE 1817 01:18:46,421 --> 01:18:48,490 VARIANTS THAT HAVE COME UP 1818 01:18:48,557 --> 01:18:50,025 WITH SOME OF THE MEN AND 1819 01:18:50,092 --> 01:18:51,760 WOMEN I HAVE WORKED WITH AND 1820 01:18:51,827 --> 01:18:55,397 AS FAR AS HIV IN WOMEN, 1821 01:18:55,464 --> 01:18:56,698 WOMEN IN PARTICULARLY -- 1822 01:18:56,765 --> 01:18:58,166 BLACK WOMEN, WE HAVE ALWAYS 1823 01:18:58,233 --> 01:18:59,201 BEEN KIND OF SECONDARY SO 1824 01:18:59,267 --> 01:19:02,971 MOST OF THE TIME, THE 1825 01:19:03,038 --> 01:19:05,040 EFFORTS ARE ADDRESSING IT IN 1826 01:19:05,107 --> 01:19:05,841 MEN. 1827 01:19:05,907 --> 01:19:09,311 BUT WE RECENTLY HAD A 1828 01:19:09,377 --> 01:19:10,078 MEETING WITH TRANSGENDER 1829 01:19:10,145 --> 01:19:14,483 BLACK WOMEN AND THEY TEND TO 1830 01:19:14,549 --> 01:19:17,185 FEEL SIMILARLY SO WE HAVE 1831 01:19:17,252 --> 01:19:21,123 SOME VARIETY IN THAT BUT 1832 01:19:21,189 --> 01:19:22,858 MANY OF THEM TO INCLUDE 1833 01:19:22,924 --> 01:19:25,527 WOMEN ARE THOUGHT OF AS 1834 01:19:25,594 --> 01:19:28,396 SECONDARY, LIKE OH WE FORGOT 1835 01:19:28,463 --> 01:19:31,566 WOMEN, LET'S PULL THEM IN. 1836 01:19:31,633 --> 01:19:34,102 AND LIKE WHY ARE WOMEN AN 1837 01:19:34,169 --> 01:19:34,536 AFTERTHOUGHT? 1838 01:19:34,603 --> 01:19:36,271 WE SHOULD BE IN THE 1839 01:19:36,338 --> 01:19:37,506 CONVERSATION AT THE 1840 01:19:37,572 --> 01:19:39,107 BEGINNING AS WELL SO NOW 1841 01:19:39,174 --> 01:19:40,742 WE'RE TRYING TO PLAY CATCHUP 1842 01:19:40,809 --> 01:19:42,444 IN A LOT OF THE WORK WE ARE 1843 01:19:42,511 --> 01:19:42,944 TO GO. 1844 01:19:43,011 --> 01:19:44,579 >> THANK YOU SO MUCH, WE ARE 1845 01:19:44,646 --> 01:19:46,381 ALMOST OUT OF TIME AND IF 1846 01:19:46,448 --> 01:19:47,983 YOU HAVE MORE QUESTIONS, 1847 01:19:48,049 --> 01:19:50,886 FEEL FREE TO REACH OUT AFTER 1848 01:19:50,952 --> 01:19:51,353 THE SESSION. 1849 01:19:51,419 --> 01:19:52,954 WE WISH TO THANK ALL 1850 01:19:53,021 --> 01:19:54,122 PRESENTERS AND ALL 1851 01:19:54,189 --> 01:19:55,290 PARTICIPANTS ON THE 1852 01:19:55,357 --> 01:19:55,657 VIDEOCAST. 1853 01:19:55,724 --> 01:20:01,096 THANK YOU FOR PARTICIPATING. 1854 01:20:01,163 --> 01:20:02,330 THIS CONCLUDES SECTION 7. 1855 01:20:02,397 --> 01:20:12,307 AND NOW TURN IT OVER TO 1856 01:20:12,374 --> 01:20:14,643 Dr. SUJATA VIJH WHO WILL 1857 01:20:14,709 --> 01:20:18,180 CONDUCT SESSION 8. 1858 01:20:18,246 --> 01:20:24,586 >> THANK YOU, TATIANA, GOOD 1859 01:20:24,653 --> 01:20:27,522 MORNING, EVERYBODY. 1860 01:20:27,589 --> 01:20:29,524 -- SEEMA DESAI. 1861 01:20:29,591 --> 01:20:35,764 I WILL BE COMODERATING THIS 1862 01:20:35,830 --> 01:20:43,538 SESSION WITH KATHLEEN 1863 01:20:43,605 --> 01:20:43,905 BORGMANN. 1864 01:20:43,972 --> 01:20:47,442 THE SCIENTIFIC COMMUNITY HAS 1865 01:20:47,509 --> 01:20:48,476 ACHIEVED REMARKABLE 1866 01:20:48,543 --> 01:20:54,382 MILESTONES EFFORTS TO REDUCE 1867 01:20:54,449 --> 01:20:56,551 HIV INCLUDING THE ANTIVIRAL 1868 01:20:56,618 --> 01:20:57,886 THERAPIES. 1869 01:20:57,953 --> 01:21:00,288 THE DIVERSE POPULATION OF 1870 01:21:00,355 --> 01:21:03,625 HIV RESEARCH IS A FUNCTIONAL 1871 01:21:03,692 --> 01:21:05,794 COMPONENT OF REACHING THE 1872 01:21:05,860 --> 01:21:06,528 HIV EPIDEMIC. 1873 01:21:06,595 --> 01:21:08,263 WE ARE LOOKING FORWARD TO 1874 01:21:08,330 --> 01:21:14,603 TODAY'S SESSION WHICH WILL 1875 01:21:14,669 --> 01:21:24,145 BE HIGHLIGHTING EXCITING AND 1876 01:21:24,212 --> 01:21:25,146 GOOD ANSWERS [ INDISCERNIBLE 1877 01:21:25,213 --> 01:21:26,881 ] AND FOR CONSIDERATIONS IN 1878 01:21:26,948 --> 01:21:29,918 THE GLOBAL SOUTH. 1879 01:21:29,985 --> 01:21:33,321 THE LONG-TERM EFFECTS AND 1880 01:21:33,388 --> 01:21:34,689 COMMUNITY PERSPECTIVE ON 1881 01:21:34,756 --> 01:21:38,860 PARTIAL ABILITIES TO ENHANCE 1882 01:21:38,927 --> 01:21:39,828 HIV TREATMENT. 1883 01:21:39,894 --> 01:21:42,430 AS A REMINDER, YOU CAN 1884 01:21:42,497 --> 01:21:43,832 SUBMIT QUESTIONS USING LIVE 1885 01:21:43,898 --> 01:21:45,000 FEEDBACK FORM AND WE WILL 1886 01:21:45,066 --> 01:21:55,510 ANSWER THEM AS WE GO. 1887 01:22:01,549 --> 01:22:02,384 NEXT SLIDE. 1888 01:22:02,450 --> 01:22:04,319 INFORMATION ON THE RETRO 1889 01:22:04,386 --> 01:22:07,122 VIRUS CAN BE FOUND ON THE 1890 01:22:07,188 --> 01:22:12,260 BACK PAGE. 1891 01:22:12,327 --> 01:22:19,334 Dr. CHLOE ORKIN, PROFESSOR 1892 01:22:19,401 --> 01:22:23,672 IN LONDON AND HAS BEEN -- 1893 01:22:23,738 --> 01:22:24,372 [INDISCERNIBLE] 1894 01:22:24,439 --> 01:22:34,115 Dr. ORKIN SERVES AS 1895 01:22:34,182 --> 01:22:36,051 COLLABORATOR -- 1896 01:22:36,117 --> 01:22:36,985 [INDISCERNIBLE] 1897 01:22:37,052 --> 01:22:39,421 CONTRIBUTED TO LICENSING FOR 1898 01:22:39,487 --> 01:22:48,229 MORE THAN 20 THERAPIES EVER 1899 01:22:48,296 --> 01:22:49,898 DEVISES ENCLOUDING HIV. 1900 01:22:49,964 --> 01:23:00,442 AND OUR SECOND SPEAKER, 1901 01:23:05,280 --> 01:23:07,282 Dr. ROSIE MNGIBISA, 1902 01:23:07,349 --> 01:23:09,651 DEVELOPMENT OF INFECTIOUS 1903 01:23:09,718 --> 01:23:20,161 DISEASES AND RESULTING 1904 01:23:28,436 --> 01:23:28,670 CONDITIONS. 1905 01:23:28,737 --> 01:23:30,338 Dr. IGHO WILL BE OUR THIRD 1906 01:23:30,405 --> 01:23:32,374 SPEAKER, A VERY 1907 01:23:32,440 --> 01:23:34,109 DISTINGUISHED PROFESSOR OF 1908 01:23:34,175 --> 01:23:36,277 MEDICINE AT EMERY SCHOOL OF 1909 01:23:36,344 --> 01:23:38,012 MEDICINE AND DIRECTOR OF 1910 01:23:38,079 --> 01:23:41,850 SOCIAL AND HEALTH EDUCATION 1911 01:23:41,916 --> 01:23:42,550 SCIENTIST AS EMERY 1912 01:23:42,617 --> 01:23:43,752 UNIVERSITY SCHOOL OF PUBLIC 1913 01:23:43,818 --> 01:23:45,687 HEALTH. 1914 01:23:45,754 --> 01:23:52,894 AS A CLINICIAN SCIENTIST, 1915 01:23:52,961 --> 01:23:58,166 Dr. OFOTOKUN'S CAREER HAS 1916 01:23:58,233 --> 01:24:00,668 BEEN ON -- 1917 01:24:00,735 --> 01:24:01,269 [INDISCERNIBLE] 1918 01:24:01,336 --> 01:24:07,876 AND FOCUSED ON THAT AGE 1919 01:24:07,942 --> 01:24:11,279 RELATED MORBIDITY IN PEOPLE 1920 01:24:11,346 --> 01:24:14,215 WITH HIV. 1921 01:24:14,282 --> 01:24:17,352 AND Dr. STEVEN DEEKS WILL 1922 01:24:17,419 --> 01:24:22,824 BE SPEAKING ON HIV MEDICINE. 1923 01:24:22,891 --> 01:24:26,227 Dr. DEEKS IS PROFESSOR AT 1924 01:24:26,294 --> 01:24:27,228 UNIVERSITY OF CALIFORNIA-SAN 1925 01:24:27,295 --> 01:24:28,730 FRANCISCO. 1926 01:24:28,797 --> 01:24:36,004 HE HAS PUBLISHED OVER 700 1927 01:24:36,070 --> 01:24:38,373 FIELD REVIEWED ARTICLES ON 1928 01:24:38,440 --> 01:24:41,576 THESE AND UNRELIED TOPICS. 1929 01:24:41,643 --> 01:24:45,780 AS A NATIVE OF PHILADELPHIA, 1930 01:24:45,847 --> 01:24:46,581 PENNSYLVANIA BUT RESIDES IN 1931 01:24:46,648 --> 01:24:48,049 NORTH CAROLINA. 1932 01:24:48,116 --> 01:24:50,718 HE HAS A BACHELOR DEGREE IN 1933 01:24:50,785 --> 01:24:51,986 SOCIAL WORK, MASTER IN 1934 01:24:52,053 --> 01:24:56,090 PUBLIC HEALTH AND HAS 1935 01:24:56,157 --> 01:24:57,325 COMPLETED DOCTOR DOCTORATE 1936 01:24:57,392 --> 01:25:02,697 COURSES THAT FOCUS ON 1937 01:25:02,764 --> 01:25:03,598 ADVOCACY AND LEADERSHIP. 1938 01:25:03,665 --> 01:25:05,800 HE DOES THIS WORK FOR 1939 01:25:05,867 --> 01:25:13,942 UNIVERSITY OF NORTH 1940 01:25:14,008 --> 01:25:14,609 CAROLINA-CHAPEL HILL AND 1941 01:25:14,676 --> 01:25:17,679 RESEARCH AT THE OFFICE OF 1942 01:25:17,745 --> 01:25:22,116 COMMUNITY ENGAGEMENT. 1943 01:25:22,183 --> 01:25:23,485 NEXT SLIDE. 1944 01:25:23,551 --> 01:25:25,820 THE FIRST PRESENTATION IS 1945 01:25:25,887 --> 01:25:32,927 FROM Dr. CHLOE ORKIN. 1946 01:25:32,994 --> 01:25:34,229 GO AHEAD, DOCTOR, THE STAGE 1947 01:25:34,295 --> 01:25:35,363 IS YOURS. 1948 01:25:35,430 --> 01:25:37,198 >> THANK YOU, NEXT SLIDE 1949 01:25:37,265 --> 01:25:37,532 PLEASE. 1950 01:25:37,599 --> 01:25:39,968 SO WHAT WOULD YOU SAY IF 1951 01:25:40,034 --> 01:25:50,578 TREATMENT FOR HIV GOT A LOT 1952 01:25:52,080 --> 01:25:52,247 SIMPLER. 1953 01:25:52,313 --> 01:25:54,582 [ POOR AUDIO ] 1954 01:25:54,649 --> 01:26:00,755 AND WHAT THE DOCTOR WAS 1955 01:26:00,822 --> 01:26:04,692 SAYING REGARDING 1956 01:26:04,759 --> 01:26:05,927 CABOTEGRAVIR AND ANOTHER 1957 01:26:05,994 --> 01:26:08,630 DRUG FOR PEOPLE WHOSE VIRUS 1958 01:26:08,696 --> 01:26:10,932 IS SUPPRESSED AND WHERE 1959 01:26:10,999 --> 01:26:17,005 CERTAIN OTHER MEDICAL 1960 01:26:17,071 --> 01:26:21,776 CRITERIA APPLY. 1961 01:26:21,843 --> 01:26:22,443 TWO-MONTHLY INJECTABLE 1962 01:26:22,510 --> 01:26:23,978 THERAPY IS AVAILABLE IN MANY 1963 01:26:24,045 --> 01:26:24,579 COUNTRIES. 1964 01:26:24,646 --> 01:26:27,148 IT WORKS VERY WELL AND 1965 01:26:27,215 --> 01:26:31,352 PEOPLE WHO CHOOSE TO GO INTO 1966 01:26:31,419 --> 01:26:33,855 THE TRIALS PREFERRED IT TO 1967 01:26:33,922 --> 01:26:34,756 ORAL THERAPY. 1968 01:26:34,822 --> 01:26:36,624 NOT ENOUGH WOMEN HAVE BEEN 1969 01:26:36,691 --> 01:26:40,595 ENROLLED IN THE TRIALS 1970 01:26:40,662 --> 01:26:42,330 TESTING AND FEWER WOMEN THAN 1971 01:26:42,397 --> 01:26:44,399 MEN ARE RECEIVING IT IN 1972 01:26:44,465 --> 01:26:47,502 CLINICS AND TRIALS ENSURING 1973 01:26:47,569 --> 01:26:48,770 EQUITABLE ENROLLMENT HAVE 1974 01:26:48,836 --> 01:26:51,105 BEEN SUCCESSFUL IN THE U.K. 1975 01:26:51,172 --> 01:26:54,208 AND VERY MUCH NEEDED. 1976 01:26:54,275 --> 01:26:55,543 NEXT SLIDE, PLEASE. 1977 01:26:55,610 --> 01:27:00,081 SO WITH THE TWO-MONTH 1978 01:27:00,148 --> 01:27:07,956 INJECTABLE THERAPY, WHERE WE 1979 01:27:08,022 --> 01:27:11,159 ARE NOW IS IN THE EARLY DAYS 1980 01:27:11,225 --> 01:27:18,132 THE SUCCESS WAS DEFINED AS 1981 01:27:18,199 --> 01:27:18,633 PROLONGING LIFE. 1982 01:27:18,700 --> 01:27:21,869 ART WAS AVAILABLE IN 1983 01:27:21,936 --> 01:27:24,138 MULTIPLE PILLS AND THEN A 1984 01:27:24,205 --> 01:27:26,174 DAILY ORAL TABLET AVAILABLE 1985 01:27:26,240 --> 01:27:31,980 IN A SINGLE PILL, THREE DRUG 1986 01:27:32,046 --> 01:27:33,481 COMPOUND GIVING US PREP 1987 01:27:33,548 --> 01:27:39,520 WHICH IS A SITUATION WHERE 1988 01:27:39,587 --> 01:27:50,031 TWO DRUGS CAN KEEP THE 1989 01:27:50,298 --> 01:27:53,935 DISEASE AT BAY. 1990 01:27:54,002 --> 01:27:59,707 AND THEN WE HAVE THE CAB AND 1991 01:27:59,774 --> 01:28:06,547 RPV TREATMENT WHERE THERE IS 1992 01:28:06,614 --> 01:28:08,249 MORE EMPHASIS ON 1993 01:28:08,316 --> 01:28:10,385 UNDERSTANDING PATIENT 1994 01:28:10,451 --> 01:28:12,720 OUTCOMES AND ENGAGEMENT 1995 01:28:12,787 --> 01:28:14,188 INTEGRAL TO SUCCESS. 1996 01:28:14,255 --> 01:28:15,456 NEXT SLIDE PLEASE. 1997 01:28:15,523 --> 01:28:21,763 SO WHAT WE HAVE NOW IS A 1998 01:28:21,829 --> 01:28:22,397 PROJECTION TREATMENT, 1999 01:28:22,463 --> 01:28:23,698 QUIVERING EVERY TWO MONTHS 2000 01:28:23,765 --> 01:28:26,434 AND IT MEANS PEOPLE CAN GO 2001 01:28:26,501 --> 01:28:27,969 FROM 365 TREATMENT DAYS A 2002 01:28:28,036 --> 01:28:30,905 YEAR TO JUST SIX. 2003 01:28:30,972 --> 01:28:35,476 AND THIS THERAPY IS LICENSED 2004 01:28:35,543 --> 01:28:36,477 IN TREATMENT GUIDELINES AND 2005 01:28:36,544 --> 01:28:39,447 WHAT IT MEANS IS IT CAN BE 2006 01:28:39,514 --> 01:28:41,649 GIVEN DEVICE MONTHLY AND IN 2007 01:28:41,716 --> 01:28:42,817 SOME COUNTRIES, BE GIVEN 2008 01:28:42,884 --> 01:28:43,151 MONTHLY. 2009 01:28:43,217 --> 01:28:46,621 SO WHERE I WAS IN EUROPE, IT 2010 01:28:46,688 --> 01:28:55,763 WAS DEVICE MONTHLY. 2011 01:28:55,830 --> 01:28:57,899 AND THE INJECTIONS -- 2012 01:28:57,965 --> 01:29:03,538 [INDISCERNIBLE] 2013 01:29:03,604 --> 01:29:06,240 NEXT SLIDE PLEASE. 2014 01:29:06,307 --> 01:29:07,975 SO WHY AM I FOCUSING ON 2015 01:29:08,042 --> 01:29:08,276 THIS? 2016 01:29:08,342 --> 01:29:10,745 AND WHY IS THIS NEEDED? 2017 01:29:10,812 --> 01:29:14,282 WHAT THE DATA ARE SHOWING IS 2018 01:29:14,348 --> 01:29:15,850 THAT THIS CAN ADDRESS SOME 2019 01:29:15,917 --> 01:29:16,918 OF THE CHALLENGES PEOPLE 2020 01:29:16,984 --> 01:29:18,519 EXPERIENCE ON ALL THERAPY. 2021 01:29:18,586 --> 01:29:21,789 NOW THERE ARE TWO RECENT 2022 01:29:21,856 --> 01:29:24,058 STUDIES, ONE IS CALLED THE 2023 01:29:24,125 --> 01:29:26,260 SOLAR STUDY AND THE OTHER 2024 01:29:26,327 --> 01:29:31,532 CALLED THE CARLOS STUDIES 2025 01:29:31,599 --> 01:29:34,802 AND THESE WERE DONE 2026 01:29:34,869 --> 01:29:35,870 EXCLUSIVELY WITH YOUNG WHITE 2027 01:29:35,937 --> 01:29:42,076 MEN AROUND THE AGE OF 30. 2028 01:29:42,143 --> 01:29:45,012 YET AT BASELINE, WHAT THEY 2029 01:29:45,079 --> 01:29:47,615 REPORTED IS THAT LARGE 2030 01:29:47,682 --> 01:29:49,450 PROPORTION OF THE PEOPLE 2031 01:29:49,517 --> 01:29:52,754 WERE WORRIED ABOUT BEING 2032 01:29:52,820 --> 01:29:53,421 UNINTENTIONALLY DISCOVERED, 2033 01:29:53,488 --> 01:29:54,622 BORDER FOR GETTING TO TAKE 2034 01:29:54,689 --> 01:29:55,790 THEIR TREATMENT AND ALSO 2035 01:29:55,857 --> 01:29:57,759 FEELING THAT LIVING WITH HIV 2036 01:29:57,825 --> 01:30:00,962 WAS SOMETHING TO BE REMINDED 2037 01:30:01,028 --> 01:30:02,797 OF BY THEIR TABLETS. 2038 01:30:02,864 --> 01:30:07,101 AND I THINK THIS IS ACTUALLY 2039 01:30:07,168 --> 01:30:11,706 IN SOME WAYS FRIGHTENING 2040 01:30:11,773 --> 01:30:13,741 BECAUSE WE KNOW THE 2041 01:30:13,808 --> 01:30:17,245 COMMUNITIES THAT ARE 2042 01:30:17,311 --> 01:30:18,980 EXCHANGING ILLNESS AND IT IS 2043 01:30:19,046 --> 01:30:24,051 NOT THE YOUNG HEALTHY 2044 01:30:24,118 --> 01:30:24,452 COMMUNITIES. 2045 01:30:24,519 --> 01:30:28,022 BUT WHAT WE ARE SEEING IS 2046 01:30:28,089 --> 01:30:29,557 THE FEELINGS ARE THERE EVEN 2047 01:30:29,624 --> 01:30:30,725 IN THIS COMMUNITY. 2048 01:30:30,792 --> 01:30:32,059 NEXT SLIDE, PLEASE. 2049 01:30:32,126 --> 01:30:35,029 SO WHAT WE'VE SEEN IS THAT 2050 01:30:35,096 --> 01:30:38,199 ACROSS MANY STUDIES THAT 2051 01:30:38,266 --> 01:30:41,402 HAVE BEEN DONE, THESE ARE 2052 01:30:41,469 --> 01:30:42,870 SEVEN STUDIES -- ACTUALLY 2053 01:30:42,937 --> 01:30:44,038 SIX STUDIES WE'RE TALKING 2054 01:30:44,105 --> 01:30:44,338 ABOUT. 2055 01:30:44,405 --> 01:30:46,240 WHAT YOU CAN SEE IS PEOPLE 2056 01:30:46,307 --> 01:30:52,547 WERE ASKED IN THE STUDY DO 2057 01:30:52,613 --> 01:30:59,020 YOU PREFER ORAL THERAPY OR 2058 01:30:59,086 --> 01:30:59,587 INJECTABLE AND ALMOST 2059 01:30:59,654 --> 01:31:06,661 90 PERCENT IN THE SOLAR 2060 01:31:06,727 --> 01:31:14,001 STUDY SAID THEY WANTED ORAL 2061 01:31:14,068 --> 01:31:17,138 AND EVEN THOUGH THE RESEARCH 2062 01:31:17,205 --> 01:31:20,441 HAS GONE ON TO INJECT HAS, 2063 01:31:20,508 --> 01:31:24,378 THEY WERE STILL HAPPY WITH 2064 01:31:24,445 --> 01:31:24,812 THEIR CHOICE. 2065 01:31:24,879 --> 01:31:28,182 THEY ARE NOT GOING TO OFFER 2066 01:31:28,249 --> 01:31:29,650 INJECT HAS UNLESS THEY WANT 2067 01:31:29,717 --> 01:31:38,893 IT AND WHAT THIS SHOWED WAS 2068 01:31:38,960 --> 01:31:42,129 THAT BOTH THERAPIES WERE 2069 01:31:42,196 --> 01:31:43,264 PREVENTIVE. 2070 01:31:43,331 --> 01:31:45,700 SO WHEN PEOPLE WERE ASKED 2071 01:31:45,766 --> 01:31:48,970 DID THEY WANT INJECTABLE 2072 01:31:49,036 --> 01:31:53,608 THERAPIES AND THEY SAID YES, 2073 01:31:53,674 --> 01:31:59,013 WE ASKED THEM WHY AND YOU 2074 01:31:59,080 --> 01:32:00,748 CAN SEE HERE THAT THE ANSWER 2075 01:32:00,815 --> 01:32:04,619 ARE REALLY ABOUT STIGMA, 2076 01:32:04,685 --> 01:32:05,653 INADVERTENT DISCLOSURE AND 2077 01:32:05,720 --> 01:32:07,488 THINKING ABOUT THE STATUS. 2078 01:32:07,555 --> 01:32:09,323 SO THIS IS THE BENEFIT IN 2079 01:32:09,390 --> 01:32:11,492 THE SENSE OF WHAT WAS 2080 01:32:11,559 --> 01:32:13,160 IMPROVED IN ADDITION TO 2081 01:32:13,227 --> 01:32:15,129 CONVENIENCE SO THERE IS 2082 01:32:15,196 --> 01:32:17,164 SOMETHING HELPFUL IN THIS 2083 01:32:17,231 --> 01:32:17,565 REGARD. 2084 01:32:17,632 --> 01:32:18,799 NEXT SLIDE PLEASE. 2085 01:32:18,866 --> 01:32:27,475 AND WHAT HAS BEEN SHOWN HOW 2086 01:32:27,541 --> 01:32:30,511 MUCH SATISFACTION WITH YOUR 2087 01:32:30,578 --> 01:32:31,412 TREATMENT INCREASES, IF YOU 2088 01:32:31,479 --> 01:32:36,384 LOOK AT THE SLIDE HERE, WHAT 2089 01:32:36,450 --> 01:32:38,319 YOU SEE IS THE GREEN 2090 01:32:38,386 --> 01:32:39,854 CATEGORY AND WHEN IT GOES 2091 01:32:39,921 --> 01:32:41,589 UP, IT WILL INCREASE AND THE 2092 01:32:41,656 --> 01:32:49,263 BLUE IS COMPARED WITH THE 2093 01:32:49,330 --> 01:32:51,966 INJECTABLE TO DAILY PILL AND 2094 01:32:52,033 --> 01:32:55,937 YOU CAN STILL SEE THE 2095 01:32:56,003 --> 01:32:56,704 IMPROVEMENT IN PEOPLE BUT IF 2096 01:32:56,771 --> 01:32:59,473 YOU GO TO THE RIGHTHAND SIDE 2097 01:32:59,540 --> 01:33:01,075 AND WITH PEOPLE WHO STARTED 2098 01:33:01,142 --> 01:33:03,044 OFF WITH AT LEAST THREE 2099 01:33:03,110 --> 01:33:04,779 CHALLENGES, WHAT YOU CAN SEE 2100 01:33:04,845 --> 01:33:06,881 IS THE AMOUNT OF BENEFIT IN 2101 01:33:06,948 --> 01:33:08,916 THE GREEN, HOW HIGH IT IS 2102 01:33:08,983 --> 01:33:10,418 ABOVE THE LINE, IT IS 2103 01:33:10,484 --> 01:33:11,886 SIGNIFICANTLY HIGHER. 2104 01:33:11,953 --> 01:33:13,321 SO WHEN PEOPLE HAVE 2105 01:33:13,387 --> 01:33:15,156 CHALLENGES, THEY FIND THE 2106 01:33:15,222 --> 01:33:16,757 INJECTABLE REALLY REALLY 2107 01:33:16,824 --> 01:33:26,200 HELPFUL. 2108 01:33:26,267 --> 01:33:27,735 NEXT SLIDE, PLEASE. 2109 01:33:27,802 --> 01:33:29,971 SO HOW WE HAVE DONE IN THE 2110 01:33:30,037 --> 01:33:35,142 BIG PHASE 3 STUDY, THE 2111 01:33:35,209 --> 01:33:36,610 ACCEPTANCE WAS OVERWHELMING 2112 01:33:36,677 --> 01:33:42,249 IN MALES AND OVERWHELMING IN 2113 01:33:42,316 --> 01:33:44,652 WHITES AND UNDER 50 YEARS SO 2114 01:33:44,719 --> 01:33:54,161 THEY ARE WOMEN AND 2115 01:33:54,228 --> 01:34:00,034 ADOLESCENTS NOT DOING WELL 2116 01:34:00,101 --> 01:34:08,876 WITH LONG-TERM USE. 2117 01:34:08,943 --> 01:34:12,747 AND SO THE WOMEN WHO ARE 2118 01:34:12,813 --> 01:34:14,615 PARTICIPATING DO NOT 2119 01:34:14,682 --> 01:34:19,020 REPRESENT ALL WOMEN BUT JUST 2120 01:34:19,086 --> 01:34:23,891 THOSE WITH THE RISK FAX TORT 2121 01:34:23,958 --> 01:34:26,060 OR BPOC AND UNDER 50 YEARS 2122 01:34:26,127 --> 01:34:26,761 OF AGE. 2123 01:34:26,827 --> 01:34:29,196 ALL THE PEOPLE LIVING WITH 2124 01:34:29,263 --> 01:34:31,032 HIV REALLY FEEL THEY ARE 2125 01:34:31,098 --> 01:34:32,400 EXPERIENCING AGEISM SO THIS 2126 01:34:32,466 --> 01:34:34,735 IS NOT GOOD EITHER. 2127 01:34:34,802 --> 01:34:35,403 NEXT SLIDE, PLEASE. 2128 01:34:35,469 --> 01:34:39,707 SO THERE HAS BEEN THIS 2129 01:34:39,774 --> 01:34:42,109 ANALYSIS THROUGH THE STUDY 2130 01:34:42,176 --> 01:34:46,847 TO SEE IF THEY CAN DETECT 2131 01:34:46,914 --> 01:34:47,815 DIFFERENCES THROUGH RISK 2132 01:34:47,882 --> 01:34:52,420 FACTORS AND SO FAR THERE ARE 2133 01:34:52,486 --> 01:34:55,823 NO SEX DIFFERENCES IN 2134 01:34:55,890 --> 01:34:58,426 OUTCOMES AT WEEK 48. 2135 01:34:58,492 --> 01:35:00,127 SO YES, NEXT SLIDE. 2136 01:35:00,194 --> 01:35:01,762 SO I THINK IT IS IMPORTANT 2137 01:35:01,829 --> 01:35:03,464 WE THINK ABOUT -- WE ARE 2138 01:35:03,531 --> 01:35:05,966 THINKING ABOUT CERTAIN 2139 01:35:06,033 --> 01:35:07,134 ASPECTS OF INCLUSION, 2140 01:35:07,201 --> 01:35:11,539 THINKING AROUND WITH THE 2141 01:35:11,605 --> 01:35:13,908 WORLD HEALTH ORGANIZATION 2142 01:35:13,974 --> 01:35:15,076 TRYING TO ENSURE WE HAVE 2143 01:35:15,142 --> 01:35:16,911 SAFER PEOPLE THAT ARE 2144 01:35:16,977 --> 01:35:18,646 PREGNANT, PEOPLE THAT ARE 2145 01:35:18,712 --> 01:35:19,780 BREASTFEEDING BUT WE ALSO 2146 01:35:19,847 --> 01:35:22,183 NEED TO THINK ABOUT STUDIES 2147 01:35:22,249 --> 01:35:27,354 AND TRIALS THAT ARE JUST 2148 01:35:27,421 --> 01:35:28,089 COMMON STUDIES. 2149 01:35:28,155 --> 01:35:29,723 SO WE NEED TO THINK ABOUT 2150 01:35:29,790 --> 01:35:33,227 WHO IS ACTUALLY GETTING 2151 01:35:33,294 --> 01:35:34,728 THESE STUDIES. 2152 01:35:34,795 --> 01:35:36,931 SO ACROSS 16 REAL WORLD 2153 01:35:36,997 --> 01:35:41,102 STUDIES THAT HAVE BEEN DONE, 2154 01:35:41,168 --> 01:35:42,303 1 INCLUDED FEMALE 2155 01:35:42,369 --> 01:35:43,771 PARTICIPANTS AND THIS IS 2156 01:35:43,838 --> 01:35:45,473 ACROSS THE REAL WORLD 2157 01:35:45,539 --> 01:35:45,940 STUDIES. 2158 01:35:46,006 --> 01:35:54,281 IN OTHER WORDS, CLINICIANS 2159 01:35:54,348 --> 01:36:00,020 ARE MANUFACTURING SPECIAL 2160 01:36:00,087 --> 01:36:04,792 MAKING CAB AND REPORTING ON 2161 01:36:04,859 --> 01:36:07,161 IT AS WELL. 2162 01:36:07,228 --> 01:36:10,030 THIS IS EXPLICITLY 2163 01:36:10,097 --> 01:36:13,200 ANTIRACISM, ANTISEXIST AND 2164 01:36:13,267 --> 01:36:14,235 ANTIAGING STUDY DESIGN AND 2165 01:36:14,301 --> 01:36:16,403 WE WORK TO MAKE SURE THEY 2166 01:36:16,470 --> 01:36:18,572 WOULD AGREE TO RECRUIT, TO 2167 01:36:18,639 --> 01:36:26,680 TARGET WITH ME AND THIS IS 2168 01:36:26,747 --> 01:36:32,319 JUST PARTICIPATION FROM HIV 2169 01:36:32,386 --> 01:36:35,823 WOMEN AND STUDIES -- 2170 01:36:35,890 --> 01:36:37,858 [INDISCERNIBLE] 2171 01:36:37,925 --> 01:36:42,630 AND WE MANAGED THIS IN A 2172 01:36:42,696 --> 01:36:43,364 MULTIPHASE LONGITUDINAL 2173 01:36:43,430 --> 01:36:47,067 STUDY DESIGN. 2174 01:36:47,134 --> 01:36:57,745 AND TO ACHIEVE OUR GOALS, 2175 01:36:57,811 --> 01:37:03,684 NEXT SLIDE, WE DEVISED THE 2176 01:37:03,751 --> 01:37:08,055 ILANA STUDY THAT MET 2177 01:37:08,122 --> 01:37:08,622 INCLUSIVITY TARGETS. 2178 01:37:08,689 --> 01:37:10,524 SO I THINK IT IS IMPORTANT 2179 01:37:10,591 --> 01:37:13,494 WE DON'T JUST DESIGN SPECIAL 2180 01:37:13,561 --> 01:37:14,495 STUDIES TO WOMEN. 2181 01:37:14,562 --> 01:37:17,331 AND THIS WAS VERY MASSIVE 2182 01:37:17,398 --> 01:37:23,671 AND INCLUSIVE TO WOMEN AND 2183 01:37:23,737 --> 01:37:24,338 ALSO RACIALLY MINORITIES BUT 2184 01:37:24,405 --> 01:37:26,073 I THINK WOULD HE NEED TO 2185 01:37:26,140 --> 01:37:27,575 THINK ABOUT TREATMENT 2186 01:37:27,641 --> 01:37:29,743 STUDIES AND MAKING SURE 2187 01:37:29,810 --> 01:37:31,245 WOMEN ARE INCLUDED IN THE 2188 01:37:31,312 --> 01:37:32,413 STUDIES WE ARE DOING IN 2189 01:37:32,479 --> 01:37:34,381 GENERAL AND IT CAN BE DONE. 2190 01:37:34,448 --> 01:37:35,216 SO NEXT SLIDE, PLEASE. 2191 01:37:35,282 --> 01:37:45,826 AND I AM GOING TO END THERE. 2192 01:37:48,095 --> 01:37:53,400 THE STUDY -- 2193 01:37:53,467 --> 01:37:56,136 [INDISCERNIBLE] 2194 01:37:56,203 --> 01:37:57,838 BUT THE STUDY CALLED SHARE 2195 01:37:57,905 --> 01:38:00,374 WHICH IS RESEARCH FOR HEALTH 2196 01:38:00,441 --> 01:38:03,410 EQUITY AND THE LIST OF THOSE 2197 01:38:03,477 --> 01:38:05,346 INVOLVED WITH THIS BECAUSE 2198 01:38:05,412 --> 01:38:10,417 WE NEED TO UNDERSTAND THE 2199 01:38:10,484 --> 01:38:12,820 DIFFERENCES AND INCLUDE ALL. 2200 01:38:12,886 --> 01:38:14,989 >> THANK YOU SO MUCH. 2201 01:38:15,055 --> 01:38:18,058 PLEASE POST YOUR QUESTIONS 2202 01:38:18,125 --> 01:38:20,527 OR COMMENTS ON THE FEEDBACK 2203 01:38:20,594 --> 01:38:30,971 OPTION OF THE LIVE 2204 01:38:34,041 --> 01:38:34,375 VIDEOCAST. 2205 01:38:34,441 --> 01:38:40,781 >> OUR NEXT SPEAKER IS ROSIE 2206 01:38:40,848 --> 01:38:41,148 MNGQIBISA. 2207 01:38:41,215 --> 01:38:45,152 >> THANK YOU VERY MUCH. 2208 01:38:45,219 --> 01:38:48,689 CAN YOU HEAR ME? 2209 01:38:48,756 --> 01:38:50,624 >> YES, I JUST HAVE TO WARN 2210 01:38:50,691 --> 01:38:52,026 YOU, I AM HAVING TROUBLE 2211 01:38:52,092 --> 01:38:53,961 WITH POWER SO HOPEFULLY IT 2212 01:38:54,028 --> 01:38:55,262 WILL HOLD TILL THE END OF MY 2213 01:38:55,329 --> 01:38:55,829 PRESENTATION. 2214 01:38:55,896 --> 01:38:58,932 SO I WOULD LIKE TO START BY 2215 01:38:58,999 --> 01:39:00,634 THANKING ORGANIZERS FOR 2216 01:39:00,701 --> 01:39:07,041 INVITING ME TO BE PART OF 2217 01:39:07,107 --> 01:39:07,908 THIS VERY IMPORTANT TOPIC 2218 01:39:07,975 --> 01:39:13,514 AND I WANT TO REMIND 2219 01:39:13,580 --> 01:39:15,549 EVERYONE THAT WOMEN CONTINUE 2220 01:39:15,616 --> 01:39:17,384 TO BE A GLOBAL CONSIDERATION 2221 01:39:17,451 --> 01:39:20,921 FOR HIV DESPITE ALL THE 2222 01:39:20,988 --> 01:39:25,225 PREVENTION AND ACCESS TO 2223 01:39:25,292 --> 01:39:25,592 TREATMENT. 2224 01:39:25,659 --> 01:39:28,729 THE ACCESS HAS IMPROVED BUT 2225 01:39:28,796 --> 01:39:30,364 STILL TREATMENT CHOICES IN 2226 01:39:30,431 --> 01:39:38,405 WOMEN WITH HIV IN SOME 2227 01:39:38,472 --> 01:39:39,606 COUNTRIES STIGMA EXISTS. 2228 01:39:39,673 --> 01:39:41,775 WOMEN IN OTHER COUNTRIES 2229 01:39:41,842 --> 01:39:42,643 FACE MANY HEALTH CHALLENGES 2230 01:39:42,710 --> 01:39:44,311 AND I WILL MENTION A FEW IN 2231 01:39:44,378 --> 01:39:46,647 THIS PRESENTATION. 2232 01:39:46,714 --> 01:39:49,650 I WILL ALSO GO THROUGH THE 2233 01:39:49,717 --> 01:39:52,286 RESEARCH GAPS FOR WOMEN'S 2234 01:39:52,353 --> 01:40:02,029 HEALTH IN SUBIS A 2235 01:40:02,096 --> 01:40:05,399 SUB-SAHARAN AFRICA. 2236 01:40:05,466 --> 01:40:12,239 IN 2022, THERE WERE 20 2237 01:40:12,306 --> 01:40:16,643 MILLION WITH HIV. 2238 01:40:16,710 --> 01:40:20,047 53PERCENT OF THE WORLD'S 2239 01:40:20,114 --> 01:40:25,519 PEOPLE LIVING WITH HIV WERE 2240 01:40:25,586 --> 01:40:27,187 MOSTLY IN AFRICA. 2241 01:40:27,254 --> 01:40:28,555 46PERCENT WERE AMONG GIRLS 2242 01:40:28,622 --> 01:40:29,957 AND WOMEN HOWEVER IF YOU 2243 01:40:30,023 --> 01:40:35,396 LOOK CLOSELY AND LOOK AT 2244 01:40:35,462 --> 01:40:38,165 SUBSAHARAN AFRICA, YOU WOULD 2245 01:40:38,232 --> 01:40:42,369 NOTE 77 PERCENT OF THE NEW 2246 01:40:42,436 --> 01:40:48,375 INFECTIONS ARE AMONG YOUNG 2247 01:40:48,442 --> 01:40:49,676 GIRLS AND AFRICAN MEN. 2248 01:40:49,743 --> 01:40:54,548 SO LOOKING AT THIS A 2249 01:40:54,615 --> 01:40:58,085 DIFFERENT WAY, THERE ARE 2250 01:40:58,152 --> 01:41:01,588 4000 PEOPLE ACQUIRING HIV 2251 01:41:01,655 --> 01:41:03,424 EVERY WEEK AND 57 PERCENT OF 2252 01:41:03,490 --> 01:41:07,094 THEM LIVE IN SUBSAHARA 2253 01:41:07,161 --> 01:41:07,494 AFRICA. 2254 01:41:07,561 --> 01:41:08,962 NEXT SLIDE, PLEASE. 2255 01:41:09,029 --> 01:41:11,899 IF YOU LOOK AT THE 2256 01:41:11,965 --> 01:41:20,007 TREATMENT, 86 PERCENT PEOPLE 2257 01:41:20,073 --> 01:41:21,542 LIVING WITH HIV, 89 PERCENT 2258 01:41:21,608 --> 01:41:23,477 WERE ACCESSING TREATMENT AND 2259 01:41:23,544 --> 01:41:25,312 93 PERCENT WERE VIRALLY 2260 01:41:25,379 --> 01:41:27,014 SUPPRESSED WHICH IS NOT BAD 2261 01:41:27,080 --> 01:41:28,649 BUT STILL BELOW THE GOALS 2262 01:41:28,715 --> 01:41:29,349 FOR 2025. 2263 01:41:29,416 --> 01:41:32,453 WHEN WE LOOK AT PREGNANT 2264 01:41:32,519 --> 01:41:33,487 WOMEN, WE REALIZE 82 PERCENT 2265 01:41:33,554 --> 01:41:39,259 OF THEM ARE LIVING WITH HIV 2266 01:41:39,326 --> 01:41:42,696 HAD ACCESS TO MEDICINES TO 2267 01:41:42,763 --> 01:41:46,800 PREVENT TRANSMISSION OF HIV 2268 01:41:46,867 --> 01:41:48,669 TO THE CHILD. 2269 01:41:48,735 --> 01:41:52,105 THIS IS A HUGE IMPROVEMENT 2270 01:41:52,172 --> 01:41:54,074 ESPECIALLY IN AFRICA BUT 2271 01:41:54,141 --> 01:41:55,209 SHOWS ACCESS, EQUITY AND 2272 01:41:55,275 --> 01:41:57,611 CHOICE IS STILL A DREAM. 2273 01:41:57,678 --> 01:41:59,913 AND ACCESS IS NOT ONLY 2274 01:41:59,980 --> 01:42:02,516 SUFFICIENT, IT IS ALSO ABOUT 2275 01:42:02,583 --> 01:42:05,252 HAVING THE RIGHT DRUGS AND 2276 01:42:05,319 --> 01:42:09,990 SAFE DRUGS TO USE FOR 2277 01:42:10,057 --> 01:42:14,061 VARIOUS COMORBIDITIES PUT WE 2278 01:42:14,127 --> 01:42:18,232 ALL KNOW THAT AFRICA IS 2279 01:42:18,298 --> 01:42:20,767 STILL A BIG EXCEPTION. 2280 01:42:20,834 --> 01:42:27,641 IF YOU COMPARE ON THE RIGHT, 2281 01:42:27,708 --> 01:42:30,277 THE LOW INCOME COUNTRIES 2282 01:42:30,344 --> 01:42:33,480 VERSUS THE HIGH INCOME 2283 01:42:33,547 --> 01:42:39,286 COUNTRIES, ONLY THE LOW 2284 01:42:39,353 --> 01:42:42,756 INCOME COUNTRIES HAD HIGH 2285 01:42:42,823 --> 01:42:45,459 HIV COMPARED TO THE HIGH 2286 01:42:45,526 --> 01:42:55,903 INCOME COUNTRIES. 2287 01:42:59,540 --> 01:43:00,007 NEXT SLIDE PLEASE. 2288 01:43:00,073 --> 01:43:02,543 SO THERE ARE BARRIERS TO 2289 01:43:02,609 --> 01:43:09,516 CARE IN WOMEN WITH HIV 2290 01:43:09,583 --> 01:43:14,655 THROUGHOUT THE WORLD. 2291 01:43:14,721 --> 01:43:16,690 THIS INCLUDES SUBOPTIMAL 2292 01:43:16,757 --> 01:43:18,158 ADHERENCE AND THOSE NOT 2293 01:43:18,225 --> 01:43:18,992 COPING WITH ALL THEY ARE 2294 01:43:19,059 --> 01:43:21,161 SUPPOSED TO BE MANAGING. 2295 01:43:21,228 --> 01:43:26,266 THERE ARE STILL BARRIERS TO 2296 01:43:26,333 --> 01:43:28,435 CARE, STIGMA AND POVERTY FOR 2297 01:43:28,502 --> 01:43:29,736 PEOPLE TO ACCESS CARE. 2298 01:43:29,803 --> 01:43:31,104 YOU FIND THEY DON'T HAVE 2299 01:43:31,171 --> 01:43:35,075 ENOUGH MONEY FOR FOOD OR TO 2300 01:43:35,142 --> 01:43:40,380 GO GET TREATMENT AND 2301 01:43:40,447 --> 01:43:41,481 SOCIOECONOMIC FACTORS A BIG 2302 01:43:41,548 --> 01:43:44,051 PART OF THIS IN LOW INCOME 2303 01:43:44,117 --> 01:43:44,418 COUNTRIES. 2304 01:43:44,484 --> 01:43:47,721 YOU ALSO FIND IN SOME 2305 01:43:47,788 --> 01:43:48,889 COUNTRIES, PEOPLE CANNOT 2306 01:43:48,956 --> 01:43:50,290 ACCESS HELP FREELY, THEY 2307 01:43:50,357 --> 01:43:51,425 HAVE TO PLAY OUT OF POCKET 2308 01:43:51,491 --> 01:43:52,593 AND REMEMBER THESE ARE 2309 01:43:52,659 --> 01:43:58,932 PEOPLE WHO CAN'T AFFORD TO 2310 01:43:58,999 --> 01:44:00,834 PAY FOR THIS. 2311 01:44:00,901 --> 01:44:04,037 AND BECAUSE THEY MONITOR 2312 01:44:04,104 --> 01:44:07,574 PEOPLE WITH HIV, YOU END UP 2313 01:44:07,641 --> 01:44:09,977 PEOPLE NOT ABLE TO BE EVEN 2314 01:44:10,043 --> 01:44:12,145 SCREENED BECAUSE OF THE OUT 2315 01:44:12,212 --> 01:44:14,181 OF POCKET COSTS ASSOCIATED 2316 01:44:14,247 --> 01:44:16,950 WITH THAT. 2317 01:44:17,017 --> 01:44:20,887 NEXT SLIDE, PLEASE. 2318 01:44:20,954 --> 01:44:23,423 SO AS NOTED BY THIS GRAPH ON 2319 01:44:23,490 --> 01:44:28,795 THE LEFT, AFRICA WILL 2320 01:44:28,862 --> 01:44:30,163 EXPERIENCE THE MOST IN THE 2321 01:44:30,230 --> 01:44:37,571 WORLD OVER THE NEXT 50 YEARS 2322 01:44:37,638 --> 01:44:39,106 AND THIS IS EVIDENCE OF NOT 2323 01:44:39,172 --> 01:44:41,341 BEING ABLE TO PROVIDE FOR 2324 01:44:41,408 --> 01:44:43,243 THE POPULATION. 2325 01:44:43,310 --> 01:44:45,178 THE POP LADIES AND 2326 01:44:45,245 --> 01:44:55,389 GENTLEMENNING WITH HIV IS 2327 01:44:55,455 --> 01:44:58,025 NEARING 4000 AND DUE TO THE 2328 01:44:58,091 --> 01:44:59,960 PROBLEMS WITH AGING 2329 01:45:00,027 --> 01:45:07,167 POPULATION, BURDEN OF NCDS, 2330 01:45:07,234 --> 01:45:08,769 INFECTIOUS DISEASE, 2331 01:45:08,835 --> 01:45:11,171 MULTIMORBIDITY, TOXICITY AND 2332 01:45:11,238 --> 01:45:11,938 CONTRACEPTION. 2333 01:45:12,005 --> 01:45:14,174 AS WELL AS THE PANDEMIC. 2334 01:45:14,241 --> 01:45:17,277 WE ALSO HAD WOMEN WITH HIV 2335 01:45:17,344 --> 01:45:23,583 WITH A HIGHER RISK OF 2336 01:45:23,650 --> 01:45:25,719 MULTIMORBIDITY IN SUBSARARAN 2337 01:45:25,786 --> 01:45:28,689 SOUTH AFRICA AND WE ALSO HAD 2338 01:45:28,755 --> 01:45:32,926 A STUDY IN ZIMBABWE WITH 2339 01:45:32,993 --> 01:45:38,265 WOMEN LIVING IN HIV AND 2340 01:45:38,331 --> 01:45:38,899 SUBJECT TO COMORBIDITIES. 2341 01:45:38,965 --> 01:45:49,509 THERE IS ALSO THE INFECTION 2342 01:45:51,845 --> 01:45:53,447 RATE, 63.6 PERCENT 2343 01:45:53,513 --> 01:45:56,183 WORLDWIDE. 2344 01:45:56,249 --> 01:45:58,618 NEXT SLIDE, PLEASE. 2345 01:45:58,685 --> 01:46:00,587 SO THINKING ABOUT THE 2346 01:46:00,654 --> 01:46:05,292 QUESTIONS FOR WOMEN'S HEALTH 2347 01:46:05,358 --> 01:46:08,528 IN SUBSARARA AFRICA PRO 2348 01:46:08,595 --> 01:46:08,962 DOMINANTLY. 2349 01:46:09,029 --> 01:46:11,298 SO WITH THE DISEASE, THE 2350 01:46:11,364 --> 01:46:16,336 ASIAN POPULATION IN AFRICA, 2351 01:46:16,403 --> 01:46:19,206 IT IS IMPORTANT WE FOCUS ON 2352 01:46:19,272 --> 01:46:22,442 THE MIDDLE TO LOW INCOME 2353 01:46:22,509 --> 01:46:25,178 COUNTRIES TO UNDERSTAND THE 2354 01:46:25,245 --> 01:46:26,680 DIFFERENCE OF HIV FOR THOSE 2355 01:46:26,747 --> 01:46:26,980 WOMEN. 2356 01:46:27,047 --> 01:46:30,650 WE NEED TO LOOK AT OPTIMAL 2357 01:46:30,717 --> 01:46:32,686 RATES FOR HUMANS AND WHAT 2358 01:46:32,753 --> 01:46:37,057 ARE THE BEST PROVIDERS FOR 2359 01:46:37,124 --> 01:46:38,592 THIS POPULATION. 2360 01:46:38,658 --> 01:46:40,527 WHAT DRUG THERAPIES WOULD BE 2361 01:46:40,594 --> 01:46:42,229 THE MOST CONCERNED ABOUT, 2362 01:46:42,295 --> 01:46:50,837 WHERE WE SHOULD STOP 2363 01:46:50,904 --> 01:46:53,573 THINKING ABOUT IMPORTANCE OF 2364 01:46:53,640 --> 01:46:55,509 INCLUSIVITY, AGING AND 2365 01:46:55,575 --> 01:47:00,714 FRAILTY AND IMPACT ON WL 2366 01:47:00,781 --> 01:47:00,981 HIV. 2367 01:47:01,047 --> 01:47:04,351 AND ALSO MENOPAUSE AND HRT, 2368 01:47:04,417 --> 01:47:09,689 WHAT WE KNOW IS BLACK WOMEN 2369 01:47:09,756 --> 01:47:17,697 ARE KNOWN TO EXPERIENCE 2370 01:47:17,764 --> 01:47:19,933 MULTIMORBIDITIES WITH HIV. 2371 01:47:20,000 --> 01:47:24,337 INCREASED DEPRESSION AND 2372 01:47:24,404 --> 01:47:28,275 ANXIETY ALSO IMPACT THIS AND 2373 01:47:28,341 --> 01:47:29,876 WHAT SYSTEMS DO WE HAVE TO 2374 01:47:29,943 --> 01:47:33,780 PUT IN PLACE TO SUPPORT 2375 01:47:33,847 --> 01:47:35,215 WOMEN AT CLINICS? 2376 01:47:35,282 --> 01:47:42,656 HOW IS IT INTEGRATED, IS IT 2377 01:47:42,722 --> 01:47:43,023 FEASIBLE? 2378 01:47:43,089 --> 01:47:45,091 WE NEED TO UNDERSTAND 2379 01:47:45,158 --> 01:47:47,060 MENOPAUSE IN WOMEN WITH HIV. 2380 01:47:47,127 --> 01:47:49,196 WE NEED TO UNDERSTAND THE 2381 01:47:49,262 --> 01:47:52,799 ROLES OF HORMONE REPLACEMENT 2382 01:47:52,866 --> 01:47:56,937 THERAPY IN PREVENTING WEIGHT 2383 01:47:57,003 --> 01:47:58,738 GAIN AND VULNERABILITY IN 2384 01:47:58,805 --> 01:48:01,575 WOMEN WITH THE DISEASE. 2385 01:48:01,641 --> 01:48:05,712 WE HAVE A WORRYING TREND OF 2386 01:48:05,779 --> 01:48:12,719 STIS WHERE WOMEN ARE 2387 01:48:12,786 --> 01:48:17,357 DISPROPORTIONATELY AFFECTED 2388 01:48:17,424 --> 01:48:18,024 MORE THAN MEN. 2389 01:48:18,091 --> 01:48:20,560 AND WE NEED TO KNOW OPTIMAL 2390 01:48:20,627 --> 01:48:23,830 TREATMENT STRATEGIES FOR 2391 01:48:23,897 --> 01:48:26,166 VULNERABLE WOMEN. 2392 01:48:26,233 --> 01:48:27,400 PREGNANT AND POSTPARTUM. 2393 01:48:27,467 --> 01:48:33,506 SO WE NEED TO FIND A WAY OF 2394 01:48:33,573 --> 01:48:36,643 MAKING SURE WOMEN GET 2395 01:48:36,710 --> 01:48:38,678 TREATMENT BECAUSE LONG 2396 01:48:38,745 --> 01:48:43,850 TREATMENT WILL IDENTIFY THE 2397 01:48:43,917 --> 01:48:45,819 VULNERABLE POPULATION. 2398 01:48:45,886 --> 01:48:47,888 WE KNOW THAT THERE IS A 2399 01:48:47,954 --> 01:48:52,692 STUDY IN AFRICA THAT WENT 2400 01:48:52,759 --> 01:48:55,495 PRETTY WELL DESPITE THE 2401 01:48:55,562 --> 01:49:00,667 RARITY BUT WHERE YOU GO TO 2402 01:49:00,734 --> 01:49:05,739 GET THE TREATMENT IT IS 2403 01:49:05,805 --> 01:49:10,510 STILL BASED ON POPULARITY. 2404 01:49:10,577 --> 01:49:15,682 NEXT SLIDE, PLEASE. 2405 01:49:15,749 --> 01:49:23,189 SO YOU WILL HAVE EPIDEMIC 2406 01:49:23,256 --> 01:49:28,495 IS NOT OVER PARTICULARLY FOR 2407 01:49:28,561 --> 01:49:31,765 WOMEN IN LOW TO MIDDLE 2408 01:49:31,831 --> 01:49:33,400 INCOME COUNTRIES AND WE NEED 2409 01:49:33,466 --> 01:49:36,469 MORE WOMEN IN CLINICAL 2410 01:49:36,536 --> 01:49:38,204 TRIALS AS MOST PARTICIPANTS 2411 01:49:38,271 --> 01:49:39,005 ARE MALE. 2412 01:49:39,072 --> 01:49:41,308 WE NEED MORE RESEARCH NEEDED 2413 01:49:41,374 --> 01:49:44,511 FOR PREVENTION, SCREENING 2414 01:49:44,577 --> 01:49:54,955 AND MANAGEMENT OF 2415 01:49:55,956 --> 01:49:56,523 MULTIMORBIDITY. 2416 01:49:56,589 --> 01:49:57,991 WE NEED IMPLEMENTATION OF 2417 01:49:58,058 --> 01:50:00,260 RESEARCH FINDINGS TO BE 2418 01:50:00,327 --> 01:50:03,663 QUICK AND INCREASE ACCESS TO 2419 01:50:03,730 --> 01:50:04,364 LIFE-SAVING INTERVENTIONS 2420 01:50:04,431 --> 01:50:07,500 WHICH IS CRITICAL TO AVOID 2421 01:50:07,567 --> 01:50:08,735 GROWING DISPARITIES. 2422 01:50:08,802 --> 01:50:10,670 WE NEED HEALTH EQUITY TO BE 2423 01:50:10,737 --> 01:50:16,309 ONE OF THE MOST URGENT 2424 01:50:16,376 --> 01:50:16,710 PRIORITIES. 2425 01:50:16,776 --> 01:50:19,946 IT NEEDS TO BE PRAGMATIC 2426 01:50:20,013 --> 01:50:22,649 COST EFFECTIVE SOLUTION FOR 2427 01:50:22,716 --> 01:50:28,521 LOW AND MIDDLE INCOME 2428 01:50:28,588 --> 01:50:31,124 COUNTRIES AND WE NEED TO 2429 01:50:31,191 --> 01:50:37,430 LISTEN TO WOMEN WHO HAVE 2430 01:50:37,497 --> 01:50:38,264 POORER TOLLABILITY. 2431 01:50:38,331 --> 01:50:41,201 SO AS A CONCLUSION, WOULD 2432 01:50:41,267 --> 01:50:46,573 NEED TO FOCUS ON 2433 01:50:46,639 --> 01:50:47,007 COMORBIDITIES. 2434 01:50:47,073 --> 01:50:49,442 WE CANNOT END HIV UNLESS WE 2435 01:50:49,509 --> 01:50:51,344 LOOK AFTER OUR WOMEN. 2436 01:50:51,411 --> 01:50:53,446 THE FACT WE HAVE STILL 2437 01:50:53,513 --> 01:50:55,048 BABIES BORN WITH HIV MEANS 2438 01:50:55,115 --> 01:50:57,417 THE END IS NOT NEAR. 2439 01:50:57,484 --> 01:50:58,018 NEXT SLIDE. 2440 01:50:58,084 --> 01:51:05,492 SO I WOULD JUST LIKE TO 2441 01:51:05,558 --> 01:51:07,527 THANK MY COLLEAGUES FOR THE 2442 01:51:07,594 --> 01:51:11,498 MATERIAL I AM PRESENTING AND 2443 01:51:11,564 --> 01:51:14,334 ALSO THE PRESENTERS IN THE 2444 01:51:14,401 --> 01:51:15,969 AFRICAN HIV WOMEN WORKSHOP. 2445 01:51:16,036 --> 01:51:21,508 THIS WAS REALLY EYE OPENING. 2446 01:51:21,574 --> 01:51:23,676 THEY REALLY DISCUSSED KEY 2447 01:51:23,743 --> 01:51:25,278 CHALLENGES AND IDEAS ABOUT 2448 01:51:25,345 --> 01:51:31,017 HOW THE EPIDEMIC IN 2449 01:51:31,084 --> 01:51:32,285 SUBSARARA SOUTH AFRICA AND 2450 01:51:32,352 --> 01:51:36,022 HOW WE CAN MOVE FORWARD TO 2451 01:51:36,089 --> 01:51:36,890 BENEFIT WOMEN. 2452 01:51:36,956 --> 01:51:38,491 THANK YOU SO MUCH. 2453 01:51:38,558 --> 01:51:40,560 >> THANK YOU DOCTOR FOR THAT 2454 01:51:40,627 --> 01:51:41,361 PRESENTATION. 2455 01:51:41,428 --> 01:51:43,096 AS A REMINDER TO THE 2456 01:51:43,163 --> 01:51:44,697 AUDIENCE, PLEASE PUT YOUR 2457 01:51:44,764 --> 01:51:46,966 QUESTIONS OR COMMENTS VIA 2458 01:51:47,033 --> 01:51:47,801 THE LIVE FEEDBACK OPTIONS AT 2459 01:51:47,867 --> 01:51:52,105 THE BOTTOM OF THE VIDEOCAST. 2460 01:51:52,172 --> 01:51:55,108 OUR NEXT PRESENTATION IS 2461 01:51:55,175 --> 01:51:59,045 FROM Dr. IGHO OFOTOKUN. 2462 01:51:59,112 --> 01:51:59,846 PLEASE GO AHEAD. 2463 01:51:59,913 --> 01:52:04,117 >> YES, THANK YOU SO MUCH 2464 01:52:04,184 --> 01:52:06,352 AND THANKS TO THE ORGANIZERS 2465 01:52:06,419 --> 01:52:07,921 FOR INVITING ME TO SHARE 2466 01:52:07,987 --> 01:52:10,757 SOME OF MY THOUGHTS ON THIS 2467 01:52:10,824 --> 01:52:16,663 VERY IMPORTANT TOPIC. 2468 01:52:16,729 --> 01:52:18,064 NEXT SLIDE SO REALLY THE 2469 01:52:18,131 --> 01:52:23,703 SUMMARY OF MY WORK IS TO 2470 01:52:23,770 --> 01:52:25,505 HIGHLIGHT LONG-TERM EFFECTS 2471 01:52:25,572 --> 01:52:26,239 OF HIV THERAPY. 2472 01:52:26,306 --> 01:52:28,875 WE ARE SEEING SOME OF THE 2473 01:52:28,942 --> 01:52:30,009 EFFECTS OF THOSE LIVING WITH 2474 01:52:30,076 --> 01:52:31,511 THE VIRUS FOR A VERY LONG 2475 01:52:31,578 --> 01:52:33,580 TIME AND HAVING TO TAKE 2476 01:52:33,646 --> 01:52:34,948 MEDICATION FOR THE ENTIRE 2477 01:52:35,014 --> 01:52:37,650 DURATION OF THEIR LIFE. 2478 01:52:37,717 --> 01:52:39,385 WHAT WE NOW KNOW IS THAT 2479 01:52:39,452 --> 01:52:49,896 PEOPLE WHO ARE TESTING WITH 2480 01:52:49,963 --> 01:52:52,532 HIV, LIVING ABOUT 16 FEWER 2481 01:52:52,599 --> 01:52:58,638 HEALTHY YEARS THAN PERSONS 2482 01:52:58,705 --> 01:53:02,942 WITHOUT HIV DUE TO NONAIDS 2483 01:53:03,009 --> 01:53:05,111 HEALTH RELATED ISSUES. 2484 01:53:05,178 --> 01:53:07,614 WOMEN ARE DISPROPORTIONATELY 2485 01:53:07,680 --> 01:53:08,548 AFFECTED BY THESE RELATED 2486 01:53:08,615 --> 01:53:12,218 HEALTH ISSUES AND WE NEED TO 2487 01:53:12,285 --> 01:53:12,619 UNDERSTAND. 2488 01:53:12,685 --> 01:53:14,921 NEXT SLIDE. 2489 01:53:14,988 --> 01:53:19,993 ONE THING THAT THE STUDIES 2490 01:53:20,059 --> 01:53:22,128 TELL US IS THAT THE VIRUS 2491 01:53:22,195 --> 01:53:24,664 AND TREATMENT HAVE LONG-TERM 2492 01:53:24,731 --> 01:53:25,365 EFFECTS. 2493 01:53:25,431 --> 01:53:28,434 THEY CONTRIBUTE TO NONAIDS 2494 01:53:28,501 --> 01:53:29,669 AGING RELATED COMORBIDITIES 2495 01:53:29,736 --> 01:53:30,703 AND ALMOST EVERY ORGAN 2496 01:53:30,770 --> 01:53:34,874 SYSTEM IN THE BODY IS 2497 01:53:34,941 --> 01:53:35,241 AFFECTED. 2498 01:53:35,308 --> 01:53:37,810 NO SYSTEM IN THE BODY IS NOT 2499 01:53:37,877 --> 01:53:41,181 AFFECTED, WHETHER IT BE THE 2500 01:53:41,247 --> 01:53:43,483 BRAIN, KIDNEY, HEART, BONE, 2501 01:53:43,550 --> 01:53:45,919 GI TRACTS. 2502 01:53:45,985 --> 01:53:48,188 SO EVERY ORGAN IS THREATENED 2503 01:53:48,254 --> 01:53:49,722 WITH THIS IMPACT OF LIVING 2504 01:53:49,789 --> 01:53:52,458 LONG WITH TREATMENT AS WELL 2505 01:53:52,525 --> 01:53:54,494 AS WITH THIS VIRUS THAT IS 2506 01:53:54,561 --> 01:53:54,827 LIVE. 2507 01:53:54,894 --> 01:53:58,131 SO THIS IS MY TEAM. 2508 01:53:58,198 --> 01:53:59,832 WE WERE REALLY INTERESTED IN 2509 01:53:59,899 --> 01:54:00,533 EXPLORING THESE QUESTIONS 2510 01:54:00,600 --> 01:54:02,936 FOR THEM AND TO LOOK AT WHAT 2511 01:54:03,002 --> 01:54:04,137 THE CONTRIBUTION OF THE 2512 01:54:04,204 --> 01:54:06,072 VIRUS IS, WHAT THE 2513 01:54:06,139 --> 01:54:07,207 CONTRIBUTION OF THE 2514 01:54:07,273 --> 01:54:08,808 TREATMENT IS. 2515 01:54:08,875 --> 01:54:09,876 WE STARRED OUR WALK FIRST 2516 01:54:09,943 --> 01:54:16,416 HERE IN THE U.S., IN ATLANTA 2517 01:54:16,482 --> 01:54:19,285 AND CONDUCTED IT FOR 100 2518 01:54:19,352 --> 01:54:19,752 DAYS. 2519 01:54:19,819 --> 01:54:21,921 THEN WE EXTENDED IT TO 2520 01:54:21,988 --> 01:54:26,826 AFRICA WHERE THE BULK OF THE 2521 01:54:26,893 --> 01:54:28,861 EPIDEMIC CURRENTLY RESIDES. 2522 01:54:28,928 --> 01:54:35,635 AND I WORKED WITH A LARGE 2523 01:54:35,702 --> 01:54:38,438 TEAM OF SCIENTISTS SO WE 2524 01:54:38,504 --> 01:54:43,409 REALLY WERE INTERESTED IN 2525 01:54:43,476 --> 01:54:46,913 WHAT -- HOW DID THIS 2526 01:54:46,980 --> 01:54:48,348 TREATMENT AND VIRUS AFFECT 2527 01:54:48,414 --> 01:54:50,149 THE BONE AND EXPANDED TO THE 2528 01:54:50,216 --> 01:54:52,518 BRAIN AS WELL AS THE HEART. 2529 01:54:52,585 --> 01:54:55,922 NEXT SLIDE. 2530 01:54:55,989 --> 01:55:00,226 SO ONE OF THE ONES OF THE 2531 01:55:00,293 --> 01:55:02,729 THINGS WE WERE ABLE TO 2532 01:55:02,795 --> 01:55:06,132 PURSUE, USING ONE OF THE 2533 01:55:06,199 --> 01:55:07,934 LARGEST LONGITUDINAL STUDIES 2534 01:55:08,001 --> 01:55:11,771 DONE IN THE U.S. AND DONE BY 2535 01:55:11,838 --> 01:55:13,273 MY COLLEAGUE WAS TO 2536 01:55:13,339 --> 01:55:14,841 HIGHLIGHT WHAT WE ALREADY 2537 01:55:14,907 --> 01:55:17,577 KNOW. 2538 01:55:17,644 --> 01:55:20,046 IT AFFECTS THE COMORBIDITIES 2539 01:55:20,113 --> 01:55:23,149 AND THAT THE BURDEN IS 2540 01:55:23,216 --> 01:55:26,753 HIGHER IN WOMEN BUT SOME OF 2541 01:55:26,819 --> 01:55:29,756 THE ANALYSIS DONNELL WAS 2542 01:55:29,822 --> 01:55:31,090 THIS EFFECT IS OCCURRING AT 2543 01:55:31,157 --> 01:55:33,159 A MUCH YOUNGER AGE. 2544 01:55:33,226 --> 01:55:36,996 SO YOU WOULD SEE TREATMENT 2545 01:55:37,063 --> 01:55:41,067 DEFERRED WOULD CAUSE THINGS 2546 01:55:41,134 --> 01:55:47,106 LIKE HYPERTENSION, PSYCH 2547 01:55:47,173 --> 01:55:49,842 ILLNESS, DYSLIPIDEMIA, LIVER 2548 01:55:49,909 --> 01:55:53,112 DISEASE, BONE DISEASE, LUNG 2549 01:55:53,179 --> 01:55:54,280 DISEASE, DIABETES, VVD AND 2550 01:55:54,347 --> 01:55:56,316 KIDNEY DISEASE AS WELL AS 2551 01:55:56,382 --> 01:55:56,649 CANCER. 2552 01:55:56,716 --> 01:55:58,651 AND EARLY IN LIFE WE ARE 2553 01:55:58,718 --> 01:56:00,019 SEEING THIS EFFECT MORE IN 2554 01:56:00,086 --> 01:56:01,688 WOMEN COMPARED TO THE 2555 01:56:01,754 --> 01:56:03,923 GENERAL POPULATION AND EVEN 2556 01:56:03,990 --> 01:56:06,793 WHEN YOU LOOK AT WOMEN 2557 01:56:06,859 --> 01:56:08,561 COMPARED TO MEN LIVING WITH 2558 01:56:08,628 --> 01:56:17,303 HIV, YOU SEE A MARKED 2559 01:56:17,370 --> 01:56:20,373 DIFFERENCE, WHICH HAS 2560 01:56:20,440 --> 01:56:22,175 PREVALENCE ON WOMEN VERSUS 2561 01:56:22,241 --> 01:56:22,442 MEN. 2562 01:56:22,508 --> 01:56:23,309 NEXT SLIDE. 2563 01:56:23,376 --> 01:56:25,978 SO ONE OF THE THINGS WE WANT 2564 01:56:26,045 --> 01:56:36,556 TO TACKLE IN OUR BON STUDY 2565 01:56:38,558 --> 01:56:41,761 HERE WAS DECIPHERING HOW 2566 01:56:41,828 --> 01:56:49,936 HIV-1 WEAKENS AND CRACKS THE 2567 01:56:50,002 --> 01:56:55,575 BONES. 2568 01:56:55,641 --> 01:56:58,344 THIS VIRUS, THE IMPACT OF 2569 01:56:58,411 --> 01:57:04,083 HIV ON T CELLS ALL TRYING TO 2570 01:57:04,150 --> 01:57:06,285 BALANCE AND THAT IS SUCH A 2571 01:57:06,352 --> 01:57:09,789 WAY YOU HAVE INCREASED 2572 01:57:09,856 --> 01:57:14,060 AMOUNT RIGHT IN YOUR BODY, 2573 01:57:14,127 --> 01:57:16,696 THE PART OF BODY THAT IS 2574 01:57:16,763 --> 01:57:17,964 INVOLVED WITH BREAKING TOWN 2575 01:57:18,030 --> 01:57:22,602 BON AND -- DOWN BONE AND 2576 01:57:22,668 --> 01:57:27,807 ALL OF THIS HAS AN IMPACT ON 2577 01:57:27,874 --> 01:57:28,341 HIV. 2578 01:57:28,408 --> 01:57:30,410 SO THEN THROUGH THIS 2579 01:57:30,476 --> 01:57:31,577 PROCESS, THEY GET BETTER 2580 01:57:31,644 --> 01:57:35,515 WHICH IS TRUE BUT THESE T 2581 01:57:35,581 --> 01:57:38,584 CELLS THAT RECREATED OR 2582 01:57:38,651 --> 01:57:40,620 RECONSTITUTED, MANY OF THESE 2583 01:57:40,686 --> 01:57:48,961 ESPECIALLY IN AN ADULT ARE 2584 01:57:49,028 --> 01:57:52,365 THE RANKL AND TNFA. 2585 01:57:52,432 --> 01:57:54,700 SO YOU SEE THE INCREASE OF 2586 01:57:54,767 --> 01:57:57,870 TREATMENT AND IMPACT OF HIV 2587 01:57:57,937 --> 01:58:00,973 WORKING TOGETHER TO REALLY 2588 01:58:01,040 --> 01:58:03,476 CREATE THESE CONDITIONS TO 2589 01:58:03,543 --> 01:58:08,047 WEAKEN THE BONES OF PEOPLE 2590 01:58:08,114 --> 01:58:11,451 WORKING FOR HIV. 2591 01:58:11,517 --> 01:58:12,985 SO NEXT SLIDE. 2592 01:58:13,052 --> 01:58:16,456 WE LOOK AT TWO KEY PROTEINS, 2593 01:58:16,522 --> 01:58:19,659 THE RANKL AND OPG THAT 2594 01:58:19,725 --> 01:58:23,729 REGULATE BONE HEALTH IN THE 2595 01:58:23,796 --> 01:58:24,030 BODY. 2596 01:58:24,096 --> 01:58:27,767 SO IF YOU HAVE A SYSTEM 2597 01:58:27,834 --> 01:58:30,036 WITHOUT A TREATMENT OR VIRUS 2598 01:58:30,102 --> 01:58:32,238 WITH ACCESS IN THE BODY, YOU 2599 01:58:32,305 --> 01:58:34,774 CAN EXTRAPOLATE THAT IT WILL 2600 01:58:34,841 --> 01:58:36,142 AFFECT DIFFERENT SYSTEMS 2601 01:58:36,209 --> 01:58:37,043 WITHIN THE BODY. 2602 01:58:37,109 --> 01:58:43,249 NEXT SLIDE. 2603 01:58:43,316 --> 01:58:45,418 SO VERY QUICKLY FROM THE 2604 01:58:45,485 --> 01:58:48,921 DATA, WHEN YOU LOOK AT THE 2605 01:58:48,988 --> 01:58:50,556 VOLUME, JUST SIMPLE WOMEN 2606 01:58:50,623 --> 01:58:52,658 WHO DO NOT HAVE SYMPTOMS, 2607 01:58:52,725 --> 01:58:56,462 THEY JUST SHOW UP FOR 2608 01:58:56,529 --> 01:59:04,337 STUDIES AND WE DO THIS TEST 2609 01:59:04,403 --> 01:59:13,779 TO MEASURE CALCIUM AND LOOK 2610 01:59:13,846 --> 01:59:16,182 AT A NUMBER OF THINGS FOR 2611 01:59:16,249 --> 01:59:19,218 HEALTH BUT WHAT WAS MOST 2612 01:59:19,285 --> 01:59:22,755 IMPRESSIVE IS THE CORONARY 2613 01:59:22,822 --> 01:59:23,089 PLAQUE. 2614 01:59:23,155 --> 01:59:24,924 IT WAS 43 PERCENT AS 2615 01:59:24,991 --> 01:59:26,526 COMPARED TO 20 PERCENT OF 2616 01:59:26,592 --> 01:59:35,067 THE CONTROLS IN BLACK WOMEN 2617 01:59:35,134 --> 01:59:36,869 OF COMPARABLE AGE. 2618 01:59:36,936 --> 01:59:38,604 AND IMPORTANTLY THE ANALYSIS 2619 01:59:38,671 --> 01:59:42,241 OF REPEAT C CTA TWO YEARS 2620 01:59:42,308 --> 01:59:45,111 APART SHOWS RAPID PLAQUE 2621 01:59:45,177 --> 01:59:45,778 PROGRESSION. 2622 01:59:45,845 --> 01:59:50,983 SO WHY ARE WOMEN 2623 01:59:51,050 --> 01:59:54,287 PROPORTIONATELY AFFECTED? 2624 01:59:54,353 --> 01:59:56,789 SO I SHOW YOU THE 2625 01:59:56,856 --> 01:59:59,058 PRELIMINARY DATA FROM ANIMAL 2626 01:59:59,125 --> 02:00:02,995 MODERATE TELLS THAT SUGGEST 2627 02:00:03,062 --> 02:00:04,096 IMMUNE-RECONSTITUTION AND 2628 02:00:04,163 --> 02:00:06,832 ESTROGEN DEFICIENCY ACT IN 2629 02:00:06,899 --> 02:00:17,376 SYNERGY TO ENHANCE BONE 2630 02:00:20,012 --> 02:00:20,179 LOSS. 2631 02:00:20,246 --> 02:00:27,186 AND THESE TWO EFFECTS, THE 2632 02:00:27,253 --> 02:00:35,061 IMPACT OF HIV TO EXAGGERATE 2633 02:00:35,127 --> 02:00:36,295 THE DEFECT OF BONE LOSS IN 2634 02:00:36,362 --> 02:00:37,363 THE BODY. 2635 02:00:37,430 --> 02:00:39,432 SO WE SEE THAT THIS IS A 2636 02:00:39,498 --> 02:00:40,800 PROBLEM AND THOUGHT WHAT CAN 2637 02:00:40,866 --> 02:00:43,636 WE DO TO ADDRESS THIS ISSUE. 2638 02:00:43,703 --> 02:00:45,805 SO THIS IS JUST A SMALL 2639 02:00:45,871 --> 02:00:47,673 PROOF OF CONCEPT STUDY THAT 2640 02:00:47,740 --> 02:00:50,409 WE DID USING BOTH OUR ANIMAL 2641 02:00:50,476 --> 02:00:53,379 STUDY AND SMALL PHASE 2 2642 02:00:53,446 --> 02:00:54,947 CLINICAL STUDY TO SEE 2643 02:00:55,014 --> 02:00:57,483 WHETHER WE CAN BLOCK THE 2644 02:00:57,550 --> 02:01:02,121 IMPACT OF THE ANTIVIRAL. 2645 02:01:02,188 --> 02:01:10,162 AND HERE WE SAW THAT WITH 2646 02:01:10,229 --> 02:01:11,197 ZOLEDRONIC ACID INFUSION 2647 02:01:11,263 --> 02:01:14,200 THAT IS USED TO TREAT 2648 02:01:14,266 --> 02:01:15,768 OSTEOPOROSIS, IF YOU GIVE IT 2649 02:01:15,835 --> 02:01:22,341 AT THE TIME OF THE ANTIRETRO 2650 02:01:22,408 --> 02:01:23,709 VIRAL INJECTION, IT 2651 02:01:23,776 --> 02:01:24,977 PROTECTED THE BONE FOR OVER 2652 02:01:25,044 --> 02:01:27,013 A PERIOD OF TEN YEARS AND 2653 02:01:27,079 --> 02:01:29,415 THAT IS AS FAR AS WE COULD 2654 02:01:29,482 --> 02:01:29,749 LOOK. 2655 02:01:29,815 --> 02:01:34,720 I AM SURE I HAVE FOLLOWED 2656 02:01:34,787 --> 02:01:36,889 THESE PEOPLE IN PHASE 2 2657 02:01:36,956 --> 02:01:40,593 TRIAL AND WE SAW THIS IN 2658 02:01:40,660 --> 02:01:42,228 ANIMAL MODEL STUDIES AS 2659 02:01:42,294 --> 02:01:42,695 WELL. 2660 02:01:42,762 --> 02:01:48,300 IN SOME OF THESE CONDITIONS, 2661 02:01:48,367 --> 02:01:51,771 WE SEE THERE ARE THINGS WE 2662 02:01:51,837 --> 02:01:54,106 CAN DO TO PREVENT BONE LOSS. 2663 02:01:54,173 --> 02:01:54,840 SO LAST SLIDE. 2664 02:01:54,907 --> 02:02:05,317 THIS IS MY LAST SLIDE TO SAY 2665 02:02:05,384 --> 02:02:08,054 THAT ANTIRETRO VIRAL THERAPY 2666 02:02:08,120 --> 02:02:14,126 INDUCE BONE LOSS, MOSTLY IN 2667 02:02:14,193 --> 02:02:18,631 WOMEN AND HIV VIRUS AND 2668 02:02:18,698 --> 02:02:20,900 TREATMENT HAVE LONG-TERM 2669 02:02:20,966 --> 02:02:23,636 EFFECTS ON MORE WOMEN THAN 2670 02:02:23,703 --> 02:02:24,670 MEN, THE UNDERLYING 2671 02:02:24,737 --> 02:02:27,173 MECHANISM IN CASE OF BONE IS 2672 02:02:27,239 --> 02:02:28,274 RELATED TO ASSAULT ON 2673 02:02:28,340 --> 02:02:29,942 DIFFERENT COMPONENTS OF THE 2674 02:02:30,009 --> 02:02:33,145 IMMUNE SYSTEM AND SYNERGY 2675 02:02:33,212 --> 02:02:36,582 BETWEEN ESTROGEN DEFICIENCY 2676 02:02:36,649 --> 02:02:38,517 AND HIV TREATMENT EFFECTS 2677 02:02:38,584 --> 02:02:41,287 MAY COACT TO CAUSE INCREASED 2678 02:02:41,353 --> 02:02:42,655 BURDEN AMONG WOMEN AND THIS 2679 02:02:42,722 --> 02:02:43,723 TYPES OF INFORMATION ARE 2680 02:02:43,789 --> 02:02:54,300 NEEDED TO HELP US FASHION 2681 02:02:55,067 --> 02:02:57,703 PREVENTIVE MEASURES FOR 2682 02:02:57,770 --> 02:02:58,404 WOMEN. 2683 02:02:58,471 --> 02:03:01,373 AND LAST SLIDE, I 2684 02:03:01,440 --> 02:03:05,544 ACKNOWLEDGE ALL OF THOSE WHO 2685 02:03:05,611 --> 02:03:07,747 CONTRIBUTE FUNDING AND THOSE 2686 02:03:07,813 --> 02:03:08,981 INVOLVED IN RESEARCH. 2687 02:03:09,048 --> 02:03:10,149 >> AS A REMINDER, PLEASE 2688 02:03:10,216 --> 02:03:12,318 POST YOUR QUESTIONS OR 2689 02:03:12,384 --> 02:03:13,552 COMMENTS ON THE FEEDBACK 2690 02:03:13,619 --> 02:03:18,190 BUTTON OF THE LIVE 2691 02:03:18,257 --> 02:03:18,824 VIDEOCAST. 2692 02:03:18,891 --> 02:03:22,828 WE NOW WILL GO TO Dr. 2693 02:03:22,895 --> 02:03:24,196 STEVEN DEEKS, THE MICROPHONE 2694 02:03:24,263 --> 02:03:24,930 IS YOURS. 2695 02:03:24,997 --> 02:03:28,734 >> THANK YOU, CAN I GET THE 2696 02:03:28,801 --> 02:03:29,301 NEXT SLIDE, PLEASE? 2697 02:03:29,368 --> 02:03:31,237 SO I AM ACTUALLY A BIT 2698 02:03:31,303 --> 02:03:33,839 INVOLVED IN THE HIV CURE 2699 02:03:33,906 --> 02:03:36,909 EFFORTS, PART OF THE 2700 02:03:36,976 --> 02:03:37,810 TREATMENT PARADIGM, FOR 10 2701 02:03:37,877 --> 02:03:40,346 OR 15 YEARS NOW AND IT IS 2702 02:03:40,412 --> 02:03:41,013 LIKE STRIKING PARTICULARLY 2703 02:03:41,080 --> 02:03:50,589 IN THE LAST TWO YEARS HOW 2704 02:03:50,656 --> 02:03:53,626 THE COMMUNITY IS BEGINNING 2705 02:03:53,692 --> 02:03:58,597 TO REALIZE THE IMPACT OF 2706 02:03:58,664 --> 02:04:02,701 BIOLOGIC SECTION ON 2707 02:04:02,768 --> 02:04:03,836 THERAPEUTIC VACCINATION ARE 2708 02:04:03,903 --> 02:04:04,170 LIMITED. 2709 02:04:04,236 --> 02:04:05,905 FEMALES MOUNT A STRONGER 2710 02:04:05,971 --> 02:04:11,377 IMMUNE RESPONSE TO 2711 02:04:11,443 --> 02:04:12,244 INFECTIONS INCLUDING HIV. 2712 02:04:12,311 --> 02:04:16,382 WE KNOW FROM OBSERVATIONAL 2713 02:04:16,448 --> 02:04:19,685 STUDIES AND ALSO FROM PEOPLE 2714 02:04:19,752 --> 02:04:20,686 OTHER THAN ANIMAL MODELS 2715 02:04:20,753 --> 02:04:22,054 THIS TO BE TRUE. 2716 02:04:22,121 --> 02:04:23,889 THEY ALSO MOUNT A STRONGER 2717 02:04:23,956 --> 02:04:25,457 IMMUNE RESPONSE TO VACCINES. 2718 02:04:25,524 --> 02:04:27,259 ON THE FLIP SIDE, AND THIS 2719 02:04:27,326 --> 02:04:29,895 IS GOING TO BE THE THEME 2720 02:04:29,962 --> 02:04:32,264 THROUGHOUT, THE CONSEQUENCE 2721 02:04:32,331 --> 02:04:33,566 OF THESE STRONGER IMMUNE 2722 02:04:33,632 --> 02:04:36,635 RESPONSES, WOMEN HAVE HIGHER 2723 02:04:36,702 --> 02:04:38,237 RISK OF INFLAMMATORY 2724 02:04:38,304 --> 02:04:39,638 DISORDERS, MORE ADVERSE 2725 02:04:39,705 --> 02:04:41,140 EVENTS TO VACCINES AND SO 2726 02:04:41,207 --> 02:04:41,507 FORTH. 2727 02:04:41,574 --> 02:04:42,908 SO I WILL GO THROUGH THAT 2728 02:04:42,975 --> 02:04:44,577 REAL QUICK. 2729 02:04:44,643 --> 02:04:46,212 DON'T HAVE TIME TO TALK 2730 02:04:46,278 --> 02:04:47,613 ABOUT IT BUT MAYBE IN THE 2731 02:04:47,680 --> 02:04:49,048 NEXT SESSION WE WILL HEAR 2732 02:04:49,114 --> 02:04:50,449 ABOUT THIS. 2733 02:04:50,516 --> 02:05:00,459 BUT THIS IS QUITE TRAUMATIC 2734 02:05:00,526 --> 02:05:06,498 FACTS EMERGING THAT THE HIV 2735 02:05:06,565 --> 02:05:08,634 LANDSCAPE DURING LONG-TERM 2736 02:05:08,701 --> 02:05:10,502 ANTIRETRO VIRAL THERAPY 2737 02:05:10,569 --> 02:05:11,937 DIFFERENCE BASED ON WHETHER 2738 02:05:12,004 --> 02:05:15,708 THEY ARE MEN OR WOMEN. 2739 02:05:15,774 --> 02:05:18,811 SO NEXT SLIDE. 2740 02:05:18,878 --> 02:05:29,355 SO WE KNOW THAT MORE HIV 2741 02:05:31,290 --> 02:05:33,225 CURE STUDIES OCCUR FOR MEN 2742 02:05:33,292 --> 02:05:34,994 VERSUS WOMEN AND IN ABSENCE 2743 02:05:35,060 --> 02:05:36,395 OF EVIDENCE, SHOULD WE BE 2744 02:05:36,462 --> 02:05:39,698 CONCERNED THAT THE EMERGING 2745 02:05:39,765 --> 02:05:40,866 CURE DEPEND AGENDA WILL 2746 02:05:40,933 --> 02:05:42,935 DIFFER BASED ON SEX OR 2747 02:05:43,002 --> 02:05:43,269 GENDER? 2748 02:05:43,335 --> 02:05:44,303 NEXT SLIDE. 2749 02:05:44,370 --> 02:05:54,813 SO WE KNOW THE FEMALE 2750 02:05:57,616 --> 02:06:01,253 EXHIBITS STRONGER INNATE AND 2751 02:06:01,320 --> 02:06:02,554 ADAPTIVE IMMUNE RESPONSES 2752 02:06:02,621 --> 02:06:06,058 THAN MALES AND THIS IS DUE 2753 02:06:06,125 --> 02:06:10,262 TO MULTIPLE FACTORS, THE X 2754 02:06:10,329 --> 02:06:12,965 LINKED INFLAMMATORY GENE, 2755 02:06:13,032 --> 02:06:16,869 TLR7 AND Y LINKED REGULATORY 2756 02:06:16,936 --> 02:06:21,240 GENES WITH HORMONAL EFFECTS. 2757 02:06:21,307 --> 02:06:23,108 IT IS COMPLICATED TO STUDY 2758 02:06:23,175 --> 02:06:25,811 THIS, IT IS UNDER STUDIES 2759 02:06:25,878 --> 02:06:29,782 WHICH WON'T BE SURPRISING. 2760 02:06:29,848 --> 02:06:34,286 BUT IT IS QUITE A DRAMATIC 2761 02:06:34,353 --> 02:06:34,620 EFFECT. 2762 02:06:34,687 --> 02:06:38,590 NEXT SLIDE. 2763 02:06:38,657 --> 02:06:42,328 AND GOING BACK 20 YEARS, 2764 02:06:42,394 --> 02:06:44,430 WOMEN HAVE A LOWER THRESHOLD 2765 02:06:44,496 --> 02:06:51,704 TO DISEASE AND MORE LIKELY 2766 02:06:51,770 --> 02:06:59,678 THAN MEN TO ACHIEVE 2767 02:06:59,745 --> 02:07:05,884 UNDETECTABLE VIRAEMIA IN 2768 02:07:05,951 --> 02:07:07,653 ABSENCE OF ART. 2769 02:07:07,720 --> 02:07:10,589 THERE ARE TWO NATURAL CURES 2770 02:07:10,656 --> 02:07:16,228 TO DATE IN WOMEN AND THE 2771 02:07:16,295 --> 02:07:20,666 REBOUND FOR INTACT GENOMES 2772 02:07:20,733 --> 02:07:22,434 IN GENIC REASONS, LOWER IN 2773 02:07:22,501 --> 02:07:24,870 WOMEN THAN MEN. 2774 02:07:24,937 --> 02:07:25,704 NEXT SLIDE. 2775 02:07:25,771 --> 02:07:27,873 BUT AGAIN ON THE FLIP SIDE, 2776 02:07:27,940 --> 02:07:30,309 GENERALLY WHEN WE LOOK AT 2777 02:07:30,376 --> 02:07:34,680 LEVELS OF T CELL ACTIVATION, 2778 02:07:34,747 --> 02:07:36,882 INFLAMMATION WHICH WE THINK 2779 02:07:36,949 --> 02:07:37,716 LONG-TERM ARE HARMFUL, THESE 2780 02:07:37,783 --> 02:07:42,254 TEND TO BE HIGHER. 2781 02:07:42,321 --> 02:07:43,022 NEXT SLIDE. 2782 02:07:43,088 --> 02:07:45,290 AND IN THE GENERAL 2783 02:07:45,357 --> 02:07:46,992 POPULATION, THIS HAS BEEN 2784 02:07:47,059 --> 02:07:50,396 KNOWN FOR A WHILE BUT NOT 2785 02:07:50,462 --> 02:07:52,931 BEEN WELL STUDIED, MANY OF 2786 02:07:52,998 --> 02:07:58,670 THE REALLY SIGNIFICANT 2787 02:07:58,737 --> 02:08:01,006 AUTOIMMUNE DISEASES, 2788 02:08:01,073 --> 02:08:04,143 INFLAMMATORY DISEASES, ROOM 2789 02:08:04,209 --> 02:08:07,179 AUTOMATIC AND LUPUS ARE 2790 02:08:07,246 --> 02:08:13,986 LINKED TO THIS LONGER IMMUNE 2791 02:08:14,053 --> 02:08:15,387 RESPONSE AND ADAPTIVE 2792 02:08:15,454 --> 02:08:16,221 ABILITY OF WOMEN. 2793 02:08:16,288 --> 02:08:17,790 NEXT SLIDE. 2794 02:08:17,856 --> 02:08:19,058 SO VACCINES, ON THE FLIP 2795 02:08:19,124 --> 02:08:20,259 SIDE, WHAT DO WE EXPECT TO 2796 02:08:20,325 --> 02:08:26,932 SEE IN TERMS OF VACCINES AND 2797 02:08:26,999 --> 02:08:36,375 ARE THERE VACCINES, ANY 2798 02:08:36,442 --> 02:08:38,444 IMMUNOTHERAPY, SHOULD WE 2799 02:08:38,510 --> 02:08:39,611 EXPECT SEX DIFFERENCES. 2800 02:08:39,678 --> 02:08:41,413 SO NEXT SLIDE. 2801 02:08:41,480 --> 02:08:44,750 LOOKING AT BODY OUTCOMES, 2802 02:08:44,817 --> 02:08:47,786 ALMOST UNIFORMLY YOU GET 2803 02:08:47,853 --> 02:08:50,389 STRONGER ANTIBODY PRODUCTION 2804 02:08:50,456 --> 02:08:53,525 AS A CONSEQUENCE OF VACCINES 2805 02:08:53,592 --> 02:08:55,727 IN WOMEN THAN MEN. 2806 02:08:55,794 --> 02:08:57,896 T CELL RESPONSES WHICH ARE 2807 02:08:57,963 --> 02:09:01,733 ANOTHER IMPORTANT PART OF 2808 02:09:01,800 --> 02:09:03,135 THE IMMUNE RESPONSE 2809 02:09:03,202 --> 02:09:04,837 APPARENTLY HAVE NOT BEEN 2810 02:09:04,903 --> 02:09:07,439 WELL STUDIES AND WHEN THEY 2811 02:09:07,506 --> 02:09:18,016 HAVE, THE DATA WAS POORLY 2812 02:09:19,651 --> 02:09:20,886 STUDIED AND INCONSISTENT. 2813 02:09:20,953 --> 02:09:21,286 NEXT SLIDE. 2814 02:09:21,353 --> 02:09:24,423 BUT ALSO ON THE FLIP SIDE AS 2815 02:09:24,490 --> 02:09:28,927 SEEN HERE, LOT EFFICACY IS 2816 02:09:28,994 --> 02:09:30,963 BETTER, IT IS LESS 2817 02:09:31,029 --> 02:09:33,832 RECOMMENDED AND WE SAW THAT 2818 02:09:33,899 --> 02:09:35,868 WITH COVID IN PARTICULAR. 2819 02:09:35,934 --> 02:09:37,903 RAISING THE ISSUE WHETHER WE 2820 02:09:37,970 --> 02:09:39,538 SHOULD GO FORWARD AND THE 2821 02:09:39,605 --> 02:09:46,311 AMOUNT OF VACCINE DOSE 2822 02:09:46,378 --> 02:09:49,581 SHOULD BE SMALLER OR SEX 2823 02:09:49,648 --> 02:09:50,082 SPECIFIC. 2824 02:09:50,149 --> 02:09:50,883 AND NEXT SLIDE. 2825 02:09:50,949 --> 02:09:57,523 IMPORTANTLY IN THE LAST DATA 2826 02:09:57,589 --> 02:09:59,992 SLIDE NOTICE NOT JUST AN 2827 02:10:00,058 --> 02:10:01,827 ISSUE WITH VACCINES. 2828 02:10:01,894 --> 02:10:02,728 IMMUNOTHERAPIES IN GENERAL 2829 02:10:02,794 --> 02:10:05,531 IN THE DATA ARE NOT A 2830 02:10:05,597 --> 02:10:06,365 HUNDRED PERCENT CONSISTENT 2831 02:10:06,431 --> 02:10:08,867 BUT ANY TIME YOU MANIPULATE 2832 02:10:08,934 --> 02:10:10,369 THE IMMUNE RESPONSE AND TRY 2833 02:10:10,435 --> 02:10:15,374 TO MAKE SOMETHING MORE 2834 02:10:15,440 --> 02:10:18,844 INFLAMMATORY, YOU GET MORE 2835 02:10:18,911 --> 02:10:19,678 ADVERSE EFFECTS OR TOXICITY 2836 02:10:19,745 --> 02:10:25,517 SO IT IS A COMPLICATED 2837 02:10:25,584 --> 02:10:25,817 THING. 2838 02:10:25,884 --> 02:10:30,289 NEXT SLIDE. 2839 02:10:30,355 --> 02:10:32,558 SO CONCLUSION, AGAIN, IN THE 2840 02:10:32,624 --> 02:10:42,234 ANIMAL MODELS AND IN PEOPLE, 2841 02:10:42,301 --> 02:10:43,735 COMPARED TO MALES, FEMALES 2842 02:10:43,802 --> 02:10:45,103 MOUNT A STRONGER IMMUNE 2843 02:10:45,170 --> 02:10:47,739 RESPONSE TO VACCINES AND IN 2844 02:10:47,806 --> 02:10:49,474 INFECTIONS WITH A STRONG 2845 02:10:49,541 --> 02:10:51,276 IMMUNE RESPONSE, IT IS 2846 02:10:51,343 --> 02:10:54,613 HELPFUL TO DO TWO STUDIES. 2847 02:10:54,680 --> 02:10:58,283 COMPARED TO MALES, FEMALES 2848 02:10:58,350 --> 02:11:01,186 HAVE MORE ADVERSE REVENTS 2849 02:11:01,253 --> 02:11:03,589 POST VACCINATION BUT AS A 2850 02:11:03,655 --> 02:11:05,557 MECHANISM LIKELY RELATED TO 2851 02:11:05,624 --> 02:11:06,758 STRONGER INFLAMMATORY 2852 02:11:06,825 --> 02:11:09,361 RESPONSE SO THEN THEY GET 2853 02:11:09,428 --> 02:11:13,198 LIKE LONG COVID IN TERMS OF 2854 02:11:13,265 --> 02:11:14,800 THAT VACCINE. 2855 02:11:14,866 --> 02:11:18,103 SO THIS DOUBLE EDGED SWORD 2856 02:11:18,170 --> 02:11:26,511 THAT HAS REALLY BEEN DRIVEN 2857 02:11:26,578 --> 02:11:28,013 BY HORMONE AND HEALTH 2858 02:11:28,080 --> 02:11:30,849 DIFFERENCES HAVE MADE THE 2859 02:11:30,916 --> 02:11:32,684 COMMUNITY VERY AWARE THAT WE 2860 02:11:32,751 --> 02:11:36,321 NEED TO DOUBLE DOWN ON OUR 2861 02:11:36,388 --> 02:11:39,291 EFFORTS TO HAVE MORE 2862 02:11:39,358 --> 02:11:40,492 STUDIES, PERHAPS SEPARATE 2863 02:11:40,559 --> 02:11:46,498 STUDIES AND NOT ONLY WRITE 2864 02:11:46,565 --> 02:11:51,637 IT DOWN BUT TO LOOK AT CURES 2865 02:11:51,703 --> 02:11:54,706 AS THEY TALK AND IT MIGHT BE 2866 02:11:54,773 --> 02:11:58,910 EASIER TO CURE IT IN WOMEN 2867 02:11:58,977 --> 02:12:00,746 THAN IN MEN AND THAT WOULD 2868 02:12:00,812 --> 02:12:07,519 MOVE THE CARE TO WHERE MOST 2869 02:12:07,586 --> 02:12:13,025 PEOPLE COULD NOT BE 2870 02:12:13,091 --> 02:12:13,425 REINFECTED. 2871 02:12:13,492 --> 02:12:15,093 >> THANK YOU FOR YOUR 2872 02:12:15,160 --> 02:12:15,994 PRESENTATION. 2873 02:12:16,061 --> 02:12:18,497 AS A REMINDER TO THE 2874 02:12:18,563 --> 02:12:21,199 AUDIENCE, PLEASE PROVIDE 2875 02:12:21,266 --> 02:12:23,201 YOUR QUESTION OR FEEDBACK IN 2876 02:12:23,268 --> 02:12:24,469 THE FEEDBACK BUTTON ON THE 2877 02:12:24,536 --> 02:12:26,938 VIDEOCAST. 2878 02:12:27,005 --> 02:12:32,277 OUR FINAL SPEAKER TODAY, YOU 2879 02:12:32,344 --> 02:12:35,480 GO AHEAD, THE PROGRAM IS 2880 02:12:35,547 --> 02:12:35,781 YOURS. 2881 02:12:35,847 --> 02:12:36,515 >> THANK YOU. 2882 02:12:36,581 --> 02:12:39,351 GOOD MORNING EVERYONE, MY 2883 02:12:39,418 --> 02:12:42,487 NAME IS ALICA DIGGS, AIM 2884 02:12:42,554 --> 02:12:44,523 DAUGHTER, SISTER MOTHER AND 2885 02:12:44,589 --> 02:12:46,925 A GRANDMOTHER AND UNITARIAN 2886 02:12:46,992 --> 02:12:48,894 AND AFRICAN-AMERICAN WOMAN 2887 02:12:48,960 --> 02:12:49,995 LIVING WITH HIV. 2888 02:12:50,062 --> 02:12:52,998 I WAS DIAGNOSED IN 2001 AND 2889 02:12:53,065 --> 02:12:54,933 AFTER LEARNING THAT MY 2890 02:12:55,000 --> 02:12:56,535 HUSBAND AT THE TIME KEPT THE 2891 02:12:56,601 --> 02:12:58,603 TRUTH ABOUT HIS DIAGNOSIS 2892 02:12:58,670 --> 02:13:01,106 FROM ME, I COULD HAVE BEEN 2893 02:13:01,173 --> 02:13:03,075 RESENTFUL OR LET MY LIFE 2894 02:13:03,141 --> 02:13:05,477 SLIP AWAY BUT INSTEAD I MADE 2895 02:13:05,544 --> 02:13:06,878 THE DECISION TO LIVE NOT 2896 02:13:06,945 --> 02:13:09,147 JUST FOR ME BUT MAINLY FOR 2897 02:13:09,214 --> 02:13:11,416 MY CHILDREN. 2898 02:13:11,483 --> 02:13:13,485 SO EVEN AFTER GOING THROUGH 2899 02:13:13,552 --> 02:13:16,588 THE FEELINGS OF BEING 2900 02:13:16,655 --> 02:13:18,523 DISAPPOINTED WITH MYSELF, 2901 02:13:18,590 --> 02:13:20,025 ANGRY, FEELING EMBARRASSED 2902 02:13:20,092 --> 02:13:21,426 AND ISOLATED, I FELT THE 2903 02:13:21,493 --> 02:13:23,395 NEED TO TELL MY STORY AND 2904 02:13:23,462 --> 02:13:25,564 DURING THAT TIME OF MY 2905 02:13:25,630 --> 02:13:27,466 DIAGNOSIS, I WASN'T HEARING 2906 02:13:27,532 --> 02:13:29,901 STORIES ABOUT BLACK WOMEN 2907 02:13:29,968 --> 02:13:31,303 ACQUIRING HIV FROM THEIR 2908 02:13:31,370 --> 02:13:33,939 PARTNERS SO STARTING TO TELL 2909 02:13:34,005 --> 02:13:36,708 MY STORY GAVE ME HOPE TO 2910 02:13:36,775 --> 02:13:37,609 PREVENT OTHER WOMEN FROM 2911 02:13:37,676 --> 02:13:38,710 GOING THROUGH WHAT I WAS 2912 02:13:38,777 --> 02:13:40,245 GOING THROUGH AT THE TIME. 2913 02:13:40,312 --> 02:13:43,148 AND EVEN IN THE EARLY 2000'S 2914 02:13:43,215 --> 02:13:44,983 THERE WAS STILL A LOT OF 2915 02:13:45,050 --> 02:13:47,986 LEARNING GOING ON ABOUT HIV. 2916 02:13:48,053 --> 02:13:50,722 IT WASN'T SO EASY TO GET 2917 02:13:50,789 --> 02:13:51,590 IMMEDIATELY INTO CARE LIKE 2918 02:13:51,656 --> 02:13:52,491 IT IS NOW. 2919 02:13:52,557 --> 02:13:55,127 DURING THE TIME OF MY 2920 02:13:55,193 --> 02:13:57,129 DIAGNOSIS, I WAS TOLD MY 2921 02:13:57,195 --> 02:13:59,197 VIRAL LOAD WAS VERY LOW AND 2922 02:13:59,264 --> 02:14:01,133 WASN'T GIVEN A DIRECT NUMBER 2923 02:14:01,199 --> 02:14:03,602 BUT MY DOCTOR AT THE TIME 2924 02:14:03,668 --> 02:14:05,170 INFORMED ME SINCE IT WAS 2925 02:14:05,237 --> 02:14:06,972 OVER 500, I DID NOT HAVE TO 2926 02:14:07,038 --> 02:14:07,572 START MEDICATION. 2927 02:14:07,639 --> 02:14:11,443 SO FOR THE FIRST TEN YEARS 2928 02:14:11,510 --> 02:14:12,811 OF MY DIAGNOSIS, I WAS 2929 02:14:12,878 --> 02:14:14,880 ACTUALLY TOLD I WAS 2930 02:14:14,946 --> 02:14:16,248 CONSIDERED A NONPROGRESSIVE 2931 02:14:16,314 --> 02:14:18,316 BECAUSE MY IMMUNE SYSTEM WAS 2932 02:14:18,383 --> 02:14:20,786 STRONG ENOUGH TO KEEP 2933 02:14:20,852 --> 02:14:22,421 FIGHTING HIV OR KEEP IT 2934 02:14:22,487 --> 02:14:22,821 SUPPRESSED. 2935 02:14:22,888 --> 02:14:26,858 SO I WANTED TO SAY IN 2008 I 2936 02:14:26,925 --> 02:14:28,360 STARTED PARTICIPATING IN 2937 02:14:28,427 --> 02:14:29,761 RESEARCH STUDIES AND ONLY 2938 02:14:29,828 --> 02:14:31,663 BECAUSE I DEALT WITH A LOT 2939 02:14:31,730 --> 02:14:32,431 OF MISTRUST. 2940 02:14:32,497 --> 02:14:34,499 OVER TIME AS I STARTED TO 2941 02:14:34,566 --> 02:14:35,400 UNDERSTAND RESEARCH AND 2942 02:14:35,467 --> 02:14:36,635 BUILD THE RELATIONSHIPS WITH 2943 02:14:36,701 --> 02:14:41,740 THOSE I WAS WORKING WITH, I 2944 02:14:41,807 --> 02:14:44,176 DELVED A LITTLE FURTHER TO 2945 02:14:44,242 --> 02:14:52,784 PARTICIPATING IN TRIALS AND 2946 02:14:52,851 --> 02:14:54,586 MOSTLY BECAUSE THERE WAS NO 2947 02:14:54,653 --> 02:14:56,087 ONE INVITING ME TO THESE 2948 02:14:56,154 --> 02:14:56,421 TRIALS. 2949 02:14:56,488 --> 02:14:58,023 I WILL STILL CHECKING MY 2950 02:14:58,089 --> 02:15:00,325 VIRAL LOAD TO MAKE SURE I 2951 02:15:00,392 --> 02:15:02,727 WAS STABLE BUT BY THE 11TH 2952 02:15:02,794 --> 02:15:03,995 YEAR OF MY DIAGNOSIS I WAS 2953 02:15:04,062 --> 02:15:07,699 NO LONGER CONSIDERED A 2954 02:15:07,766 --> 02:15:08,166 NONPROGRESSIVE. 2955 02:15:08,233 --> 02:15:09,968 I NOTICED MY NUMBERS WERE IN 2956 02:15:10,035 --> 02:15:10,869 THE INCORRECT DIRECTION FOR 2957 02:15:10,936 --> 02:15:13,171 ME AND THAT MADE ME NERVOUS 2958 02:15:13,238 --> 02:15:15,941 SO I STARTED LOOKING INTO 2959 02:15:16,007 --> 02:15:16,608 MEDICATION. 2960 02:15:16,675 --> 02:15:19,544 OVER THE YEARS, 80s, 2961 02:15:19,611 --> 02:15:23,982 90s, SO MANY PEOPLE WERE 2962 02:15:24,049 --> 02:15:26,618 GETTING AIDS AND DIED AND 2963 02:15:26,685 --> 02:15:27,953 HAD COMPLICATIONS FROM 2964 02:15:28,019 --> 02:15:29,721 MEDICATION, I WAS TERRIFIED, 2965 02:15:29,788 --> 02:15:32,357 NOT OF THE DISEASE BUT THE 2966 02:15:32,424 --> 02:15:32,757 MEDICATION. 2967 02:15:32,824 --> 02:15:33,859 BUT AFTER DISCUSSIONS WITH 2968 02:15:33,925 --> 02:15:36,862 AND SUPPORT OF MY DOCTOR, I 2969 02:15:36,928 --> 02:15:37,462 STARTED MEDICATION, I 2970 02:15:37,529 --> 02:15:38,129 STARTED TREATMENT. 2971 02:15:38,196 --> 02:15:40,465 AND LIKE I SAID, I WAS 2972 02:15:40,532 --> 02:15:41,566 TERRIFIED BECAUSE I KNEW 2973 02:15:41,633 --> 02:15:43,201 ONCE I TOOK THAT FIRST PILL, 2974 02:15:43,268 --> 02:15:45,136 I WOULD HAVE TO DO IT FOR 2975 02:15:45,203 --> 02:15:46,872 THE REST OF MY LIFE AND I 2976 02:15:46,938 --> 02:15:49,174 WASN'T SURE WHAT REACTIONS I 2977 02:15:49,241 --> 02:15:51,009 WOULD EXPERIENCE TO THESE 2978 02:15:51,076 --> 02:15:52,077 MEDICATIONS, ESPECIALLY THE 2979 02:15:52,143 --> 02:15:55,113 LONG-TERM EFFECTS OF THEM. 2980 02:15:55,180 --> 02:15:58,950 SO OVER THE PAST 12 YEARS, I 2981 02:15:59,017 --> 02:16:00,919 HAVE CHANGED MEDICATIONS 2982 02:16:00,986 --> 02:16:03,455 ABOUT FOUR TIMES. 2983 02:16:03,522 --> 02:16:10,529 I WAS ONCE ON TRICLO, THEN 2984 02:16:10,595 --> 02:16:13,999 TRIAMED AND VERY ACTIVE INTO 2985 02:16:14,065 --> 02:16:16,067 THE INJECT HAS AND THREE 2986 02:16:16,134 --> 02:16:17,435 MONTHS INTO TAKING CAB, IT 2987 02:16:17,502 --> 02:16:18,703 FAILED ME. 2988 02:16:18,770 --> 02:16:21,273 I WAS SO DEVASTATED BECAUSE 2989 02:16:21,339 --> 02:16:24,442 I BECAME DETECTABLE AND 2990 02:16:24,509 --> 02:16:28,914 GAINED RESISTANCE TO A 2991 02:16:28,980 --> 02:16:29,514 NONREVERSE TRANSCRIPTASE 2992 02:16:29,581 --> 02:16:34,152 INHIB TO YOUR AND SEVERAL 2993 02:16:34,219 --> 02:16:34,920 OTHER INHIBITORS. 2994 02:16:34,986 --> 02:16:37,689 BUT MY DOCTOR WAS SO AMAZING 2995 02:16:37,756 --> 02:16:41,326 AND ACTED FAST TO GET ME ON 2996 02:16:41,393 --> 02:16:44,796 TREATMENT TO GET BACK TO A 2997 02:16:44,863 --> 02:16:45,530 UNDETECTABLE STATUS. 2998 02:16:45,597 --> 02:16:49,167 SO NOW I AM ON A NEW 2999 02:16:49,234 --> 02:16:50,435 MEDICATION AND UNDETECTABLE 3000 02:16:50,502 --> 02:16:50,769 AGAIN. 3001 02:16:50,835 --> 02:16:53,772 THIS IS THE FIRST TIME OF 3002 02:16:53,838 --> 02:16:54,806 SHARING MY MEDICATIONS TO 3003 02:16:54,873 --> 02:16:57,842 THE PUBLIC BUT DO SO BECAUSE 3004 02:16:57,909 --> 02:17:00,278 I HAVE HAD GREAT DOCTORS WHO 3005 02:17:00,345 --> 02:17:02,814 REALLY LISTENED TO ME AND WE 3006 02:17:02,881 --> 02:17:05,951 WORKED TOGETHER AS A TEAM TO 3007 02:17:06,017 --> 02:17:07,018 KEEP ME HEALTHY. 3008 02:17:07,085 --> 02:17:13,158 BUT TO BE HONEST WITH YOU 3009 02:17:13,224 --> 02:17:17,495 ALL, IT IS NOT EASY TO GET 3010 02:17:17,562 --> 02:17:18,663 AFFORDABLE CARE. 3011 02:17:18,730 --> 02:17:21,066 THERE IS STILL STIGMA WHICH 3012 02:17:21,132 --> 02:17:22,734 PLAYS A HUGE PART TO 3013 02:17:22,801 --> 02:17:23,635 TREATMENT AND EQUITY. 3014 02:17:23,702 --> 02:17:26,838 AND I KNOW SO MANY WOMEN WHO 3015 02:17:26,905 --> 02:17:27,639 SAY HEALTHCARE PROVIDERS 3016 02:17:27,706 --> 02:17:29,240 DON'T LISTEN TO THEM WHEN 3017 02:17:29,307 --> 02:17:30,408 THEY ARE SHARING THEIR 3018 02:17:30,475 --> 02:17:31,676 HEALTH ISSUES AND HOW THEY 3019 02:17:31,743 --> 02:17:32,110 FEEL. 3020 02:17:32,177 --> 02:17:34,546 AND WE KNOW HISTORICALLY 3021 02:17:34,613 --> 02:17:36,815 TRAUMA HAS BEEN IMPOSED ON 3022 02:17:36,881 --> 02:17:38,483 BLACK AND BROWN BODIES AND 3023 02:17:38,550 --> 02:17:40,385 IT IS A LONG ACTING SCAR 3024 02:17:40,452 --> 02:17:42,921 THAT REALLY NEEDS TO BE 3025 02:17:42,988 --> 02:17:50,328 ACKNOWLEDGED AND ADDS TO THE 3026 02:17:50,395 --> 02:17:50,695 MISTRUST. 3027 02:17:50,762 --> 02:17:51,963 SO SINCE THERE HAS BEEN -- I 3028 02:17:52,030 --> 02:17:54,366 AM SORRY, THERE HAS TO BE 3029 02:17:54,432 --> 02:17:55,600 TRUST BETWEEN HEALTHCARE 3030 02:17:55,667 --> 02:17:56,334 PROVIDERS AND PATIENTS TO 3031 02:17:56,401 --> 02:17:57,435 START TO LISTEN TO WOMEN. 3032 02:17:57,502 --> 02:17:59,371 THIS HAS TO BE SAID MULTIPLE 3033 02:17:59,437 --> 02:18:00,438 TIMES DURING THIS WORKSHOP 3034 02:18:00,505 --> 02:18:02,374 AND IT HAS BEEN SAID 3035 02:18:02,440 --> 02:18:03,875 MULTIPLE TIMES IN THIS 3036 02:18:03,942 --> 02:18:05,143 WORKSHOP THAT YOU HAVE TO 3037 02:18:05,210 --> 02:18:06,311 LISTEN TO WOMEN AND ALTHOUGH 3038 02:18:06,378 --> 02:18:08,513 MANY OF US MAY NOT BE 3039 02:18:08,580 --> 02:18:10,148 PHYSICIANS, WE DO KNOW OUR 3040 02:18:10,215 --> 02:18:12,984 BODIES, HOW WE FEEL AND WHAT 3041 02:18:13,051 --> 02:18:14,152 WE'RE GOING THROUGH. 3042 02:18:14,219 --> 02:18:15,987 WOMEN TRULY DESIRE TO WORK 3043 02:18:16,054 --> 02:18:17,922 WITH OUR HEALTHCARE 3044 02:18:17,989 --> 02:18:21,226 PROVIDERS AND OUR HEALTHCARE 3045 02:18:21,292 --> 02:18:23,428 TEAM AND TEAM MEMBERS TO 3046 02:18:23,495 --> 02:18:26,731 MAKE SURE WE CONTINUE TO 3047 02:18:26,798 --> 02:18:28,566 DELIVER LARGE ON HIV. 3048 02:18:28,633 --> 02:18:30,168 AND WE KNOW HISTORICALLY 3049 02:18:30,235 --> 02:18:32,003 WOMEN TEND TO BE DIAGNOSED 3050 02:18:32,070 --> 02:18:34,205 LATER IN THEIR DISEASE THAN 3051 02:18:34,272 --> 02:18:36,641 MEN AND FEWER WOMEN THAN MEN 3052 02:18:36,708 --> 02:18:38,576 ARE GETTING HIV TREATMENT. 3053 02:18:38,643 --> 02:18:40,311 SOMETIMES WOMEN DELAY 3054 02:18:40,378 --> 02:18:41,246 GETTING MEDICAL TREATMENT 3055 02:18:41,312 --> 02:18:43,882 AND CARE AND CHOOSE NOT TO 3056 02:18:43,948 --> 02:18:45,483 EVEN DISCLOSE THEIR HIV 3057 02:18:45,550 --> 02:18:45,817 STATUS. 3058 02:18:45,884 --> 02:18:49,387 THIS IS ALL FEW TO NUMEROUS 3059 02:18:49,454 --> 02:18:51,222 REASONS, STIGMA BEING NUMBER 3060 02:18:51,289 --> 02:18:53,258 ONE, BUT ALSO IN THE U.S., 3061 02:18:53,324 --> 02:18:56,928 WOMEN WITHOUT HEALTH CARE 3062 02:18:56,995 --> 02:18:58,863 INSURANCE, ARE UNABLE TO GET 3063 02:18:58,930 --> 02:19:00,565 ADEQUATE CARE FOR 3064 02:19:00,632 --> 02:19:00,965 MEDICATIONS. 3065 02:19:01,032 --> 02:19:04,269 EVEN THOUGH WE HAVE THE AIDS 3066 02:19:04,335 --> 02:19:07,739 PROGRAM AVAILABLE TO ASSIST 3067 02:19:07,806 --> 02:19:09,474 WITH MEDICATIONS FOR PEOPLE 3068 02:19:09,541 --> 02:19:10,275 WITHOUT INSURANCE. 3069 02:19:10,341 --> 02:19:12,711 TRANSPORTATION IS ANOTHER 3070 02:19:12,777 --> 02:19:13,044 BARRIER. 3071 02:19:13,111 --> 02:19:13,845 UNSTABLE HOUSING. 3072 02:19:13,912 --> 02:19:16,247 AND WE TALKED ABOUT THIS IN 3073 02:19:16,314 --> 02:19:18,249 THE SESSIONS YESTERDAY, 3074 02:19:18,316 --> 02:19:21,953 INTIMATE PARTNER VIOLENCE. 3075 02:19:22,020 --> 02:19:24,889 WOMEN ARE IN FEAR AT HOME. 3076 02:19:24,956 --> 02:19:26,157 THEY HAVE SEVERAL 3077 02:19:26,224 --> 02:19:27,058 RESPONSIBILITIES SUCH AS 3078 02:19:27,125 --> 02:19:31,162 TRYING TO GET CHILDCARE OR 3079 02:19:31,229 --> 02:19:32,664 CARE FOR SICK FAMILY 3080 02:19:32,731 --> 02:19:32,997 MEMBERS. 3081 02:19:33,064 --> 02:19:34,065 WE ALWAYS TAKE CARE OF 3082 02:19:34,132 --> 02:19:35,467 OTHERS BEFORE WE TAKE CARE 3083 02:19:35,533 --> 02:19:36,201 OF OURSELVES. 3084 02:19:36,267 --> 02:19:39,704 THERE MAY BE PROBLEMS WITH 3085 02:19:39,771 --> 02:19:40,205 ADDICTION, STRESS, 3086 02:19:40,271 --> 02:19:40,605 DEPRESSION. 3087 02:19:40,672 --> 02:19:42,073 THERE IS A LACK OF MENTAL 3088 02:19:42,140 --> 02:19:44,609 CARE FOR SO MANY PEOPLE. 3089 02:19:44,676 --> 02:19:46,211 MENTAL HEALTHCARE IS A 3090 02:19:46,277 --> 02:19:47,946 CONVERSATION THAT IS NOT 3091 02:19:48,012 --> 02:19:49,347 REALLY HAD IN A LOT OF 3092 02:19:49,414 --> 02:19:50,982 COMMUNITIES BUT WE NEED 3093 02:19:51,049 --> 02:19:55,386 ACCESS TO MENTAL HEALTHCARE. 3094 02:19:55,453 --> 02:19:57,055 LACK OF FINANCIAL RESOURCES. 3095 02:19:57,122 --> 02:19:59,390 I REMEMBER WHEN I HAD 3096 02:19:59,457 --> 02:20:00,125 LOWER-PAYING JOBS, MY 3097 02:20:00,191 --> 02:20:01,393 CONCERN WAS ALWAYS MAKING 3098 02:20:01,459 --> 02:20:03,128 SURE I HAD FOOD ON THE 3099 02:20:03,194 --> 02:20:04,796 TABLE, MAKING SURE MY 3100 02:20:04,863 --> 02:20:05,597 TRANSPORTATION WAS ADEQUATE 3101 02:20:05,663 --> 02:20:07,565 TO GET ME TO WORK, GET MY 3102 02:20:07,632 --> 02:20:09,534 CHILDREN TO SCHOOL SO HIV 3103 02:20:09,601 --> 02:20:11,436 WAS DEFINITELY NOT A MAJOR 3104 02:20:11,503 --> 02:20:12,904 CONCERN FOR ME, MOO SO THE 3105 02:20:12,971 --> 02:20:14,572 THINGS THAT WERE GOING ON IN 3106 02:20:14,639 --> 02:20:16,641 MY HOUSEHOLD AND AS I 3107 02:20:16,708 --> 02:20:17,776 MENTIONED BEFORE, MISTRUST 3108 02:20:17,842 --> 02:20:20,411 OF THE HEALTHCARE PROVIDERS 3109 02:20:20,478 --> 02:20:22,714 AND MEDICAL SYSTEM, THAT IS 3110 02:20:22,781 --> 02:20:24,349 A MAJOR BARRIER. 3111 02:20:24,415 --> 02:20:27,485 ANOTHER CONCERN IS 3112 02:20:27,552 --> 02:20:28,086 NONINCLUSIVE MARKETING. 3113 02:20:28,153 --> 02:20:30,054 IT IS LEADING TO LACK OF 3114 02:20:30,121 --> 02:20:32,490 AWARENESS OF WHO WILL 3115 02:20:32,557 --> 02:20:34,292 BENEFIT FOR TREATMENT. 3116 02:20:34,359 --> 02:20:35,460 FEWER TREATMENT OPTIONS FOR 3117 02:20:35,527 --> 02:20:37,762 WOMEN THAN MEN ARE AVAILABLE 3118 02:20:37,829 --> 02:20:39,597 AND MEDICAL PROFESSIONALS 3119 02:20:39,664 --> 02:20:42,767 CAN BE WARY IN PRESCRIBING 3120 02:20:42,834 --> 02:20:46,204 TREATMENT SUCH AS PREP. 3121 02:20:46,271 --> 02:20:49,274 WE DO KNOW ANTIRETRO VIRAL 3122 02:20:49,340 --> 02:20:50,975 THERAPY CAN HELP WOMEN LIVE 3123 02:20:51,042 --> 02:20:52,577 LONGER AND HEALTHIER LIVES 3124 02:20:52,644 --> 02:20:55,880 IS WHEN PEOPLE HAVE ACCESS 3125 02:20:55,947 --> 02:20:59,984 TO ART AND HAVE A CONSISTENT 3126 02:21:00,051 --> 02:21:01,486 UNDETECTABLE VIRAL MODE, THE 3127 02:21:01,553 --> 02:21:03,188 VIRUS CANNOT BE TRANSMITTED 3128 02:21:03,254 --> 02:21:05,023 THROUGH SEX. 3129 02:21:05,089 --> 02:21:09,160 THIS WAS DISCUSSED BY Dr. 3130 02:21:09,227 --> 02:21:10,595 DEVEENA CONNOR WHERE HE IS 3131 02:21:10,662 --> 02:21:10,862 DAY. 3132 02:21:10,929 --> 02:21:12,897 THERE NEEDS TO BE NEW MODELS 3133 02:21:12,964 --> 02:21:14,966 OF CARE THAT PROVIDE 3134 02:21:15,033 --> 02:21:17,669 COMPREHENSIVE HEALTHCARE FOR 3135 02:21:17,735 --> 02:21:21,239 OLDER ADULTS THAT INSTIGATE 3136 02:21:21,306 --> 02:21:24,075 HIV CARE, HEALTH MANAGEMENT, 3137 02:21:24,142 --> 02:21:24,609 GERIATRIC CARE. 3138 02:21:24,676 --> 02:21:27,846 NOW THAT I AM 50 AND OLDER, 3139 02:21:27,912 --> 02:21:29,113 THOSE THINGS I AM CONCERNED 3140 02:21:29,180 --> 02:21:31,282 ABOUT NOW WHEN HONESTLY I 3141 02:21:31,349 --> 02:21:32,116 DIDN'T KNOW I WOULD EVEN 3142 02:21:32,183 --> 02:21:33,585 MAKE IT TO THAT. 3143 02:21:33,651 --> 02:21:35,687 BUT ALL OF THE WORK THAT HAS 3144 02:21:35,753 --> 02:21:37,622 BEEN DONE WITH ADVANCEMENT 3145 02:21:37,689 --> 02:21:40,458 IN RESEARCH AND MEDICATIONS, 3146 02:21:40,525 --> 02:21:42,227 IS VERY IMPORTANT TO THAT 3147 02:21:42,293 --> 02:21:44,262 AND WE DO ACKNOWLEDGE AND 3148 02:21:44,329 --> 02:21:44,762 APPRECIATE THAT. 3149 02:21:44,829 --> 02:21:47,232 BUT EVEN WITH THAT, WE ASK 3150 02:21:47,298 --> 02:21:48,333 PROVIDER THINK OF THE WHOLE 3151 02:21:48,399 --> 02:21:51,202 PERSON AND HOW EVERYTHING IN 3152 02:21:51,269 --> 02:21:56,241 OUR LIFE IMPACTS US, NOT 3153 02:21:56,307 --> 02:21:56,975 JUST HIV. 3154 02:21:57,041 --> 02:21:59,577 WE ARE DIVERSE, FROM 3155 02:21:59,644 --> 02:22:00,278 DIFFERENT BACKGROUNDS BUT WE 3156 02:22:00,345 --> 02:22:02,247 ARE TREATED ALL THE SAME. 3157 02:22:02,313 --> 02:22:04,215 AND USE FIRST PERSON 3158 02:22:04,282 --> 02:22:05,049 LANGUAGE. 3159 02:22:05,116 --> 02:22:06,184 I CANNOT EXPRESS THAT 3160 02:22:06,251 --> 02:22:06,651 ENOUGH. 3161 02:22:06,718 --> 02:22:09,787 THIS IS WHY I STARTED MY 3162 02:22:09,854 --> 02:22:10,755 INTRODUCTION OFF WITH WHO I 3163 02:22:10,822 --> 02:22:12,824 AM AND NOT A DIAGNOSIS. 3164 02:22:12,891 --> 02:22:15,026 PEOPLE LIVING WITH HIV ARE 3165 02:22:15,093 --> 02:22:16,394 NOT INFECTIONS BUT WE 3166 02:22:16,461 --> 02:22:20,465 CONTINUE TO HEAR 3167 02:22:20,531 --> 02:22:21,532 STIGMATIZING LANGUAGE FROM 3168 02:22:21,599 --> 02:22:22,867 HEALTHCARE PROVIDERS THAT 3169 02:22:22,934 --> 02:22:26,905 ADDIBLE ADDS TO THE STIGMA 3170 02:22:26,971 --> 02:22:28,273 WE ALREADY HAVE. 3171 02:22:28,339 --> 02:22:30,608 WE UNDERSTAND THERE ARE 3172 02:22:30,675 --> 02:22:32,243 MEDICAL TERMS OR JARGON USED 3173 02:22:32,310 --> 02:22:37,215 IN WORK SETTINGS BUT AS SAID 3174 02:22:37,282 --> 02:22:40,385 YESTERDAY BY Dr. MCDONALD, 3175 02:22:40,451 --> 02:22:42,520 AS WOMEN, PEOPLE WHO LIVE 3176 02:22:42,587 --> 02:22:45,256 WITH HIV, WE SUGGEST USING 3177 02:22:45,323 --> 02:22:46,724 FIRST PERSON LANGUAGE. 3178 02:22:46,791 --> 02:22:49,360 TREAT US AS HUMAN BEINGS, AS 3179 02:22:49,427 --> 02:22:52,030 PEOPLE FIRST, NOT A 3180 02:22:52,096 --> 02:22:52,664 INFECTION OR DISEASE. 3181 02:22:52,730 --> 02:22:55,066 THERE IS A GREAT ARTICLE ON 3182 02:22:55,133 --> 02:23:01,606 THE WEBSITE OF WHY HIV 3183 02:23:01,673 --> 02:23:03,975 MATTERS, AND MANY OTHER 3184 02:23:04,042 --> 02:23:08,613 ORGANIZATIONS THAT HAVE 3185 02:23:08,680 --> 02:23:11,783 GUIDES AVAILABLE OR THEIR 3186 02:23:11,849 --> 02:23:14,886 WEBSITES FOR PERSONS 3187 02:23:14,953 --> 02:23:15,653 AFFECTED TO ACCESS. 3188 02:23:15,720 --> 02:23:18,856 AND I WILL CLOSE WITH THIS. 3189 02:23:18,923 --> 02:23:20,692 IT WAS MENTIONED YESTERDAY 3190 02:23:20,758 --> 02:23:21,960 OW PROVIDERS HAVE TO CARE 3191 02:23:22,026 --> 02:23:24,028 ENOUGH TO DO THIS WORK FOR 3192 02:23:24,095 --> 02:23:26,698 ALL OF US HOLISTICALLY, 3193 02:23:26,764 --> 02:23:30,335 OTHERWISE WE WILL NOT BE 3194 02:23:30,401 --> 02:23:33,371 ABLE TO ACCESS ADEQUATE 3195 02:23:33,438 --> 02:23:33,738 CARE. 3196 02:23:33,805 --> 02:23:36,507 WE NEED TO TREAT WOMEN WITH 3197 02:23:36,574 --> 02:23:37,875 HUMANITY AND COMPASSION. 3198 02:23:37,942 --> 02:23:42,413 WE CANNOT END THE HIV 3199 02:23:42,480 --> 02:23:43,348 EPIDEMIC WITHOUT TREATING 3200 02:23:43,414 --> 02:23:43,648 WOMEN. 3201 02:23:43,715 --> 02:23:48,186 SO IN THE WORDS OF DIALO, 3202 02:23:48,252 --> 02:23:49,487 MEET PEOPLE WHERE THEY NEED 3203 02:23:49,554 --> 02:23:50,288 TO BE MET. 3204 02:23:50,355 --> 02:23:51,189 THANKS FOR THE OPPORTUNITY 3205 02:23:51,255 --> 02:23:52,890 TO SHARE AND I LOOK FORWARD 3206 02:23:52,957 --> 02:23:54,392 TO ANY QUESTIONS. 3207 02:23:54,459 --> 02:23:58,129 >> THANK YOU, MS. DIGGS. 3208 02:23:58,196 --> 02:24:02,533 AND FOR ALL OF US, WE WOULD 3209 02:24:02,600 --> 02:24:04,102 LIKE TO RESPOND TO THE 3210 02:24:04,168 --> 02:24:06,537 QUESTIONS, IF YOU WANT TO 3211 02:24:06,604 --> 02:24:09,140 SUBMIT YOUR COMMENT OR 3212 02:24:09,207 --> 02:24:11,542 QUESTION, DO SO VIA THE LIVE 3213 02:24:11,609 --> 02:24:12,243 FEEDBACK BUTTON AT THE 3214 02:24:12,310 --> 02:24:14,445 BOTTOM OF THE PAGE AND THEN 3215 02:24:14,512 --> 02:24:16,748 WE INVITE ALL OF OUR 3216 02:24:16,814 --> 02:24:18,349 PRESENTERS TO TURN ON YOUR 3217 02:24:18,416 --> 02:24:24,555 CAMERA SO WE CAN HAVE A 3218 02:24:24,622 --> 02:24:25,423 CONVERSATION. 3219 02:24:25,490 --> 02:24:25,890 THANK YOU ALL. 3220 02:24:25,957 --> 02:24:27,125 WE DO HAVE A LIST OF 3221 02:24:27,191 --> 02:24:28,493 QUESTIONS HERE FOR US TO 3222 02:24:28,559 --> 02:24:30,094 START ASKING. 3223 02:24:30,161 --> 02:24:40,671 OUR FIRST QUESTION IS FOR 3224 02:24:42,607 --> 02:24:43,408 Dr. MNGIBISA. 3225 02:24:43,474 --> 02:24:45,276 WHERE CAN WOMEN GO FOR 3226 02:24:45,343 --> 02:24:47,145 OPPORTUNITIES TO PARTICIPATE 3227 02:24:47,211 --> 02:24:48,780 IN THERAPEUTIC RESEARCH? 3228 02:24:48,846 --> 02:24:59,357 YOU MIGHT STILL BE MUTED. 3229 02:25:07,098 --> 02:25:08,099 >> HE MIGHT BE STRUGGLE LING 3230 02:25:08,166 --> 02:25:09,000 WITH HIS CONNECTION IF YOU 3231 02:25:09,067 --> 02:25:11,102 WANT TO MOVE TO THE NEXT 3232 02:25:11,169 --> 02:25:11,369 ONE. 3233 02:25:11,436 --> 02:25:12,437 >> YES, DOCTOR ORKIN IS NOT 3234 02:25:12,503 --> 02:25:13,905 WITH US AT THE MOMENT SO WE 3235 02:25:13,971 --> 02:25:18,409 WILL MOVE ON TO A QUESTION 3236 02:25:18,476 --> 02:25:19,277 FOR Dr. OFOTOKUN. 3237 02:25:19,343 --> 02:25:21,379 ARE THE THERAPY 3238 02:25:21,446 --> 02:25:25,183 RECOMMENDATIONS FOR WOE 3239 02:25:25,249 --> 02:25:26,884 MORBIDITY LIKE BONE LOSS OR 3240 02:25:26,951 --> 02:25:28,619 HEART DISEASE DIFFERENT FOR 3241 02:25:28,686 --> 02:25:31,022 WOMEN WITH HIV THAN THOSE 3242 02:25:31,089 --> 02:25:33,024 WITHOUT? 3243 02:25:33,091 --> 02:25:35,226 >> NOT NECESSARILY 3244 02:25:35,293 --> 02:25:35,593 DIFFERENT. 3245 02:25:35,660 --> 02:25:37,361 I THINK WHAT THE DATA SEEM 3246 02:25:37,428 --> 02:25:38,396 TO BE SUGGESTING IS THAT WE 3247 02:25:38,463 --> 02:25:40,965 NEED TO BE MORE VIGILANT IN 3248 02:25:41,032 --> 02:25:42,900 SCREENING WOMEN LIVING WITH 3249 02:25:42,967 --> 02:25:45,103 HIV FOR SOME OF THESE 3250 02:25:45,169 --> 02:25:49,574 COHORDE COMORBIDITIES AND 3251 02:25:49,640 --> 02:25:53,544 IF WE USE THE CURRENT DRIVEN 3252 02:25:53,611 --> 02:25:56,047 GUIDELINE FOR SCREENING, A 3253 02:25:56,114 --> 02:26:04,655 LOT OF WOMEN, ALREADY 3254 02:26:04,722 --> 02:26:05,890 DIAGNOSED EARLIER THAN MEN, 3255 02:26:05,957 --> 02:26:08,226 SO IF YOU ARE IN A CLINIC 3256 02:26:08,292 --> 02:26:10,228 TAKING CARE OF A WOMAN 3257 02:26:10,294 --> 02:26:12,363 LIVING WITH HIV, YOU WANT TO 3258 02:26:12,430 --> 02:26:13,731 START THIS CONVERSATION 3259 02:26:13,798 --> 02:26:16,134 EARLY SO BEGIN IT TALK ABOUT 3260 02:26:16,200 --> 02:26:18,469 YOUR HEART, TALK ABOUT YOUR 3261 02:26:18,536 --> 02:26:19,971 BONE, THE GI SCREENING 3262 02:26:20,037 --> 02:26:26,444 BECAUSE SOME OF THIS 3263 02:26:26,511 --> 02:26:30,982 CONDITION, WE ARE SEEING 3264 02:26:31,048 --> 02:26:35,253 THEM MUCH BETTER IN THE 3265 02:26:35,319 --> 02:26:37,054 SECOND OR THIRD DECK CADE OF 3266 02:26:37,121 --> 02:26:39,390 LIFE, NOT THE FOURTH OR 3267 02:26:39,457 --> 02:26:42,693 FIFTH OR SIXTH DECADE OF 3268 02:26:42,760 --> 02:26:43,060 LIFE. 3269 02:26:43,127 --> 02:26:45,730 WE DON'T HAVE AN ORDER OF 3270 02:26:45,796 --> 02:26:47,131 THESE CONDITIONS BUT THERE 3271 02:26:47,198 --> 02:26:49,667 IS THE PRIEST STUDY THAT 3272 02:26:49,734 --> 02:26:52,470 SUGGESTS PUTTING EVERYBODY 3273 02:26:52,537 --> 02:26:56,607 ON STATINS WITH HIV, IT DOES 3274 02:26:56,674 --> 02:26:57,842 REDUCE CARDIOVASCULAR EVENTS 3275 02:26:57,909 --> 02:26:58,376 AND INFLAMMATION. 3276 02:26:58,442 --> 02:26:59,544 SO THE TREATMENT IS THE SAME 3277 02:26:59,610 --> 02:27:01,412 BUT WE NEED TO BE MORE 3278 02:27:01,479 --> 02:27:03,047 VIGILANT AT THIS POINT. 3279 02:27:03,114 --> 02:27:03,481 >> THANK YOU. 3280 02:27:03,548 --> 02:27:06,851 I HAD A QUESTION FOR Dr. 3281 02:27:06,918 --> 02:27:07,418 DEEKS. 3282 02:27:07,485 --> 02:27:10,121 FEMALES HAVE A STRONGER 3283 02:27:10,188 --> 02:27:10,955 REACTION TO INFECTION, 3284 02:27:11,022 --> 02:27:12,190 STRONGER RESPONSE TO 3285 02:27:12,256 --> 02:27:14,158 VACCINES AND A LOWER VIRAL 3286 02:27:14,225 --> 02:27:15,259 LOAD SET POINT. 3287 02:27:15,326 --> 02:27:16,627 IS THE SAME TRUE FOR 3288 02:27:16,694 --> 02:27:17,862 TRANSWOMEN AND HOW MUCH OF 3289 02:27:17,929 --> 02:27:20,765 THIS IS BECAUSE OF THE X 3290 02:27:20,831 --> 02:27:22,166 CHROMOSOME VERSUS THE 3291 02:27:22,233 --> 02:27:22,500 HORMONE? 3292 02:27:22,567 --> 02:27:24,068 >> YOU WOULD THINK 3293 02:27:24,135 --> 02:27:24,936 STUDYING -- I DON'T THINK 3294 02:27:25,002 --> 02:27:26,771 THAT HAS BEEN -- WELL, WE 3295 02:27:26,837 --> 02:27:29,040 DON'T KNOW THE ANSWER IN 3296 02:27:29,106 --> 02:27:30,575 TERMS OF TRANSWOMEN AND WHAT 3297 02:27:30,641 --> 02:27:31,943 WOULD HAPPEN AS THEY 3298 02:27:32,009 --> 02:27:32,343 TRANSITION. 3299 02:27:32,410 --> 02:27:39,417 IT WOULD BE AN IDEA TO STUDY 3300 02:27:39,483 --> 02:27:49,126 SOME OF THESE ESPECIALLY 3301 02:27:49,193 --> 02:27:49,927 WITH COOR MULTICONDITIONS. 3302 02:27:49,994 --> 02:27:51,762 BUT WITH THE TRANSITION, IS 3303 02:27:51,829 --> 02:27:53,798 MAKES IT MORE DIFFICULT TO 3304 02:27:53,864 --> 02:27:56,067 DO THE DEEPER DIVE AS FAR AS 3305 02:27:56,133 --> 02:27:57,868 BLOOD SO THE ANSWER IS IT IS 3306 02:27:57,935 --> 02:27:59,470 NOT KNOWN. 3307 02:27:59,537 --> 02:28:00,771 THE RELATED QUESTION TO GET 3308 02:28:00,838 --> 02:28:03,174 AT THINGS AS THEY CHANGE IS 3309 02:28:03,241 --> 02:28:05,243 MENOPAUSE AND THERE THE DATA 3310 02:28:05,309 --> 02:28:07,745 SUGGESTS THAT AS WOMEN GO 3311 02:28:07,812 --> 02:28:08,879 THROUGH MENOPAUSE AND 3312 02:28:08,946 --> 02:28:11,382 ESTROGEN LEVELS CHANGE, IT 3313 02:28:11,449 --> 02:28:13,651 DOES HAVE A IMPACT AND TENDS 3314 02:28:13,718 --> 02:28:17,154 TO INCREASE IN MOST IF NOT 3315 02:28:17,221 --> 02:28:18,256 ALL WOMEN. 3316 02:28:18,322 --> 02:28:19,690 >> THANK YOU. 3317 02:28:19,757 --> 02:28:24,262 I HAVE A FOLLOW UP FOR Dr. 3318 02:28:24,328 --> 02:28:25,229 OFOTOKUN. 3319 02:28:25,296 --> 02:28:28,132 THE CHALLENGES YOU SAY COME 3320 02:28:28,199 --> 02:28:30,801 WITH A LOT OF CHALLENGE DEAL 3321 02:28:30,868 --> 02:28:32,803 WITH PHYSICAL ABILITY AND 3322 02:28:32,870 --> 02:28:35,973 HEALTH ISSUES. 3323 02:28:36,040 --> 02:28:37,808 HOW CAN PAIN BE MANAGED 3324 02:28:37,875 --> 02:28:39,877 BECAUSE IT SOAPS LIKE IT IS 3325 02:28:39,944 --> 02:28:41,712 OVERSTATED AND THEREFORE 3326 02:28:41,779 --> 02:28:43,814 PEOPLE DON'T GET ADEQUATE 3327 02:28:43,881 --> 02:28:45,016 PAIN MANAGEMENT AFFECTING 3328 02:28:45,082 --> 02:28:45,483 QUALITY OF LIFE. 3329 02:28:45,549 --> 02:28:46,684 >> I THINK THAT IS A GREAT 3330 02:28:46,751 --> 02:28:51,355 QUESTION AND I THINK WHAT WE 3331 02:28:51,422 --> 02:28:53,758 ARE ADVOCATING IS THE WAY 3332 02:28:53,824 --> 02:28:55,126 YOU MANAGE MEN MAY BE 3333 02:28:55,192 --> 02:29:02,833 DIFFERENT FROM THE WAY YOU 3334 02:29:02,900 --> 02:29:04,669 MANAGE WOMEN. 3335 02:29:04,735 --> 02:29:06,270 THE PRESSURE FOR CERTAIN 3336 02:29:06,337 --> 02:29:08,673 THERAPIES OR SCREENING FOR 3337 02:29:08,739 --> 02:29:10,374 IMPACT OF SYMPTOMS, WHERE 3338 02:29:10,441 --> 02:29:13,611 THERE IS PAIN, DEPRESSION, 3339 02:29:13,678 --> 02:29:14,745 ANXIETY, THE THRESHOLD FOR 3340 02:29:14,812 --> 02:29:16,347 SCREENING FOR THEM SHOULD BE 3341 02:29:16,414 --> 02:29:21,852 HIGHER WHEN YOU ARE DEALING 3342 02:29:21,919 --> 02:29:24,522 WITH WOMEN AND THE PRESSURE 3343 02:29:24,588 --> 02:29:25,523 FOR ANY INTERVENTION SHOULD 3344 02:29:25,589 --> 02:29:27,158 BE LOWER WHEN YOU DEAL WITH 3345 02:29:27,224 --> 02:29:29,760 WOMEN BECAUSE NOT ONLY ARE 3346 02:29:29,827 --> 02:29:31,829 THEIR CONDITION MORE COMMON, 3347 02:29:31,896 --> 02:29:33,564 WHEN THEY APPEAR AS THE 3348 02:29:33,631 --> 02:29:34,498 QUESTION SUGGESTS, THEY TEND 3349 02:29:34,565 --> 02:29:36,334 TO BE MORE SEVERE. 3350 02:29:36,400 --> 02:29:40,237 SO IF YOU ARE USED TO 3351 02:29:40,304 --> 02:29:41,639 DEALING WITH MEN, IF YOU 3352 02:29:41,706 --> 02:29:43,240 APPLY THE SAME PRESSURE TO 3353 02:29:43,307 --> 02:29:44,742 WOMEN, YOU WOULD SUBJECT 3354 02:29:44,809 --> 02:29:47,078 MANY WOMEN TO UNDUE 3355 02:29:47,144 --> 02:29:47,545 SUFFERING BEFORE 3356 02:29:47,611 --> 02:29:47,978 INTERVENTION. 3357 02:29:48,045 --> 02:29:51,215 SO THIS IS SOMETHING THAT -- 3358 02:29:51,282 --> 02:29:52,950 THIS IS THE MESSAGE WE NEED 3359 02:29:53,017 --> 02:29:55,252 TO CONTINUE TO HIGHLIGHT TO 3360 02:29:55,319 --> 02:29:57,088 PEOPLE WHO TAKE CARE OF 3361 02:29:57,154 --> 02:29:59,857 PEOPLE LIVING WITH HIV, 3362 02:29:59,924 --> 02:30:01,992 PARTICULARLY WOMEN WHO ARE 3363 02:30:02,059 --> 02:30:03,427 LIVING WITH HIV. 3364 02:30:03,494 --> 02:30:04,328 >> I ACTUALLY HAVE ANOTHER 3365 02:30:04,395 --> 02:30:12,002 FOLLOW UP QUESTION FOR YOU. 3366 02:30:12,069 --> 02:30:13,137 ISN'T THE EARLIER 3367 02:30:13,204 --> 02:30:16,474 SIGNIFICANT THERE WILL FOR 3368 02:30:16,540 --> 02:30:17,675 CARDIOVASCULAR HEALTH IN THE 3369 02:30:17,742 --> 02:30:23,381 STUDIES THAT YOU HAVE A 3370 02:30:23,447 --> 02:30:24,515 FEATURE OF PREGNANCY, EVENTS 3371 02:30:24,582 --> 02:30:26,183 THAT WOULD NOT BE OBSERVED 3372 02:30:26,250 --> 02:30:28,519 IN MALES AT THE SAME YOUNG 3373 02:30:28,586 --> 02:30:28,786 AGE? 3374 02:30:28,853 --> 02:30:30,488 >> I THINK THAT IS A GREAT 3375 02:30:30,554 --> 02:30:35,393 QUESTION AND ASK HAVE TO DO 3376 02:30:35,459 --> 02:30:37,528 WITH EXTRA CELLS. 3377 02:30:37,595 --> 02:30:40,398 WE WE DO ANALYSIS IN SOME OF 3378 02:30:40,464 --> 02:30:42,833 OUR DATA WE TAKE IN 3379 02:30:42,900 --> 02:30:44,902 PREGNANCY, WE SEE INCREASET 3380 02:30:44,969 --> 02:30:46,237 BODIES OF THESE CONDITIONS 3381 02:30:46,303 --> 02:30:47,037 IN WOMEN. 3382 02:30:47,104 --> 02:30:49,540 SO WHEN WE SENSE PEOPLE HAVE 3383 02:30:49,607 --> 02:30:50,241 BEEN PREGNANT. 3384 02:30:50,307 --> 02:30:53,644 WE DO HAVE ANOTHER COHORT 3385 02:30:53,711 --> 02:30:55,613 THAT IS CALLED THE STACK 3386 02:30:55,679 --> 02:31:01,118 COHORT AND FUNDED BY NIACHD 3387 02:31:01,185 --> 02:31:04,221 WHERE WE INCLUDE YOUNG WOMEN 3388 02:31:04,288 --> 02:31:05,356 OF REPRODUCTIVE PHASE AND 3389 02:31:05,423 --> 02:31:07,758 TRYING TO LOOK AT -- ONE OF 3390 02:31:07,825 --> 02:31:09,960 THE GOALS OF THAT PARTICULAR 3391 02:31:10,027 --> 02:31:12,163 COHORT IS TO STUDY IMPACT OF 3392 02:31:12,229 --> 02:31:14,965 PREGNANCY ON SOME OF THESE 3393 02:31:15,032 --> 02:31:17,401 COMORBIDITIES BUT IN THE 3394 02:31:17,468 --> 02:31:20,204 COMBINED COHORT STUDIES, ALL 3395 02:31:20,271 --> 02:31:21,405 OF THESE BODIES OF DISEASE, 3396 02:31:21,472 --> 02:31:24,141 EVEN IN THE ABSENCE WHEN YOU 3397 02:31:24,208 --> 02:31:29,380 CONTROL FOR PREGNANCY, 3398 02:31:29,447 --> 02:31:29,680 OCCUR. 3399 02:31:29,747 --> 02:31:32,283 >> THANK YOU, I NOW HAVE A 3400 02:31:32,349 --> 02:31:34,885 QUESTION FOR ALICIA DIGGS. 3401 02:31:34,952 --> 02:31:37,388 WHERE CAN A YOUNG WOMAN 3402 02:31:37,455 --> 02:31:39,223 INVOLVED IN ACTIVIST LEARN 3403 02:31:39,290 --> 02:31:39,790 MORE? 3404 02:31:39,857 --> 02:31:41,358 SOMETIMES THESE SPACES ARE 3405 02:31:41,425 --> 02:31:41,826 MALE DOMINATED. 3406 02:31:41,892 --> 02:31:43,294 >> THANK YOU FOR THE 3407 02:31:43,360 --> 02:31:43,961 QUESTION. 3408 02:31:44,028 --> 02:31:44,962 I WILL BRIEFLY SHARE THAT 3409 02:31:45,029 --> 02:31:48,132 FOR ME THERE IS AN 3410 02:31:48,199 --> 02:31:49,200 ORGANIZATION HERE WHERE I 3411 02:31:49,266 --> 02:31:52,636 LIVE IN THE PIEDMONT 3412 02:31:52,703 --> 02:31:54,338 TRIANGLE AREA, PIEDMONT 3413 02:31:54,405 --> 02:31:55,706 HEALTH SERVICES AND 3414 02:31:55,773 --> 02:31:56,340 SICKLE-CELL AGENCY. 3415 02:31:56,407 --> 02:32:02,613 THEY ARE AN AGENCY THAT 3416 02:32:02,680 --> 02:32:04,682 PROVIDE TREATMENT FOR 3417 02:32:04,748 --> 02:32:06,650 SICKLE-CELL AS WELL AS HIV 3418 02:32:06,717 --> 02:32:09,353 CARE AND HONESTLY I JUST 3419 02:32:09,420 --> 02:32:10,721 WENT THERE TO START TELLING 3420 02:32:10,788 --> 02:32:12,256 THIS IS WHO I AM AND I HAVE 3421 02:32:12,323 --> 02:32:13,991 A DESIRE TO TALK TO OTHER 3422 02:32:14,058 --> 02:32:14,692 PEOPLE. 3423 02:32:14,758 --> 02:32:16,660 AND FROM THERE, I GAINED 3424 02:32:16,727 --> 02:32:21,499 MENTORS AND WAS GUIDED INTO 3425 02:32:21,565 --> 02:32:23,501 THIS WORK BUT I WOULD 3426 02:32:23,567 --> 02:32:26,470 DEFINITELY SUGGEST, LIKE I 3427 02:32:26,537 --> 02:32:27,738 MENTIONED EARLIER, THE WELL 3428 02:32:27,805 --> 02:32:29,340 PROJECT WEBSITE IS AMAZING, 3429 02:32:29,406 --> 02:32:32,209 HAS A LOT OF WONDERFUL 3430 02:32:32,276 --> 02:32:32,710 INFORMATION. 3431 02:32:32,776 --> 02:32:35,479 SISTERHOOD AS WELL AS THE 3432 02:32:35,546 --> 02:32:36,313 POSITIVE WOMEN'S NETWORK 3433 02:32:36,380 --> 02:32:39,817 USA, THERE IS HE A 3434 02:32:39,884 --> 02:32:41,886 ORGANIZATION AVAILABLE FOR 3435 02:32:41,952 --> 02:32:43,921 BLACK CIS GENDER WOMEN WHICH 3436 02:32:43,988 --> 02:32:46,590 IS CALLED THE ETHIC MOVEMENT 3437 02:32:46,657 --> 02:32:48,926 FOR YOUNG WOMEN LIVING WITH 3438 02:32:48,993 --> 02:32:50,461 HIV BUT I WOULD SUGGEST 3439 02:32:50,528 --> 02:32:55,933 CONNECTING WITH ANY OF YOUR 3440 02:32:56,000 --> 02:32:57,968 LOCAL ASO'S OR COMMUNITY 3441 02:32:58,035 --> 02:33:00,237 BASED ORGANIZATIONS AND JUST 3442 02:33:00,304 --> 02:33:01,171 PROVIDE THEM WITH THE WORK 3443 02:33:01,238 --> 02:33:03,440 YOU WANT TO DO. 3444 02:33:03,507 --> 02:33:05,743 YOU CAN ALSO CONNECT WITH 3445 02:33:05,809 --> 02:33:07,778 SOCIAL MEDIA OR TPHRO*EUB, I 3446 02:33:07,845 --> 02:33:10,080 AM HAPPY TO GUIDE A LITTLE 3447 02:33:10,147 --> 02:33:13,684 BIT MORE WITH YOU YEAH, I 3448 02:33:13,751 --> 02:33:15,786 HOPE THAT ANSWERS THE 3449 02:33:15,853 --> 02:33:16,153 QUESTIONS. 3450 02:33:16,220 --> 02:33:17,621 >> THANK YOU SO MUCH. 3451 02:33:17,688 --> 02:33:19,256 I INVITE THE PANELISTS TO 3452 02:33:19,323 --> 02:33:20,324 SHARE ANY OTHER INFORMATION 3453 02:33:20,391 --> 02:33:25,396 YOU MIGHT WANT TO GET OUT IN 3454 02:33:25,462 --> 02:33:28,198 OUR QUESTION AND ANSWER 3455 02:33:28,265 --> 02:33:28,666 SESSION. 3456 02:33:28,732 --> 02:33:30,267 IF THERE ARE NO FURTHER 3457 02:33:30,334 --> 02:33:31,969 COMMENTS, I WOULD LIKE TO 3458 02:33:32,036 --> 02:33:34,638 CONCLUDE SECTION 8 ON HIV 3459 02:33:34,705 --> 02:33:35,806 TREATMENT AND I WELCOME YOU 3460 02:33:35,873 --> 02:33:40,945 TO COME BACK AT 11:45 A.M. 3461 02:33:41,011 --> 02:33:43,914 EASTERN TIME FOR THE NEXT 3462 02:33:43,981 --> 02:33:46,884 SESSION ON HIV RESEARCH. 3463 02:33:46,951 --> 02:33:52,089 THANK YOU. 3464 02:33:52,156 --> 02:33:53,490 SO WELCOME BACK AND THANK 3465 02:33:53,557 --> 02:34:00,331 YOU AGAIN FOR JOINING US. 3466 02:34:00,397 --> 02:34:06,203 TODAY THE NEXT SESSION IS 3467 02:34:06,270 --> 02:34:05,269 HIV CURE-RELATED RESEARCH, I 3468 02:34:05,269 --> 02:34:07,504 AM ELIZABETH BARR FROM THE 3469 02:34:07,571 --> 02:34:11,475 OFFICE OF RESEARCH ON 3470 02:34:11,542 --> 02:34:19,450 WOMEN'S HEALTH AND HERE 3471 02:34:19,516 --> 02:34:25,823 TODAY TO KICK OFF TODAY 3472 02:34:25,889 --> 02:34:36,400 INFORMATION ON SESSION 9. 3473 02:34:49,947 --> 02:34:54,485 SO ONLY 70 PERCENT OF 3474 02:34:54,551 --> 02:34:56,387 PARTICIPANTS TO HIV CURE 3475 02:34:56,453 --> 02:34:57,888 RELATED RESEARCH WERE FEMALE 3476 02:34:57,955 --> 02:35:00,057 AND PARTICIPATION IN THE 3477 02:35:00,124 --> 02:35:02,226 TRIAL INCLUDED REQUIREMENTS 3478 02:35:02,292 --> 02:35:05,429 TO ATTEND FREQUENT AND LONG 3479 02:35:05,496 --> 02:35:12,069 STUDY VISITS, INVASIVE 3480 02:35:12,136 --> 02:35:13,203 SAMPLING AND -- 3481 02:35:13,270 --> 02:35:13,804 [INDISCERNIBLE] 3482 02:35:13,871 --> 02:35:14,772 MOST OF THE RESEARCH HAS 3483 02:35:14,838 --> 02:35:20,878 BEEN IN THE U.S. BUT AT THE 3484 02:35:20,944 --> 02:35:24,281 SAME TIME GLOBALLY, IT IS 3485 02:35:24,348 --> 02:35:27,117 IMPERATIVE TO ENROLL WOMEN, 3486 02:35:27,184 --> 02:35:28,485 ESPECIALLY ADOLESCENT GIRLS 3487 02:35:28,552 --> 02:35:34,458 AND YOUNG WOMEN, WHO ARE 3488 02:35:34,525 --> 02:35:35,125 DISPROPORTIONATELY AFFECTED 3489 02:35:35,192 --> 02:35:37,695 WITH THE CURE STUDIES. 3490 02:35:37,761 --> 02:35:39,163 COMMUNITY VOICES IS ALSO 3491 02:35:39,229 --> 02:35:48,172 QUEUE AS FAR AS 3492 02:35:48,238 --> 02:35:52,342 IMPLEMENTATION IN RESEARCH 3493 02:35:52,409 --> 02:35:54,812 AND SO THIS IS AN IMPORTANT 3494 02:35:54,878 --> 02:35:57,147 TOPIC AND WE ARE REAL LOW 3495 02:35:57,214 --> 02:35:59,917 PLEASED TODAY TO BE JOINED 3496 02:35:59,983 --> 02:36:05,889 BY ADVOCATES WHO WILL 3497 02:36:05,956 --> 02:36:06,924 HIGHLIGHT HIV CURE-RELATED 3498 02:36:06,990 --> 02:36:08,025 RESEARCH FOR WOMEN. 3499 02:36:08,092 --> 02:36:08,726 NEXT SLIDE, PLEASE. 3500 02:36:08,792 --> 02:36:15,499 SO THIS IS A WONDERFUL PANEL 3501 02:36:15,566 --> 02:36:16,800 OF SPEAKERS. 3502 02:36:16,867 --> 02:36:27,377 AND WE HAVE EILEEN SCULLY, 3503 02:36:33,684 --> 02:36:34,218 WOMEN'S COLLABORATIVE 3504 02:36:34,284 --> 02:36:39,957 SCIENCE GROUP, A MEMBER OF 3505 02:36:40,023 --> 02:36:41,792 THE AGENCY FOR WOMEN AND A 3506 02:36:41,859 --> 02:36:42,826 MEMBER OF THE U.S. 3507 02:36:42,893 --> 02:36:44,561 DEPARTMENT OF HEALTH AND 3508 02:36:44,628 --> 02:36:50,434 HUMAN SERVICES PANEL AND 3509 02:36:50,501 --> 02:36:54,505 ANTIRETRO VIRAL INFORMATION 3510 02:36:54,571 --> 02:37:04,982 FOR ADULTS AND HIV 3511 02:37:07,851 --> 02:37:08,619 PATIENTS -- 3512 02:37:08,685 --> 02:37:09,086 [INDISCERNIBLE] 3513 02:37:09,153 --> 02:37:19,363 THEN WE HAVE Dr. 3514 02:37:19,429 --> 02:37:20,164 KARINE DUBE, ASSISTANTS 3515 02:37:20,230 --> 02:37:22,199 PROFESSOR IN GLOBAL PUBLIC 3516 02:37:22,266 --> 02:37:24,368 HEALTH AND STUDIES THE 3517 02:37:24,434 --> 02:37:26,537 BEHAVIORAL SCIENCES AND AN 3518 02:37:26,603 --> 02:37:28,639 EXPERIENCED RESEARCH PROGRAM 3519 02:37:28,705 --> 02:37:30,440 HAMMER WHO INTEGRATES 3520 02:37:30,507 --> 02:37:32,309 BIOMEDICAL, SOCIAL SCIENCES, 3521 02:37:32,376 --> 02:37:34,011 ETHICS AND PATIENT 3522 02:37:34,077 --> 02:37:36,180 ENGAGEMENT AROUND HIV 3523 02:37:36,246 --> 02:37:36,980 RELATED RESEARCH IN THE 3524 02:37:37,047 --> 02:37:40,751 UNITED STATES AND SOUTH 3525 02:37:40,818 --> 02:37:41,185 AFRICA. 3526 02:37:41,251 --> 02:37:49,893 WE WILL THEN HAVE PHILLISTER 3527 02:37:49,960 --> 02:37:52,062 ADHIAMBO MADLEGA WHO WORKS 3528 02:37:52,129 --> 02:37:56,033 AS A SCIENTIST IN THE HIV 3529 02:37:56,099 --> 02:37:56,934 PREVENTION AND CLINICAL 3530 02:37:57,000 --> 02:37:58,669 RESEARCH TRIALS AND 3531 02:37:58,735 --> 02:38:00,938 CURRENTLY A COORDINATOR IN 3532 02:38:01,004 --> 02:38:11,181 THE COVID VACCINE PREVENTION 3533 02:38:11,248 --> 02:38:15,152 WORK COVID PM30008 STUDY. 3534 02:38:15,219 --> 02:38:22,459 SHE IS WORKING AS A HIV CURE 3535 02:38:22,526 --> 02:38:23,393 FELLOW -- 3536 02:38:23,460 --> 02:38:25,229 [INDISCERNIBLE] 3537 02:38:25,295 --> 02:38:28,599 THEN WE HAVE RICHARD 3538 02:38:28,665 --> 02:38:30,234 JEFFREYS AND HIS CURRENT 3539 02:38:30,300 --> 02:38:34,471 ROLE IS IN THE TREATMENT 3540 02:38:34,538 --> 02:38:39,676 ACTION GROUP, TAG, VACCINE 3541 02:38:39,743 --> 02:38:43,614 SCIENCE AND PROJECTS. 3542 02:38:43,680 --> 02:38:49,519 HIV FUNDING IN RESEARCH AND 3543 02:38:49,586 --> 02:38:54,524 ADVOCACY AND HIV LISTING OF 3544 02:38:54,591 --> 02:38:56,093 RELATED CURE STUDIES ON THE 3545 02:38:56,159 --> 02:38:57,327 TAG WEBSITE. 3546 02:38:57,394 --> 02:39:07,871 AND THEN WE HAVE Dr. AN 3547 02:39:08,872 --> 02:39:10,774 TONIA DORSAY, SECRETARY OF 3548 02:39:10,841 --> 02:39:19,783 THE INLAND EMPIRE PLANNING 3549 02:39:19,850 --> 02:39:22,252 COUNCIL, STUDIES CLINICAL 3550 02:39:22,319 --> 02:39:25,222 RESEARCH, FOUNDER OF 3551 02:39:25,289 --> 02:39:26,456 TRANS100 AND -- 3552 02:39:26,523 --> 02:39:26,924 [INDISCERNIBLE] 3553 02:39:26,990 --> 02:39:29,660 THIS IS A FABULOUS PANEL. 3554 02:39:29,726 --> 02:39:32,095 AND FOR ALL OF THOSE WISHING 3555 02:39:32,162 --> 02:39:33,230 TO INTERACT, JUST REMEMBER 3556 02:39:33,297 --> 02:39:36,400 YOU CAN POST ANY QUESTIONS 3557 02:39:36,466 --> 02:39:44,241 USING THE LIVE FEEDBACK THAT 3558 02:39:44,308 --> 02:39:53,283 YOU CAN SEE ON THE BOTTOM OF 3559 02:39:53,350 --> 02:39:55,652 YOUR SCREEN AND CAN ALSO 3560 02:39:55,719 --> 02:40:04,027 SUBMIT QUESTIONS AT 3561 02:40:04,094 --> 02:40:04,628 WOMENANDHIV@OD.NIH.GOV. 3562 02:40:04,695 --> 02:40:06,530 SO WE WILL START WITH THE 3563 02:40:06,596 --> 02:40:08,765 FIRST SPEAKER, Dr. SCULLY. 3564 02:40:08,832 --> 02:40:10,300 >> OKAY, THANKS FOR HAVING 3565 02:40:10,367 --> 02:40:11,368 ME HERE TODAY. 3566 02:40:11,435 --> 02:40:12,202 NEXT SLIDE. 3567 02:40:12,269 --> 02:40:13,704 JUST A SUMMARY OF WHAT I AM 3568 02:40:13,770 --> 02:40:18,642 GOING TO DISCUSS TODAY, THE 3569 02:40:18,709 --> 02:40:21,511 HIV PATHOGENESIS HAS MARKED 3570 02:40:21,578 --> 02:40:25,449 DIFFERENCES BASED ON SEX AND 3571 02:40:25,515 --> 02:40:27,751 THE EVIDENCE OF DIFFERENCES 3572 02:40:27,818 --> 02:40:33,623 IN HIV REGS SKY BETWEEN CIS 3573 02:40:33,690 --> 02:40:35,225 GENDER MEN AND WOMEN AND 3574 02:40:35,292 --> 02:40:39,262 THERE IS EMERGING EVIDENCE 3575 02:40:39,329 --> 02:40:41,898 THAT HIV RESERVOIR DYNAMICS 3576 02:40:41,965 --> 02:40:43,567 MAY BE INFLUENCED BY SEX 3577 02:40:43,633 --> 02:40:46,069 STEROID HORPL HONES AND 3578 02:40:46,136 --> 02:40:47,938 REPRODUCTIVE AGING. 3579 02:40:48,005 --> 02:40:49,072 NEXT SLIDE. 3580 02:40:49,139 --> 02:40:50,340 SO GENDER IS DIFFERENT AND 3581 02:40:50,407 --> 02:40:52,309 IS RELATED TO AN INTERNAL 3582 02:40:52,376 --> 02:40:54,644 SENSE OF SELF WITH THE CIS 3583 02:40:54,711 --> 02:40:56,646 GENDER AND WE HAVE MANY 3584 02:40:56,713 --> 02:40:58,115 DIFFERENT EXCEPTIONS IN 3585 02:40:58,181 --> 02:40:59,149 DIFFERENT CONTEXTS. 3586 02:40:59,216 --> 02:40:59,916 CRITICALLY, BOTH OF THESE 3587 02:40:59,983 --> 02:41:01,418 ARE VERY IMPORTANT FOR 3588 02:41:01,485 --> 02:41:03,153 HEALTH OUTCOME AND I THINK 3589 02:41:03,220 --> 02:41:04,888 ONE OF THE CHALLENGES AND 3590 02:41:04,955 --> 02:41:06,823 TRULY EVERY MEDICAL FIELD IN 3591 02:41:06,890 --> 02:41:08,558 SCIENCE IS TO BE VERY 3592 02:41:08,625 --> 02:41:11,194 PRECISE ABOUT WHAT QUESTIONS 3593 02:41:11,261 --> 02:41:13,397 WE'RE ASKING AND WA DATA WE 3594 02:41:13,463 --> 02:41:15,932 HAVE AVAILABLE TO SEE CAN 3595 02:41:15,999 --> 02:41:17,367 BETTER TAILOR WERE SREPBGSZ 3596 02:41:17,434 --> 02:41:19,069 AND TREATMENT BASED ON WHERE 3597 02:41:19,136 --> 02:41:20,570 WE HAVE GATHERED 3598 02:41:20,637 --> 02:41:21,204 INFORMATION. 3599 02:41:21,271 --> 02:41:22,406 HAVE WE GATHERED INFORMATION 3600 02:41:22,472 --> 02:41:23,807 RELATED TO SEX OR THOSE 3601 02:41:23,874 --> 02:41:25,776 RELATED TO GENDER? 3602 02:41:25,842 --> 02:41:27,077 BUT REGARDLESS, WHETHER OR 3603 02:41:27,144 --> 02:41:31,581 NOT WE ARE THINKING ABOUT 3604 02:41:31,648 --> 02:41:39,656 SEX OR GENDER, WE ARE ALL 3605 02:41:39,723 --> 02:41:43,026 HAVING HORMONES AND THEY MAY 3606 02:41:43,093 --> 02:41:46,430 NOT BE CONCORDANT WITH THOSE 3607 02:41:46,496 --> 02:41:46,797 AT BIRTH. 3608 02:41:46,863 --> 02:41:49,066 SO IT IS A VERY COMPLEX 3609 02:41:49,132 --> 02:41:51,902 SYSTEM AND THAT CAN BE A 3610 02:41:51,968 --> 02:41:53,603 DISINCENTIVE FOR SOME PEOPLE 3611 02:41:53,670 --> 02:41:54,771 IN TERMS OF RESEARCH BUT FOR 3612 02:41:54,838 --> 02:41:56,740 US IT IS THE MOST 3613 02:41:56,807 --> 02:41:57,874 INTERESTING PLACE TO BE 3614 02:41:57,941 --> 02:41:59,910 BECAUSE THERE ARE SO MANY 3615 02:41:59,976 --> 02:42:00,610 POSSIBILITIES AND 3616 02:42:00,677 --> 02:42:01,778 INTERESTING AVENUES TO 3617 02:42:01,845 --> 02:42:02,946 PURSUE. 3618 02:42:03,013 --> 02:42:03,413 SO NEXT SLIDE. 3619 02:42:03,480 --> 02:42:05,348 NEXT I WOULD LIKE TO TALK A 3620 02:42:05,415 --> 02:42:07,951 LITTLE BIT ABOUT THE 3621 02:42:08,018 --> 02:42:11,488 FRAMEWORK FOR CURATIVE 3622 02:42:11,555 --> 02:42:17,627 INTERVENTIONS AND YOU THIS 3623 02:42:17,694 --> 02:42:19,463 THEY FIT INTO THAT. 3624 02:42:19,529 --> 02:42:24,434 SO WE HAVE LATENCY AND ONE 3625 02:42:24,501 --> 02:42:27,737 WAY WE THINK OF TO CURE IS 3626 02:42:27,804 --> 02:42:29,873 TO BLOCK TRANSMISSION AND IF 3627 02:42:29,940 --> 02:42:31,775 WE BLOCK IT, IT DOESN'T 3628 02:42:31,842 --> 02:42:32,109 MATTER. 3629 02:42:32,175 --> 02:42:36,746 THIS IS A ROCK AND BLOCK 3630 02:42:36,813 --> 02:42:39,916 IMPACT WHERE HIV DOESN'T 3631 02:42:39,983 --> 02:42:42,119 PERSIST AND HAVE LITTLE 3632 02:42:42,185 --> 02:42:45,088 IMPACT ON THE PERSON 3633 02:42:45,155 --> 02:42:47,023 CARRYING IT. 3634 02:42:47,090 --> 02:42:49,759 BLOCKING HIV, WHAT IT DOES 3635 02:42:49,826 --> 02:42:51,128 IS POTENTIALLY BLOCK THE 3636 02:42:51,194 --> 02:42:52,295 RECOGNITION OF THAT CELL. 3637 02:42:52,362 --> 02:42:54,364 THERE IS AN INDICATION THE 3638 02:42:54,431 --> 02:42:56,500 CELL IS CARRYING HIV AND NO 3639 02:42:56,566 --> 02:42:57,968 REASON IT WOULD BE TARGETED 3640 02:42:58,034 --> 02:43:00,937 OR REMOVED BUT WHEN WE 3641 02:43:01,004 --> 02:43:03,073 ACTIVATE TRANSCRIPTION, WE 3642 02:43:03,140 --> 02:43:05,175 CAN IN THEORY IDENTIFY THAT 3643 02:43:05,242 --> 02:43:07,444 CELL AND REMOVE IT. 3644 02:43:07,511 --> 02:43:09,613 THEN THIS LEADS TO THE NEXT 3645 02:43:09,679 --> 02:43:12,582 RESPONSE WHICH IS AN MRNA 3646 02:43:12,649 --> 02:43:15,886 RESPONSE, THINKING ABOUT HOW 3647 02:43:15,952 --> 02:43:17,521 WE CAN THERAPEUTICALLY 3648 02:43:17,587 --> 02:43:19,289 ACTIVATE THE RESPONSE OF HIV 3649 02:43:19,356 --> 02:43:21,057 AND THAT IS ANOTHER ACTIVE 3650 02:43:21,124 --> 02:43:22,792 PART OF WORK ONGOING. 3651 02:43:22,859 --> 02:43:25,228 SO NOW WE WILL TRY TO 3652 02:43:25,295 --> 02:43:27,397 ADDRESS HIV THAT MIGHT BE 3653 02:43:27,464 --> 02:43:28,798 IMPACTFUL FOR EACH OF THESE 3654 02:43:28,865 --> 02:43:31,168 DIFFERENT PARTS OF THE 3655 02:43:31,234 --> 02:43:32,335 FRAMEWORK WHERE WE ARE 3656 02:43:32,402 --> 02:43:33,069 THINKING CURE. 3657 02:43:33,136 --> 02:43:37,240 SO THE NEXT SLIDE, MAYBE ONE 3658 02:43:37,307 --> 02:43:39,409 OF THE PRESSURE POINTS WHERE 3659 02:43:39,476 --> 02:43:44,781 GENDER MAY COME TO BEAR IS 3660 02:43:44,848 --> 02:43:47,384 PARTICULARLY THINKING OF HIV 3661 02:43:47,450 --> 02:43:53,256 LATENCY AND WAYS WE MAY 3662 02:43:53,323 --> 02:43:56,660 BLOCK IT WITH RNA 3663 02:43:56,726 --> 02:43:57,928 EXPRESSION, WOMEN TYPICALLY 3664 02:43:57,994 --> 02:44:00,063 HAVE A LOWER VIRAL LOAD AND 3665 02:44:00,130 --> 02:44:02,065 THIS DOES NOT PROTECT 3666 02:44:02,132 --> 02:44:02,766 AGAINST DISEASE PROGRESSION. 3667 02:44:02,832 --> 02:44:04,267 SO EVEN THOUGH A WOMAN'S 3668 02:44:04,334 --> 02:44:06,136 VIRAL LOAD IS LOWER, IT WILL 3669 02:44:06,203 --> 02:44:12,676 PROGRESS THE SAME AS A MAN 3670 02:44:12,742 --> 02:44:14,744 WITH A HIGHER VIRAL LOAD. 3671 02:44:14,811 --> 02:44:25,222 WE ALSO KNOW THERE IS LOWER 3672 02:44:25,288 --> 02:44:30,293 PLASMA RNA HIV PLUS LYMPH 3673 02:44:30,360 --> 02:44:32,629 NODE CELL. 3674 02:44:32,696 --> 02:44:34,831 WE ALSO KNOW THE IMMUNE 3675 02:44:34,898 --> 02:44:40,337 RESPONSE TO THE VIRUS IS A 3676 02:44:40,403 --> 02:44:42,639 LITTLE BIT TURNED ON AND 3677 02:44:42,706 --> 02:44:47,777 TEND TO BE MORE ROBUST AND 3678 02:44:47,844 --> 02:44:51,014 THEN TYPICALLY THERE IS 3679 02:44:51,081 --> 02:44:56,019 HIGHER IFN ALPHA PRODUCTION 3680 02:44:56,086 --> 02:44:58,855 PER HIV RNA STIMULATION. 3681 02:44:58,922 --> 02:45:00,490 SO THIS WAS TALKED ABOUT IN 3682 02:45:00,557 --> 02:45:03,693 THE LAST SESSION BY ALICIA 3683 02:45:03,760 --> 02:45:05,395 WHERE WOMEN WITH A LOWER 3684 02:45:05,462 --> 02:45:08,665 VIRAL LOAD AT THE BEGINNING 3685 02:45:08,732 --> 02:45:16,172 OF THE EPIDEMIC WAS NOT 3686 02:45:16,239 --> 02:45:20,443 STUDIED DUE TO THE 3687 02:45:20,510 --> 02:45:21,845 DIFFERENCE WITH MEN. 3688 02:45:21,911 --> 02:45:27,417 SO WHEN WE LOOK AT THERAPY, 3689 02:45:27,484 --> 02:45:32,289 ARE THERE DIFFERENCES IN THE 3690 02:45:32,355 --> 02:45:34,024 HIV RESERVOIR AND WHAT CAN 3691 02:45:34,090 --> 02:45:36,293 WE EXPECT IS HAPPENING? 3692 02:45:36,359 --> 02:45:40,930 WE DID A STUDY THAT INVOLVED 3693 02:45:40,997 --> 02:45:41,865 REPRODUCTIVE AGED MEN AND 3694 02:45:41,931 --> 02:45:43,033 WOMEN WHO HAD BEEN ON 3695 02:45:43,099 --> 02:45:45,001 TREATMENT FOR A DURATION OF 3696 02:45:45,068 --> 02:45:48,204 TIME BEFORE THEIR RESERVOIRS 3697 02:45:48,271 --> 02:45:49,506 GET STABILIZED AND LOOKED AT 3698 02:45:49,572 --> 02:45:50,907 A COUPLE OF FEATURES. 3699 02:45:50,974 --> 02:45:53,977 WHAT WE FOUND IS THERE WERE 3700 02:45:54,044 --> 02:45:57,580 LOWER LEVELS OF RESIDUAL 3701 02:45:57,647 --> 02:46:01,251 PLASMA BY SINGLE COPY ASSAY, 3702 02:46:01,318 --> 02:46:03,086 AND LOWER LEVELS OF PLASMA 3703 02:46:03,153 --> 02:46:04,487 VIRUS IN FEMALES IN OUR 3704 02:46:04,554 --> 02:46:05,755 STUDY AND THEN IN SEPARATE 3705 02:46:05,822 --> 02:46:10,327 WORKS WITH A COHORT IN 3706 02:46:10,393 --> 02:46:13,730 UGANDA, WE SAW THERE WERE 3707 02:46:13,797 --> 02:46:17,367 LOWER LEVELS OF INDUCIBLE 3708 02:46:17,434 --> 02:46:20,236 RESERVOIR EXPRESSION BY 3709 02:46:20,303 --> 02:46:20,904 QUANTITATIVE VIRAL OUTGROWTH 3710 02:46:20,970 --> 02:46:22,405 ASS AY IN WOMEN VERSUS MEN. 3711 02:46:22,472 --> 02:46:24,674 SO THAT IS ONE AREA WHERE WE 3712 02:46:24,741 --> 02:46:26,242 CAN EXPECT TO SEE 3713 02:46:26,309 --> 02:46:29,112 DIFFERENCES IN HOW TIGHTLY 3714 02:46:29,179 --> 02:46:33,016 HIV LATENCY IS CONTROLLED. 3715 02:46:33,083 --> 02:46:33,783 SO NEXT SLIDE. 3716 02:46:33,850 --> 02:46:35,985 THIS WILL ALSO TALK ABOUT 3717 02:46:36,052 --> 02:46:37,287 WHAT THE MECHANISMS WILL BE. 3718 02:46:37,354 --> 02:46:39,789 SO IF WE SUGGEST THERE ARE 3719 02:46:39,856 --> 02:46:40,957 DIFFERENCES IN RNA 3720 02:46:41,024 --> 02:46:42,158 EXPRESSION, CAN WE FIGURE 3721 02:46:42,225 --> 02:46:43,259 OUT WHY? 3722 02:46:43,326 --> 02:46:46,730 SO WE DID SOME STUDIES TO 3723 02:46:46,796 --> 02:46:57,307 SHOW THAT 17 BETAESTRODIAL 3724 02:46:59,442 --> 02:47:04,314 CIRCULATING IN WOMEN AND IF 3725 02:47:04,381 --> 02:47:06,082 WE TRIED TO SIMULATE TURNING 3726 02:47:06,149 --> 02:47:10,019 THAT ON IN THE PRESENCE OF 3727 02:47:10,086 --> 02:47:13,123 ESTRADIOL, WE BLOCKED THE 3728 02:47:13,189 --> 02:47:14,157 EXPRESSION OF RNA. 3729 02:47:14,224 --> 02:47:15,525 AND WE ALSO FOUND IF YOU 3730 02:47:15,592 --> 02:47:18,395 KNOCK DOWN THE EXPRESSION OF 3731 02:47:18,461 --> 02:47:22,065 THE RECEPTOR 1, WE CAN ALSO 3732 02:47:22,132 --> 02:47:24,434 ALTER THEIR HIV 3733 02:47:24,501 --> 02:47:25,502 TRANSCRIPTION IN CELL MODELS 3734 02:47:25,568 --> 02:47:27,704 AND IF YOU CAN ADVANCE AND 3735 02:47:27,771 --> 02:47:29,839 THEN ADVANCE AGAIN, AND THEN 3736 02:47:29,906 --> 02:47:34,944 WE ALSO SAW THAT THE 3737 02:47:35,011 --> 02:47:39,582 EXPRESSION INCREASES IN 3738 02:47:39,649 --> 02:47:41,151 MENOPAUSE AND THIS WAS PART 3739 02:47:41,217 --> 02:47:44,220 OF THE TALK WE HEARD 3740 02:47:44,287 --> 02:47:49,392 YESTERDAY BUT AGAIN SHOWS 3741 02:47:49,459 --> 02:47:50,627 THAT ESTRADIOL CAN IMPACT 3742 02:47:50,693 --> 02:47:52,262 LOWER THE LIFE CONTROL AND 3743 02:47:52,328 --> 02:47:55,932 MAY HAVE AN IMPACT ON HIV 3744 02:47:55,999 --> 02:47:56,866 RESERVOIR STABILITY. 3745 02:47:56,933 --> 02:47:59,736 SO THE NEXT SLIDE, THINKING 3746 02:47:59,803 --> 02:48:02,005 ABOUT HOW WE ARM OR LEVERAGE 3747 02:48:02,071 --> 02:48:03,206 OUR IMMUNE RESPONSE, THERE 3748 02:48:03,273 --> 02:48:04,707 ARE HIGHER RATES OF CONTROL 3749 02:48:04,774 --> 02:48:06,876 IN COHORT STUDIES THAT LOOK 3750 02:48:06,943 --> 02:48:08,511 AT FEMALES VERSUS MALES. 3751 02:48:08,578 --> 02:48:09,579 YOU CAN ADVANCE. 3752 02:48:09,646 --> 02:48:16,085 AND THEN WE ALSO SO HERE 3753 02:48:16,152 --> 02:48:19,689 WITH BEING IN SPONTANEOUS 3754 02:48:19,756 --> 02:48:20,757 CONTROL IS 1.5 PERCENT 3755 02:48:20,824 --> 02:48:22,392 HIGHER IN FEMALES THAN MEN 3756 02:48:22,459 --> 02:48:24,027 AND PARTICULARLY HIGHER WITH 3757 02:48:24,093 --> 02:48:24,928 AFRICAN-AMERICAN WOMEN. 3758 02:48:24,994 --> 02:48:27,330 AND THEN NEXT SLIDE. 3759 02:48:27,397 --> 02:48:29,766 AND WITH STUDIES WE DID, WE 3760 02:48:29,833 --> 02:48:30,900 LOOKED AT SPECIFIC GENES 3761 02:48:30,967 --> 02:48:32,936 THAT WERE ASSOCIATED WITH 3762 02:48:33,002 --> 02:48:36,239 VIRAL LOAD SETPOINT AND IN 3763 02:48:36,306 --> 02:48:39,442 FEMALES HAVING MALES, WE SAW 3764 02:48:39,509 --> 02:48:41,044 CHROMOSOME 19 THAT IMPACTED 3765 02:48:41,110 --> 02:48:43,646 THE VIRAL LOAD BUT ONLY IN 3766 02:48:43,713 --> 02:48:44,714 MALES AND NOT FEMALES. 3767 02:48:44,781 --> 02:48:46,316 SO THIS SHOWS US THERE IS A 3768 02:48:46,382 --> 02:48:48,485 DIFFERENCE IN CONTROL AND 3769 02:48:48,551 --> 02:48:49,853 THAT CHROMOSOMES MAY IMPACT 3770 02:48:49,919 --> 02:48:51,020 THE OVERALL VIRAL LOAD THAT 3771 02:48:51,087 --> 02:48:52,856 YOU HAVE IN ADDITION TO 3772 02:48:52,922 --> 02:48:55,525 OTHER DATA ABOUT SEX 3773 02:48:55,592 --> 02:48:56,159 HORMONES. 3774 02:48:56,226 --> 02:48:59,128 AND THEN FINALLY WE DID SEE 3775 02:48:59,195 --> 02:49:00,864 A COHORT IN REPRODUCTIVE MEN 3776 02:49:00,930 --> 02:49:05,602 THERE WERE A HIGHER LOAD OF 3777 02:49:05,668 --> 02:49:06,536 TESTOSTERONE MARKERS IN 3778 02:49:06,603 --> 02:49:12,709 MALES THAN IN FEMALES IN 3779 02:49:12,775 --> 02:49:14,577 THIS HIV TREATED SITUATION. 3780 02:49:14,644 --> 02:49:16,479 SO WHAT ARE THE OTHER NOVELS 3781 02:49:16,546 --> 02:49:17,280 IN THE FIELD? 3782 02:49:17,347 --> 02:49:20,116 I WILL JUST MENTION HERE, 3783 02:49:20,183 --> 02:49:21,718 THE SEX DIFFERENCES IN 3784 02:49:21,784 --> 02:49:27,857 TRANSMISSION BETWEEN MALE 3785 02:49:27,924 --> 02:49:29,559 AND FEMALE FETUSES, SEX 3786 02:49:29,626 --> 02:49:33,696 DIFFERENTIAL RATES OF 3787 02:49:33,763 --> 02:49:34,497 SPONTANEOUS VIROLOGIC 3788 02:49:34,564 --> 02:49:36,900 CONTROL IN EARLY LIFE AND 3789 02:49:36,966 --> 02:49:39,302 ACCUMULATION OF PRO-VIRUSES 3790 02:49:39,369 --> 02:49:40,436 IN SPECIFIC EPIGENETIC 3791 02:49:40,503 --> 02:49:41,704 REGIONS. 3792 02:49:41,771 --> 02:49:42,438 SO NEXT SLIDE. 3793 02:49:42,505 --> 02:49:45,842 SO WE HAVE TO ASK HOW THIS 3794 02:49:45,909 --> 02:49:46,876 AFFECTS EXPRESSIBILITY OVER 3795 02:49:46,943 --> 02:49:51,180 TIME, WE CAN USE THE SEX 3796 02:49:51,247 --> 02:49:52,682 DIFFERENCES TO ELUCIDATE 3797 02:49:52,749 --> 02:49:54,384 MECHANISMS OF VIRAL 3798 02:49:54,450 --> 02:49:55,184 REGULATION AND IMMUNE 3799 02:49:55,251 --> 02:49:57,186 CONTROL AND THEN HOW DO WE 3800 02:49:57,253 --> 02:50:00,823 CONSIDER ALL PEOPLE, CIS AND 3801 02:50:00,890 --> 02:50:02,458 TRANSGENDER, AND WEIGH THE 3802 02:50:02,525 --> 02:50:04,160 IMPACT OF BIOLOGICAL SEX IN 3803 02:50:04,227 --> 02:50:07,163 THE CONTEXT OF OTHER 3804 02:50:07,230 --> 02:50:07,530 FEATURES. 3805 02:50:07,597 --> 02:50:10,633 NEXT SLIDE. 3806 02:50:10,700 --> 02:50:12,035 SO WE HAVE TO CLEARLY BE 3807 02:50:12,101 --> 02:50:13,670 ABLE TO IDENTIFY THE 3808 02:50:13,736 --> 02:50:15,939 POPULATIONS THE DATA IS 3809 02:50:16,005 --> 02:50:18,341 APPLIED TO AND ALL FINDINGS 3810 02:50:18,408 --> 02:50:20,443 CAN BE APPLIED TO ALL 3811 02:50:20,510 --> 02:50:20,843 INDIVIDUALS. 3812 02:50:20,910 --> 02:50:21,244 NEXT SLIDE. 3813 02:50:21,311 --> 02:50:23,079 SO I WOULD LIKE TO THANK THE 3814 02:50:23,146 --> 02:50:25,381 PEOPLE WHO WORKED ON THE 3815 02:50:25,448 --> 02:50:27,016 STUDIES WITH ME, COMMUNITY 3816 02:50:27,083 --> 02:50:28,851 MEMBERS WHO HAVE BEEN MY 3817 02:50:28,918 --> 02:50:30,553 ADVOCATES AND HELPED ME 3818 02:50:30,620 --> 02:50:31,721 LEARN HOW TO EFFECTIVELY 3819 02:50:31,788 --> 02:50:33,256 WORK IN THIS SPACE AND 3820 02:50:33,323 --> 02:50:34,691 THANKS FOR THE OPPORTUNITY 3821 02:50:34,757 --> 02:50:35,391 TO BE HERE. 3822 02:50:35,458 --> 02:50:36,492 >> WONDERFUL, THANK YOU SO 3823 02:50:36,559 --> 02:50:36,926 MUCH. 3824 02:50:36,993 --> 02:50:39,095 AND AS A REMINDER FOR THE 3825 02:50:39,162 --> 02:50:41,130 AUDIENCE, PLEASE SUBMIT YOUR 3826 02:50:41,197 --> 02:50:43,499 QUESTIONS OR COMMENTS 3827 02:50:43,566 --> 02:50:45,435 THROUGH THE FEEDBACK AND WE 3828 02:50:45,501 --> 02:50:46,803 WILL ANSWER THEM ALL AT THE 3829 02:50:46,869 --> 02:50:47,070 END. 3830 02:50:47,136 --> 02:50:50,907 SO WE ARE GOING TO HAVE NOW 3831 02:50:50,974 --> 02:50:58,281 OUR NEXT SPEAKER AND THAT IS 3832 02:50:58,348 --> 02:50:59,382 Dr. DUBE. 3833 02:50:59,449 --> 02:51:00,650 >> THANKS SO MUCH TO THE OR 3834 02:51:00,717 --> 02:51:03,586 NICER FOR THIS ABILITY TO 3835 02:51:03,653 --> 02:51:04,854 PRESENT TODAY ON BEHAVIORAL 3836 02:51:04,921 --> 02:51:09,759 AND SOCIAL SCIENCES AND HIV 3837 02:51:09,826 --> 02:51:11,294 CURE-RELATED RESEARCH. 3838 02:51:11,361 --> 02:51:13,696 STAY OFF CAMERA BECAUSE MY 3839 02:51:13,763 --> 02:51:14,263 INTERNET IS UNSTABLE. 3840 02:51:14,330 --> 02:51:15,665 SO HERE IS WHAT I WOULD LIKE 3841 02:51:15,732 --> 02:51:21,704 TO TALK ABOUT IN THIS 3842 02:51:21,771 --> 02:51:22,505 SESSION. 3843 02:51:22,572 --> 02:51:26,275 WE NEED MORE RESEARCH AND 3844 02:51:26,342 --> 02:51:28,311 CLINICAL TRIAL DESIGNS FOR 3845 02:51:28,378 --> 02:51:28,645 WOMEN. 3846 02:51:28,711 --> 02:51:32,548 WE NEED TO CALL FOR 3847 02:51:32,615 --> 02:51:33,816 JUSTICE-INFORMED HIV CURE 3848 02:51:33,883 --> 02:51:35,752 RELATED TRIALS FOR 3849 02:51:35,818 --> 02:51:37,220 ANALYTICAL TREATMENT 3850 02:51:37,286 --> 02:51:39,255 INTERRUPTIONS OR ATI WHICH 3851 02:51:39,322 --> 02:51:41,124 WE WILL HEAR A LOT IN THIS 3852 02:51:41,190 --> 02:51:41,758 SESSION. 3853 02:51:41,824 --> 02:51:44,460 WE ALSO NEED TO CALL FOR 3854 02:51:44,527 --> 02:51:45,461 INTEGRATED COMPONENTS IN THE 3855 02:51:45,528 --> 02:51:47,997 TRIALS AND ALL THE REASONS 3856 02:51:48,064 --> 02:51:50,099 WE OUTLINE PARTICULARLY FOR 3857 02:51:50,166 --> 02:51:52,235 TRIAL OF ATI. 3858 02:51:52,301 --> 02:51:54,237 NEXT SLIDE. 3859 02:51:54,303 --> 02:51:56,105 THIS SLIDE SHOWS A 3860 02:51:56,172 --> 02:51:58,608 THEORETICAL FOUNDATION OF 3861 02:51:58,675 --> 02:52:00,410 FRAMEWORK AND BASIS FOR 3862 02:52:00,476 --> 02:52:03,513 RESEARCH WITH Dr. CINDY 3863 02:52:03,579 --> 02:52:04,914 GROSSMAN, WE OUTLINED THE 3864 02:52:04,981 --> 02:52:13,322 AGENDA FOR RESEARCH THAT 3865 02:52:13,389 --> 02:52:16,392 INTEGRATE SOCIAL BEHAVIORAL 3866 02:52:16,459 --> 02:52:19,128 RESEARCH FUNCTIONAL 3867 02:52:19,195 --> 02:52:20,830 FRAMEWORK TO HIV CURE 3868 02:52:20,897 --> 02:52:21,864 RESEARCH. 3869 02:52:21,931 --> 02:52:23,533 WE ALSO IDENTIFIED THE 3870 02:52:23,599 --> 02:52:26,102 FUNCTIONAL FRAMEWORK OF THE 3871 02:52:26,169 --> 02:52:27,804 RESEARCH AND OUTLINED THE 3872 02:52:27,870 --> 02:52:31,708 PRIDES TO ALIGN WITH BASIC, 3873 02:52:31,774 --> 02:52:34,143 BSSR, ELEMENTARYAL AND 3874 02:52:34,210 --> 02:52:38,081 INTEGRATED BSSR TO 3875 02:52:38,147 --> 02:52:40,349 STRENGTHEN HOW MANY PEOPLE 3876 02:52:40,416 --> 02:52:41,384 GET CLINICAL TRIALS. 3877 02:52:41,451 --> 02:52:42,085 AND NEXT SLIDE. 3878 02:52:42,151 --> 02:52:44,954 THERE HAVE BEEN A NUMBER OF 3879 02:52:45,021 --> 02:52:46,422 SURVEYS WITH WOMEN WHO 3880 02:52:46,489 --> 02:52:49,325 PARTICIPATE IN AND TAKE 3881 02:52:49,392 --> 02:52:51,461 RISKS FROM HIV CURE RESEARCH 3882 02:52:51,527 --> 02:52:52,729 AND WE FOUND SPECIFIC 3883 02:52:52,795 --> 02:52:54,097 DIFFERENCES BY SEX AND 3884 02:52:54,163 --> 02:52:54,797 GENDER. 3885 02:52:54,864 --> 02:52:58,901 WHEN WE LOOKED AT HOW PEOPLE 3886 02:52:58,968 --> 02:53:02,305 WITH HIV PERCEIVED RISK OR 3887 02:53:02,371 --> 02:53:04,674 TREATMENT, THE IMPACT ON 3888 02:53:04,741 --> 02:53:08,745 BONE OR MUSCLES, HAVING 3889 02:53:08,811 --> 02:53:11,547 CHILDREN AND ATI WAS 3890 02:53:11,614 --> 02:53:12,348 SIGNIFICANT FOR WOMEN. 3891 02:53:12,415 --> 02:53:14,517 WOMEN WERE IN GENERAL MORE 3892 02:53:14,584 --> 02:53:15,184 AVERSE TO PAIN. 3893 02:53:15,251 --> 02:53:17,553 WE ALSO FOUND WOMEN WERE 3894 02:53:17,620 --> 02:53:19,956 MORE CONCERNED ABOUT 3895 02:53:20,022 --> 02:53:23,860 BECOMING DETECTABLE FOR 3896 02:53:23,926 --> 02:53:24,193 HIV ATI. 3897 02:53:24,260 --> 02:53:25,561 WHEN ASKED ABOUT 3898 02:53:25,628 --> 02:53:29,766 PREFERENCES, THE LONG ACTING 3899 02:53:29,832 --> 02:53:31,534 TREATMENT AND HIV REMISSION. 3900 02:53:31,601 --> 02:53:35,371 WHEN WE GET INTO THE 3901 02:53:35,438 --> 02:53:42,111 DATABASE BY BENDER, MEN ARE 3902 02:53:42,178 --> 02:53:52,688 MORE LIKELY TO ENTER INTO 3903 02:53:56,993 --> 02:53:57,193 TREATMENT. 3904 02:53:57,260 --> 02:53:57,794 [ OFF AUDIO ] 3905 02:53:57,860 --> 02:54:01,164 -- ABLE TO INTEGRATE AND THE 3906 02:54:01,230 --> 02:54:02,498 TRIALS AND FOUND IMPORTANT 3907 02:54:02,565 --> 02:54:04,267 DIFFERENCES -- CAN YOU HEAR 3908 02:54:04,333 --> 02:54:04,700 ME? 3909 02:54:04,767 --> 02:54:06,068 >> NOW WE CAN, YES. 3910 02:54:06,135 --> 02:54:10,873 >> OKAY SO IN THE FIRST 3911 02:54:10,940 --> 02:54:15,011 TRIAL IMPLEMENTED ENTIRELY 3912 02:54:15,077 --> 02:54:19,448 WITH WOMEN IN THE U.S. WITH 3913 02:54:19,515 --> 02:54:20,616 Dr. LIEBERT, 3914 02:54:20,683 --> 02:54:21,751 CONSIDERATIONS FOR 3915 02:54:21,818 --> 02:54:23,252 INCROWSING RACIAL, ETHNIC 3916 02:54:23,319 --> 02:54:25,988 GENDER AND SEXUAL DIVERSITY 3917 02:54:26,055 --> 02:54:30,860 IN HIV CURE RELATED RESEARCH 3918 02:54:30,927 --> 02:54:37,533 WITH ANALYTICAL TREATMENT 3919 02:54:37,600 --> 02:54:47,610 INTERRUPTIONS OR ATI. 3920 02:54:47,677 --> 02:54:48,411 SO NEXT SLIDE. 3921 02:54:48,477 --> 02:54:48,978 NEXT SLIDE. 3922 02:54:49,045 --> 02:54:53,883 THIS WAS A STUDY INCREASING 3923 02:54:53,950 --> 02:54:55,585 THE MEANINGFUL -- 3924 02:54:55,651 --> 02:55:02,358 [ AUDIO CUTTING OUT ] 3925 02:55:02,425 --> 02:55:08,664 [ NEXT SLIDE PLEASE AND 3926 02:55:08,731 --> 02:55:12,068 ABLE TO IDENTIFY FACTORS OF 3927 02:55:12,134 --> 02:55:13,703 WOMEN WITH THEIR HOLISTIC 3928 02:55:13,769 --> 02:55:14,270 NEEDS. 3929 02:55:14,337 --> 02:55:21,811 THIS IS A STUDY BY Dr. 3930 02:55:21,878 --> 02:55:23,613 POTEAT ON TRANSGENDER WOMEN 3931 02:55:23,679 --> 02:55:25,948 ACROSS THE UNITED STATES. 3932 02:55:26,015 --> 02:55:34,757 NEXT SLIDE. 3933 02:55:34,824 --> 02:55:36,158 NEXT SLIDE. 3934 02:55:36,225 --> 02:55:36,559 NEXT SLIDE. 3935 02:55:36,626 --> 02:55:42,431 SO THIS IS A STUDY 3936 02:55:42,498 --> 02:55:44,967 IMPLEMENTED IN COLLABORATION 3937 02:55:45,034 --> 02:55:47,470 WITH FEMALE RISING THROUGH 3938 02:55:47,536 --> 02:55:49,105 EDUCATION SUPPORT AND HEALTH 3939 02:55:49,171 --> 02:55:51,707 IN SOUTH AFRICA, THE STUDY 3940 02:55:51,774 --> 02:55:57,680 OF YOUNG WOMEN AGE 18-24 AND 3941 02:55:57,747 --> 02:56:03,019 FOUR TIMES GREATER THAN MEN 3942 02:56:03,085 --> 02:56:05,922 AND PARTICIPATED IN THE 3943 02:56:05,988 --> 02:56:06,255 STUDY -- 3944 02:56:06,322 --> 02:56:10,126 [ AUDIO CUTTING OUT ] 3945 02:56:10,192 --> 02:56:13,663 >> I THINK WE'RE LOSING YOUR 3946 02:56:13,729 --> 02:56:17,500 AUDIO AGAIN. 3947 02:56:17,566 --> 02:56:18,200 >> -- PARTICULARLY ATI 3948 02:56:18,267 --> 02:56:19,835 TRIALS -- I AM SO SORRY, CAN 3949 02:56:19,902 --> 02:56:22,638 YOU HEAR ME NOW? 3950 02:56:22,705 --> 02:56:23,873 >> YES AND MELISSA, YOU MAY 3951 02:56:23,940 --> 02:56:25,808 WANT TO GO BACK TWO 3952 02:56:25,875 --> 02:56:28,344 SLIDES -- ONE SLIDE, THAT 3953 02:56:28,411 --> 02:56:29,545 ONE, YEAH. 3954 02:56:29,612 --> 02:56:32,014 >> AGAIN EXTREMELY SORRY FOR 3955 02:56:32,081 --> 02:56:34,150 MY AUDIO ISSUES. 3956 02:56:34,216 --> 02:56:35,751 WE HAVE EXTREMELY LIMITED 3957 02:56:35,818 --> 02:56:40,489 DATA ON MENTAL HEALTH ASPECT 3958 02:56:40,556 --> 02:56:50,032 IN CAN A CAN STUDY THROUGH 3959 02:56:50,099 --> 02:56:58,074 RISE WHERE WOMEN TRIALS TEND 3960 02:56:58,140 --> 02:57:00,810 TO BE INVOLVED IN STUDIES 3961 02:57:00,876 --> 02:57:03,012 AND HOPING TO CHANGE THIS 3962 02:57:03,079 --> 02:57:03,679 ISSUE BY 2024. 3963 02:57:03,746 --> 02:57:04,280 NEXT SLIDE. 3964 02:57:04,347 --> 02:57:07,717 SO WE ARE CURRENTLY 3965 02:57:07,783 --> 02:57:11,554 PARTNERING WITH Dr -- 3966 02:57:11,620 --> 02:57:12,922 [ NO AUDIO ] 3967 02:57:12,989 --> 02:57:23,532 >> WE'RE MISSING YOU AGAIN. 3968 02:57:24,433 --> 02:57:31,574 AND NOW WE LOST YOU 3969 02:57:31,640 --> 02:57:31,974 COMPLETELY. 3970 02:57:32,041 --> 02:57:33,309 MAYBE WE SHOULD MOVE ON TO 3971 02:57:33,376 --> 02:57:34,443 THE NEXT PRESENTATION AND 3972 02:57:34,510 --> 02:57:39,115 YOU CAN CALL BACK IN? 3973 02:57:39,181 --> 02:57:40,983 >> YEAH, LET'S DO THAT. 3974 02:57:41,050 --> 02:57:44,153 >> OKAY, SO THINGS HAPPEN. 3975 02:57:44,220 --> 02:57:54,730 SO WE WILL MOVE ON TO Dr. 3976 02:58:02,605 --> 02:58:03,372 CALER'S PRESENTATION. 3977 02:58:03,439 --> 02:58:04,206 NEXT SLIDE. 3978 02:58:04,273 --> 02:58:10,813 >> THANK YOU SO MUCH FOR 3979 02:58:10,880 --> 02:58:19,121 INVITING ME, I AM PHILISTER 3980 02:58:19,188 --> 02:58:19,455 MADIEGA. 3981 02:58:19,522 --> 02:58:24,994 AND I WOULD LIKE TO SAY THAT 3982 02:58:25,061 --> 02:58:35,604 TODAY THAT WOMEN WITH HIV IS 3983 02:58:40,910 --> 02:58:45,114 A PRIORITY AREA. 3984 02:58:45,181 --> 02:58:45,648 [INDISCERNIBLE] 3985 02:58:45,714 --> 02:58:49,418 I WOULD LIKE TO ALSO ENTER 3986 02:58:49,485 --> 02:58:52,588 THE NEED FOR COMMUNITY 3987 02:58:52,655 --> 02:58:54,924 IMPROVEMENT AND MOBILIZATION 3988 02:58:54,990 --> 02:59:02,231 OF FUNDAMENTALS TO ENSURE 3989 02:59:02,298 --> 02:59:07,636 THAT THIS QRE UPTICK IN 3990 02:59:07,703 --> 02:59:11,373 AFRICA AMONG THE MOVEMENT 3991 02:59:11,440 --> 02:59:17,113 AND TO ENSURE THAT WE HAVE 3992 02:59:17,179 --> 02:59:19,715 OPTIMAL PARTICIPATION FOR 3993 02:59:19,782 --> 02:59:21,717 AGREEMENT WHO BETTER TO 3994 02:59:21,784 --> 02:59:23,185 TREAT WITH HIV. 3995 02:59:23,252 --> 02:59:27,356 WE MUST ENSURE THAT 3996 02:59:27,423 --> 02:59:29,658 COMMUNITY ENGAGEMENT USING 3997 02:59:29,725 --> 02:59:31,360 THE CDC GUIDELINES, WE MUST 3998 02:59:31,427 --> 02:59:35,231 INCLUDE THAT WHEN WE TEST 3999 02:59:35,297 --> 02:59:39,435 THE WOMEN AND WE ARE 4000 02:59:39,502 --> 02:59:42,805 TRANSPARENTLY ENGAGING THEM 4001 02:59:42,872 --> 02:59:45,941 AND ALSO TRANSPARENCY WHEN 4002 02:59:46,008 --> 02:59:47,810 IT COMES TO THE LEVEL OF 4003 02:59:47,877 --> 02:59:50,212 RESEARCH WE ARE GOING TO 4004 02:59:50,279 --> 03:00:00,289 CONDUCT ON WOMEN IN AFRICA. 4005 03:00:00,356 --> 03:00:02,558 AND MOSTLY LOOK AT THE 4006 03:00:02,625 --> 03:00:03,492 COMMUNITY ENGAGEMENT PLANS 4007 03:00:03,559 --> 03:00:07,463 THAT WE HAVE, WE HAVE TO 4008 03:00:07,530 --> 03:00:11,967 ENSURE THAT WE ALSO -- 4009 03:00:12,034 --> 03:00:12,735 [INDISCERNIBLE] 4010 03:00:12,801 --> 03:00:14,470 -- AMONG DIFFERENT AND 4011 03:00:14,537 --> 03:00:17,873 DIVERSE COMMUNITIES THAT ARE 4012 03:00:17,940 --> 03:00:18,908 REPRESENTED, MUST INCLUDE 4013 03:00:18,974 --> 03:00:20,843 REPRESENTATION IN THE 4014 03:00:20,910 --> 03:00:24,013 COMMUNITY ADVISORY BOARD OF 4015 03:00:24,079 --> 03:00:30,619 WOMEN FROM DIFFERENT 4016 03:00:30,686 --> 03:00:31,053 POPULATIONS. 4017 03:00:31,120 --> 03:00:32,388 WE HAVE FEMALES IN THE 4018 03:00:32,454 --> 03:00:33,422 COMMUNITY, YOUNG WOMEN ALSO, 4019 03:00:33,489 --> 03:00:34,990 WE HAVE TO ENSURE THAT THEY 4020 03:00:35,057 --> 03:00:38,961 ARE THERE AND PARTICIPATING. 4021 03:00:39,028 --> 03:00:41,931 WE HAVE PUBLISHED AN 4022 03:00:41,997 --> 03:00:43,532 ADVISORY GROUP TO ENABLE 4023 03:00:43,599 --> 03:00:46,035 YOUNG WOMEN TO VOICE THEIR 4024 03:00:46,101 --> 03:00:51,473 ISSUE TO BE ADDRESSED AND BE 4025 03:00:51,540 --> 03:00:53,509 TAKEN UP ALSO. 4026 03:00:53,576 --> 03:00:56,879 WE ALSO ENSURE THAT WE LOOK 4027 03:00:56,946 --> 03:00:59,281 AT PARTICIPATION IN THE 4028 03:00:59,348 --> 03:01:02,685 COMMUNITY ENGAGEMENT SO THE 4029 03:01:02,751 --> 03:01:08,457 ADVOCACY WILL HELP US IN 4030 03:01:08,524 --> 03:01:11,493 ENSURING THAT GUIDELINES AND 4031 03:01:11,560 --> 03:01:12,661 DECISIONS AND -- 4032 03:01:12,728 --> 03:01:13,128 [INDISCERNIBLE] 4033 03:01:13,195 --> 03:01:18,234 WE HAVE TO ENSURE THAT WORK 4034 03:01:18,300 --> 03:01:20,736 IN THE COMMUNITY IS DONE 4035 03:01:20,803 --> 03:01:28,644 TOSURE THAT WOMEN ARE 4036 03:01:28,711 --> 03:01:30,246 INCLUDED IN RESEARCH. 4037 03:01:30,312 --> 03:01:30,879 THROUGH COMMUNITY 4038 03:01:30,946 --> 03:01:33,082 ENGAGEMENT, WE WILL BE ABLE 4039 03:01:33,148 --> 03:01:35,050 TO BUILD COHORTS AND 4040 03:01:35,117 --> 03:01:36,418 MOMENTUM AMONG THESE WOMEN 4041 03:01:36,485 --> 03:01:45,995 AND ALSO BUILD COLLABORATION 4042 03:01:46,061 --> 03:01:50,633 TO ENSURE WE ARE BEING 4043 03:01:50,699 --> 03:01:52,801 INCLUSIVE AND DISPARAGE NOT 4044 03:01:52,868 --> 03:01:54,403 BEING INCLUSIVE AND WOMEN 4045 03:01:54,470 --> 03:01:58,774 HAVE THE PERMISSION TO 4046 03:01:58,841 --> 03:02:01,277 PARTICIPATE IN THE PROCESS. 4047 03:02:01,343 --> 03:02:06,582 WE MUST ALSO ENSURE THAT 4048 03:02:06,649 --> 03:02:11,620 THERE IS STRUCTURAL 4049 03:02:11,687 --> 03:02:13,389 COMPATIBILITY WHEREBY WITH 4050 03:02:13,455 --> 03:02:14,990 THE RESPONSES THEY REQUIRE 4051 03:02:15,057 --> 03:02:25,601 FOR THEM TO MAKE A INFORMED 4052 03:02:28,370 --> 03:02:33,175 DECISION AND -- [ 4053 03:02:33,242 --> 03:02:36,111 INDISCERNIBLE ] WHEREBY THE 4054 03:02:36,178 --> 03:02:38,847 IDEA LEADS TO THE PRINCIPLES 4055 03:02:38,914 --> 03:02:41,183 THAT WE ARE HANDING UP. 4056 03:02:41,250 --> 03:02:43,986 AND THIS COULD BE DONE BY 4057 03:02:44,053 --> 03:02:45,454 LIVED EXPERIENCES AND WHAT 4058 03:02:45,521 --> 03:02:48,624 THEY FEEL. 4059 03:02:48,691 --> 03:02:55,230 THEY NEED TO BE CONSIDERED 4060 03:02:55,297 --> 03:02:58,500 IN THE PRINCIPLES AND ALSO 4061 03:02:58,567 --> 03:03:01,804 BE A CLEAR ACCESSIBILITY, 4062 03:03:01,870 --> 03:03:04,306 LIKE POSSESSION OF 4063 03:03:04,373 --> 03:03:08,344 MATERIALS, GROUPS OF WOMEN, 4064 03:03:08,410 --> 03:03:10,446 SOMETIMES YOUNG WOMEN TO 4065 03:03:10,512 --> 03:03:15,451 ENSURE THAT THE KIND OF 4066 03:03:15,517 --> 03:03:17,219 COMMUNITY EDUCATION IS 4067 03:03:17,286 --> 03:03:21,123 REALLY TO THEM AND CAN MAKE 4068 03:03:21,190 --> 03:03:26,862 A INFORMED CHOICE. 4069 03:03:26,929 --> 03:03:28,931 FOR COMMUNITY ENGAGEMENT 4070 03:03:28,997 --> 03:03:34,937 REALLY PLAYS AN INTEGRAL 4071 03:03:35,003 --> 03:03:36,872 ROLE FOR INSURING THE 4072 03:03:36,939 --> 03:03:38,474 COMMUNITY HEALTH SUCH AS 4073 03:03:38,540 --> 03:03:44,580 STERILIZATION AND ISSUES OF 4074 03:03:44,646 --> 03:03:47,149 CONTRACEPTION, THIS COULD BE 4075 03:03:47,216 --> 03:03:49,818 ADDRESSED RIGHT IN THEIR OWN 4076 03:03:49,885 --> 03:03:56,658 PLACE BEFORE THEY DECIDE TO 4077 03:03:56,725 --> 03:03:58,660 PARTICIPATE. 4078 03:03:58,727 --> 03:04:01,263 ALSO RELATED WOULD BE 4079 03:04:01,330 --> 03:04:05,100 PRINCIPLES OF STIGMA AND 4080 03:04:05,167 --> 03:04:07,903 ISOLATION TO BE ADDRESSED AT 4081 03:04:07,970 --> 03:04:12,641 A PARTICULAR POINT TO ENSURE 4082 03:04:12,708 --> 03:04:19,181 WOMEN REALLY BENEFIT FROM 4083 03:04:19,248 --> 03:04:20,449 THESE SPES PHYSICIAN TEASE 4084 03:04:20,516 --> 03:04:22,084 INSTEAD OF WOMEN NOT BEING 4085 03:04:22,151 --> 03:04:27,823 ABLE TO ENJOY THE FRUITS OF 4086 03:04:27,890 --> 03:04:31,693 RESEARCH BUT BEING STOUBGTD 4087 03:04:31,760 --> 03:04:33,328 INTIMATE SEXUAL VIOLENCE OR 4088 03:04:33,395 --> 03:04:43,806 WAITING FOR THE MALE 4089 03:04:44,006 --> 03:04:44,673 COUNTERPART AND FOR INSTANCE 4090 03:04:44,740 --> 03:04:51,914 IF A SITUATION WITH A STI, 4091 03:04:51,980 --> 03:04:56,318 HOW YOU TACKLE THESE WITH 4092 03:04:56,385 --> 03:05:01,957 OUR PARTNERS SO WE NEED TO 4093 03:05:02,024 --> 03:05:03,358 BEGIN TO REQUIRE OUR 4094 03:05:03,425 --> 03:05:09,932 PARTNERS TO GO FOR CONDOM. 4095 03:05:09,998 --> 03:05:14,169 AND ALSO WE WOULD LIKE TO 4096 03:05:14,236 --> 03:05:15,838 INFUSE THE LEVEL OF STIGMA 4097 03:05:15,904 --> 03:05:24,413 WHERE IF THE WOMAN IS 4098 03:05:24,480 --> 03:05:25,614 STRESSED, IF THERE ARE OTHER 4099 03:05:25,681 --> 03:05:27,916 MEN IN THE ROOM, SHE IS 4100 03:05:27,983 --> 03:05:35,057 ALREADY STRESSED AND WHEREBY 4101 03:05:35,123 --> 03:05:40,696 EVEN USING A RING, A MAN CAN 4102 03:05:40,762 --> 03:05:41,129 GO -- 4103 03:05:41,196 --> 03:05:41,897 [INDISCERNIBLE] 4104 03:05:41,964 --> 03:05:45,934 SO OTHER THINGS, YOU KNOW TO 4105 03:05:46,001 --> 03:05:48,003 REDUCE INFORMATION, WE CAN 4106 03:05:48,070 --> 03:05:51,540 USE COMMUNITY ENGAGEMENT TO 4107 03:05:51,607 --> 03:05:54,076 ADDRESS THESE CHALLENGES OF 4108 03:05:54,142 --> 03:06:00,849 LANGUAGE THAT LEADS TO 4109 03:06:00,916 --> 03:06:01,850 INFORMATION AND FOR 4110 03:06:01,917 --> 03:06:06,722 APARTMENTS PARTICIPANTS IN 4111 03:06:06,788 --> 03:06:12,928 THE PROCESS AND THAT COULD 4112 03:06:12,995 --> 03:06:14,897 INCLUDE JUST WOMEN BEING MET 4113 03:06:14,963 --> 03:06:20,335 IN A LANGUAGE THEY CAN 4114 03:06:20,402 --> 03:06:24,806 UNDERSTAND AND ACKNOWLEDGE 4115 03:06:24,873 --> 03:06:35,384 THAT WOMEN ARE DIFFERENT 4116 03:06:41,757 --> 03:06:43,258 MEMBERS. 4117 03:06:43,325 --> 03:06:53,802 SO THE ADDITIONAL LEVEL OF 4118 03:06:53,869 --> 03:06:55,871 STIGMA AND PROCESSES LEADING 4119 03:06:55,938 --> 03:06:57,806 TO DIFFERENCES IN WOMEN WITH 4120 03:06:57,873 --> 03:06:58,273 THAT. 4121 03:06:58,340 --> 03:07:01,076 AND COMMUNITY ENGAGEMENT 4122 03:07:01,143 --> 03:07:04,146 SHOULD BE THE FIRST DESIGN 4123 03:07:04,212 --> 03:07:08,984 OF THE PROTOCOL AND 4124 03:07:09,051 --> 03:07:11,019 INTEGRATION OF RESOURCE AND 4125 03:07:11,086 --> 03:07:21,597 PROVIDE SOLUTION IN TERMS 4126 03:07:25,834 --> 03:07:26,301 OF -- 4127 03:07:26,368 --> 03:07:26,768 [INDISCERNIBLE] 4128 03:07:26,835 --> 03:07:30,172 >> THANK YOU SO MUCH, 4129 03:07:30,238 --> 03:07:30,872 PHILISTER. 4130 03:07:30,939 --> 03:07:32,007 AS A REMINDER, WE WILL HAVE 4131 03:07:32,074 --> 03:07:34,509 QUESTIONS AT THE END SO FOR 4132 03:07:34,576 --> 03:07:36,912 THE AUDIENCE, PLEASE PUT 4133 03:07:36,979 --> 03:07:40,349 YOUR QUESTIONS IN THE 4134 03:07:40,415 --> 03:07:43,151 FEEDBACK TAB. 4135 03:07:43,218 --> 03:07:50,726 SO NOW WE HAVE KAREN BACK 4136 03:07:50,792 --> 03:07:53,195 AND SO I THOUGHT WE WERE TO 4137 03:07:53,261 --> 03:07:53,662 FINISH HER TALK. 4138 03:07:53,729 --> 03:07:57,165 AM I RIGHT IN THAT? 4139 03:07:57,232 --> 03:07:58,767 >> YES, SO MELISSA SHOULD BE 4140 03:07:58,834 --> 03:08:02,871 PULLING UP HER SLIDES FROM 4141 03:08:02,938 --> 03:08:04,239 EARLIER. 4142 03:08:04,306 --> 03:08:05,540 >> VERY GOOD. 4143 03:08:05,607 --> 03:08:09,511 KIN, WHENEVER -- KAREN, 4144 03:08:09,578 --> 03:08:14,983 WHENEVER YOU ARE READY. 4145 03:08:15,050 --> 03:08:15,651 >> IS SHE MUTED? 4146 03:08:15,717 --> 03:08:23,025 >> YEAH, I AM TRYING TO 4147 03:08:23,091 --> 03:08:23,992 UNMUTE HER. 4148 03:08:24,059 --> 03:08:27,429 BACK THERE YOU ALL HEAR ME? 4149 03:08:27,496 --> 03:08:30,966 YES, UNMUTE YOUR LAPTOP. 4150 03:08:31,033 --> 03:08:34,136 >> OH, KAREN, WHAT YOU NEED 4151 03:08:34,202 --> 03:08:36,405 TO DO IS PUT LIKE IF YOU 4152 03:08:36,471 --> 03:08:37,606 HAVE THE HEAD SET OPTION 4153 03:08:37,673 --> 03:08:39,975 WHEN YOU ARE ON THE LAPTOP, 4154 03:08:40,042 --> 03:08:42,144 I LEARNED THAT AS WELL. 4155 03:08:42,210 --> 03:08:43,912 IF YOU MUTE YOURSELF, IT IS 4156 03:08:43,979 --> 03:08:48,850 GOING TO -- WE CANNOT HEAR 4157 03:08:48,917 --> 03:08:49,117 YOU. 4158 03:08:49,184 --> 03:08:50,986 SO SHE HAS TO GO TO THE 4159 03:08:51,053 --> 03:08:56,758 MICROPHONE, THERE IS A 4160 03:08:56,825 --> 03:08:57,726 HEADSET OPTION. 4161 03:08:57,793 --> 03:08:58,026 BACK. 4162 03:08:58,093 --> 03:09:06,101 >> >>>: YOU ALL HEAR ME? 4163 03:09:06,168 --> 03:09:06,702 >> YES. 4164 03:09:06,768 --> 03:09:07,335 >> YES. 4165 03:09:07,402 --> 03:09:11,840 >> JUST AN INTERNET ISSUE, I 4166 03:09:11,907 --> 03:09:15,243 DEEPLY APOLOGIZE. 4167 03:09:15,310 --> 03:09:17,312 OKAY, SO I WILL ACTUALLY 4168 03:09:17,379 --> 03:09:20,215 EMPHASIZE SEVERAL POINTS 4169 03:09:20,282 --> 03:09:25,420 MADE BY PHILISTER INVOLVING 4170 03:09:25,487 --> 03:09:28,123 FEMALE RISING THROUGH 4171 03:09:28,190 --> 03:09:30,892 EDUCATION SUPPORT AND ARE 4172 03:09:30,959 --> 03:09:34,696 HEALTH COHORTS IN DURBAN AND 4173 03:09:34,763 --> 03:09:39,534 SOUTH AFRICA. 4174 03:09:39,601 --> 03:09:42,204 SO WE BELIEVE -- 4175 03:09:42,270 --> 03:09:52,714 >> UH-OH, WE LOST YOU, 4176 03:09:52,914 --> 03:09:53,415 KAREN. 4177 03:09:53,482 --> 03:09:53,882 >> SLIDE? 4178 03:09:53,949 --> 03:09:56,118 >> NO, NO, SORRY, LET'S GO 4179 03:09:56,184 --> 03:09:56,384 ON. 4180 03:09:56,451 --> 03:09:59,821 >> NEXT SLIDE. 4181 03:09:59,888 --> 03:10:00,722 NEXT SLIDE. 4182 03:10:00,789 --> 03:10:05,660 THIS SLIDE SHOWS OUR STUDY 4183 03:10:05,727 --> 03:10:08,230 DESIGN CURRENTLY WITH THE 4184 03:10:08,296 --> 03:10:10,432 FEMALE COHORT, WE ARE DOING 4185 03:10:10,499 --> 03:10:12,934 EIGHT STUDIES IN THE 4186 03:10:13,001 --> 03:10:14,002 PREVENTION TREATMENT FOR 4187 03:10:14,069 --> 03:10:15,504 CURE AND ACKNOWLEDGE THE 4188 03:10:15,570 --> 03:10:17,773 PARTNER PROTECTION PACKAGE 4189 03:10:17,839 --> 03:10:19,040 FOR HIV CURE RELATED 4190 03:10:19,107 --> 03:10:20,208 INDIVIDUALS AND THIS SHOWS 4191 03:10:20,275 --> 03:10:30,218 THE NEED FOR GREATER 4192 03:10:30,285 --> 03:10:31,920 ASSESSMENT AS KEY PARTNERS, 4193 03:10:31,987 --> 03:10:34,322 AND THEN THE LAST SLIDE WE 4194 03:10:34,389 --> 03:10:39,294 ARE CALLING FOR JUSTICE 4195 03:10:39,361 --> 03:10:40,996 REFORM. 4196 03:10:41,062 --> 03:10:46,134 SO AGAIN, SINCERE POLICY 4197 03:10:46,201 --> 03:10:49,571 APOLOGIES FOR ALL THESE 4198 03:10:49,638 --> 03:10:52,641 TECHNICAL DIFFICULTIES. 4199 03:10:52,707 --> 03:10:53,708 >> WELL, THANK YOU. 4200 03:10:53,775 --> 03:10:54,843 SO QUESTIONS AT THE END AND 4201 03:10:54,910 --> 03:11:02,250 WE WILL MOVE ON TO THE NEXT 4202 03:11:02,317 --> 03:11:02,584 SPEAKER. 4203 03:11:02,651 --> 03:11:03,885 GO AHEAD WHEN YOU ARE READY. 4204 03:11:03,952 --> 03:11:05,387 >> I WAS ON MUTE. 4205 03:11:05,453 --> 03:11:06,788 THANKS SO MUCH TO THE 4206 03:11:06,855 --> 03:11:08,290 ORGANIZERS FOR THE INVITE TO 4207 03:11:08,356 --> 03:11:10,358 PARTICIPATE IN THIS AMAZING 4208 03:11:10,425 --> 03:11:10,725 WORKSHOP. 4209 03:11:10,792 --> 03:11:16,064 I AM VERY GREATFUL GRATEFUL 4210 03:11:16,131 --> 03:11:17,199 TO BE HERE. 4211 03:11:17,265 --> 03:11:18,099 NEXT SLIDE. 4212 03:11:18,166 --> 03:11:21,837 I CAN GO PRETTY QUICKLY, THE 4213 03:11:21,903 --> 03:11:25,440 SLIDES ARE JUST A QUICK 4214 03:11:25,507 --> 03:11:27,042 SUMMARY OF WHAT I WILL TALK 4215 03:11:27,108 --> 03:11:29,244 ABOUT THE CURE RELATED 4216 03:11:29,311 --> 03:11:31,646 RESEARCH AND CIS AND 4217 03:11:31,713 --> 03:11:32,480 TRANSGENDER WOMEN ARE 4218 03:11:32,547 --> 03:11:33,081 UNDER-REPRESENTED AND I 4219 03:11:33,148 --> 03:11:34,549 THINK THIS IS SORT OF 4220 03:11:34,616 --> 03:11:36,751 STATING THE OBVIOUS A LITTLE 4221 03:11:36,818 --> 03:11:39,754 BIT BUT DISCLOSURE OF 4222 03:11:39,821 --> 03:11:40,455 PARTICIPANT DEMOGRAPHIC 4223 03:11:40,522 --> 03:11:41,590 INFORMATION IS REALLY 4224 03:11:41,656 --> 03:11:42,490 ESSENTIAL FOR TRACKING WHAT 4225 03:11:42,557 --> 03:11:42,924 IS HAPPENING. 4226 03:11:42,991 --> 03:11:44,593 ALTHOUGH I AM NOT GOING TO 4227 03:11:44,659 --> 03:11:46,294 TALK MUCH ABOUT THIS LAST 4228 03:11:46,361 --> 03:11:48,029 POINT BUT PERHAPS ONE THING 4229 03:11:48,096 --> 03:11:49,764 TO CONSIDER WHEN THERE IS A 4230 03:11:49,831 --> 03:11:53,535 LOT OF SMALL, YOU KNOW -- 4231 03:11:53,602 --> 03:11:55,270 STUDIES TEND TO BE SMALLER 4232 03:11:55,337 --> 03:11:57,806 AT THE MOMENT, PARTICULARLY 4233 03:11:57,873 --> 03:11:59,107 THE INTERVENTIONAL TRIALS 4234 03:11:59,174 --> 03:12:00,108 AND OPPORTUNITIES TO 4235 03:12:00,175 --> 03:12:01,309 AGGREGATE DATA AND SHARE 4236 03:12:01,376 --> 03:12:06,615 DATA TO TRY TO GET MORE 4237 03:12:06,681 --> 03:12:08,183 ROBUST ANALYSIS OF SUBSETS 4238 03:12:08,250 --> 03:12:08,717 OF PARTICIPANTS. 4239 03:12:08,783 --> 03:12:13,154 BUT I KNOW THIS CAN BE QUITE 4240 03:12:13,221 --> 03:12:14,122 TECHNICALLY AND LOGISTICALLY 4241 03:12:14,189 --> 03:12:15,290 CHALLENGING BUT MIGHT BE 4242 03:12:15,357 --> 03:12:16,258 SOMETHING TO CONSIDER. 4243 03:12:16,324 --> 03:12:16,892 NEXT SLIDE. 4244 03:12:16,958 --> 03:12:20,395 AND SO THERE HAS BEEN PAST 4245 03:12:20,462 --> 03:12:23,131 RESEARCH DONE SORT OF 4246 03:12:23,198 --> 03:12:24,399 LITERATURE REVIEWS FOR THE 4247 03:12:24,466 --> 03:12:33,208 PARTICIPATION OF WOMEN IN 4248 03:12:33,275 --> 03:12:43,118 HIV-CURE RELATED STUDIES. 4249 03:12:43,184 --> 03:12:45,754 JOHNSON AND HEITZEG 4250 03:12:45,820 --> 03:12:47,555 PUBLISHED THESE STUDIES 4251 03:12:47,622 --> 03:12:48,790 SHOWING ONLY 21 PERCENT OF 4252 03:12:48,857 --> 03:12:50,558 THE PARTICIPANTS IN THE 4253 03:12:50,625 --> 03:12:51,793 CLINICAL TRIALS WERE WOMEN. 4254 03:12:51,860 --> 03:12:52,193 NEXT SLIDE. 4255 03:12:52,260 --> 03:12:54,162 SO WHAT WE ARE TRYING TO DO 4256 03:12:54,229 --> 03:12:57,999 IS TRY TO TRACK THE 4257 03:12:58,066 --> 03:12:58,900 RESEARCH-CURE HAPPENING 4258 03:12:58,967 --> 03:13:00,201 USING CHILD REGISTER STRESS 4259 03:13:00,268 --> 03:13:03,171 AVAILABLE TO THE PUBLIC, 4260 03:13:03,238 --> 03:13:05,840 PARTICULARLY THE U.S. 4261 03:13:05,907 --> 03:13:06,975 CLINICAL TRIALS.GOV. 4262 03:13:07,042 --> 03:13:08,410 SO WE UPDATE THIS MONTHLY, 4263 03:13:08,476 --> 03:13:10,712 IT IS ONLINE AND A LOT OF 4264 03:13:10,779 --> 03:13:14,516 INFORMATION TO HANDLE SO IT 4265 03:13:14,582 --> 03:13:16,151 IS NOT ALWAYS PRESENTED IN 4266 03:13:16,217 --> 03:13:18,753 THE MOST IDEAL WAY BUT ALL 4267 03:13:18,820 --> 03:13:19,054 THERE. 4268 03:13:19,120 --> 03:13:21,856 THERE IS SO MUCH, WE TRY TO 4269 03:13:21,923 --> 03:13:23,959 ADD LINKS TO STUDIES AS WE 4270 03:13:24,025 --> 03:13:25,327 FIND OUT ABOUT THEM AS WELL 4271 03:13:25,393 --> 03:13:28,196 SO THE TRIALS ARE INCLUDED 4272 03:13:28,263 --> 03:13:30,765 IN THE LISTINGS BUT WE 4273 03:13:30,832 --> 03:13:33,301 PROPOSE TO PUBLISH WITH THE 4274 03:13:33,368 --> 03:13:34,069 UNPRESENTED RESULTS. 4275 03:13:34,135 --> 03:13:34,936 NEXT SLIDE. 4276 03:13:35,003 --> 03:13:37,472 AND WHAT THIS HAS ALLOWED US 4277 03:13:37,539 --> 03:13:39,975 TO DO IS EXTRACT WHEN IT IS 4278 03:13:40,041 --> 03:13:42,210 PRESENTED THE INFORMATION ON 4279 03:13:42,277 --> 03:13:43,979 THE DEMOGRAPHICS OF THE 4280 03:13:44,045 --> 03:13:44,779 STUDY PARTICIPANTS AS THESE 4281 03:13:44,846 --> 03:13:47,248 RESULTS FROM THE STUDIES 4282 03:13:47,315 --> 03:13:49,150 BECOME AVAILABLE. 4283 03:13:49,217 --> 03:13:52,153 SO IN 2022, WE CREATED THIS 4284 03:13:52,220 --> 03:13:54,556 BIG XL FILE OF ALL THE STUDY 4285 03:13:54,622 --> 03:14:03,698 RESULTS WE HAVE ADDED SINCE 4286 03:14:03,765 --> 03:14:05,633 THE BEGINNING OF 2018 TO 4287 03:14:05,700 --> 03:14:08,269 MAKE THAT ACCESSIBLE TO 4288 03:14:08,336 --> 03:14:09,904 PEOPLE FOLLOWING THE TOPIC. 4289 03:14:09,971 --> 03:14:10,438 NEXT SLIDE. 4290 03:14:10,505 --> 03:14:14,376 SO THIS IS A SUMMARY OF 4291 03:14:14,442 --> 03:14:20,582 WHERE WE ARE WITH THAT WORK 4292 03:14:20,648 --> 03:14:21,783 AND THE RECENT UPDATE. 4293 03:14:21,850 --> 03:14:23,118 I WON'T GO THROUGH ALL THE 4294 03:14:23,184 --> 03:14:26,087 NUMBERS AS YOU CAN SEE THEM 4295 03:14:26,154 --> 03:14:31,860 THERE BUT THEY SAY IT IS 142 4296 03:14:31,926 --> 03:14:40,869 TRIALS, BUT IT IS 132 IN 4297 03:14:40,935 --> 03:14:43,104 ADULT AND 9 WITH PEDIATRIC 4298 03:14:43,171 --> 03:14:44,639 AND CHILDREN BUT YOU CAN SEE 4299 03:14:44,706 --> 03:14:47,275 IT IS VERY FEW TRANSGENDER 4300 03:14:47,342 --> 03:14:49,344 MEN AND WOMEN AND STILL SOME 4301 03:14:49,411 --> 03:14:51,880 ISSUES AS YOU CAN SEE THERE 4302 03:14:51,946 --> 03:14:52,914 AROUND DEMO GRAPHIC 4303 03:14:52,981 --> 03:14:54,949 INFORMATION NOT BEING 4304 03:14:55,016 --> 03:14:57,986 RECORDED FOR SEX OR RACE 4305 03:14:58,053 --> 03:14:58,353 ETHNICITY. 4306 03:14:58,420 --> 03:14:58,753 NEXT SLIDE. 4307 03:14:58,820 --> 03:15:00,722 AND THEN I ALSO BROKE THIS 4308 03:15:00,789 --> 03:15:04,859 OUT TO GET A BIT MORE DETAIL 4309 03:15:04,926 --> 03:15:09,931 ON INTERVENTIONAL AND 4310 03:15:09,998 --> 03:15:12,600 OBSERVATIONAL STUDIES SO 4311 03:15:12,667 --> 03:15:13,835 INTERVENTIONAL IS 4312 03:15:13,902 --> 03:15:22,177 ADMINISTERED TO PEOPLE WHERE 4313 03:15:22,243 --> 03:15:23,111 OBSERVATIONAL IS JUST 4314 03:15:23,178 --> 03:15:24,846 PRESENTED TO THE STUDY AND 4315 03:15:24,913 --> 03:15:27,148 AS YOU CAN SEE INFORMATIONAL 4316 03:15:27,215 --> 03:15:33,421 IS MORE STARK WITH 4317 03:15:33,488 --> 03:15:35,590 11 PERCENT VERSUS 88 PERCENT 4318 03:15:35,657 --> 03:15:37,625 WITH REDUCTIONS IN 4319 03:15:37,692 --> 03:15:40,161 TRANSGENDER AND NONBINARY 4320 03:15:40,228 --> 03:15:40,495 PEOPLE. 4321 03:15:40,562 --> 03:15:42,730 THE FOOTNOTES REFLECT SOME 4322 03:15:42,797 --> 03:15:45,366 OF THE ISSUES REFLECTING NO 4323 03:15:45,433 --> 03:15:49,370 DATA AND THE WORK THAT JP 4324 03:15:49,437 --> 03:15:50,505 SPOKE ABOUT YESTERDAY WHERE 4325 03:15:50,572 --> 03:15:53,608 IF PEOPLE DON'T USE THE 4326 03:15:53,675 --> 03:15:54,976 TWO-STEP RECORDING OF BIRTH 4327 03:15:55,043 --> 03:15:56,811 AND CURRENT GENDER, IT CAN 4328 03:15:56,878 --> 03:16:02,750 LEAD THESE KIND OF GAPS 4329 03:16:02,817 --> 03:16:06,688 WHERE THE FENDERS -- 4330 03:16:06,754 --> 03:16:08,089 GENDERS CAN'T BE BROKEN OUT. 4331 03:16:08,156 --> 03:16:08,556 NEXT SLIDE. 4332 03:16:08,623 --> 03:16:12,660 AND THIS IS THE SAME 4333 03:16:12,727 --> 03:16:14,028 BREAKDOWN ON OBSERVATIONAL 4334 03:16:14,095 --> 03:16:16,464 STUDIES WITH THE 22 WE 4335 03:16:16,531 --> 03:16:20,235 TRACKED TO DATE AND THE 4336 03:16:20,301 --> 03:16:20,835 REPRESENTATION IS LIKE 4337 03:16:20,902 --> 03:16:23,505 DIFFERENT HERE WITH A 4338 03:16:23,571 --> 03:16:27,342 DECREASE IN CIS GENDER WOMEN 4339 03:16:27,408 --> 03:16:29,410 AT 20 PERCENT AND THEN NEXT 4340 03:16:29,477 --> 03:16:30,879 SLIDE. 4341 03:16:30,945 --> 03:16:31,813 THIS IS PEDIATRIC, 4342 03:16:31,880 --> 03:16:34,549 ADOLESCENT AND MORE OF THESE 4343 03:16:34,616 --> 03:16:37,418 STUDIES ARE HAPPENING 4344 03:16:37,485 --> 03:16:38,786 MULTINATIONALLY AS OPPOSED 4345 03:16:38,853 --> 03:16:43,525 TO THE AFRICAN STUDY, A 4346 03:16:43,591 --> 03:16:45,593 TRIAL STUDY AND THERE IS 4347 03:16:45,660 --> 03:16:47,962 ANOTHER TRIAL WITH HIV 4348 03:16:48,029 --> 03:16:50,832 INFECTION IN YOUNG PEOPLE 4349 03:16:50,899 --> 03:16:52,934 AGE 16-24 WHICH IS INCLUDED 4350 03:16:53,001 --> 03:16:53,668 HERE AS WELL. 4351 03:16:53,735 --> 03:16:54,102 NEXT SLIDE. 4352 03:16:54,169 --> 03:16:57,071 AND THEN THE LOCATION OF THE 4353 03:16:57,138 --> 03:16:59,374 STUDY GIVING A SENSE OF HOW 4354 03:16:59,440 --> 03:17:02,043 IT IS STILL SKEWED TO THE 4355 03:17:02,110 --> 03:17:07,782 U.S. AND NOT SO MUCH IN THE 4356 03:17:07,849 --> 03:17:08,716 GEOGRAPHIC LOCATIONS WHERE 4357 03:17:08,783 --> 03:17:11,786 THERE IS MORE HIV IN BLACK 4358 03:17:11,853 --> 03:17:12,086 WOMEN. 4359 03:17:12,153 --> 03:17:14,656 SO I THINK YOU CAN SEE THE 4360 03:17:14,722 --> 03:17:24,232 WE DO YO GRAPHIC -- 4361 03:17:24,299 --> 03:17:31,506 GEOGRAPHIC INFORMATION IS 4362 03:17:31,573 --> 03:17:33,775 STILL SKEWED, CIS GENDER 4363 03:17:33,841 --> 03:17:37,879 TRANSGENDER WOMEN ARE OFTEN 4364 03:17:37,946 --> 03:17:40,381 UNDER-REPRESENTED IN 4365 03:17:40,448 --> 03:17:42,584 RESEARCH PARTICULARLY 4366 03:17:42,650 --> 03:17:43,318 INTERVENTIONAL TRIALS, 4367 03:17:43,384 --> 03:17:45,186 GEOGRAPHIC DISTRIBUTION OF 4368 03:17:45,253 --> 03:17:47,655 STUDY SITES REMAIN LIMITED 4369 03:17:47,722 --> 03:17:51,459 AND SKEWED TO THE U.S., AND 4370 03:17:51,526 --> 03:17:51,993 NEXT SLIDE. 4371 03:17:52,060 --> 03:17:54,395 THE IMPORTANCE OF THIS WORK 4372 03:17:54,462 --> 03:17:56,297 FOR AIDS RESEARCH AND ALSO 4373 03:17:56,364 --> 03:18:03,938 THE BILL AND MELINDA GATES 4374 03:18:04,005 --> 03:18:05,873 FOUNDATION AND ELIZABETH 4375 03:18:05,940 --> 03:18:08,176 BARR AND I WANT TO THANK 4376 03:18:08,243 --> 03:18:08,876 RESEARCHERS AND TRIAL 4377 03:18:08,943 --> 03:18:11,079 SPONSORS WHO TAKE THE TIME 4378 03:18:11,145 --> 03:18:14,916 TO REGISTER THEIR CLINICAL 4379 03:18:14,983 --> 03:18:17,418 STUDIES AND ARE DILIGENT 4380 03:18:17,485 --> 03:18:18,753 ABOUT REPORTING PARTICIPANT 4381 03:18:18,820 --> 03:18:19,454 DEMOGRAPHICS BECAUSE THEY 4382 03:18:19,520 --> 03:18:20,488 ARE IMPORTANT. 4383 03:18:20,555 --> 03:18:22,257 THANK YOU SO MUCH. 4384 03:18:22,323 --> 03:18:22,924 >> THANK YOU. 4385 03:18:22,991 --> 03:18:33,534 AND WE ARE GOING TO MOVE TO 4386 03:18:38,339 --> 03:18:41,276 OUR LAST TALK WITH TONI. 4387 03:18:41,342 --> 03:18:42,777 >> HI EVERYONE, I DON'T HAVE 4388 03:18:42,844 --> 03:18:44,078 A SLIDE SHOW BUT I WANTED TO 4389 03:18:44,145 --> 03:18:47,048 BE LAST SO THE FIRST THING I 4390 03:18:47,115 --> 03:18:52,553 WILL REMIND YOU, THERE IS A 4391 03:18:52,620 --> 03:18:53,688 COMMON LINE HERE IN THIS 4392 03:18:53,755 --> 03:18:56,658 SESSION AND I THINK SOME OF 4393 03:18:56,724 --> 03:18:57,692 THE OTHER SESSIONS AND I 4394 03:18:57,759 --> 03:19:03,931 THINK WE CAN SUM IT UP AS 4395 03:19:03,998 --> 03:19:08,036 HELL -- HEALTH IS OTHER 4396 03:19:08,102 --> 03:19:08,369 PEOPLE. 4397 03:19:08,436 --> 03:19:09,871 THAT POINTS TO THE FACT WE 4398 03:19:09,937 --> 03:19:10,938 DON'T HAVE DATA AND THE DATA 4399 03:19:11,005 --> 03:19:12,907 WE HAVE IS NOT GOOD ENOUGH. 4400 03:19:12,974 --> 03:19:14,542 IT IS BAD DATA BECAUSE IT 4401 03:19:14,609 --> 03:19:16,344 DOESN'T PROVIDE US WITH THE 4402 03:19:16,411 --> 03:19:18,079 DEPTH OF INFORMATION, THE 4403 03:19:18,146 --> 03:19:19,213 FULL STRENGTH OF 4404 03:19:19,280 --> 03:19:20,782 UNDERSTANDING THAT WE NEED 4405 03:19:20,848 --> 03:19:23,217 BUT ALSO IT IS KIND OF A 4406 03:19:23,284 --> 03:19:24,252 CHALLENGE BECAUSE WE OFTEN 4407 03:19:24,319 --> 03:19:27,588 DON'T KNOW THE QUESTIONS WE 4408 03:19:27,655 --> 03:19:28,256 NEED TO ASK. 4409 03:19:28,323 --> 03:19:33,227 CURRENTLY I AM WORKING FOR A 4410 03:19:33,294 --> 03:19:34,896 COMPANY CALLED BIOS CLINICAL 4411 03:19:34,962 --> 03:19:35,563 RESEARCH AND WHAT IS 4412 03:19:35,630 --> 03:19:40,168 INTERESTING TO ME IS I WAS 4413 03:19:40,234 --> 03:19:40,868 LOOKING AT KARIM'S 4414 03:19:40,935 --> 03:19:42,136 PRESENTATION AND THERE WAS 4415 03:19:42,203 --> 03:19:44,105 ONE OF MY COWORKERS ON IT 4416 03:19:44,172 --> 03:19:45,440 AND I THOUGHT THAT WAS COOL 4417 03:19:45,506 --> 03:19:48,209 AS I HAVE HAD SITUATIONS 4418 03:19:48,276 --> 03:19:50,044 WITH KARIM IN OTHER AREAS. 4419 03:19:50,111 --> 03:19:51,779 AND THE THING IS THIS IS 4420 03:19:51,846 --> 03:19:53,247 STILL A SMALL COMMUNITY NO 4421 03:19:53,314 --> 03:19:54,849 MATTER HOW MUCH WE TRY TO 4422 03:19:54,916 --> 03:19:55,583 FORGET THAT. 4423 03:19:55,650 --> 03:19:56,818 THIS CONFERENCE IS AN IDEA 4424 03:19:56,884 --> 03:19:58,386 HOW SMALL IT IS, THERE ARE 4425 03:19:58,453 --> 03:19:59,487 SO MANY CONNECTIONS BETWEEN 4426 03:19:59,554 --> 03:20:02,924 US AND THOSE ARE ALL 4427 03:20:02,990 --> 03:20:03,858 INTERSECTIONS. 4428 03:20:03,925 --> 03:20:05,993 I AM A TRANSWOMAN WHO IS OF 4429 03:20:06,060 --> 03:20:07,495 MIXED RACE WHO HOLDS ON TO 4430 03:20:07,562 --> 03:20:09,263 ALL OF HER INDIVIDUAL 4431 03:20:09,330 --> 03:20:12,934 CATEGORIES AND LINES. 4432 03:20:13,000 --> 03:20:15,069 I AM BISEXUAL, A WIDOW, 4433 03:20:15,136 --> 03:20:16,537 GRANDMOTHER, A MOTHER, I AM 4434 03:20:16,604 --> 03:20:17,672 ALL OF THESE DIFFERENT 4435 03:20:17,739 --> 03:20:19,741 THINGS AND THE KEY TO IT IS 4436 03:20:19,807 --> 03:20:26,180 HOW DO YOU SLUICE ME UP 4437 03:20:26,247 --> 03:20:27,782 SLICE ME UP WHEN YOU ARE 4438 03:20:27,849 --> 03:20:28,516 DOING RESEARCH? 4439 03:20:28,583 --> 03:20:31,018 HOW DO WE LOOK INTO THAT? 4440 03:20:31,085 --> 03:20:32,420 WE ALREADY KNOW THE LOW 4441 03:20:32,487 --> 03:20:33,554 HANGING FRUIT IS GONE. 4442 03:20:33,621 --> 03:20:35,123 THIS IS NOT ABOUT THE EASY 4443 03:20:35,189 --> 03:20:36,624 RESEARCH, THIS IS ABOUT THE 4444 03:20:36,691 --> 03:20:38,192 DIFFICULT RESEARCH AND ABOUT 4445 03:20:38,259 --> 03:20:40,395 FINDING A CURE WHICH HAS 4446 03:20:40,461 --> 03:20:42,263 ALLUDED US FOR DECADES. 4447 03:20:42,330 --> 03:20:46,901 AND WE'RE FINDING OUT IN 4448 03:20:46,968 --> 03:20:48,970 SOME OF THIS MORE EVOLVED 4449 03:20:49,036 --> 03:20:50,671 RESEARCH SOME OF THE REASONS 4450 03:20:50,738 --> 03:20:51,873 THIS HAS BEEN ELUSIVE TO US 4451 03:20:51,939 --> 03:20:55,042 AND THAT IS THE 4452 03:20:55,109 --> 03:20:56,544 PRESUPPOSITIONS AND INHERENT 4453 03:20:56,611 --> 03:20:58,880 BIASES WITH OUR OWN SYSTEMS 4454 03:20:58,946 --> 03:20:59,414 ARE LIMITING US. 4455 03:20:59,480 --> 03:21:01,015 THIS CONFERENCE IS TRYING TO 4456 03:21:01,082 --> 03:21:03,117 BREAK DOWN SOME OF THOSE, TO 4457 03:21:03,184 --> 03:21:07,088 USE THE DATA TO SHOW THAT. 4458 03:21:07,155 --> 03:21:11,159 THE CATCH IS THAT, A COMMON 4459 03:21:11,225 --> 03:21:11,959 REFRAIN FROM MANY OF THE 4460 03:21:12,026 --> 03:21:13,127 PRESENTATIONS I HAVE HEARD 4461 03:21:13,194 --> 03:21:16,898 THE LAST FEW DAYS, WE DON'T 4462 03:21:16,964 --> 03:21:19,367 HAVE GOOD DEMOGRAPHICS SO I 4463 03:21:19,434 --> 03:21:21,102 WILL DRIVE HOME HOW TRUE 4464 03:21:21,169 --> 03:21:21,436 THAT IS. 4465 03:21:21,502 --> 03:21:26,174 EVERY SLIDE I HAVE SEEN THAT 4466 03:21:26,240 --> 03:21:32,113 HAS US IN IT ARE TRANSWOMEN, 4467 03:21:32,180 --> 03:21:33,681 TRANSMEN AND NONBINARY. 4468 03:21:33,748 --> 03:21:35,249 THERE ARE THOUSANDS OF 4469 03:21:35,316 --> 03:21:37,452 BINARY ENTITIES. 4470 03:21:37,518 --> 03:21:38,820 IN THE AREA THAT I WORK, 4471 03:21:38,886 --> 03:21:40,121 THERE ARE ONLY SEVEN THAT 4472 03:21:40,188 --> 03:21:40,888 ARE COMMON. 4473 03:21:40,955 --> 03:21:41,989 IN AN AREA IN A DIFFERENT 4474 03:21:42,056 --> 03:21:43,357 PART OF THE UNITED STATES, 4475 03:21:43,424 --> 03:21:46,060 THERE MIGHT BE ONLY FOUR. 4476 03:21:46,127 --> 03:21:48,529 IN AN AREA IN BRAZIL, THERE 4477 03:21:48,596 --> 03:21:50,097 MIGHT BE 12. 4478 03:21:50,164 --> 03:21:51,933 IT ALL DEPENDS, BUT IF WE 4479 03:21:51,999 --> 03:21:53,568 CONTINUE TO ONLY USE THESE 4480 03:21:53,634 --> 03:21:55,069 THREE CATEGORIES, WHAT WE'RE 4481 03:21:55,136 --> 03:21:58,072 GOING TO END UP WITH IS THE 4482 03:21:58,139 --> 03:22:00,007 SAME CHALLENGE FOR JUST THAT 4483 03:22:00,074 --> 03:22:01,609 SMALL PORTION OF NONBINARY 4484 03:22:01,676 --> 03:22:02,777 INDIVIDUALS THAT WE DEAL 4485 03:22:02,844 --> 03:22:09,517 WITH WHEN WE TALK ABOUT THE 4486 03:22:09,584 --> 03:22:10,551 TRANSAND CIS GENDER 4487 03:22:10,618 --> 03:22:12,453 ENVIRONMENT IT IS. 4488 03:22:12,520 --> 03:22:14,489 THAT WON'T WORK AND WHAT WE 4489 03:22:14,555 --> 03:22:15,823 WANT TO REPORT. 4490 03:22:15,890 --> 03:22:18,493 WHEN ASKED TO SUBMIT OUR 4491 03:22:18,559 --> 03:22:20,228 FINDINGS, WE'RE ASKED TO 4492 03:22:20,294 --> 03:22:22,663 SUBMIT THEM IN A FORMAT 4493 03:22:22,730 --> 03:22:23,865 WHERE THE CATEGORIES ARE 4494 03:22:23,931 --> 03:22:25,566 OFTEN MORE NARROW THAN THE 4495 03:22:25,633 --> 03:22:27,201 STUFF WE USE IN COLLECTING 4496 03:22:27,268 --> 03:22:27,568 THE DATA. 4497 03:22:27,635 --> 03:22:29,203 THAT IS WHY WE NEED TO MAKE 4498 03:22:29,270 --> 03:22:32,073 SURE WHAT WE REPORT IS FULLY 4499 03:22:32,139 --> 03:22:37,645 DEM O NSTRATIVE TO THE 4500 03:22:37,712 --> 03:22:38,679 INFORMATION WE HAVE 4501 03:22:38,746 --> 03:22:39,080 COLLECTED. 4502 03:22:39,146 --> 03:22:40,615 WHAT IS INTERESTING IS WE 4503 03:22:40,681 --> 03:22:41,649 DON'T MENTION THINGS LIKE 4504 03:22:41,716 --> 03:22:44,318 ZERO AND WHEN WE ARE DOING A 4505 03:22:44,385 --> 03:22:45,920 LARGER STUDY, YOU CAN 4506 03:22:45,987 --> 03:22:46,787 INCLUDE ZERO IF THERE IS 4507 03:22:46,854 --> 03:22:49,957 ZERO IN THERE FOR ALL THE 4508 03:22:50,024 --> 03:22:50,758 DIFFERENT DEMOGRAPHIC 4509 03:22:50,825 --> 03:22:52,393 STRUCTURES WE USE, WE KNOW 4510 03:22:52,460 --> 03:22:53,261 WE'RE REPORTING ABOUT A 4511 03:22:53,327 --> 03:22:54,362 PARTICULAR THING. 4512 03:22:54,428 --> 03:22:55,496 AND THAT MATTERS BECAUSE 4513 03:22:55,563 --> 03:22:57,231 THAT WAY WE CAN SEE WHERE 4514 03:22:57,298 --> 03:22:59,333 OUR GAPS ARE AND A LOT OF 4515 03:22:59,400 --> 03:23:00,768 WHAT WE'RE DEALING WITH IS 4516 03:23:00,835 --> 03:23:03,804 TRYING TO IDENTIFY THE AREAS 4517 03:23:03,871 --> 03:23:04,939 WE WEREN'T SUCCESSFUL IN 4518 03:23:05,006 --> 03:23:07,808 BECAUSE IN A LOT OF CASES 4519 03:23:07,875 --> 03:23:11,412 THE POPULATIONS WE'RE 4520 03:23:11,479 --> 03:23:15,383 ATTEMPTING TO ADDRESS, 4521 03:23:15,449 --> 03:23:16,284 WOMEN, TRANSINDIVIDUALS, 4522 03:23:16,350 --> 03:23:18,386 PERSONS OF COLOR, VARIANCES 4523 03:23:18,452 --> 03:23:21,122 IN SEX DEVELOPMENT, ALL OF 4524 03:23:21,188 --> 03:23:21,756 THESE DIFFERENT ELEMENTS, 4525 03:23:21,822 --> 03:23:24,625 ONE OF THE THINGS WE NEED TO 4526 03:23:24,692 --> 03:23:26,594 UNDERSTAND IS HOW DO YOU 4527 03:23:26,661 --> 03:23:29,063 SURVEIL A POPULATION THAT IS 4528 03:23:29,130 --> 03:23:29,897 IN HIDING? 4529 03:23:29,964 --> 03:23:30,865 IN THE SOUTHERN UNITED 4530 03:23:30,932 --> 03:23:33,534 STATES RIGHT NOW, THERE'S A 4531 03:23:33,601 --> 03:23:35,770 TREMENDOUS AMOUNT OF FEAR 4532 03:23:35,836 --> 03:23:37,271 AND TERROR THAT IS ABOVE AND 4533 03:23:37,338 --> 03:23:42,143 BEYOND WHAT WE WOULD 4534 03:23:42,209 --> 03:23:44,579 NORMALLY SEE BECAUSE OF A 4535 03:23:44,645 --> 03:23:45,980 GENERALIZED HOSTILITY THAT 4536 03:23:46,047 --> 03:23:46,514 IS BEING ENGAGED. 4537 03:23:46,581 --> 03:23:48,749 THIS IS NOT THE ONLY COUNTRY 4538 03:23:48,816 --> 03:23:49,383 DEALING WITH THAT. 4539 03:23:49,450 --> 03:23:51,485 ONE OF THE ELEMENTS THAT IS 4540 03:23:51,552 --> 03:23:53,020 IMPORTANT TO THAT IS IF YOU 4541 03:23:53,087 --> 03:23:54,355 CAN'T REACH THEM, YOU CAN'T 4542 03:23:54,422 --> 03:23:55,890 TALK TO THEM AND IF YOU 4543 03:23:55,957 --> 03:23:58,025 CAN'T TALK TO THEM YOU CAN'T 4544 03:23:58,092 --> 03:23:59,327 MAKE IT ABOUT THEM AND IF 4545 03:23:59,393 --> 03:24:00,628 YOU CAN'T MAKE IT ABOUT 4546 03:24:00,695 --> 03:24:01,696 THEM, YOU WILL NEVER GET 4547 03:24:01,762 --> 03:24:03,497 THEM INVOLVED AND THE CORE 4548 03:24:03,564 --> 03:24:04,899 ELEMENT OFTEN USED TO SPEAK 4549 03:24:04,966 --> 03:24:06,701 TO THIS IS NOTHING ABOUT US 4550 03:24:06,767 --> 03:24:07,201 WITHOUT US. 4551 03:24:07,268 --> 03:24:08,803 THE PROBLEM IS YOU CAN'T GET 4552 03:24:08,869 --> 03:24:10,571 TO THEM TO START GETTING 4553 03:24:10,638 --> 03:24:11,939 SOMETHING ABOUT THEM UNLESS 4554 03:24:12,006 --> 03:24:14,075 YOU KNOW WHO AND WHERE THEY 4555 03:24:14,141 --> 03:24:14,342 ARE. 4556 03:24:14,408 --> 03:24:18,879 ONE OF THE POINTS RAISED UP 4557 03:24:18,946 --> 03:24:22,149 EARLIER IS YOU HAVE TO 4558 03:24:22,216 --> 03:24:22,950 INCORPORATE SOCIAL AND 4559 03:24:23,017 --> 03:24:25,152 BEHAVIORAL SYSTEMS AND 4560 03:24:25,219 --> 03:24:26,721 UNDERSTANDING OF THE SCIENCE 4561 03:24:26,787 --> 03:24:27,655 AROUND THOSE ELEMENTS. 4562 03:24:27,722 --> 03:24:28,990 SHE WAS POINTING OUT HOW 4563 03:24:29,056 --> 03:24:33,227 IMPORTANT IT WAS FOR ATIS. 4564 03:24:33,294 --> 03:24:35,696 I WILL TELL YOU IT IS 4565 03:24:35,763 --> 03:24:36,497 IMPORTANT FOR STUDY DESIGN 4566 03:24:36,564 --> 03:24:38,165 AND TO BE ABLE TO REACH 4567 03:24:38,232 --> 03:24:38,499 PEOPLE. 4568 03:24:38,566 --> 03:24:39,900 YOU CAN'T REACH PEOPLE 4569 03:24:39,967 --> 03:24:41,936 UNLESS YOU REACH THEM WHERE 4570 03:24:42,003 --> 03:24:44,338 THEY LIVE AND UNDERSTAND 4571 03:24:44,405 --> 03:24:45,373 THEIR DEMOGRAPHICS AND THAT 4572 03:24:45,439 --> 03:24:48,809 MEANS YOU WILL NEVER BE ABLE 4573 03:24:48,876 --> 03:24:49,543 TO IDENTIFY THOSE. 4574 03:24:49,610 --> 03:24:52,179 IN CASES YOU WILL NEVER BE 4575 03:24:52,246 --> 03:24:53,447 ABLE TO IDENTIFY THE 4576 03:24:53,514 --> 03:24:54,482 ENVIRONMENTS WHERE THEY 4577 03:24:54,548 --> 03:24:54,815 EXIST. 4578 03:24:54,882 --> 03:24:56,450 ONE OF THE REASONS WHY 4579 03:24:56,517 --> 03:25:01,288 RESEARCH HAS BEEN SO 4580 03:25:01,355 --> 03:25:02,923 SUCCESSFUL IN GAINING OUR 4581 03:25:02,990 --> 03:25:05,960 TEAM IS WOMEN. 4582 03:25:06,027 --> 03:25:06,627 NOT ENTIRELY WOMEN, I DON'T 4583 03:25:06,694 --> 03:25:07,962 WANT ANYONE TO FEEL LIKE HE 4584 03:25:08,029 --> 03:25:09,463 IS BEING LEFT OUT BUT THAT 4585 03:25:09,530 --> 03:25:11,432 IS ONE OF OUR BENEFITS, 4586 03:25:11,499 --> 03:25:12,566 TRADITIONALLY WE ARE WOMEN 4587 03:25:12,633 --> 03:25:13,934 OF COLOR AND THAT MEANS WE 4588 03:25:14,001 --> 03:25:15,670 ARE ABLE TO IDENTIFY THINGS 4589 03:25:15,736 --> 03:25:17,438 FROM OUR OWN PERSONAL 4590 03:25:17,505 --> 03:25:19,874 EXPERIENCE WHEN LOOKING AT A 4591 03:25:19,940 --> 03:25:21,342 PERSONAL STUDY THAT ALLOW US 4592 03:25:21,409 --> 03:25:23,210 TO CONVERT AND CHANGE STUDY 4593 03:25:23,277 --> 03:25:24,945 METRICS INTO THE REALITY OF 4594 03:25:25,012 --> 03:25:26,747 LIFE BECAUSE THERE IS A 4595 03:25:26,814 --> 03:25:28,315 DIVISION THERE, TWO THOSE 4596 03:25:28,382 --> 03:25:29,116 TWO THINGS. 4597 03:25:29,183 --> 03:25:30,418 THAT MEANS ALSO THAT IF YOU 4598 03:25:30,484 --> 03:25:31,819 ARE GOING TO REACH SOMEBODY, 4599 03:25:31,886 --> 03:25:34,188 YOU HAVE TO REACH THEM IN A 4600 03:25:34,255 --> 03:25:36,924 MANNER THAT BENEFITS THEM. 4601 03:25:36,991 --> 03:25:38,826 OFTENTIMES WE ARE TALKING TO 4602 03:25:38,893 --> 03:25:39,894 COMMUNITIES WHERE THERE IS 4603 03:25:39,960 --> 03:25:42,530 ARE A DEEP LEVEL OF MEDICAL 4604 03:25:42,596 --> 03:25:44,965 MISTRUST SUCH AS OH, WELL, 4605 03:25:45,032 --> 03:25:45,599 WOMEN GET HYSTERICAL AND 4606 03:25:45,666 --> 03:25:48,502 THAT IS THE CAUSE OF YOUR 4607 03:25:48,569 --> 03:25:51,372 PROBLEM. 4608 03:25:51,439 --> 03:25:53,708 OR TRANSWOMEN IN THE PROCESS 4609 03:25:53,774 --> 03:25:55,876 OF CHANGING, HOW CAN WE 4610 03:25:55,943 --> 03:25:57,044 STUDY THEM BEFORE AND DURING 4611 03:25:57,111 --> 03:25:58,879 AND AFTER THE CHANGE WHEN 4612 03:25:58,946 --> 03:26:00,247 THEY ARE ON HORMONES BECAUSE 4613 03:26:00,314 --> 03:26:03,217 THAT IS A STUDY WE DON'T 4614 03:26:03,284 --> 03:26:04,151 HAVE ENOUGH DATA ON THE 4615 03:26:04,218 --> 03:26:04,752 DIFFERENCES OF. 4616 03:26:04,819 --> 03:26:06,687 AND WE ALL KNOW THERE IS A 4617 03:26:06,754 --> 03:26:09,924 DIFFERENCE IN A TRANSWOMAN, 4618 03:26:09,990 --> 03:26:14,895 BETWEEN A CIS MAN AND CIS 4619 03:26:14,962 --> 03:26:17,198 WOMAN TO A TRANSWOMAN BEFORE 4620 03:26:17,264 --> 03:26:19,266 ANY CHANGES HAVE BEEN TAKEN 4621 03:26:19,333 --> 03:26:20,634 ON BY THAT WOMAN. 4622 03:26:20,701 --> 03:26:22,269 WE DON'T KNOW IF THERE IS A 4623 03:26:22,336 --> 03:26:24,472 DIFFERENCE TWO THOSE FOUR 4624 03:26:24,538 --> 03:26:25,506 GROUPINGS IN NONBINARY 4625 03:26:25,573 --> 03:26:25,840 PEOPLE. 4626 03:26:25,906 --> 03:26:27,208 WE DON'T HAVE ENOUGH DATA 4627 03:26:27,274 --> 03:26:28,976 AND WILL NOT BE ABLE TO PICK 4628 03:26:29,043 --> 03:26:32,279 THE RIGHT QUESTIONS TO ASK. 4629 03:26:32,346 --> 03:26:33,781 NOW, IF YOU ARE TRYING TO 4630 03:26:33,848 --> 03:26:34,915 REACH COMMUNITY AND TRYING 4631 03:26:34,982 --> 03:26:36,584 TO BREAK INTO A COMMUNITY, 4632 03:26:36,650 --> 03:26:37,685 THE THING THAT IS MOST 4633 03:26:37,752 --> 03:26:38,486 IMPORTANT TO UNDERSTAND IS 4634 03:26:38,552 --> 03:26:40,187 THAT YOU ARE GOING TO HAVE 4635 03:26:40,254 --> 03:26:42,256 RISKS WHEN IT COMES TO 4636 03:26:42,323 --> 03:26:43,624 DEALING WITH THAT COMMUNITY 4637 03:26:43,691 --> 03:26:46,627 IF IN ANY WAY, SHAPE OR FORM 4638 03:26:46,694 --> 03:26:49,764 THE LARGER, THE CULTURAL 4639 03:26:49,830 --> 03:26:51,499 ETHOS THAT SURROUNDS THAT 4640 03:26:51,565 --> 03:26:54,769 COMMUNITY IS PUSHING THEM 4641 03:26:54,835 --> 03:26:55,069 DOWN. 4642 03:26:55,136 --> 03:26:56,070 THAT MEANS YOU HAVE TO TAKE 4643 03:26:56,137 --> 03:26:57,204 RISKS NO MATTER WHAT ELSE 4644 03:26:57,271 --> 03:26:58,839 MAY GO ON AND UNFORTUNATELY 4645 03:26:58,906 --> 03:27:00,040 THAT IS A HUGE CHALLENGE 4646 03:27:00,107 --> 03:27:01,742 NONE OF US WANT TO DO 4647 03:27:01,809 --> 03:27:03,577 BECAUSE WE DON'T HAVE TIME 4648 03:27:03,644 --> 03:27:05,679 TO DEAL WITH SOCIAL POLITICS 4649 03:27:05,746 --> 03:27:06,747 AND BEHAVIORAL CHALLENGES. 4650 03:27:06,814 --> 03:27:08,415 WE'RE TRYING TO GET SOME 4651 03:27:08,482 --> 03:27:10,351 FACTS AND SOME DATA BUT WE 4652 03:27:10,417 --> 03:27:11,986 CAN'T GET THOSE DATA UNLESS 4653 03:27:12,052 --> 03:27:12,953 WE TAKE THOSE RISKS. 4654 03:27:13,020 --> 03:27:14,321 THAT MEANS WE HAVE TO MAKE 4655 03:27:14,388 --> 03:27:16,090 SURE OUR SYSTEMS ARE MORE 4656 03:27:16,157 --> 03:27:17,591 HARDENED WHEN WE TALK ABOUT 4657 03:27:17,658 --> 03:27:18,559 DATA COLLECTION AND STORAGE. 4658 03:27:18,626 --> 03:27:19,693 THAT MEANS WE HAVE TO BE 4659 03:27:19,760 --> 03:27:21,662 ABLE TO COLLECT A GREATER 4660 03:27:21,729 --> 03:27:22,797 LEVEL OF DATA THAT IS 4661 03:27:22,863 --> 03:27:24,932 IMPORTANT TO THEM, NOT TO US 4662 03:27:24,999 --> 03:27:25,733 BUT TO THEM. 4663 03:27:25,800 --> 03:27:27,468 IT MEANS THAT IN THE CASE OF 4664 03:27:27,535 --> 03:27:29,837 SOMEBODY SUCH AS A 4665 03:27:29,904 --> 03:27:33,340 TRANSCOMMUNITY, THERE IS A 4666 03:27:33,407 --> 03:27:35,142 DEARTH OF PEOPLE WHO ARE 4667 03:27:35,209 --> 03:27:36,177 WILLING AND ABLE AND THEN 4668 03:27:36,243 --> 03:27:37,478 HAVE THE KNOWLEDGE NECESSARY 4669 03:27:37,545 --> 03:27:39,413 TO PROVIDE THE PARTICULAR 4670 03:27:39,480 --> 03:27:41,582 FORMS OF CARE WHICH IS MORE 4671 03:27:41,649 --> 03:27:45,686 THAN WE'RE GOING TO GIVE YOU 4672 03:27:45,753 --> 03:27:46,821 ESTROGEN OR TESTOSTERONE. 4673 03:27:46,887 --> 03:27:51,091 THERE IS A HUGE DEARTH OF 4674 03:27:51,158 --> 03:27:55,362 ABILITY TO PROVIDE 4675 03:27:55,429 --> 03:27:56,864 DIAGNOSTIC MATERIAL, CORE 4676 03:27:56,931 --> 03:27:57,698 STANDARDS FOR MEDICAL 4677 03:27:57,765 --> 03:27:58,699 STRUCTURE BECAUSE WE DON'T 4678 03:27:58,766 --> 03:28:00,534 UNDERSTAND THE BASE MEDICINE 4679 03:28:00,601 --> 03:28:02,703 OF THIS PARTICULAR 4680 03:28:02,770 --> 03:28:04,138 POPULATION YET TRYING TO 4681 03:28:04,205 --> 03:28:05,940 CURE THE DISEASE IT REQUIRES 4682 03:28:06,006 --> 03:28:06,674 US TO. 4683 03:28:06,740 --> 03:28:09,043 SO IF YOU AROUND PROVIDING 4684 03:28:09,109 --> 03:28:10,477 THOSE SERVICES, IF YOU 4685 03:28:10,544 --> 03:28:11,378 AREN'T FINDING THE 4686 03:28:11,445 --> 03:28:12,012 CONNECTIONS WITHIN YOUR 4687 03:28:12,079 --> 03:28:13,147 LOCAL COMMUNITY TO BE ABLE 4688 03:28:13,214 --> 03:28:14,882 TO GIVE THEM A CHANCE TO 4689 03:28:14,949 --> 03:28:15,950 MOVE FORWARD IN THEIR 4690 03:28:16,016 --> 03:28:17,651 INDIVIDUAL GOALS, IF YOU ARE 4691 03:28:17,718 --> 03:28:19,053 NOT MAKING THIS RESEARCH 4692 03:28:19,119 --> 03:28:20,020 SOMETHING THAT BENEFITS 4693 03:28:20,087 --> 03:28:22,056 THEM, YOU ARE NOT GOING TO 4694 03:28:22,122 --> 03:28:22,389 SUCCEED. 4695 03:28:22,456 --> 03:28:24,158 AND I JUST GOT MY FLASH SO I 4696 03:28:24,225 --> 03:28:26,327 AM GOING TO GO AHEAD AND 4697 03:28:26,393 --> 03:28:28,395 STOP HERE AND SAY -- 4698 03:28:28,462 --> 03:28:28,762 [LAUGHTER] 4699 03:28:28,829 --> 03:28:29,797 -- EVERYBODY THANK YOU FOR 4700 03:28:29,864 --> 03:28:32,166 YOUR TIME AND ENERGY AND FOR 4701 03:28:32,233 --> 03:28:33,667 INVITING ME AND THE REST OF 4702 03:28:33,734 --> 03:28:34,301 THE PANELISTS. 4703 03:28:34,368 --> 03:28:36,370 I AM HONORED TO BE HERE AND 4704 03:28:36,437 --> 03:28:36,704 INVITED. 4705 03:28:36,770 --> 03:28:37,471 THANK YOU VERY MUCH. 4706 03:28:37,538 --> 03:28:41,175 >> THANK YOU SO MUCH, TONI, 4707 03:28:41,242 --> 03:28:43,510 THANKS FOR THAT. 4708 03:28:43,577 --> 03:28:45,546 >> THANK YOU LIZ AND TO ALL 4709 03:28:45,613 --> 03:28:46,046 THE PANELISTS. 4710 03:28:46,113 --> 03:28:47,581 WE HAVE SOME TIME FOR 4711 03:28:47,648 --> 03:28:53,254 DISCUSSION SO I WILL INVITE 4712 03:28:53,320 --> 03:28:54,321 EILEEN AND PHILISTER AND 4713 03:28:54,388 --> 03:28:56,724 RICHARD, IF YOU CAN COME 4714 03:28:56,790 --> 03:28:57,992 BACK ON CAMERA, WE PUT A 4715 03:28:58,058 --> 03:28:58,959 COUPLE OF QUESTIONS IN THE 4716 03:28:59,026 --> 03:29:00,494 CHAT SO YOU CAN SEE THEM AND 4717 03:29:00,561 --> 03:29:04,098 I WILL ASK THEM TO YOU 4718 03:29:04,164 --> 03:29:04,431 OUTLOUD. 4719 03:29:04,498 --> 03:29:06,734 SO FIRST, WE RECEIVED A 4720 03:29:06,800 --> 03:29:14,541 QUESTION ARE THERE PLANS TO 4721 03:29:14,608 --> 03:29:18,746 DO POLYPHENOME IN WOMEN OR 4722 03:29:18,812 --> 03:29:21,248 T-1 IN WOMEN OVER MALES, CAN 4723 03:29:21,315 --> 03:29:23,217 YOU SPEAK TO THAT? 4724 03:29:23,284 --> 03:29:24,051 >> YES, THAT IS A GOOD 4725 03:29:24,118 --> 03:29:26,020 QUESTION AND IN OUR STUDY WE 4726 03:29:26,086 --> 03:29:27,388 ACTUALLY TRIED TO DO THAT. 4727 03:29:27,454 --> 03:29:29,590 IT IS THE LARGEST GENOME 4728 03:29:29,657 --> 03:29:32,927 STUDY OF PEOPLE LIVING WITH 4729 03:29:32,993 --> 03:29:35,062 HIV SPECIFICALLY LOOKING AT 4730 03:29:35,129 --> 03:29:36,597 FEATURES TO CONTROL SET 4731 03:29:36,664 --> 03:29:37,631 POINT VIRAL LOADS. 4732 03:29:37,698 --> 03:29:38,666 ALTHOUGH I MENTIONED WOMEN 4733 03:29:38,732 --> 03:29:44,371 ARE MORE LIKELY TO BE 4734 03:29:44,438 --> 03:29:47,741 CONTROLLED AND 17 PERCENT OF 4735 03:29:47,808 --> 03:29:50,044 CONTROLLERS CONCLUDED AS WAS 4736 03:29:50,110 --> 03:29:51,545 SO ELOQUENTLY DISCUSSED IN 4737 03:29:51,612 --> 03:29:53,480 OUR LAST TALK, WE DO NOT 4738 03:29:53,547 --> 03:29:54,782 KNOW AND FROM THE ANALYSIS 4739 03:29:54,848 --> 03:29:58,686 WE JUST DID OF THIS TYPE, WE 4740 03:29:58,752 --> 03:30:03,057 DON'T HAVE THE ADEQUATE DATA 4741 03:30:03,123 --> 03:30:04,425 THAT WERE SPECIFIC TO MALES 4742 03:30:04,491 --> 03:30:07,528 AND FEMALES WITH CONTROL. 4743 03:30:07,594 --> 03:30:12,933 >> THANKS SO MUCH, EILEEN. 4744 03:30:13,000 --> 03:30:14,668 KARINE, I WILL ASK YOU A 4745 03:30:14,735 --> 03:30:16,870 QUESTION AND WE CAN SEE YOU 4746 03:30:16,937 --> 03:30:19,406 SO HOPEFULLY YOUR INTERNET 4747 03:30:19,473 --> 03:30:20,841 WILL HOLD STEADY. 4748 03:30:20,908 --> 03:30:24,044 CAN YOU TALK TO ONGOING WORK 4749 03:30:24,111 --> 03:30:26,680 TO PREPARE PARTICIPATION IN 4750 03:30:26,747 --> 03:30:31,919 ATI IN LONG-TERM STUDIES, 4751 03:30:31,986 --> 03:30:35,089 INCLUDING INCLUSION OF DATA 4752 03:30:35,155 --> 03:30:38,258 THAT MAY NOT BE VERIFIED AND 4753 03:30:38,325 --> 03:30:40,127 REGULAR POLICY AND OTHER 4754 03:30:40,194 --> 03:30:40,928 STRUCTURAL ISSUES? 4755 03:30:40,995 --> 03:30:43,564 >> THANK YOU AGAIN AND 4756 03:30:43,630 --> 03:30:44,765 APOLOGIES FOR MY TECHNICAL 4757 03:30:44,832 --> 03:30:45,199 ISSUES TODAY. 4758 03:30:45,265 --> 03:30:47,568 SO THERE ARE A FEW STUDIES 4759 03:30:47,634 --> 03:30:50,637 GOING ON TODAY AS PART OF 4760 03:30:50,704 --> 03:30:51,705 ATI TRIALS AND PROJECTS. 4761 03:30:51,772 --> 03:30:54,942 A LOT OF THIS WORK REMAINS 4762 03:30:55,009 --> 03:30:56,543 UNFUNDED AND VOLUNTEER 4763 03:30:56,610 --> 03:30:56,877 EFFORTS. 4764 03:30:56,944 --> 03:30:59,747 FOR EXAMPLE, THE DETECTION 4765 03:30:59,813 --> 03:31:00,447 GROUP WAS -- 4766 03:31:00,514 --> 03:31:01,015 [INDISCERNIBLE] 4767 03:31:01,081 --> 03:31:04,284 SO WE NEED A LOT MORE 4768 03:31:04,351 --> 03:31:05,552 EVIDENCE AROUND 4769 03:31:05,619 --> 03:31:06,253 EXCLUSION/INCLUSION CRITERIA 4770 03:31:06,320 --> 03:31:08,555 AND HOW TO SUPPORT PEOPLE TO 4771 03:31:08,622 --> 03:31:10,524 PARTICIPATE IN TRIALS 4772 03:31:10,591 --> 03:31:11,125 INCLUDING SUPPORT TEAMS. 4773 03:31:11,191 --> 03:31:15,195 THERE WILL BE A NEW TI 4774 03:31:15,262 --> 03:31:16,630 CONSENSUS MEETING IN MAY 4775 03:31:16,697 --> 03:31:18,265 WHERE WE WILL BE EXPLORING 4776 03:31:18,332 --> 03:31:20,334 THESE ISSUES AS WELL BUT WE 4777 03:31:20,401 --> 03:31:22,469 NEED A LOT MORE RESEARCH TO 4778 03:31:22,536 --> 03:31:23,837 INFORM THESE TOPICS. 4779 03:31:23,904 --> 03:31:24,204 THANK YOU. 4780 03:31:24,271 --> 03:31:27,941 >> THANK YOU AND A QUESTION 4781 03:31:28,008 --> 03:31:29,410 FOR YOU, RICHARD. 4782 03:31:29,476 --> 03:31:32,146 SO YOUR REGISTRY SAYS 2014. 4783 03:31:32,212 --> 03:31:35,983 HAVE YOU SEEN ANY CHANGES OR 4784 03:31:36,050 --> 03:31:37,217 PROGRESS IN REPORTING 4785 03:31:37,284 --> 03:31:38,385 BESIDES THE GROWTH IN THE 4786 03:31:38,452 --> 03:31:44,691 NUMBER OF STUDIES TO REPORT? 4787 03:31:44,758 --> 03:31:49,263 >> YOU Y O U ARE STILL 4788 03:31:49,329 --> 03:31:49,563 MUTED. 4789 03:31:49,630 --> 03:31:54,635 >> SORRY, I HAVE BEEN SO 4790 03:31:54,701 --> 03:31:56,003 WORRIED ABOUT ACCIDENTAL 4791 03:31:56,070 --> 03:31:56,437 LISTENING. 4792 03:31:56,503 --> 03:31:58,739 SO THERE HAS BEEN SOME 4793 03:31:58,806 --> 03:31:59,440 IMPROVEMENT IN CONSISTENCY 4794 03:31:59,506 --> 03:32:01,442 OF THE STUDY OF DEMOGRAPHICS 4795 03:32:01,508 --> 03:32:04,078 BUT IT HAS BEEN KIND OF 4796 03:32:04,144 --> 03:32:04,378 SLOW. 4797 03:32:04,445 --> 03:32:05,712 I THINK THERE IS STILL ROOM 4798 03:32:05,779 --> 03:32:06,914 FOR IMPROVEMENT. 4799 03:32:06,980 --> 03:32:09,783 SOME OF THE ISSUES TONI WAS 4800 03:32:09,850 --> 03:32:11,952 MENTIONING I THINK AFFECTS 4801 03:32:12,019 --> 03:32:15,122 HOW CATEGORIES ARE REPORTED 4802 03:32:15,189 --> 03:32:16,190 FOR EXAMPLE, CLINICAL TRIALS 4803 03:32:16,256 --> 03:32:17,357 DOES HAVE AN OPTION FOR 4804 03:32:17,424 --> 03:32:18,625 PEOPLE TO POST THE RESULTS 4805 03:32:18,692 --> 03:32:20,461 THERE BUT SOMETIMES IT JUST 4806 03:32:20,527 --> 03:32:23,297 SEEMS LIKE THE DEMOGRAPHIC 4807 03:32:23,363 --> 03:32:24,465 CATEGORIES AREN'T REALLY 4808 03:32:24,531 --> 03:32:25,732 APPROPRIATE SO I THINK THERE 4809 03:32:25,799 --> 03:32:26,967 IS STILL ROOM FOR 4810 03:32:27,034 --> 03:32:28,368 IMPROVEMENT THERE. 4811 03:32:28,435 --> 03:32:29,870 THE GENERAL TREND JUST THAT 4812 03:32:29,937 --> 03:32:32,372 WE HAVE NOTICED RECENTLY, IT 4813 03:32:32,439 --> 03:32:35,476 DOES SEEM FOR UPPER AGE 4814 03:32:35,542 --> 03:32:37,644 LIMITS FOR THE CURE-RELATED 4815 03:32:37,711 --> 03:32:39,279 STUDIES BUT BEYOND THAT, I 4816 03:32:39,346 --> 03:32:41,215 THINK THE BARRIERS TO 4817 03:32:41,281 --> 03:32:42,149 PARTICIPATION STILL EXIST 4818 03:32:42,216 --> 03:32:44,551 SIMILAR TO TREATMENT STUDIES 4819 03:32:44,618 --> 03:32:46,220 AROUND THINGS LIKE 4820 03:32:46,286 --> 03:32:46,987 CONTRACEPTIVES REQUIREMENTS 4821 03:32:47,054 --> 03:32:50,691 AND THOSE KIND OF THINGS. 4822 03:32:50,757 --> 03:32:53,861 >> THANKS, RICHARD. 4823 03:32:53,927 --> 03:32:55,295 AND PHILISTER, CAN YOU SHARE 4824 03:32:55,362 --> 03:32:55,896 MORE ABOUT THE IMMEDIATE 4825 03:32:55,963 --> 03:32:58,432 THINGS YOU ARE WORKING ON 4826 03:32:58,499 --> 03:33:00,934 RIGHT NOW THAT CAN BE 4827 03:33:01,001 --> 03:33:04,805 ADDRESSED TODAY AND HAVE YOU 4828 03:33:04,872 --> 03:33:06,140 SEEN ANY PROGRESS IN AND 4829 03:33:06,206 --> 03:33:08,475 THAT IS ALSO IN THE CHAT. 4830 03:33:08,542 --> 03:33:14,214 >> OKAY, THANK YOU SO MUCH 4831 03:33:14,281 --> 03:33:15,949 FOR THAT QUESTION. 4832 03:33:16,016 --> 03:33:18,886 SO CURRENTLY I AM 4833 03:33:18,952 --> 03:33:20,454 COLLABORATING WITH THE IRD 4834 03:33:20,521 --> 03:33:30,964 AND WE ARE WORKING ON 4835 03:33:33,867 --> 03:33:35,536 TEENAGER FOR VEHICLE FOR 4836 03:33:35,602 --> 03:33:36,803 TRANSMISSION AND ABLE TO 4837 03:33:36,870 --> 03:33:40,807 ENGAGE WITH A COMMUNITY OF 4838 03:33:40,874 --> 03:33:45,078 RESEARCHERS, COMMUNITY 4839 03:33:45,145 --> 03:33:47,314 STAKEHOLDERS, COMMUNITY 4840 03:33:47,381 --> 03:33:48,715 ADVISORY BOARD ON THE 4841 03:33:48,782 --> 03:33:50,551 INITIATIVE WE HAVE DEVELOPED 4842 03:33:50,617 --> 03:33:58,292 AND HAVE LEARNED A LOT FROM 4843 03:33:58,358 --> 03:34:00,027 IT BECAUSE THE OPTIONS WE 4844 03:34:00,093 --> 03:34:01,562 COVER, MOST PEOPLE DO NOT 4845 03:34:01,628 --> 03:34:03,697 REALLY UNDERSTAND WHAT IT 4846 03:34:03,764 --> 03:34:04,498 MEANS. 4847 03:34:04,565 --> 03:34:07,901 AND FROM OUR LEARNINGS, EVEN 4848 03:34:07,968 --> 03:34:11,205 IN TRADITION, THEY SHOULD 4849 03:34:11,271 --> 03:34:18,178 CHANGE THEIR TERMINOLOGY 4850 03:34:18,245 --> 03:34:21,548 SUBSAHARAN AND USE THEIR 4851 03:34:21,615 --> 03:34:22,716 INDIGENOUS NAMES. 4852 03:34:22,783 --> 03:34:27,087 THE WOMEN TO WANT 4853 03:34:27,154 --> 03:34:35,162 PARTICIPATE TO BE ABLE TO 4854 03:34:35,229 --> 03:34:36,964 MAKE INFORMED DECISIONS ON 4855 03:34:37,030 --> 03:34:41,902 WHETHER TO PARTICIPATE OR 4856 03:34:41,969 --> 03:34:42,269 NOT. 4857 03:34:42,336 --> 03:34:50,277 AND ALSO WE ARE LOOKING AT 4858 03:34:50,344 --> 03:34:51,912 THE PRECEDING MODELS WHICH 4859 03:34:51,979 --> 03:34:56,617 GIVE US INPUT ON THE TYPE OF 4860 03:34:56,683 --> 03:35:02,256 MEDIA WE NEED WHERE WOMEN 4861 03:35:02,322 --> 03:35:03,924 GET INFORMATION AND 4862 03:35:03,991 --> 03:35:06,026 INFORMATION PEOPLE USE TO 4863 03:35:06,093 --> 03:35:09,062 PROGRESS TO VIDEO AND SOME 4864 03:35:09,129 --> 03:35:10,764 JUST HAVING ONE OR MORE 4865 03:35:10,831 --> 03:35:13,634 CONDITIONS IDEAL FOR THEM TO 4866 03:35:13,700 --> 03:35:15,335 GET THEIR INFORMATION ABOUT 4867 03:35:15,402 --> 03:35:17,037 THIS STUDY. 4868 03:35:17,104 --> 03:35:20,507 AND SOME OF THIS SEEMS WHAT 4869 03:35:20,574 --> 03:35:24,177 IS SUGGESTED, THEY WANT TO 4870 03:35:24,244 --> 03:35:30,450 BE PART OF THE COUNTERPARTS 4871 03:35:30,517 --> 03:35:35,589 AT THE BEGINNING SO THEY CAN 4872 03:35:35,656 --> 03:35:36,823 COOPERATE IN THE INITIAL 4873 03:35:36,890 --> 03:35:38,592 PART TO REALLY BE SEEN AS A 4874 03:35:38,659 --> 03:35:42,195 PART OF THE RESEARCH 4875 03:35:42,262 --> 03:35:43,330 PROCESS. 4876 03:35:43,397 --> 03:35:46,800 >> THANKS SO MUCH, 4877 03:35:46,867 --> 03:35:47,301 PHILISTER. 4878 03:35:47,367 --> 03:35:48,402 RICHARD, I MIGHT PASS THIS 4879 03:35:48,468 --> 03:35:51,872 ONE TO YOU AS OUR DATA 4880 03:35:51,938 --> 03:35:52,673 EXPERT. 4881 03:35:52,739 --> 03:36:01,648 WHERE WOULD A WOMAN GO TO TO 4882 03:36:01,715 --> 03:36:07,988 FIND OUT IF THIS IS TAKING 4883 03:36:08,055 --> 03:36:11,391 ANTIRETRO VIRAL DRUGS ARE 4884 03:36:11,458 --> 03:36:11,925 WOMEN? 4885 03:36:11,992 --> 03:36:13,627 >> YOU KNOW, I THINK THERE 4886 03:36:13,694 --> 03:36:14,494 ARE POSSIBLY COMMUNITY 4887 03:36:14,561 --> 03:36:18,999 PARTNERS LINKED TO THE ACCG 4888 03:36:19,066 --> 03:36:20,834 BUT NOT COMPLETELY SURE, 4889 03:36:20,901 --> 03:36:21,501 SORRY. 4890 03:36:21,568 --> 03:36:23,670 NOT SURE IF ANYONE ELSE MAY 4891 03:36:23,737 --> 03:36:24,204 KNOW. 4892 03:36:24,271 --> 03:36:26,239 SORRY I CAN'T ANSWER. 4893 03:36:26,306 --> 03:36:26,707 >> EILEEN? 4894 03:36:26,773 --> 03:36:28,508 >> I CAN JUST SAY FOR ANY 4895 03:36:28,575 --> 03:36:32,612 INDIVIDUAL MEDICATION YOU 4896 03:36:32,679 --> 03:36:35,716 ARE TAKING, IF YOU GO TO THE 4897 03:36:35,782 --> 03:36:37,584 PACKAGE INSERT WHICH IS 4898 03:36:37,651 --> 03:36:39,186 GOOGLE-ABLE, IT WILL GIVE 4899 03:36:39,252 --> 03:36:40,120 YOU THE ORIGINAL REFERENCE 4900 03:36:40,187 --> 03:36:41,254 TO THE DRUGS. 4901 03:36:41,321 --> 03:36:43,223 SO IN SOME CASES IF THE DRUG 4902 03:36:43,290 --> 03:36:44,991 HAS BEEN AROUND FOR A LONG 4903 03:36:45,058 --> 03:36:47,294 TIME, THERE MAY BE FOLLOW UP 4904 03:36:47,361 --> 03:36:49,196 STUDIES AND USE IN BROADER 4905 03:36:49,262 --> 03:36:50,530 POPULATIONS BUT IN TERMS OF 4906 03:36:50,597 --> 03:36:52,699 WHAT LED THE FDA TO SAY IT 4907 03:36:52,766 --> 03:36:55,135 IS OKAY TO TAKE THIS, IT 4908 03:36:55,202 --> 03:36:58,638 WILL BE INSERTED IN THE FDA 4909 03:36:58,705 --> 03:37:00,374 PACKAGE INSERT AND THAT IS A 4910 03:37:00,440 --> 03:37:02,175 CASE WHERE THE ACTUAL 4911 03:37:02,242 --> 03:37:04,010 INFORMATION COULD BE FOUND. 4912 03:37:04,077 --> 03:37:08,448 >> SOUND LIKE A MUCH NEEDED 4913 03:37:08,515 --> 03:37:09,516 RESOURCE. 4914 03:37:09,583 --> 03:37:10,951 SO OUR LAST QUESTION IN JUST 4915 03:37:11,017 --> 03:37:12,786 THE TWO MINUTES WE HAVE 4916 03:37:12,853 --> 03:37:15,489 REMAINING IS FOR YOU TONY 4917 03:37:15,555 --> 03:37:26,099 AND DO -- TONI, DO YOU SEE 4918 03:37:27,801 --> 03:37:28,268 COMMUNITIES OF TRANSWOMEN 4919 03:37:28,335 --> 03:37:33,807 THERE IS A STIGMA OR 4920 03:37:33,874 --> 03:37:34,708 TRANSWOMEN ARE DISTRUSTFUL? 4921 03:37:34,775 --> 03:37:36,510 >> THAT IS AN OUTSTANDING 4922 03:37:36,576 --> 03:37:37,577 QUESTION AND GETS TO ONE OF 4923 03:37:37,644 --> 03:37:38,879 THE HEARTS OF TRYING TO FIND 4924 03:37:38,945 --> 03:37:42,048 THE WAY IN TO A COMMUNITY. 4925 03:37:42,115 --> 03:37:44,117 THE KEY ELEMENT THERE IS 4926 03:37:44,184 --> 03:37:45,285 WHILE STIGMA IS AN IMPORTANT 4927 03:37:45,352 --> 03:37:47,754 ISSUE, IT IS NOT NECESSARILY 4928 03:37:47,821 --> 03:37:50,490 ALWAYS OR ONLY 4929 03:37:50,557 --> 03:37:51,725 STIGMA-RELATING TO HIV. 4930 03:37:51,792 --> 03:37:53,760 MORE IMPORTANTLY, IT IS THE 4931 03:37:53,827 --> 03:37:55,362 PERCEPTION WHICH IS OFTEN 4932 03:37:55,429 --> 03:38:01,435 VERY ACCURATE THAT THE 4933 03:38:01,501 --> 03:38:05,505 MEDICAL SYSTEM ITSELF HAS 4934 03:38:05,572 --> 03:38:06,807 TALKED TO TRANSAND GENDER 4935 03:38:06,873 --> 03:38:07,841 INDIVIDUALS, FOR EXAMPLE IF 4936 03:38:07,908 --> 03:38:09,075 YOU EVER FILLED OUT A FORM 4937 03:38:09,142 --> 03:38:11,945 AND YOU ARE A TRANSWOMAN WHO 4938 03:38:12,012 --> 03:38:14,781 HAS A BIRTH CERTIFICATE THAT 4939 03:38:14,848 --> 03:38:16,149 SAYS YOU WERE BORN FEMALE, 4940 03:38:16,216 --> 03:38:18,251 IT SAYS WHAT IS YOUR SEX AND 4941 03:38:18,318 --> 03:38:20,720 GENDER IT DOESN'T GIVE YOU 4942 03:38:20,787 --> 03:38:22,355 THE CHANCE TO SAY TRANSAND 4943 03:38:22,422 --> 03:38:24,458 WOMAN, IT GIVES YOU MALE OR 4944 03:38:24,524 --> 03:38:26,059 FEMALE AND IF YOU CLICK 4945 03:38:26,126 --> 03:38:28,361 FEMALE, OKAY THAT IS YOUR 4946 03:38:28,428 --> 03:38:29,629 REALITY, YOUR FUNCTIONAL 4947 03:38:29,696 --> 03:38:31,231 STRUCTURE, THE PROBLEM IS 4948 03:38:31,298 --> 03:38:32,632 THAT DOESN'T DO ANYTHING 4949 03:38:32,699 --> 03:38:35,702 MEDICALLY FOR US AS 4950 03:38:35,769 --> 03:38:37,437 RESEARCHERS AND WE DEPEND ON 4951 03:38:37,504 --> 03:38:38,238 THAT PARTICULAR ELEMENT 4952 03:38:38,305 --> 03:38:39,739 THERE BUT WHAT IF, FOR 4953 03:38:39,806 --> 03:38:41,107 EXAMPLE, YOU ARE IN AN AREA 4954 03:38:41,174 --> 03:38:43,076 WHERE YOU WERE BORN IN 4955 03:38:43,143 --> 03:38:45,045 CALIFORNIA, HAVE AN X ON 4956 03:38:45,111 --> 03:38:46,279 YOUR GENDERMILE -PER-HOURER, 4957 03:38:46,346 --> 03:38:48,114 WHERE DO YOU FALL IN BECAUSE 4958 03:38:48,181 --> 03:38:49,516 HOW MANY SYSTEMS ALLOW YOU 4959 03:38:49,583 --> 03:38:51,651 TO PICK SOMETHING THAT IS 4960 03:38:51,718 --> 03:38:52,486 NOT FAIL OR FEMALE? 4961 03:38:52,552 --> 03:38:55,088 THAT IS THE REALITY. 4962 03:38:55,155 --> 03:38:57,624 AND IN SOME CASES THERE IS A 4963 03:38:57,691 --> 03:38:58,692 LEGAL REASON WHY A 4964 03:38:58,758 --> 03:39:00,060 TRANSWOMAN MAY NOT BE ABLE 4965 03:39:00,126 --> 03:39:02,395 TO CHECK IN WHICH A LOT OF 4966 03:39:02,462 --> 03:39:04,297 PEOPLE DON'T UNDERSTAND. 4967 03:39:04,364 --> 03:39:06,132 SO THERE IS A MEDICAL 4968 03:39:06,199 --> 03:39:07,634 MISTRUST AND THE HISTORY 4969 03:39:07,701 --> 03:39:09,269 BEHIND THE MEDICAL MISTRUST 4970 03:39:09,336 --> 03:39:10,670 THAT SERIOUSLY IMPACTS AND 4971 03:39:10,737 --> 03:39:11,738 LIMITS US, PARTICULARLY IN 4972 03:39:11,805 --> 03:39:13,507 THE AREA OF HIV WHERE, IF 4973 03:39:13,573 --> 03:39:16,142 YOU GO OUT AND ASK MOST 4974 03:39:16,209 --> 03:39:18,178 TRANSWOMEN, THEY WILL SAY 4975 03:39:18,245 --> 03:39:20,280 THE CDC CALLS US ALL MEN SO 4976 03:39:20,347 --> 03:39:21,781 WHY SHOULD WE HELP THEM. 4977 03:39:21,848 --> 03:39:24,084 >> I WANT TO ASK EILEEN, 4978 03:39:24,150 --> 03:39:26,586 COULD YOU MAYBE COMMENT ON 4979 03:39:26,653 --> 03:39:31,591 THE RESERVOIR STUDY YOU ARE 4980 03:39:31,658 --> 03:39:32,759 INVOLVED IN? 4981 03:39:32,826 --> 03:39:34,928 BECAUSE IT JUST SEEMS LIKE 4982 03:39:34,995 --> 03:39:35,996 THE LEVELS OF TRAUMA 4983 03:39:36,062 --> 03:39:43,270 INVOLVED ARE OR HICK. 4984 03:39:43,336 --> 03:39:43,637 HORRIFIC. 4985 03:39:43,703 --> 03:39:49,209 AND THERE ARE LIKE 22CIS AND 4986 03:39:49,276 --> 03:39:51,044 TRANSGENDER WOMEN IN THAT 4987 03:39:51,111 --> 03:39:51,311 ONE. 4988 03:39:51,378 --> 03:39:52,546 >> YES, THAT WAS TRYING TO 4989 03:39:52,612 --> 03:39:55,515 LOOK AT WHETHER WE COULD 4990 03:39:55,582 --> 03:39:57,450 IDENTIFY THE SEX ON THE 4991 03:39:57,517 --> 03:39:58,652 RESERVOIR DYNAMIC. 4992 03:39:58,718 --> 03:39:59,753 IT RAISES ONE OF THE 4993 03:39:59,819 --> 03:40:01,655 CHALLENGES THAT I THINK TONI 4994 03:40:01,721 --> 03:40:03,156 IS HIGHLIGHTING AND ALSO WE 4995 03:40:03,223 --> 03:40:05,458 NEED TO TAKE GREAT CARE WITH 4996 03:40:05,525 --> 03:40:07,627 OUR STUDIES THAT WHEN YOU 4997 03:40:07,694 --> 03:40:09,029 ENTER A COMMUNITY WHERE THE 4998 03:40:09,095 --> 03:40:12,299 EXPERIENCE IS BROAD AND 4999 03:40:12,365 --> 03:40:14,267 INVOLVES MULTIPLE BIOLOGICAL 5000 03:40:14,334 --> 03:40:15,969 AND ENVIRONMENTAL FACTORS, 5001 03:40:16,036 --> 03:40:17,971 YOU CAN'T JUST LOOK AT THE 5002 03:40:18,038 --> 03:40:20,340 BIOLOGICAL FACTOR YOU MAY BE 5003 03:40:20,407 --> 03:40:22,108 INTERESTED IN OR EXPOSURE 5004 03:40:22,175 --> 03:40:23,543 BUT THINK ABOUT THE TRAUMA 5005 03:40:23,610 --> 03:40:25,946 WITHIN THE COMMUNITY THAT 5006 03:40:26,012 --> 03:40:26,513 IMPACTS OTHER THINGS. 5007 03:40:26,580 --> 03:40:29,316 SO WE HAVE INCLUDED A COHORT 5008 03:40:29,382 --> 03:40:32,285 IN BRAZIL THAT INCLUDES 5009 03:40:32,352 --> 03:40:32,919 TRANSFEMININE INDIVIDUALS 5010 03:40:32,986 --> 03:40:36,856 WHO ARE BOTH ON OR OFF 5011 03:40:36,923 --> 03:40:39,259 GENDER AFFIRMING HORMONE 5012 03:40:39,326 --> 03:40:40,760 THERAPY TO TRY TO SEPARATE 5013 03:40:40,827 --> 03:40:46,533 OUT SOME OF THESE QUESTIONS 5014 03:40:46,600 --> 03:40:48,735 ON ESTRODIOL OR NOT AND I 5015 03:40:48,802 --> 03:40:50,103 THINK WE'RE OUT OF TIME SO I 5016 03:40:50,170 --> 03:40:56,743 WILL LEAVE IT THERE. 5017 03:40:56,810 --> 03:40:59,980 >> SO I THINK SOME OF THESE 5018 03:41:00,046 --> 03:41:00,480 ARE BRIEF UNITED. 5019 03:41:00,547 --> 03:41:05,885 >> I WILL ALSO SAY THE ACCG 5020 03:41:05,952 --> 03:41:11,558 IS CURRENTLY ENROLLING 5021 03:41:11,625 --> 03:41:13,960 INDIVIDUALS ON ESTRODIOL TO 5022 03:41:14,027 --> 03:41:15,629 MEET AT THAT DISSATISFACTION 5023 03:41:15,695 --> 03:41:17,430 AND THE WORK TO LOOK AT ONE 5024 03:41:17,497 --> 03:41:19,232 INDIVIDUAL OVER TIME AND TO 5025 03:41:19,299 --> 03:41:22,268 LOOK AT A SEPARATE MENOPAUSE 5026 03:41:22,335 --> 03:41:25,505 STUDY THAT CENTERED AROUND 5027 03:41:25,572 --> 03:41:28,775 HORMONE THERAPY. 5028 03:41:28,842 --> 03:41:32,412 AND I CITE THOSE STUDIES SO 5029 03:41:32,479 --> 03:41:35,382 THOSE ARE WHERE WE CAN HONE 5030 03:41:35,448 --> 03:41:40,787 IN ON THE VARIABLES AND WORK 5031 03:41:40,854 --> 03:41:42,856 WHERE YOU CAN CONSULT WITH 5032 03:41:42,922 --> 03:41:44,691 THE COMMUNITY AND HONE IN 5033 03:41:44,758 --> 03:41:49,462 WHERE THE DATA IS NEEDED, IT 5034 03:41:49,529 --> 03:41:50,830 IS A MUCH MORE COMPREHENSION 5035 03:41:50,897 --> 03:41:51,498 SAN FRANCISCO UNDERSTANDING 5036 03:41:51,564 --> 03:41:56,836 OF WHAT THE -- 5037 03:41:56,903 --> 03:41:57,504 COMPREHENSIVE UNDERSTANDING 5038 03:41:57,570 --> 03:41:58,738 OF WHAT THE QUESTIONS ARE 5039 03:41:58,805 --> 03:42:00,674 YOU ARE ASKING. 5040 03:42:00,740 --> 03:42:02,375 >> TONI, ANOTHER ONE FOR 5041 03:42:02,442 --> 03:42:02,909 YOU. 5042 03:42:02,976 --> 03:42:05,178 SINCE ROMPING CATEGORIES CAN 5043 03:42:05,245 --> 03:42:07,013 BE VERY RESTRICTIVE AND 5044 03:42:07,080 --> 03:42:08,314 MINIMAL, FOR EXAMPLE, HAVING 5045 03:42:08,381 --> 03:42:10,016 ONLY THREE OPTIONS, MALE, 5046 03:42:10,083 --> 03:42:14,988 FEMALE OR NONE, HOW DO YOU 5047 03:42:15,055 --> 03:42:16,322 RECOMMEND LETTING PEOPLE 5048 03:42:16,389 --> 03:42:17,624 KNOW WHO YOU HAVE ENROLLED 5049 03:42:17,691 --> 03:42:20,460 IN TERMS EVER GENDER, 5050 03:42:20,527 --> 03:42:30,470 DIVERSITY AND VARIATIONS IN 5051 03:42:30,537 --> 03:42:31,571 SEX CHARACTERISTICS. 5052 03:42:31,638 --> 03:42:34,674 >> I WILL SKIP OVER THE PART 5053 03:42:34,741 --> 03:42:35,975 OF YOUR RESEARCH TOOLS THAT 5054 03:42:36,042 --> 03:42:38,578 MAY NOT ALLOW YOU TO COLLECT 5055 03:42:38,645 --> 03:42:40,380 THAT DATA BUT BEYOND THAT, 5056 03:42:40,447 --> 03:42:41,514 YOU COLLECT THAT DATA 5057 03:42:41,581 --> 03:42:42,949 YOURSELF AND IF NECESSARY, 5058 03:42:43,016 --> 03:42:44,017 DO A SPREADSHEET. 5059 03:42:44,084 --> 03:42:47,020 AND THEN NOT ONLY WILL YOU 5060 03:42:47,087 --> 03:42:48,388 BE STANDARD REPORTING, BUT 5061 03:42:48,455 --> 03:42:50,924 WHEN YOU SUPPLY YOUR DATA TO 5062 03:42:50,990 --> 03:42:51,991 THE PARTICULAR ORGANIZATION, 5063 03:42:52,058 --> 03:42:53,426 WHATEVER, YOU INCLUDE THE 5064 03:42:53,493 --> 03:42:54,961 ACTUAL DATA YOU HAVE 5065 03:42:55,028 --> 03:42:56,296 ALONGSIDE THE DATA BEING 5066 03:42:56,362 --> 03:42:56,896 REQUIRED FOR REPORTING. 5067 03:42:56,963 --> 03:42:59,432 AND IT IS ALSO A GOOD IDEA 5068 03:42:59,499 --> 03:43:01,634 TO INCLUDE YOUR CONVERSION 5069 03:43:01,701 --> 03:43:03,103 BECAUSE THERE'S STILL A SET 5070 03:43:03,169 --> 03:43:04,437 OF CONVERSIONS YOU CAN DO. 5071 03:43:04,504 --> 03:43:10,009 I MEAN IT IS ULTIMATELY 5072 03:43:10,076 --> 03:43:11,511 PROGRAMMATICALLY DONE IF YOU 5073 03:43:11,578 --> 03:43:14,514 CATEGORIZE THEM IN A CERTAIN 5074 03:43:14,581 --> 03:43:15,315 WAY. 5075 03:43:15,381 --> 03:43:17,150 YOU HAVE YOUR BREAKDOWNS, 5076 03:43:17,217 --> 03:43:18,184 THIS IS WHAT WE WERE, THIS 5077 03:43:18,251 --> 03:43:19,619 IS WHAT YOU COLLECT AND 5078 03:43:19,686 --> 03:43:20,720 THERE IS YOUR DATA. 5079 03:43:20,787 --> 03:43:24,991 AND A LOT OF PEOPLE DON'T 5080 03:43:25,058 --> 03:43:26,893 DIG INTO IT. 5081 03:43:26,960 --> 03:43:28,828 YOUR ACTUAL WHITE PAPER WILL 5082 03:43:28,895 --> 03:43:29,996 STILL CONTAIN THE DATA AND 5083 03:43:30,063 --> 03:43:32,265 THAT WILL TELL THE FUNDERS 5084 03:43:32,332 --> 03:43:33,566 THROUGH THAT PROCESS 5085 03:43:33,633 --> 03:43:34,467 PARTICULARLY THROUGH 5086 03:43:34,534 --> 03:43:35,869 REPETITION THAT THEY ARE 5087 03:43:35,935 --> 03:43:37,337 MISSING SOMETHING AND 5088 03:43:37,403 --> 03:43:38,638 ESPECIALLY WHERE THEIR DATA 5089 03:43:38,705 --> 03:43:40,473 DOESN'T SHOW AN ABSENCE OR 5090 03:43:40,540 --> 03:43:42,408 GAP OR A PROBLEM AND THEIRS 5091 03:43:42,475 --> 03:43:43,042 DOES. 5092 03:43:43,109 --> 03:43:45,478 THEN THEY WILL START 5093 03:43:45,545 --> 03:43:48,381 NARROWING DOWN ON THAT AND 5094 03:43:48,448 --> 03:43:49,282 CHANGE THEIR PRACTICES. 5095 03:43:49,349 --> 03:43:50,750 >> THANK YOU, ANOTHER ONE 5096 03:43:50,817 --> 03:43:53,520 FOR YOU Dr. SCULLY. 5097 03:43:53,586 --> 03:43:56,456 IF WOMEN HAVE LOWER VIRAL 5098 03:43:56,523 --> 03:44:01,161 SET POINTS AND LIKELY TO 5099 03:44:01,227 --> 03:44:04,130 CONTROL THE DISEASE THAN MEN 5100 03:44:04,197 --> 03:44:06,199 WHAT IS THE EXPECT OUTCOME 5101 03:44:06,266 --> 03:44:07,734 WITH REGARD TO THE DISEASE? 5102 03:44:07,801 --> 03:44:08,234 >> GREAT QUESTION. 5103 03:44:08,301 --> 03:44:12,505 THIS IS THE YIN AND YAN OF 5104 03:44:12,572 --> 03:44:14,974 THE BALANCE OF SUCCESSFUL 5105 03:44:15,041 --> 03:44:18,111 RESPONSE AND IF YOU AREN'T 5106 03:44:18,178 --> 03:44:21,815 SUCCESSFUL AT CONTROLLING 5107 03:44:21,881 --> 03:44:24,651 IT, THERE IS A PAYLOAD ON 5108 03:44:24,717 --> 03:44:26,019 THE RESPONSE. 5109 03:44:26,085 --> 03:44:27,520 THE THEORY IS THAT BECAUSE 5110 03:44:27,587 --> 03:44:30,156 WOMEN HAVE A LOWERED 5111 03:44:30,223 --> 03:44:34,427 RESPONSE, THERE MAY BE 5112 03:44:34,494 --> 03:44:36,596 CHRONIC DEPRESSION WHEN THE 5113 03:44:36,663 --> 03:44:38,665 STIMULUS LEADS TO 5114 03:44:38,731 --> 03:44:40,133 INFLAMMATORY RESPONSES LIKE 5115 03:44:40,200 --> 03:44:40,934 CARDIOVASCULAR OR BONE 5116 03:44:41,000 --> 03:44:43,369 DISEASE BUT THAT IS LARGELY 5117 03:44:43,436 --> 03:44:43,703 THEORY. 5118 03:44:43,770 --> 03:44:45,605 >> THANK YOU AND I AM JUST 5119 03:44:45,672 --> 03:44:53,947 CHECKING IF I HAVE MISSED 5120 03:44:54,013 --> 03:44:55,215 ANY QUESTIONS IN THE CHAT. 5121 03:44:55,281 --> 03:45:00,987 I DO NOT SEE ANY ADDITIONAL 5122 03:45:01,054 --> 03:45:01,354 QUESTIONS. 5123 03:45:01,421 --> 03:45:05,158 SO LIZ CORRECT ME IF I AM 5124 03:45:05,225 --> 03:45:05,792 MISSING ONE. 5125 03:45:05,859 --> 03:45:08,795 >> I THINK YOU COVERED THEM 5126 03:45:08,862 --> 03:45:09,295 ALL. 5127 03:45:09,362 --> 03:45:10,630 >> OKAY, THEN WE WILL THANK 5128 03:45:10,697 --> 03:45:14,234 YOU ALL SO MUCH, THIS WAS 5129 03:45:14,300 --> 03:45:17,003 REALLY JUST A TREAT AND 5130 03:45:17,070 --> 03:45:19,038 HIGHLY INFORMATIVE. 5131 03:45:19,105 --> 03:45:21,574 WE WILL TAKE A SLIGHTLY 5132 03:45:21,641 --> 03:45:24,844 EXTENDED BREAK AND SEE YOU 5133 03:45:24,911 --> 03:45:30,083 AT 1:40 P.M. EASTERN TIME 5134 03:45:30,149 --> 03:45:36,656 FOR OUR NEXT SESSION ON -- 5135 03:45:36,723 --> 03:45:41,027 [INDISCERNIBLE] THANK YOU. 5136 03:45:41,094 --> 03:45:42,495 >> WELCOME BACK. 5137 03:45:42,562 --> 03:45:45,298 THANK YOU FOR JOINING US FOR 5138 03:45:45,365 --> 03:45:47,233 THIS SESSION ADDRESSING 5139 03:45:47,300 --> 03:45:47,967 COMORBIDITY AND MULTI-MORBIDITY 5140 03:45:48,034 --> 03:45:50,103 IN THE CONTEXT OF HIV. 5141 03:45:50,169 --> 03:45:51,971 I'M DR. ANGELA LEE-WINN, WITH 5142 03:45:52,038 --> 03:45:54,274 THE NATIONAL INSTITUTE OF DRUG 5143 03:45:54,340 --> 03:45:55,875 ABUSE, NIDA, THRILLED TO BE 5144 03:45:55,942 --> 03:45:58,978 JOINED BY DR. MARIELLE GROSS, 5145 03:45:59,045 --> 03:46:00,947 MODERATING THIS SESSION. 5146 03:46:01,014 --> 03:46:02,348 MULTI-MORBIDITY IS A 5147 03:46:02,415 --> 03:46:04,217 CO-OCCURRENCE OF TWO OR MORE 5148 03:46:04,284 --> 03:46:08,421 CHRONIC CONDITIONS, IT IS COMMON 5149 03:46:08,488 --> 03:46:11,624 ACROSS THE LIFESPAN, ALTHOUGH 5150 03:46:11,691 --> 03:46:14,260 CISGENDER RISK FROM GREATER RISK 5151 03:46:14,327 --> 03:46:17,096 THAN CISGENDER MEN IN THE 5152 03:46:17,163 --> 03:46:17,397 POPULATION. 5153 03:46:17,463 --> 03:46:18,331 THIS SEX DIFFERENCE IS 5154 03:46:18,398 --> 03:46:20,266 HEIGHTENED AMONG PEOPLE WITH 5155 03:46:20,333 --> 03:46:22,702 HIV. 5156 03:46:22,769 --> 03:46:24,904 DEVELOPMENT OF INNOVATIVE 5157 03:46:24,971 --> 03:46:26,639 HIV-SPECIFIC SEX-TAILORED TOOLS 5158 03:46:26,706 --> 03:46:28,608 AND STRATEGIES TO MITIGATE THE 5159 03:46:28,675 --> 03:46:33,980 RISK OF DEVELOPMENT AND 5160 03:46:34,047 --> 03:46:36,349 PROGRESSION ARE URGENTLY NEEDED. 5161 03:46:36,416 --> 03:46:40,787 IN THE ERA OF ART MORBIDITY AND 5162 03:46:40,853 --> 03:46:43,189 MORTALITY IS INCREASING DUE TO 5163 03:46:43,256 --> 03:46:46,159 CARDIOVASCULAR, KIDNEY, 5164 03:46:46,225 --> 03:46:46,793 N EUROCOGNITIVE DISEASES AM 5165 03:46:46,859 --> 03:46:51,965 WE'RE THRILLED TO BE JOINED BY 5166 03:46:52,031 --> 03:46:54,500 SCIENTISTS AN ACTIVISTS 5167 03:46:54,567 --> 03:46:59,439 HIGHLIGHTING KEY ISSUES AMONG 5168 03:46:59,505 --> 03:47:00,406 WOMEN WITH HIV. 5169 03:47:00,473 --> 03:47:03,242 TODAY'S SPEAKERS ARE SHOWN HERE, 5170 03:47:03,309 --> 03:47:10,016 BIOS FOUND IN THE EVENT WEB 5171 03:47:10,083 --> 03:47:20,193 PAGE. 5172 03:47:22,261 --> 03:47:24,864 NIDA FADUL IN UNIVERSITY OF 5173 03:47:24,931 --> 03:47:26,299 NEBRASKA MEDICAL CENTER, 5174 03:47:26,366 --> 03:47:28,968 FOCUSING ON HIV DISPARITIES. 5175 03:47:29,035 --> 03:47:30,069 JULIE WOMACK IS ASSOCIATE 5176 03:47:30,136 --> 03:47:38,878 PROFESSOR AT YALE SCHOOL OF 5177 03:47:38,945 --> 03:47:41,881 NURSING, RESEARCH ON HIV AND 5178 03:47:41,948 --> 03:47:49,122 AGING, WITH CONCENTRATION ON 5179 03:47:49,188 --> 03:47:50,757 CONDITIONS THAT 5180 03:47:50,823 --> 03:47:54,027 DISPROPORTIONATELY AFFECT WOMEN. 5181 03:47:54,093 --> 03:47:58,431 AMY JUSTICE IS A PROFESSOR AT 5182 03:47:58,498 --> 03:47:59,665 YALE UNIVERSITY, CLINICAL 5183 03:47:59,732 --> 03:48:00,566 EPIDEMIOLOGIST, INTERNATIONALLY 5184 03:48:00,633 --> 03:48:03,703 RECOGNIZED EXPERT IN AGING WITH 5185 03:48:03,770 --> 03:48:05,505 HIV INFECTION. 5186 03:48:05,571 --> 03:48:08,408 IN 1996, SHE STARTED THE 5187 03:48:08,474 --> 03:48:11,277 VETERANS AGING COHORT STUDY, 5188 03:48:11,344 --> 03:48:15,248 ONGOING LONGITUDINAL STUDY OF 5189 03:48:15,314 --> 03:48:20,620 MORE THAN 180,000 VETERANS WITH 5190 03:48:20,686 --> 03:48:22,155 AND WITHOUT HIV. 5191 03:48:22,221 --> 03:48:25,558 LEAH RUBIN IS PROFESSOR OF 5192 03:48:25,625 --> 03:48:28,161 NEUROLOGY, PSYCHIATRY, 5193 03:48:28,227 --> 03:48:28,594 BEHAVIORAL SCIENCES, 5194 03:48:28,661 --> 03:48:29,262 EPIDEMIOLOGY, JOHNS HOPKINS 5195 03:48:29,328 --> 03:48:31,230 UNIVERSITY, HER WORK IS 5196 03:48:31,297 --> 03:48:32,231 DEDICATED TO IMPROVING COGNITIVE 5197 03:48:32,298 --> 03:48:35,001 AND MENTAL HEALTH OF A NUMBER OF 5198 03:48:35,068 --> 03:48:37,003 VULNERABLE POPULATIONS INCLUDING 5199 03:48:37,070 --> 03:48:40,573 PEOPLE WITH HIV, SERIOUS MENTAL 5200 03:48:40,640 --> 03:48:44,210 ILLNESS, TRAUMATIC BRAIN INJURY. 5201 03:48:44,277 --> 03:48:47,146 MARTHA CAMERON IS EXECUTIVE 5202 03:48:47,213 --> 03:48:48,047 DIRECTOR, INTERNATIONAL 5203 03:48:48,114 --> 03:48:54,187 COMMUNITY OF WOMEN LIVING WITH 5204 03:48:54,253 --> 03:48:57,557 HIV NORTH AMERICA, INVOLVED IN 5205 03:48:57,623 --> 03:49:00,193 POLICY, ADVOCACY, RESEARCH 5206 03:49:00,259 --> 03:49:04,597 FORUMS. 5207 03:49:04,664 --> 03:49:05,364 KATHLEEN SIKKEMA, COLUMBIA 5208 03:49:05,431 --> 03:49:11,704 MAILMAN SCHOOL OF PUBLIC HEALTH, 5209 03:49:11,771 --> 03:49:12,371 CONDUCTED COMMUNITY-BASED 5210 03:49:12,438 --> 03:49:13,306 INTERVENTION RESEARCH FOCUSED ON 5211 03:49:13,372 --> 03:49:14,040 HIV PREVENTION AND MENTAL HEALTH 5212 03:49:14,107 --> 03:49:19,045 TREATMENT IN THE UNITED STATES 5213 03:49:19,112 --> 03:49:22,548 AND LOW- AND MIDDLE-INCOME 5214 03:49:22,615 --> 03:49:23,282 COUNTRIES. 5215 03:49:23,349 --> 03:49:24,283 YOU CAN SEND QUESTIONS, WE'LL 5216 03:49:24,350 --> 03:49:34,060 ANSWER AS WE'RE ABLE. 5217 03:49:34,127 --> 03:49:37,029 YOU CAN E-MAIL QUESTIONS. 5218 03:49:37,096 --> 03:49:41,400 THE FIRST PRESENTATION IS FROM 5219 03:49:41,467 --> 03:49:41,767 DR. FADUL. 5220 03:49:41,834 --> 03:49:43,169 >> THANK YOU FOR HAVING ME. 5221 03:49:43,236 --> 03:49:45,071 IT'S MY PLEASURE TO BE HERE 5222 03:49:45,138 --> 03:49:49,375 TODAY TO SPEAK TO YOU DID 5223 03:49:49,442 --> 03:49:51,010 COVID-19 AND HIV, INTERSECTION 5224 03:49:51,077 --> 03:49:52,578 OF THE TWO EPIDEMICS AND 5225 03:49:52,645 --> 03:49:53,112 PANDEMICS. 5226 03:49:53,179 --> 03:50:03,723 IF WE CAN MOVE TO THE NEXT SLIDE 5227 03:50:09,195 --> 03:50:09,629 PLEASE. 5228 03:50:09,695 --> 03:50:10,363 WOMEN AND MINORITIZED 5229 03:50:10,429 --> 03:50:15,635 POPULATIONS WHO HAVE HIV HAVE 5230 03:50:15,701 --> 03:50:20,573 BEEN HIGHLY IMPACTED BY 5231 03:50:20,640 --> 03:50:20,840 COVID-19. 5232 03:50:20,907 --> 03:50:23,109 WE DIDN'T NEED TO SUSTAIN THE 5233 03:50:23,176 --> 03:50:24,043 LESSONS FROM THE COVID-19 5234 03:50:24,110 --> 03:50:26,579 PANDEMIC AND SEE HOW WE CAN USE 5235 03:50:26,646 --> 03:50:30,316 THESE LESSONS TO ENHANCE HIV 5236 03:50:30,383 --> 03:50:31,651 CARE AND BE PREPARED FOR WHEN 5237 03:50:31,717 --> 03:50:34,187 THE NEXT PANDEMIC WILL HAPPEN. 5238 03:50:34,253 --> 03:50:35,788 WE ALL KNOW I THINK WE NEED TO 5239 03:50:35,855 --> 03:50:42,361 GET READY FOR THE NEXT 5240 03:50:42,428 --> 03:50:45,231 PANDEMIC, WHEN, NOT IF. 5241 03:50:45,298 --> 03:50:46,332 ALL THE IF. 5242 03:50:46,399 --> 03:50:50,570 ALL THE LESSONS HAVE BEEN PUT ON 5243 03:50:50,636 --> 03:50:51,704 THE SHELF. 5244 03:50:51,771 --> 03:51:02,281 WE DON'T EXCEED THE SAME CARE 5245 03:51:15,228 --> 03:51:16,429 DISPARITIES IN COVID-19, I THINK 5246 03:51:16,495 --> 03:51:18,397 MOST OF THE PEOPLE HERE IN THIS 5247 03:51:18,464 --> 03:51:20,800 AUDIENCE KNOW THAT WHEN IT COMES 5248 03:51:20,866 --> 03:51:23,869 TO PEOPLE WITH HIV, THERE WERE 5249 03:51:23,936 --> 03:51:25,071 MAJOR DISPARITIES IN INCIDENCE 5250 03:51:25,137 --> 03:51:27,940 OF COVID-19, IN TREATMENT OF 5251 03:51:28,007 --> 03:51:30,009 COVID-19, AND OUTCOMES OF 5252 03:51:30,076 --> 03:51:30,543 COVID-19. 5253 03:51:30,610 --> 03:51:32,745 AND THIS IMPACTED SPECIFICALLY 5254 03:51:32,812 --> 03:51:34,413 PEOPLE WITH HIV FROM RACIAL AND 5255 03:51:34,480 --> 03:51:36,015 ETHNIC MINORITIES AS WELL AS 5256 03:51:36,082 --> 03:51:38,251 THOSE IMPACTED BY OTHER SOCIAL 5257 03:51:38,317 --> 03:51:39,118 DETERMINANTS OF HEALTH. 5258 03:51:39,185 --> 03:51:41,854 I'M SHARING AN EXAMPLE OF THAT, 5259 03:51:41,921 --> 03:51:44,257 THIS IS NOT COMPREHENSIVE BUT 5260 03:51:44,323 --> 03:51:46,993 JUST AN EXAMPLE BY THE N3C COVID 5261 03:51:47,059 --> 03:51:54,867 LAB A ACTIVE THAT -- 5262 03:51:54,934 --> 03:51:57,470 COLLABORATIVE TO SEES OUT WHO IS 5263 03:51:57,536 --> 03:51:59,805 AT RISK OF GETTING COVID-19 OF 5264 03:51:59,872 --> 03:52:02,041 PEOPLE WITH HIV AND BEING 5265 03:52:02,108 --> 03:52:03,342 IMPACTED BY COVID-19. 5266 03:52:03,409 --> 03:52:06,545 THEY LOOKED AT THE COHORT AND 5267 03:52:06,612 --> 03:52:09,515 FOUND .7% OF THE N3C COHORT WERE 5268 03:52:09,582 --> 03:52:11,384 IDENTIFIED AS PEOPLE WITH HIV, 5269 03:52:11,450 --> 03:52:12,618 WE'LL TALK ABOUT THAT 5270 03:52:12,685 --> 03:52:14,754 IDENTIFICATION A LITTLE LATER. 5271 03:52:14,820 --> 03:52:16,956 OUT OF THOSE, 13% TESTED 5272 03:52:17,023 --> 03:52:18,424 POSITIVE FOR COVID. 5273 03:52:18,491 --> 03:52:19,458 THERE WAS A GOOD PERCENTAGE OF 5274 03:52:19,525 --> 03:52:23,429 THOSE PEOPLE IN THE COHORT WHO 5275 03:52:23,496 --> 03:52:24,964 TESTED POSITIVE FOR COVID-19. 5276 03:52:25,031 --> 03:52:28,467 PEOPLE WITH BOTH COVID AND HIV, 5277 03:52:28,534 --> 03:52:29,635 PEOPLE WHO TESTED POSITIVE FOR 5278 03:52:29,702 --> 03:52:31,671 COVID WERE MORE LIKELY TO BE 5279 03:52:31,737 --> 03:52:33,572 OLDER, MORE LIKELY TO BE MALE, 5280 03:52:33,639 --> 03:52:35,875 MORE LIKELY TO BE BLACK. 5281 03:52:35,941 --> 03:52:39,745 COMPARED TO THOSE WHO WERE HIV 5282 03:52:39,812 --> 03:52:41,013 NEGATIVE. 5283 03:52:41,080 --> 03:52:41,647 THIS SPEAKS TO INTERSECTIONALITY 5284 03:52:41,714 --> 03:52:43,749 OF SOCIAL DETERMINANTS OF HEALTH 5285 03:52:43,816 --> 03:52:45,217 AND STIGMA THAT IMPACTS THIS 5286 03:52:45,284 --> 03:52:45,618 POPULATION. 5287 03:52:45,685 --> 03:52:46,852 WHEN THEY LOOKED AT WHO IS 5288 03:52:46,919 --> 03:52:49,255 LIKELY OUT OF THE HIV COHORT, 5289 03:52:49,322 --> 03:52:53,125 LIKELY TO BE IMPACTED BY 5290 03:52:53,192 --> 03:52:54,994 COVID-19, AGAIN RACIAL/ETHNIC 5291 03:52:55,061 --> 03:52:56,929 MINORITY GROUPS, ESPECIALLY 5292 03:52:56,996 --> 03:52:57,763 BLACK, LATINX, INTERESTINGLY 5293 03:52:57,830 --> 03:53:00,299 ASIANS WERE ALSO MORE LIKELY TO 5294 03:53:00,366 --> 03:53:03,736 HAVE COVID-19, AND THIS IS AFTER 5295 03:53:03,803 --> 03:53:04,470 ADJUSTING FOR AGE, SEX, 5296 03:53:04,537 --> 03:53:05,805 COMORBIDITY SCORE. 5297 03:53:05,871 --> 03:53:08,341 THE LESSON TO BE TAKEN HOME, IF 5298 03:53:08,407 --> 03:53:09,542 WE LOOK AT PEOPLE NOT LIVING 5299 03:53:09,608 --> 03:53:11,077 WITH PEOPLE AND PEOPLE LIVING 5300 03:53:11,143 --> 03:53:13,379 WITH HIV, OR WE LOOK AT PEOPLE 5301 03:53:13,446 --> 03:53:17,650 WITHIN THE SAME HIV COHORT, 5302 03:53:17,717 --> 03:53:18,184 RACIAL/ETHNIC MINORITY AND 5303 03:53:18,250 --> 03:53:18,951 SOCIAL DETERMINANTS OF HEALTH 5304 03:53:19,018 --> 03:53:20,920 SEEM TO RISE AS MAIN RISK 5305 03:53:20,986 --> 03:53:25,891 FACTORS FOR PEOPLE CONTRACTING 5306 03:53:25,958 --> 03:53:26,225 COVID-19. 5307 03:53:26,292 --> 03:53:27,526 MORE STUDIES EXAMINE THAT IN 5308 03:53:27,593 --> 03:53:29,095 DEPTH CURRENTLY UNDER REVIEW 5309 03:53:29,161 --> 03:53:30,329 LOOKING AT INDIVIDUAL SOCIAL 5310 03:53:30,396 --> 03:53:32,131 DETERMINANTS OF HEALTH, ONE IS 5311 03:53:32,198 --> 03:53:35,534 LED BY JESSICA, ONE LED BY 5312 03:53:35,601 --> 03:53:38,504 THERESA, ALSO THOSE WILL COME UP 5313 03:53:38,571 --> 03:53:39,038 SOON. 5314 03:53:39,105 --> 03:53:40,473 NEXT SLIDE PLEASE. 5315 03:53:40,539 --> 03:53:42,775 A LITTLE BIT ABOUT THE N3C 5316 03:53:42,842 --> 03:53:44,543 COHORT, A REALLY GOOD COHORT TO 5317 03:53:44,610 --> 03:53:47,680 GO BACK TO WHEN WE TRY TO 5318 03:53:47,747 --> 03:53:49,849 UNDERSTAND MORE ABOUT COVID-19 5319 03:53:49,915 --> 03:53:52,818 AND HOW IT IMPACTS PATIENTS WITH 5320 03:53:52,885 --> 03:53:53,285 HIV. 5321 03:53:53,352 --> 03:53:58,824 DATA IS USING COMPUTATIONAL 5322 03:53:58,891 --> 03:54:07,600 PHENOTYPING TO IDENTIFY, AS WELL 5323 03:54:07,666 --> 03:54:08,601 AS PRE-EXPOSURE PROPHYLAXIS. 5324 03:54:08,667 --> 03:54:19,145 AND WE DID A SMALL CLINICIAN 5325 03:54:23,349 --> 03:54:25,918 VALIDATION, AND WHEN WE LOOKED 5326 03:54:25,985 --> 03:54:27,887 AT COMPUTATIONAL PHENOTYPING 5327 03:54:27,953 --> 03:54:29,655 ACTUALLY THIS COHORT IS PRETTY 5328 03:54:29,722 --> 03:54:32,591 ACCURATE IN PREDICTING PEOPLE 5329 03:54:32,658 --> 03:54:36,429 WHO HAVE HIV WITH GOOD 5330 03:54:36,495 --> 03:54:38,731 SENSITIVITY, BASICALLY DONE BY 5331 03:54:38,798 --> 03:54:40,366 DIAGNOSIS, MEDICATION, AS WELL 5332 03:54:40,433 --> 03:54:43,536 AS VIRAL LOAD TESTING. 5333 03:54:43,602 --> 03:54:45,438 NEXT SLIDE PLEASE. 5334 03:54:45,504 --> 03:54:46,806 SO THEN EARLY ON IN THE PANDEMIC 5335 03:54:46,872 --> 03:54:49,675 WE WANTED TO LOOK AT OUR OWN 5336 03:54:49,742 --> 03:54:52,611 CLINIC POPULATION AND IDENTIFY 5337 03:54:52,678 --> 03:54:57,450 THOSE STRUCTURAL 5338 03:54:57,516 --> 03:54:58,417 VULNERABILITIES, AND WE FOUND 5339 03:54:58,484 --> 03:55:00,186 THE SAME EXACT FINDINGS IN OUR 5340 03:55:00,252 --> 03:55:00,486 POPULATION. 5341 03:55:00,553 --> 03:55:02,354 WE FOUND THAT IF WE COMPARE 5342 03:55:02,421 --> 03:55:08,194 PEOPLE WHO HAD COVID-19 AND HIV, 5343 03:55:08,260 --> 03:55:09,261 TO OVERALL CLINIC POPULATION, 5344 03:55:09,328 --> 03:55:11,997 OVER TWICE THE ONES WITH 5345 03:55:12,064 --> 03:55:14,967 COVID-19 WERE HISPANIC, THREE 5346 03:55:15,034 --> 03:55:16,368 TIMES WERE UNDOCUMENTED 5347 03:55:16,435 --> 03:55:19,004 PATIENTS, AND FOUR TIMES WERE 5348 03:55:19,071 --> 03:55:20,639 REFUGEE PATIENTS WHO CONTRACTED 5349 03:55:20,706 --> 03:55:22,741 COVID-19 AND THESE ARE 5350 03:55:22,808 --> 03:55:24,343 POPULATIONS NOT USUALLY PAID 5351 03:55:24,410 --> 03:55:24,677 ATTENTION TO. 5352 03:55:24,743 --> 03:55:30,883 THIS IS A SPECIFIC UNIQUE THING 5353 03:55:30,950 --> 03:55:32,384 ABOUT NEBRASKA, A MAJOR REFUGEE 5354 03:55:32,451 --> 03:55:34,053 STATE IN THE COUNTRY, SO WE SEE 5355 03:55:34,119 --> 03:55:36,455 A LOT OF REFUGEE PATIENTS AND WE 5356 03:55:36,522 --> 03:55:39,825 HAVE A LARGE UNDOCUMENTED 5357 03:55:39,892 --> 03:55:40,125 POPULATION. 5358 03:55:40,192 --> 03:55:43,562 THOSE PEOPLE TEND TO BE HIGHLY 5359 03:55:43,629 --> 03:55:44,563 IMPACTED BY STRUCTURAL 5360 03:55:44,630 --> 03:55:45,898 VULNERABLES BECAUSE WE WORK, 5361 03:55:45,965 --> 03:55:47,766 THEIR CONDITIONS ARE NOT 5362 03:55:47,833 --> 03:55:49,101 CONDUCIVE TO PREVENTION OF 5363 03:55:49,168 --> 03:55:49,902 COVID-19 INFECTION. 5364 03:55:49,969 --> 03:55:51,570 THE OTHER FINDING WE FOUND IS 5365 03:55:51,637 --> 03:55:57,076 OVER 80% OF THOSE WHO HAD 5366 03:55:57,142 --> 03:56:07,653 COVID-19 LIVED BELOW THE 300% 5367 03:56:08,754 --> 03:56:09,855 POVERTY LIMIT. 5368 03:56:09,922 --> 03:56:10,623 NEXT SLIDE PLEASE. 5369 03:56:10,689 --> 03:56:12,258 I FEEL LIKE THIS IS A REALLY 5370 03:56:12,324 --> 03:56:13,959 IMPORTANT STUDY TO SHARE IN SUCH 5371 03:56:14,026 --> 03:56:15,794 A FORUM WHEN TALKING ABOUT 5372 03:56:15,861 --> 03:56:17,663 IMPACT OF COVID-19 ON WOMEN. 5373 03:56:17,730 --> 03:56:19,465 THIS STUDY WAS DONE OUT OF 5374 03:56:19,532 --> 03:56:22,601 CHICAGO, THE TITLE TELLS THE 5375 03:56:22,668 --> 03:56:24,470 WHOLE STORY, EVEN IF I'M 5376 03:56:24,537 --> 03:56:26,605 UNDETECTABLE I JUST FEEL LIKE I 5377 03:56:26,672 --> 03:56:27,072 WILL DIE. 5378 03:56:27,139 --> 03:56:29,675 THIS WAS EQUAL IT THATTIVE STUDY 5379 03:56:29,742 --> 03:56:32,344 LOOKING AT PSYCHOSOCIAL AND 5380 03:56:32,411 --> 03:56:33,379 SOCIOECONOMIC IMPACT OF WOMEN 5381 03:56:33,445 --> 03:56:38,484 LIVING WITH HIV, THE IMPACT WAS 5382 03:56:38,551 --> 03:56:42,254 HUGE, RANGING FROM DISRUPTION IN 5383 03:56:42,321 --> 03:56:45,190 CARE, MEDICATION ADHERENCE, 5384 03:56:45,257 --> 03:56:46,125 SOCIOECONOMIC IMPACT, LOSS OF 5385 03:56:46,191 --> 03:56:48,060 CHILD CARE, LOSS OF EMPLOYMENT, 5386 03:56:48,127 --> 03:56:48,961 MENTAL HEALTH CONCERNS, 5387 03:56:49,028 --> 03:56:50,829 ASSOCIATE ISOLATION. 5388 03:56:50,896 --> 03:56:52,998 WOMEN WITH HIV FACE SIGNIFICANT 5389 03:56:53,065 --> 03:56:55,634 SOCIAL ISOLATION ISSUES AND THE 5390 03:56:55,701 --> 03:56:56,969 PANDEMIC JUST AUGMENTED THAT 5391 03:56:57,036 --> 03:56:57,436 SIGNIFICANTLY. 5392 03:56:57,503 --> 03:57:03,943 LET'S GO TO THE NEXT SLIDE 5393 03:57:04,009 --> 03:57:04,209 PLEASE. 5394 03:57:04,276 --> 03:57:08,781 TO THINK MORE ABOUT THE 5395 03:57:08,847 --> 03:57:11,183 PERCEIVED RISK OF COVID-19 AND 5396 03:57:11,250 --> 03:57:13,586 HOW THAT RELATES TO VACCINATION 5397 03:57:13,652 --> 03:57:15,721 WE DID A QUALITATIVE STUDY ON 5398 03:57:15,788 --> 03:57:26,332 OUR PATIENTS, EXAMINED PERCEIVED 5399 03:57:27,299 --> 03:57:29,368 RISK OF COVID-19. 5400 03:57:29,435 --> 03:57:30,569 PERCEIVED RISK WAS MODERATE. 5401 03:57:30,636 --> 03:57:34,673 THAT I WAS DONE IN 2021, COVID 5402 03:57:34,740 --> 03:57:36,375 HAD BEEN THERE OVER A YEAR. 5403 03:57:36,442 --> 03:57:38,711 PEOPLE HAD MORE OF A MODERATE 5404 03:57:38,777 --> 03:57:40,679 PERCEIVED RISK OF COVID-19, AND 5405 03:57:40,746 --> 03:57:42,581 WE FOUND 85% OF OUR PATIENTS 5406 03:57:42,648 --> 03:57:45,718 RECEIVED AT LEAST ONE DOSE OF 5407 03:57:45,784 --> 03:57:46,452 COVID-19. 5408 03:57:46,518 --> 03:57:48,120 AND ABOUT A THIRD REPORTED 5409 03:57:48,187 --> 03:57:54,126 HISTORY OF COVID-19 ABOUT THAT 5410 03:57:54,193 --> 03:57:54,460 TIME. 5411 03:57:54,526 --> 03:57:57,096 PATIENTS 19-30 HAD A LOWER 5412 03:57:57,162 --> 03:57:59,398 PERCEIVED RISK OF COVID-19, ALSO 5413 03:57:59,465 --> 03:58:03,102 HAD HIGHER INCIDENCE OF 5414 03:58:03,168 --> 03:58:05,004 CONTRACTING COVID-19. 5415 03:58:05,070 --> 03:58:06,939 NOW, INTERESTINGLY WE ALSO FOUND 5416 03:58:07,006 --> 03:58:09,341 THAT THE FEAR OF COVID OR 5417 03:58:09,408 --> 03:58:11,010 PERCEIVED RISK OF COVID WANED 5418 03:58:11,076 --> 03:58:13,278 OVER TIME, SO THE MORE PEOPLE 5419 03:58:13,345 --> 03:58:15,280 HAD LIVED WITH THE PANDEMIC THEY 5420 03:58:15,347 --> 03:58:17,583 HAD THE LOWER RISK, LOWER 5421 03:58:17,650 --> 03:58:19,885 PERCEIVED RISK OF CONTRACTING 5422 03:58:19,952 --> 03:58:20,252 COVID-19. 5423 03:58:20,319 --> 03:58:22,755 WE ASKED PARTICIPANTS ABOUT 5424 03:58:22,821 --> 03:58:24,156 THEIR PERCEPTIONS ABOUT THE 5425 03:58:24,223 --> 03:58:25,457 COVID-19 VACCINATION, THOSE WHO 5426 03:58:25,524 --> 03:58:26,759 DID NOT RECEIVE VACCINATION, DID 5427 03:58:26,825 --> 03:58:28,827 NOT RECEIVE A BOOSTER DOSE, 5428 03:58:28,894 --> 03:58:32,665 REVEALED THEY ARE LACK OF TRUST 5429 03:58:32,731 --> 03:58:35,501 IN THE VACCINE WAS THE MAIN 5430 03:58:35,567 --> 03:58:37,803 HESITANCY, INFLUENCED BY MEDIA, 5431 03:58:37,870 --> 03:58:40,039 WHAT THEY WERE HEARING FROM 5432 03:58:40,105 --> 03:58:41,840 PEERS AND NETWORKS AT THE TIME, 5433 03:58:41,907 --> 03:58:44,009 A LOT OF TALK WHETHER VACCINES 5434 03:58:44,076 --> 03:58:48,647 WERE STUDY ENOUGH, AND WE FOUND 5435 03:58:48,714 --> 03:58:50,883 INTERESTING CODES THAT MATCHED 5436 03:58:50,949 --> 03:58:52,284 WITH WHAT THE MEDIA ET. 5437 03:58:52,351 --> 03:58:55,788 LET'S GO TO THE NEXT SLIDE 5438 03:58:55,854 --> 03:58:56,255 PLEASE. 5439 03:58:56,321 --> 03:58:57,956 MOST OF YOU ARE AWARE DURING 5440 03:58:58,023 --> 03:59:00,225 COVID-19 WE HAD TO SWITCH VERY 5441 03:59:00,292 --> 03:59:01,994 QUICKLY TO TELEHEALTH. 5442 03:59:02,061 --> 03:59:03,762 WE USED A MULTI-FACETED 5443 03:59:03,829 --> 03:59:04,396 IMPLEMENTATION STRATEGY TO 5444 03:59:04,463 --> 03:59:06,365 IMPLEMENT HEALTH IN OUR CLINIC 5445 03:59:06,432 --> 03:59:08,200 TO ENSURE THAT FIRST WE STUDIED 5446 03:59:08,267 --> 03:59:13,672 THIS, HOW IT'S DONE, SO WE USE 5447 03:59:13,739 --> 03:59:16,141 IT IN THE FUTURE IN A SYSTEMATIC 5448 03:59:16,208 --> 03:59:21,547 WAY THAT DOES NOT IMPACT OUR 5449 03:59:21,613 --> 03:59:23,649 PATIENTS. 5450 03:59:23,716 --> 03:59:25,851 YEAR 1, BETWEEN APRIL AND 5451 03:59:25,918 --> 03:59:29,288 OCTOBER, 2020, 30% OF VISITS 5452 03:59:29,354 --> 03:59:31,190 THROUGH TELEHEALTH, VIRAL 5453 03:59:31,256 --> 03:59:33,092 EXPRESSION RATE REMIND HIGH, 97% 5454 03:59:33,158 --> 03:59:35,627 OF TELEHEALTH PATIENTS WERE 5455 03:59:35,694 --> 03:59:37,463 VIRALLY SUPPRESSED COMPARED TO 5456 03:59:37,529 --> 03:59:40,866 91% FOR INPATIENT VISITS, DID 5457 03:59:40,933 --> 03:59:42,568 NOT AFFECT RETENTION AND CARE, 5458 03:59:42,634 --> 03:59:44,369 THEY WERE SHOWING UP FOR 5459 03:59:44,436 --> 03:59:46,438 TELEHEALTH VISITS. 5460 03:59:46,505 --> 03:59:49,875 WE OFFERED MODALITY, SOME WANTED 5461 03:59:49,942 --> 03:59:55,547 PHONE, SOME WANTED VIDEO VISIT, 5462 03:59:55,614 --> 03:59:57,015 WE ACCOMMODATED ALL. 5463 03:59:57,082 --> 03:59:59,752 IN YEAR 2 WE FOUND DISPARITIES 5464 03:59:59,818 --> 04:00:01,353 THAT IMPACTED TELEHEALTH 5465 04:00:01,420 --> 04:00:02,020 UTILIZATION. 5466 04:00:02,087 --> 04:00:05,390 PEOPLE WHO USED IT HAD HIGHER 5467 04:00:05,457 --> 04:00:07,059 FEDERAL POVERTY LEVEL, MORE 5468 04:00:07,126 --> 04:00:07,926 LIKELY TO HAVE UNDETECTABLE 5469 04:00:07,993 --> 04:00:09,128 VIRAL LOAD. 5470 04:00:09,194 --> 04:00:11,864 WE DID NOT FIND ASSOCIATION WHEN 5471 04:00:11,930 --> 04:00:13,966 RACE, GENDER, OR YEAR OF HIV 5472 04:00:14,032 --> 04:00:14,666 DIAGNOSIS, WHEN WE LOOKED 5473 04:00:14,733 --> 04:00:17,436 FURTHER AT THE DATA WE FOUND 5474 04:00:17,503 --> 04:00:20,506 NONE OF OUR PATIENTS WERE 5475 04:00:20,572 --> 04:00:21,607 TRANSGENDER USED TELEHEALTH, 5476 04:00:21,673 --> 04:00:26,111 THAT SPEAKS TO ISSUES AROUND 5477 04:00:26,178 --> 04:00:27,513 CONFIDENTIALITY, STIGMA, WHETHER 5478 04:00:27,579 --> 04:00:29,882 THERE'S FEAR OF BREAKING 5479 04:00:29,948 --> 04:00:30,382 CONFIDENTIALITY IN THIS 5480 04:00:30,449 --> 04:00:30,682 POPULATION. 5481 04:00:30,749 --> 04:00:31,784 NEXT SLIDE PLEASE. 5482 04:00:31,850 --> 04:00:33,752 SO IN AN ATTEMPT TO ADDRESS SOME 5483 04:00:33,819 --> 04:00:36,321 OF THESE DISPARITIES WE NOW HAVE 5484 04:00:36,388 --> 04:00:38,590 AN IMPLEMENTATION STUDY GOING ON 5485 04:00:38,657 --> 04:00:40,459 THAT'S LOOKING AT IMPLEMENTATION 5486 04:00:40,526 --> 04:00:41,560 OF TELEHEALTH, EXACT SAME 5487 04:00:41,627 --> 04:00:45,931 POPULATION NOT USED BEFORE SO 5488 04:00:45,998 --> 04:00:48,333 PEOPLE WITH CHALLENGES, DETECT 5489 04:00:48,400 --> 04:00:53,038 AL VIRAL LOADS, 47 OUT OF 50 5490 04:00:53,105 --> 04:00:54,973 ENROLLED, ATTENDING MOST 10 OUT 5491 04:00:55,040 --> 04:00:57,576 OF 12 COUNSELING SESSIONS. 5492 04:00:57,643 --> 04:01:01,079 ANYTHING FROM EDUCATION OF HIV, 5493 04:01:01,146 --> 04:01:07,219 SUSTENANCE, SOCIAL SUPPORT, 5494 04:01:07,286 --> 04:01:10,823 HEALTHY LIFESTYLES, ABOUT 520 5495 04:01:10,889 --> 04:01:13,725 INTERVENTION EXPOSURES. 5496 04:01:13,792 --> 04:01:14,626 NEXT SLIDE PLEASE. 5497 04:01:14,693 --> 04:01:17,162 I WANTED TO SPEAK ABOUT ANOTHER 5498 04:01:17,229 --> 04:01:18,463 IMPLEMENTATION STUDY THAT TRIED 5499 04:01:18,530 --> 04:01:19,865 TO ADDRESS DISPARITIES WE'RE 5500 04:01:19,932 --> 04:01:21,366 SEEING IN OUR PATIENT 5501 04:01:21,433 --> 04:01:21,667 POPULATIONS. 5502 04:01:21,733 --> 04:01:32,244 WHEN YOU LOOK AT PEOPLE USING 5503 04:01:33,078 --> 04:01:34,146 INJECTABLE, AT LEAST EVERY MONTH 5504 04:01:34,213 --> 04:01:39,384 OR EVERY TWO MONTHS TO RECEIVE 5505 04:01:39,451 --> 04:01:41,353 INJECTIONS. 5506 04:01:41,420 --> 04:01:42,821 THREE PHASES, CURRENTLY 5507 04:01:42,888 --> 04:01:43,722 PRE-IMPLEMENTATION ASSESSING 5508 04:01:43,789 --> 04:01:44,823 ACCESSIBILITY AND FEASIBILITY 5509 04:01:44,890 --> 04:01:45,824 DELIVERING AT REMOTE SITES 5510 04:01:45,891 --> 04:01:50,495 CLOSER TO WHERE THEY LIVE. 5511 04:01:50,562 --> 04:01:53,098 WE'RE USING THE FRAMEWORKS IN 5512 04:01:53,165 --> 04:01:54,566 TERMS OF IMPLEMENTATION AND 5513 04:01:54,633 --> 04:01:55,968 EVALUATION FRAMEWORKS. 5514 04:01:56,034 --> 04:01:57,302 DURING THE IMPLEMENTATION PERIOD 5515 04:01:57,369 --> 04:02:02,007 WE'LL USE TELEHEALTH, TEXT 5516 04:02:02,074 --> 04:02:04,209 MESSAGING, CREATING A LEARNING 5517 04:02:04,276 --> 04:02:06,178 COLLABORATIVE IN RURAL SITES, 5518 04:02:06,245 --> 04:02:07,613 MORE FAMILIAR WITH TAKING 5519 04:02:07,679 --> 04:02:10,215 PATIENTS OF HIV, AND WILL 5520 04:02:10,282 --> 04:02:14,586 CONTINUE TO ENSURE 5521 04:02:14,653 --> 04:02:15,220 SUSTAINABILITY OF OUR 5522 04:02:15,287 --> 04:02:15,954 INTERVENTION. 5523 04:02:16,021 --> 04:02:17,122 NEXT SLIDE PLEASE. 5524 04:02:17,189 --> 04:02:20,192 KEY MESSAGE TO TAKE HOME, 5525 04:02:20,259 --> 04:02:21,360 COVID-19 AMPLIFIED THE 5526 04:02:21,426 --> 04:02:22,094 DISPARITIES EXPERIENCED WITH 5527 04:02:22,160 --> 04:02:24,329 HIV, BUT ALSO GAVE US A LOT OF 5528 04:02:24,396 --> 04:02:27,499 OPPORTUNITIES TO LEARN LESSONS 5529 04:02:27,566 --> 04:02:29,501 ABOUT HOW TO ENSURE ACCESS IN 5530 04:02:29,568 --> 04:02:31,870 THESE DIFFICULT CIRCUMSTANCES, 5531 04:02:31,937 --> 04:02:33,872 AND IMPLEMENTATION SCIENCE CAN 5532 04:02:33,939 --> 04:02:36,174 ADDRESS DISPARITIES WHETHER IT 5533 04:02:36,241 --> 04:02:39,344 COMES TO COVID-19 OR TREATMENT 5534 04:02:39,411 --> 04:02:40,245 ACCESS OR HIV TREATMENT ACCESS 5535 04:02:40,312 --> 04:02:42,180 OR WHETHER IT COMES TO 5536 04:02:42,247 --> 04:02:43,315 ADDRESSING HEALTH DISPARITIES. 5537 04:02:43,382 --> 04:02:45,884 WE HAVE A LOT OF CENTRALIZED 5538 04:02:45,951 --> 04:02:47,552 DATA SOURCES, N3C AND OTHER DATA 5539 04:02:47,619 --> 04:02:49,655 SOURCES FROM COVID-19 THAT COULD 5540 04:02:49,721 --> 04:02:50,822 BE LEVERAGED TO UNDERSTAND 5541 04:02:50,889 --> 04:02:52,124 DISPARITIES BETTER AND HOW TO 5542 04:02:52,190 --> 04:02:53,358 ADDRESS THEM. 5543 04:02:53,425 --> 04:02:57,829 I WANTED TO EMPHASIZE THE ROLE 5544 04:02:57,896 --> 04:03:02,000 OF TRAUMA-INFORMED APPROACHES, 5545 04:03:02,067 --> 04:03:03,101 ESPECIALLY WOMEN LIVING WITH 5546 04:03:03,168 --> 04:03:03,468 HIV. 5547 04:03:03,535 --> 04:03:06,004 WE REALLY NEED SOME STRATEGIES 5548 04:03:06,071 --> 04:03:07,539 TO ACCELERATE IMPLEMENTATION OF 5549 04:03:07,606 --> 04:03:08,907 NEW MODALITIES OF TREATMENT 5550 04:03:08,974 --> 04:03:12,110 BEFORE WE ACTUALLY GET THEM TO 5551 04:03:12,177 --> 04:03:14,212 FDA APPROVAL BECAUSE WE 5552 04:03:14,279 --> 04:03:15,213 EXPERIENCE WITH INJECTABLES 5553 04:03:15,280 --> 04:03:16,181 AFTER WE START IMPLEMENTATION IN 5554 04:03:16,248 --> 04:03:18,350 THE REAL WORLD WE FACE ALL THE 5555 04:03:18,417 --> 04:03:20,118 CHALLENGES, NOW WE TRY TO 5556 04:03:20,185 --> 04:03:22,087 ADDRESS SOME CHALLENGES BUT I 5557 04:03:22,154 --> 04:03:24,156 REALLY FEEL STRONGLY 5558 04:03:24,222 --> 04:03:24,756 IMPLEMENTATION SCIENCE SHOULD 5559 04:03:24,823 --> 04:03:27,759 START EARLY ON DURING THE FIRST 5560 04:03:27,826 --> 04:03:28,961 STAGES OF STUDY OF THESE 5561 04:03:29,027 --> 04:03:31,163 TREATMENTS IN ORDER TO MAKE THEM 5562 04:03:31,229 --> 04:03:35,434 EFFECTIVE ONCE THEY GET FDA 5563 04:03:35,500 --> 04:03:35,701 APPROVAL. 5564 04:03:35,767 --> 04:03:37,736 LASTLY I WANT TO THANK OUR STAFF 5565 04:03:37,803 --> 04:03:38,937 AND OUR PARTNERS AND COMMUNITY 5566 04:03:39,004 --> 04:03:41,540 PARTNERS FOR ALL THE ROLE THEY 5567 04:03:41,606 --> 04:03:43,542 PLAY IN MAKING THIS EFFORT 5568 04:03:43,608 --> 04:03:44,843 SUCCESSFUL AND FOREVER GRATEFUL 5569 04:03:44,910 --> 04:03:45,377 FOR THE EFFORTS. 5570 04:03:45,444 --> 04:03:50,849 THANK YOU SO MUCH AND OVER TO 5571 04:03:50,916 --> 04:03:51,516 YOU. 5572 04:03:51,583 --> 04:03:55,687 >> THANK YOU SO MUCH, DR. FADUL. 5573 04:03:55,754 --> 04:03:57,990 REMINDER TO AUDIENCE, SEND YOUR 5574 04:03:58,056 --> 04:03:59,091 QUESTIONS OR COMMENTS VIA THE 5575 04:03:59,157 --> 04:04:02,160 "LIVE FEEDBACK" OPTION BELOW THE 5576 04:04:02,227 --> 04:04:02,894 VIDEOCAST. 5577 04:04:02,961 --> 04:04:06,198 WE'LL NOW HEAR FROM JULIE 5578 04:04:06,264 --> 04:04:06,431 WOMACK. 5579 04:04:06,498 --> 04:04:06,999 >> GOOD MORNING. 5580 04:04:07,065 --> 04:04:09,901 THANK YOU FOR JOINING US FOR 5581 04:04:09,968 --> 04:04:10,569 THIS TALK. 5582 04:04:10,635 --> 04:04:15,374 I'M GOING TO BE SPEAKING ABOUT 5583 04:04:15,440 --> 04:04:20,746 HIV AND GERIATRIC SYNDROME, 5584 04:04:20,812 --> 04:04:23,815 FALLS AND FRAGILITY FRACTURES. 5585 04:04:23,882 --> 04:04:26,084 THERE ARE FOUR POINTS I'M HOPING 5586 04:04:26,151 --> 04:04:27,953 TO MAKE IN THIS TALK. 5587 04:04:28,020 --> 04:04:30,055 FIRST IS THAT AS THEY AGE, 5588 04:04:30,122 --> 04:04:31,990 PERSONS LIVING WITH HIV ARE AT 5589 04:04:32,057 --> 04:04:34,726 GREATER RISK FOR FALLS AND 5590 04:04:34,793 --> 04:04:36,161 FRAGILITY FRACTURES THAN THOSE 5591 04:04:36,228 --> 04:04:38,597 AGING WITHOUT HIV IN MANY BUT 5592 04:04:38,663 --> 04:04:43,935 NOT ALL STUDIES. 5593 04:04:44,002 --> 04:04:47,539 SECOND, THE COUNT IS PREDICTOR 5594 04:04:47,606 --> 04:04:49,674 OF FALLS AND FRAGILITY 5595 04:04:49,741 --> 04:04:51,510 FRACTURES, WE NEED MORE RESEARCH 5596 04:04:51,576 --> 04:04:56,948 DETERMINING WHEN TO ADD ANOTHER 5597 04:04:57,015 --> 04:04:57,249 MEDICATION. 5598 04:04:57,315 --> 04:04:59,017 RISK FACTORS ARE SIMILAR BETWEEN 5599 04:04:59,084 --> 04:05:01,019 MEN AND WOMEN BUT RATES OF BOTH 5600 04:05:01,086 --> 04:05:04,589 ARE HIGHER IN WOMEN THAN MEN. 5601 04:05:04,656 --> 04:05:07,526 AMONG PEOPLE AGING WITH HIV WE 5602 04:05:07,592 --> 04:05:09,327 LIKELY UNDERESTIMATE IMPORTANCE 5603 04:05:09,394 --> 04:05:12,531 OF SERIOUS FALSE, FRAGILITY 5604 04:05:12,597 --> 04:05:16,001 FRACTURES, OTHER GERIATRIC 5605 04:05:16,068 --> 04:05:16,902 SYNDROMES, MOST COMMONLY AMONG 5606 04:05:16,968 --> 04:05:19,504 THOSE 80 YEARS OF AGE OR OLDER. 5607 04:05:19,571 --> 04:05:24,076 MORE OF THE POPULATION LIVING 5608 04:05:24,142 --> 04:05:25,710 WITH HIV JOINS THIS CATEGORY, 5609 04:05:25,777 --> 04:05:28,680 UNTIL THEN WE WON'T HAVE AN IDEA 5610 04:05:28,747 --> 04:05:29,314 OF FULL IMPACT. 5611 04:05:29,381 --> 04:05:31,817 I THINK IT'S IMPORTANT TO 5612 04:05:31,883 --> 04:05:35,120 RECOGNIZE EVEN AT RELATIVELY 5613 04:05:35,187 --> 04:05:36,121 YOUNG AGES, GERIATRIC SYNDROMES 5614 04:05:36,188 --> 04:05:38,390 ARE BEGINNING TO BE A PROBLEM 5615 04:05:38,457 --> 04:05:40,725 FOR PEOPLE AGING WITH HIV, AS 5616 04:05:40,792 --> 04:05:43,261 SHOWN IN A POPULATION WHERE THE 5617 04:05:43,328 --> 04:05:46,565 MEAN AGE WAS 52 YEARS AND 85% 5618 04:05:46,631 --> 04:05:53,071 WERE MEN, 30% OF THE SAMPLE 5619 04:05:53,138 --> 04:05:54,372 POPULATION REPORTEDLY 5620 04:05:54,439 --> 04:05:56,808 EXPERIENCING A PAUL IN THE 5621 04:05:56,875 --> 04:06:03,815 PAST -- FALL IN THE PAST YEAR, 5622 04:06:03,882 --> 04:06:04,683 61% REPEAT, FEMALES ASSOCIATED 5623 04:06:04,749 --> 04:06:07,986 WITH INCREASED RISK IN THIS 5624 04:06:08,053 --> 04:06:08,620 STUDY. 5625 04:06:08,687 --> 04:06:13,024 ACCORDING TO PINETTI, THE 5626 04:06:13,091 --> 04:06:15,694 SYNDROMES OCCUR IN MULTIPLE 5627 04:06:15,760 --> 04:06:17,829 ORGAN SYSTEMS RENDERING AN OLDER 5628 04:06:17,896 --> 04:06:20,365 PERSON VULNERABLE. 5629 04:06:20,432 --> 04:06:23,969 FROM THE WORK WE'VE DONE, WE 5630 04:06:24,035 --> 04:06:26,338 INCLUDE FALLS, FRAGILITY 5631 04:06:26,404 --> 04:06:27,606 FRACTURES, PHYSIOLOGIC FRAILTY, 5632 04:06:27,672 --> 04:06:29,040 COGNITIVE IMPAIRMENT, FUNCTIONAL 5633 04:06:29,107 --> 04:06:30,342 DISABILITY IN THIS DEFINITION. 5634 04:06:30,408 --> 04:06:33,078 OUR FOCUS TODAY IS GOING TO BE 5635 04:06:33,145 --> 04:06:39,518 ON TWO GERIATRIC SYNDROMES, 5636 04:06:39,584 --> 04:06:40,519 FALLS AND FRAGILITY FRACTURES. 5637 04:06:40,585 --> 04:06:43,555 GERIATRIC SYNDROMES ARE A FOCUS 5638 04:06:43,622 --> 04:06:44,222 OF CARE, ASSOCIATED WITH 5639 04:06:44,289 --> 04:06:46,525 DEPENDENCE, DECREASED QUALITY OF 5640 04:06:46,591 --> 04:06:47,859 LIFE, AND DEATH. 5641 04:06:47,926 --> 04:06:48,960 RESEARCH SUGGESTS THAT PERSONS 5642 04:06:49,027 --> 04:06:50,695 LIVING WITH HIV MAY BE AT 5643 04:06:50,762 --> 04:06:52,664 GREATER RISK FOR THESE OUTCOMES 5644 04:06:52,731 --> 04:06:54,633 RELATIVE TO THOSE LIVING WITHOUT 5645 04:06:54,699 --> 04:06:57,569 HIV, AND WOMEN APPEAR TO BE AT 5646 04:06:57,636 --> 04:07:08,113 GREATER RISK FOR GERIATRIC 5647 04:07:08,647 --> 04:07:09,648 SYNDROMES THAN MEN. 5648 04:07:09,714 --> 04:07:11,917 WE'VE BUILT A PREDICTIVE MODEL 5649 04:07:11,983 --> 04:07:16,454 FOR SERIOUS FALLS AMONG PERSONS 5650 04:07:16,521 --> 04:07:17,422 AGING WITH HIV. 5651 04:07:17,489 --> 04:07:19,724 ON THE LEFT SIDE OF THE SLIDE WE 5652 04:07:19,791 --> 04:07:21,359 HAVE BASIC DEMOGRAPHIC 5653 04:07:21,426 --> 04:07:23,128 INFORMATION ABOUT OUR SAMPLES, 5654 04:07:23,195 --> 04:07:24,462 INCLUDING ONLY INDIVIDUALS 5655 04:07:24,529 --> 04:07:26,531 LIVING WITH HIV WHO WERE 50+ 5656 04:07:26,598 --> 04:07:30,902 YEARS OF AGE, THE MAJORITY WERE 5657 04:07:30,969 --> 04:07:33,538 BETWEEN 50 AND 54, AND 90% LESS 5658 04:07:33,605 --> 04:07:36,908 THAN 65 YEARS OF AGE. 5659 04:07:36,975 --> 04:07:41,313 2% WOMEN, 60% PEOPLE OF COLOR. 5660 04:07:41,379 --> 04:07:43,014 ON THE RIGHT PREDICTIVE MODEL, 5661 04:07:43,081 --> 04:07:46,585 RISK FACTORS ON THE LEFT, AND 5662 04:07:46,651 --> 04:07:51,356 ODDS RATIOS WITH 95% CONFIDENCE 5663 04:07:51,423 --> 04:07:52,724 INTERVALS ARE NOTED. 5664 04:07:52,791 --> 04:07:55,827 DISCRIMINATION OR AREA UNDER THE 5665 04:07:55,894 --> 04:07:58,430 CURVE WAS GOOD AT 0.73. 5666 04:07:58,496 --> 04:08:01,066 I SHOULD NOTE INCLUSION OF 5667 04:08:01,132 --> 04:08:03,001 ANTIRETROVIRAL THERAPY AS DRUG 5668 04:08:03,068 --> 04:08:04,669 CLASSES OR INDIVIDUAL 5669 04:08:04,736 --> 04:08:07,405 MEDICATIONS DID NOT IMPROVE 5670 04:08:07,472 --> 04:08:11,676 MODELS, WE DID NOT INCLUDE THEM 5671 04:08:11,743 --> 04:08:12,811 FOR FINAL MODELS. 5672 04:08:12,877 --> 04:08:14,346 MUCH OF THE MODEL IS CONSISTENT 5673 04:08:14,412 --> 04:08:16,147 WITH WHAT WE FIND TO BE KEY 5674 04:08:16,214 --> 04:08:18,283 PREDICTORS OF FALLS IN THE 5675 04:08:18,350 --> 04:08:19,084 GENERAL POPULATION, INCLUDING 5676 04:08:19,150 --> 04:08:22,087 HISTORY OF FALL WITHIN THE PAST 5677 04:08:22,153 --> 04:08:26,691 YEAR, PHYSICAL HEALTH CONDITIONS 5678 04:08:26,758 --> 04:08:27,726 OR MULTI-MORBIDITY, CHRONIC 5679 04:08:27,792 --> 04:08:30,962 MEDICATION, SPECIFIC HIGH RISK 5680 04:08:31,029 --> 04:08:37,736 MEDICATIONS NOTED HERE. 5681 04:08:37,802 --> 04:08:39,604 ANTI-CONVULSANTS, 5682 04:08:39,671 --> 04:08:40,405 BENZODIAZEPINES, PRESCRIPTION 5683 04:08:40,472 --> 04:08:41,773 OPIOIDS, SSRIs. 5684 04:08:41,840 --> 04:08:42,907 FACTORS PROTECTIVE AGAINST FALLS 5685 04:08:42,974 --> 04:08:45,110 ARE FOUND IN LITERATURE FROM THE 5686 04:08:45,176 --> 04:08:46,745 GENERAL POPULATION, SO BEING A 5687 04:08:46,811 --> 04:08:48,847 PERSON OF COLOR, HAVING A BODY 5688 04:08:48,913 --> 04:08:53,118 MASS INDEX GREATER THAN OR EQUAL 5689 04:08:53,184 --> 04:08:53,985 TO 25. 5690 04:08:54,052 --> 04:08:56,054 BUT THERE ARE ALSO IMPORTANT 5691 04:08:56,121 --> 04:08:57,822 DIFFERENCES BETWEEN RISK FACTORS 5692 04:08:57,889 --> 04:08:59,024 IDENTIFIED AMONG PERSONS LIVING 5693 04:08:59,090 --> 04:09:00,659 WITH HIV, AND WHAT HAS BEEN 5694 04:09:00,725 --> 04:09:02,560 IDENTIFIED IN THE GENERAL 5695 04:09:02,627 --> 04:09:02,994 POPULATION. 5696 04:09:03,061 --> 04:09:05,964 AMONG PERSONS LIVING WITH HIV, 5697 04:09:06,031 --> 04:09:09,434 PAIN SCORE WAS IMPORTANT. 5698 04:09:09,501 --> 04:09:11,936 EVERY ONE POINT INCREASE WAS 5699 04:09:12,003 --> 04:09:15,106 ASSOCIATED WITH ADDITIONAL 3% 5700 04:09:15,173 --> 04:09:17,275 INCREASED ODDS OF FALL. 5701 04:09:17,342 --> 04:09:21,246 HAVING ALCOHOL USE DISORDER 5702 04:09:21,313 --> 04:09:22,480 INCREASING LEVELS WERE 5703 04:09:22,547 --> 04:09:26,484 ASSOCIATED WITH INCREASED ODDS 5704 04:09:26,551 --> 04:09:28,586 OF SERIOUS FALL. 5705 04:09:28,653 --> 04:09:29,354 CONTRIBUTION OF PHYSICAL 5706 04:09:29,421 --> 04:09:31,623 COMORBIDITY TO FALLS IS WELL 5707 04:09:31,690 --> 04:09:33,358 ESTABLISHED IN OLDER ADULTS, BUT 5708 04:09:33,425 --> 04:09:35,694 CONTRIBUTION OF MENTAL HEALTH 5709 04:09:35,760 --> 04:09:36,428 COMORBIDITIES BEYOND DEPRESSION 5710 04:09:36,494 --> 04:09:37,896 HAVE NOT RECEIVED THE SAME LEVEL 5711 04:09:37,962 --> 04:09:40,065 OF ATTENTION AND YET BOTH ARE 5712 04:09:40,131 --> 04:09:41,399 IMPORTANT PREDICTORS OF FALLS 5713 04:09:41,466 --> 04:09:49,207 AMONG PERSONS AGING WITH HIV. 5714 04:09:49,274 --> 04:09:51,710 AN INCREASE IN THE MEASURE OF 5715 04:09:51,776 --> 04:09:53,378 PHYSIOLOGIC FAIL WAS ASSOCIATED 5716 04:09:53,445 --> 04:09:59,050 WITH INCREASED ODDS OF SERIOUS 5717 04:09:59,117 --> 04:09:59,384 FALL. 5718 04:09:59,451 --> 04:10:02,387 FEMALE SEX WAS NOT SIGNIFICANTLY 5719 04:10:02,454 --> 04:10:03,455 ASSOCIATED WITH SERIOUS FALLS. 5720 04:10:03,521 --> 04:10:04,556 WHY NOT? 5721 04:10:04,622 --> 04:10:09,060 IT MAY BE A QUESTION OF SAMPLE 5722 04:10:09,127 --> 04:10:09,327 SIZE. 5723 04:10:09,394 --> 04:10:10,895 HOWEVER, EARLIER WORK ALSO FOUND 5724 04:10:10,962 --> 04:10:12,630 THAT AMONG INDIVIDUALS LIVING 5725 04:10:12,697 --> 04:10:14,933 WITH HIV FEMALE SEX WAS NOT 5726 04:10:14,999 --> 04:10:15,600 ASSOCIATED WITH INCREASED RISK 5727 04:10:15,667 --> 04:10:17,235 OF A FALL. 5728 04:10:17,302 --> 04:10:20,839 SO THIS REQUIRES FURTHER 5729 04:10:20,905 --> 04:10:21,306 EXPLORATION. 5730 04:10:21,373 --> 04:10:27,011 IN THE CASE OF SERIOUS FALLS 5731 04:10:27,078 --> 04:10:27,979 ALREADY SUBSTANTIAL SIMILARITIES 5732 04:10:28,046 --> 04:10:29,581 BETWEEN WHAT PREDICTS FALLS IN 5733 04:10:29,647 --> 04:10:31,483 THOSE WITH HIV AND GENERAL 5734 04:10:31,549 --> 04:10:32,951 POPULATION. 5735 04:10:33,017 --> 04:10:34,419 WE CAN BASE A LOT OF PREVENTIVE 5736 04:10:34,486 --> 04:10:36,354 EFFORTS ON INFORMATION FROM THE 5737 04:10:36,421 --> 04:10:37,522 GENERAL POPULATION BUT THERE ARE 5738 04:10:37,589 --> 04:10:38,323 ADDITIONAL CONDITIONS OR 5739 04:10:38,390 --> 04:10:39,357 CONCERNS WE NEED TO PAY 5740 04:10:39,424 --> 04:10:41,726 ATTENTION TO SUCH AS PAIN, 5741 04:10:41,793 --> 04:10:43,695 ALCOHOL USE, MENTAL HEALTH 5742 04:10:43,762 --> 04:10:45,530 DIAGNOSES, THAT ARE NOT A FOCUS 5743 04:10:45,597 --> 04:10:47,766 OF FALL RISK ASSESSMENT AND 5744 04:10:47,832 --> 04:10:51,503 INTERVENTIONS AMONG OLDER ADULTS 5745 04:10:51,569 --> 04:10:53,438 IN THE GENERAL POPULATION. 5746 04:10:53,505 --> 04:10:56,441 TURNING NOW TO FRAGILITY 5747 04:10:56,508 --> 04:10:57,375 FRACTURES, I'M GOING TO WORK 5748 04:10:57,442 --> 04:10:59,677 REPRESENTING PRELIMINARY DATA 5749 04:10:59,744 --> 04:11:02,447 FROM ONGOING R01, THE PURPOSE OF 5750 04:11:02,514 --> 04:11:07,218 THE PROJECT IS A ONE-YEAR 5751 04:11:07,285 --> 04:11:08,653 PREDICTIVE MODEL FOR FRAGILITY 5752 04:11:08,720 --> 04:11:11,923 FRACTURES IN PEOPLE WITH HIV, 5753 04:11:11,990 --> 04:11:13,458 FAIRLY WELL ESTABLISHED EXISTING 5754 04:11:13,525 --> 04:11:16,995 FRACTURE RISK PREDICTION MODELS 5755 04:11:17,061 --> 04:11:19,364 UNDERPREDICT RISK AMONG PEOPLE 5756 04:11:19,431 --> 04:11:20,365 AGING WITH HIV. 5757 04:11:20,432 --> 04:11:21,699 WE'RE WORKING TO DEVELOP A MODEL 5758 04:11:21,766 --> 04:11:27,205 THAT WORKS BETTER FOR THIS 5759 04:11:27,272 --> 04:11:27,705 POPULATION. 5760 04:11:27,772 --> 04:11:31,376 A FEW NOTES, WE USED DATA FROM 5761 04:11:31,443 --> 04:11:33,178 2011-2020, WE DIVIDED FOLLOW-UP 5762 04:11:33,244 --> 04:11:34,846 INTO ONE-YEAR INTERVALS FOR EACH 5763 04:11:34,913 --> 04:11:37,115 PARTICIPANT, AS WE WERE 5764 04:11:37,182 --> 04:11:38,983 INTERESTED IN PREDICTING RISK OF 5765 04:11:39,050 --> 04:11:41,019 FRAGILITY FRACTURE WITHIN A 5766 04:11:41,085 --> 04:11:41,953 ONE-YEAR INTERVAL. 5767 04:11:42,020 --> 04:11:44,722 WE INCLUDED MEN AND WOMEN 5768 04:11:44,789 --> 04:11:47,158 VETERANS WITH HIV 50+ YEARS OF 5769 04:11:47,225 --> 04:11:49,861 AGE, 2% OF SAMPLE WAS WOMEN. 5770 04:11:49,928 --> 04:11:51,296 WE DEFINED FRAGILITY FRACTURES 5771 04:11:51,362 --> 04:11:53,398 AS THOSE FRACTURES MOST COMMONLY 5772 04:11:53,465 --> 04:11:57,001 ASSOCIATED WITH OLDER AGE. 5773 04:11:57,068 --> 04:11:59,737 SO FOREARM FRACTURE, HIP AND 5774 04:11:59,804 --> 04:12:03,007 FEMORAL, VERTEBRAL, UPPER ARM 5775 04:12:03,074 --> 04:12:03,875 AND SHOULDER FRACTURES. 5776 04:12:03,942 --> 04:12:06,044 THIS IS ONE OF OUR PRELIMINARY 5777 04:12:06,110 --> 04:12:08,346 MODELS IN THE LOWER LEFT-HAND 5778 04:12:08,413 --> 04:12:10,014 CORNER YOU SEE MODEL 5779 04:12:10,081 --> 04:12:11,516 DISCRIMINATION, AREA UNDER THE 5780 04:12:11,583 --> 04:12:14,686 CURVE, IT'S VERY GOOD AT 0.77. 5781 04:12:14,752 --> 04:12:16,754 YOU CAN SEE VARIABLES LISTED ON 5782 04:12:16,821 --> 04:12:19,390 THE LEFT, FOLLOWED BY ODDS 5783 04:12:19,457 --> 04:12:22,327 RATIOS, AND LOWER AND UPPER 5784 04:12:22,393 --> 04:12:23,761 LIMITS OF THE CONFIDENCE 5785 04:12:23,828 --> 04:12:27,799 INTERVALS AND FIGURE OF THESE 5786 04:12:27,866 --> 04:12:28,500 RESULTS ON THE RIGHT. 5787 04:12:28,566 --> 04:12:31,736 VALUES ARE LOG SCALE TO FIT 5788 04:12:31,803 --> 04:12:33,371 EVERYTHING IN ONE IMAGE. 5789 04:12:33,438 --> 04:12:35,540 THE VARIABLES INCLUDED IN THE 5790 04:12:35,607 --> 04:12:38,643 MODEL ARE AGE, FEMALE SEX, BODY 5791 04:12:38,710 --> 04:12:42,113 MASS INDEX, WHICH IS PROTECTIVE, 5792 04:12:42,180 --> 04:12:49,521 ALBUMIN , COPD, LIVER DISEASE, 5793 04:12:49,587 --> 04:12:55,193 FALL IN THE PAST YEAR WHICH HAS 5794 04:12:55,260 --> 04:12:56,261 GREATEST IMPACT, ON 5795 04:12:56,327 --> 04:12:57,896 NON-ANTIRETROVIRAL MEDICATION, 5796 04:12:57,962 --> 04:13:00,031 FOR EVERY ADDITIONAL MEDICATION 5797 04:13:00,098 --> 04:13:03,334 ADDED TO A REGIMEN, RISK OF 5798 04:13:03,401 --> 04:13:05,637 FRAGILITY FRACTURE INCREASES BY 5799 04:13:05,703 --> 04:13:05,870 5%. 5800 04:13:05,937 --> 04:13:10,909 SHOULD ALSO NOTE WE COMPARED 5801 04:13:10,975 --> 04:13:13,111 MODEL BY SEX, WORKS EQUALLY WELL 5802 04:13:13,177 --> 04:13:15,113 IN WOMEN AND MEN. 5803 04:13:15,179 --> 04:13:20,852 IN WOMEN AREA UNDER THE CURVING 5804 04:13:20,919 --> 04:13:22,186 0.78, IN MEN 0.77. 5805 04:13:22,253 --> 04:13:23,588 KEY REMAINING QUESTION FOR US IS 5806 04:13:23,655 --> 04:13:26,224 WHAT IS THE PURPOSE OF THIS 5807 04:13:26,291 --> 04:13:26,958 PREDICTIVE MODEL? 5808 04:13:27,025 --> 04:13:28,993 WE WANT TO IDENTIFY PEOPLE AT 5809 04:13:29,060 --> 04:13:30,461 RISK FOR FRAGILITY FRACTURE. 5810 04:13:30,528 --> 04:13:31,229 BUT THEN WHAT? 5811 04:13:31,296 --> 04:13:33,631 WHAT DO WE DO ABOUT IT? 5812 04:13:33,698 --> 04:13:38,236 A NUMBER OF FRACTURE RISKS 5813 04:13:38,303 --> 04:13:39,304 PREDICTION MODELS CAN IDENTIFY 5814 04:13:39,370 --> 04:13:40,638 INDIVIDUALS WHO MIGHT BENEFIT 5815 04:13:40,705 --> 04:13:43,174 FROM A DEXA SCAN TO EVALUATE 5816 04:13:43,241 --> 04:13:44,475 BONE MINERAL DENSITY. 5817 04:13:44,542 --> 04:13:46,110 OTHERS USE MODELS TO IDENTIFY 5818 04:13:46,177 --> 04:13:48,212 INDIVIDUALS WHO WOULD BENEFIT 5819 04:13:48,279 --> 04:13:50,381 FROM INITIATING MEDICATION TO 5820 04:13:50,448 --> 04:13:53,451 TREAT OSTEOPOROSIS AND PREVENT 5821 04:13:53,518 --> 04:13:54,319 FRAGILITY FRACTURE. 5822 04:13:54,385 --> 04:13:57,188 BUT BEFORE WE MOVE DIRECTLY TO 5823 04:13:57,255 --> 04:14:01,259 USING THE MODEL TO ADD ANOTHER 5824 04:14:01,326 --> 04:14:02,594 MEDICATION, I THINK THERE ARE A 5825 04:14:02,660 --> 04:14:04,529 FEW THINGS WE NEED TO THINK 5826 04:14:04,596 --> 04:14:05,163 ABOUT. 5827 04:14:05,229 --> 04:14:08,032 THE FIRST IS THAT THE MEAN 5828 04:14:08,099 --> 04:14:09,400 NUMBER OF NON-ANTIRETROVIRAL 5829 04:14:09,467 --> 04:14:14,872 MEDICATIONS IN THIS SAMPLE IS 5830 04:14:14,939 --> 04:14:15,406 10. 5831 04:14:15,473 --> 04:14:17,942 INDIVIDUALS TOOK TEN CHRONIC 5832 04:14:18,009 --> 04:14:19,744 MEDICATIONS IN ADDITION TO 5833 04:14:19,811 --> 04:14:20,111 ANTIRETROVIRAL. 5834 04:14:20,178 --> 04:14:23,314 AS I MENTIONED EARLIER FOR EVERY 5835 04:14:23,381 --> 04:14:25,049 NON-ANTIRETROVIRAL MEDICATION AN 5836 04:14:25,116 --> 04:14:27,719 INDIVIDUAL TAKES, THE RISK OF 5837 04:14:27,785 --> 04:14:30,588 FRACTURE FOR BOTH INCREASES BY 5838 04:14:30,655 --> 04:14:32,957 5%, SOMEONE TAKING 10 5839 04:14:33,024 --> 04:14:34,258 MEDICATIONS, THEIR RISK OF 5840 04:14:34,325 --> 04:14:36,961 FRAGILITY FRACTURE WITHIN THE 5841 04:14:37,028 --> 04:14:38,096 NEXT YEAR INCREASES BY 50% 5842 04:14:38,162 --> 04:14:41,733 WITHOUT CONSIDERING ANY OF THE 5843 04:14:41,799 --> 04:14:42,433 OTHER RISK FACTORS. 5844 04:14:42,500 --> 04:14:45,436 WE NEED TO UNDERSTAND LEVEL OF 5845 04:14:45,503 --> 04:14:47,071 FRACTURE RISK, RISK OF FRAGILITY 5846 04:14:47,138 --> 04:14:48,506 FRACTURE OUTWEIGHS RISK OF 5847 04:14:48,573 --> 04:14:50,475 ADDING ONE MORE CHRONIC 5848 04:14:50,541 --> 04:14:51,209 MEDICATION TO A PERSON'S 5849 04:14:51,275 --> 04:14:52,677 MEDICATION LIST, THIS IS A KEY 5850 04:14:52,744 --> 04:14:56,581 NEXT STEP IN OUR WORK. 5851 04:14:56,648 --> 04:14:59,317 SO TO CONCLUDE, I THINK THE KEY 5852 04:14:59,384 --> 04:15:03,321 MESSAGES OF THE TALK ARE FIRST 5853 04:15:03,388 --> 04:15:04,889 THAT THE FULL IMPACT OF 5854 04:15:04,956 --> 04:15:06,524 GERIATRIC SYNDROME AMONG PERSONS 5855 04:15:06,591 --> 04:15:08,926 WITH HIV HAS YET TO BE FULLY 5856 04:15:08,993 --> 04:15:11,562 APPRECIATED, STILL A VERY YOUNG 5857 04:15:11,629 --> 04:15:11,863 POPULATION. 5858 04:15:11,929 --> 04:15:17,902 SERIOUS FALSE AND FRAGILITY 5859 04:15:17,969 --> 04:15:18,670 FRACTURES ARE MORE COMMON IN 5860 04:15:18,736 --> 04:15:19,804 THOSE WITH HIV. 5861 04:15:19,871 --> 04:15:21,673 RATES OF SERIOUS FALLS AND 5862 04:15:21,739 --> 04:15:23,408 FRAGILITY FRACTURES ARE HIGHER 5863 04:15:23,474 --> 04:15:26,044 AMONG WOMEN THAN MEN AGING WITH 5864 04:15:26,110 --> 04:15:28,046 HIV, RISK FACTORS FOR THESE 5865 04:15:28,112 --> 04:15:30,114 OUTCOMES SEEM TO BE THE SAME IN 5866 04:15:30,181 --> 04:15:31,182 MEN AND WOMEN. 5867 04:15:31,249 --> 04:15:34,919 I THINK IT'S IMPORTANT TO NOTE 5868 04:15:34,986 --> 04:15:35,887 THAT NON-ART CHRONIC MEDICATION 5869 04:15:35,953 --> 04:15:37,989 COUNT IS AN IMPORTANT PREDICTOR 5870 04:15:38,056 --> 04:15:39,457 FOR BOTH OUTCOMES. 5871 04:15:39,524 --> 04:15:41,259 MOVING FORWARD WE NEED A BETTER 5872 04:15:41,325 --> 04:15:43,528 UNDERSTANDING OF WHEN BENEFITS 5873 04:15:43,594 --> 04:15:44,529 OF ADDITIONAL MEDICATIONS 5874 04:15:44,595 --> 04:15:46,397 OUTWEIGH RISKS, WHICH MEANS WE 5875 04:15:46,464 --> 04:15:50,101 NEED TO IDENTIFY AND ACKNOWLEDGE 5876 04:15:50,168 --> 04:15:51,202 THESE RISKS. 5877 04:15:51,269 --> 04:15:58,342 PROVIDERS AND PATIENTS NEED TO 5878 04:15:58,409 --> 04:15:59,744 KEEP RECORDS AND DISCUSS 5879 04:15:59,811 --> 04:16:01,179 DISCONTINUING OR DECREASING THE 5880 04:16:01,245 --> 04:16:04,916 DOSE OF HIGH RISK MEDICATIONS 5881 04:16:04,982 --> 04:16:07,452 SUCH AS BENZODIAZEPINES, 5882 04:16:07,518 --> 04:16:08,219 PRESCRIPTION OPIOIDS, MUSCLE 5883 04:16:08,286 --> 04:16:08,753 RELAXANTS. 5884 04:16:08,820 --> 04:16:10,755 WE'D LIKE TO THANK OUR FUNDERS 5885 04:16:10,822 --> 04:16:11,923 FOR MAKING THIS RESEARCH 5886 04:16:11,989 --> 04:16:15,960 POSSIBLE, WE WOULD LIKE TO THANK 5887 04:16:16,027 --> 04:16:19,464 RESEARCH TEAM, PARTICIPANTS, AND 5888 04:16:19,530 --> 04:16:21,532 THE COLLABORATORS AT THE 5889 04:16:21,599 --> 04:16:22,033 CONSORTIUM. 5890 04:16:22,100 --> 04:16:29,407 THANK YOU FOR YOUR TIME. 5891 04:16:31,642 --> 04:16:34,746 >> THANK YOU SO MUCH, DR. 5892 04:16:34,812 --> 04:16:35,780 WOMACK. 5893 04:16:35,847 --> 04:16:37,148 REMINDER TO THE AUDIENCE, SEND 5894 04:16:37,215 --> 04:16:38,549 YOUR QUESTIONS OR COMMENTS VIA 5895 04:16:38,616 --> 04:16:40,551 THE LIVE FEEDBACK OPTION BELOW 5896 04:16:40,618 --> 04:16:42,587 THE VIDEOCAST. 5897 04:16:42,653 --> 04:16:45,089 WE'LL NOW HEAR REMARKS FROM LEAH 5898 04:16:45,156 --> 04:16:45,890 RUBIN. 5899 04:16:45,957 --> 04:16:47,825 PLEASE GO AHEAD, DR. RUBIN. 5900 04:16:47,892 --> 04:16:49,193 >> ANGELA, I'VE TRIED TO START 5901 04:16:49,260 --> 04:16:52,930 MY VIDEO BUT IT WON'T LET ME, 5902 04:16:52,997 --> 04:16:54,465 FOR SOME REASON. 5903 04:16:54,532 --> 04:16:55,867 >> LET'S FIGURE THIS OUT. 5904 04:16:55,933 --> 04:16:57,735 >> START MY VIDEO. 5905 04:16:57,802 --> 04:16:58,002 OKAY. 5906 04:16:58,069 --> 04:16:59,504 YOU'RE ALLOWING ME TO START MY 5907 04:16:59,570 --> 04:17:06,210 VIDEO NOW. 5908 04:17:06,277 --> 04:17:08,880 I'M GOING TO GET STARTED AND 5909 04:17:08,946 --> 04:17:10,715 HOPEFULLY I CAN MAKE THIS WORK. 5910 04:17:10,782 --> 04:17:13,217 FIRST I WANT TO THANK THE 5911 04:17:13,284 --> 04:17:14,919 ORGANIZERS FOR THE OPPORTUNITY 5912 04:17:14,986 --> 04:17:16,154 TO SPEAK TODAY. 5913 04:17:16,220 --> 04:17:17,255 I WAS SPECIFICALLY ASKED TO 5914 04:17:17,321 --> 04:17:19,857 SPEAK ABOUT THE ISSUE OF 5915 04:17:19,924 --> 04:17:23,861 POLYPHARMACY ON COGNITION IN 5916 04:17:23,928 --> 04:17:25,062 WOMEN WITH HIV. 5917 04:17:25,129 --> 04:17:28,266 I'VE BEEN FOCUSING ON PATTERNS 5918 04:17:28,332 --> 04:17:30,268 AND PREDICTORS OF COGNITION FOR 5919 04:17:30,334 --> 04:17:33,471 A NUMBER OF YEARS, AND 5920 04:17:33,538 --> 04:17:35,706 POLYPHARMACY IS JUST ONE FACTOR 5921 04:17:35,773 --> 04:17:37,141 THAT WE NEED TO PAY ATTENTION 5922 04:17:37,208 --> 04:17:38,209 TO. 5923 04:17:38,276 --> 04:17:43,681 THERE'S MANY OTHER FACTORS, AND 5924 04:17:43,748 --> 04:17:45,283 THEY OFTEN INTERSECT AND 5925 04:17:45,349 --> 04:17:50,588 PREVIOUSLY SPOKEN DID -- ABOUT 5926 04:17:50,655 --> 04:17:53,324 SOCIAL DETERMINANTS OF HEALTH, 5927 04:17:53,391 --> 04:17:54,926 DIET, METABOLIC, EARLY LIFE 5928 04:17:54,992 --> 04:17:56,060 TRAUMA, HONESTLY THIS TALK IS 5929 04:17:56,127 --> 04:17:57,929 COMING AT A PERFECT SEGUE 5930 04:17:57,995 --> 04:18:02,300 BECAUSE YOU JUST HEARD FROM THE 5931 04:18:02,366 --> 04:18:03,167 PREVIOUS DISCUSSION ABOUT 5932 04:18:03,234 --> 04:18:04,502 NON-ART CHRONIC MEDICATIONS THAT 5933 04:18:04,569 --> 04:18:05,770 ARE IMPORTANT FOR PREDICTORS OF 5934 04:18:05,837 --> 04:18:07,972 FALLS AND FRACTURES, AND NOW 5935 04:18:08,039 --> 04:18:10,141 IT'S ALSO IMPORTANT WHEN WE 5936 04:18:10,208 --> 04:18:13,878 THINK ABOUT COGNITION. 5937 04:18:13,945 --> 04:18:15,947 SO NEXT SLIDE PLEASE. 5938 04:18:16,013 --> 04:18:17,281 COMMUNITY SUMMARY, SO FIRST AND 5939 04:18:17,348 --> 04:18:19,217 FOREMOST THERE ARE VERY FEW 5940 04:18:19,283 --> 04:18:21,786 STUDIES THAT EVALUATED THE 5941 04:18:21,853 --> 04:18:23,621 CONTRIBUTION OF POLYPHARMACY TO 5942 04:18:23,688 --> 04:18:25,289 COGNITIVE FUNCTION SPECIFICALLY 5943 04:18:25,356 --> 04:18:30,027 IN WOMEN WITH HIV DOING MORE 5944 04:18:30,094 --> 04:18:31,429 STANDARD COGNITIVE ASSESSMENTS. 5945 04:18:31,495 --> 04:18:33,164 SECONDLY, OF THE STUDIES THAT 5946 04:18:33,231 --> 04:18:35,366 HAVE BEEN CONDUCTED WE'VE FOUND 5947 04:18:35,433 --> 04:18:36,734 POLYPHARMACY PARTICULARLY THE 5948 04:18:36,801 --> 04:18:39,070 DEGREE OF POLYPHARMACY TO BE 5949 04:18:39,136 --> 04:18:41,639 ASSOCIATED WITH POOR COGNITION 5950 04:18:41,706 --> 04:18:43,674 IN WOMEN WITH HIV. 5951 04:18:43,741 --> 04:18:45,877 THIRD, THE DRUGS WITHIN SELECT 5952 04:18:45,943 --> 04:18:47,612 CLASSES OR DRUGS WITH CERTAIN 5953 04:18:47,678 --> 04:18:49,881 SIDE EFFECT PROFILES ARE ALSO 5954 04:18:49,947 --> 04:18:51,115 ASSOCIATED WITH POOR COGNITION 5955 04:18:51,182 --> 04:18:53,317 IN WOMEN WITH HIV. 5956 04:18:53,384 --> 04:18:55,052 AND IT'S NOT REALLY A 5957 04:18:55,119 --> 04:18:56,153 ONE-SIZE-FITS-ALL HAT. 5958 04:18:56,220 --> 04:18:57,688 POLYPHARMACY IS JUST LIKE THIS 5959 04:18:57,755 --> 04:18:59,090 GENERAL CONSTRUCT WHICH I'M 5960 04:18:59,156 --> 04:19:00,858 GOING TO GET INTO, AND THERE'S A 5961 04:19:00,925 --> 04:19:02,293 LOT OF HETEROGENEITY WITHIN 5962 04:19:02,360 --> 04:19:04,829 THERE, AND THERE'S DIFFERENT 5963 04:19:04,896 --> 04:19:07,198 MEDICATIONS AND DIFFERENT 5964 04:19:07,265 --> 04:19:08,065 COMBINATIONS. 5965 04:19:08,132 --> 04:19:09,033 AND FINALLY, TRADITIONAL 5966 04:19:09,100 --> 04:19:11,102 STATISTICAL METHODS ARE NOT WELL 5967 04:19:11,168 --> 04:19:12,436 SUITED FOR ADDRESSING THE 5968 04:19:12,503 --> 04:19:13,871 CONTRIBUTION OF DRUG 5969 04:19:13,938 --> 04:19:15,306 COMBINATIONS ON COGNITIVE HEALTH 5970 04:19:15,373 --> 04:19:17,508 MORE BROADLY, WE HAVE A NUMBER 5971 04:19:17,575 --> 04:19:21,779 OF METHODS IN DEVELOPMENT THAT 5972 04:19:21,846 --> 04:19:23,414 WILL HOPEFULLY PUSH THIS 5973 04:19:23,481 --> 04:19:26,584 FORWARD, MORE WORK IS NEEDED. 5974 04:19:26,651 --> 04:19:29,620 NEXT SLIDE PLEASE. 5975 04:19:29,687 --> 04:19:31,822 AS AN EPIDEMIOLOGIST AND 5976 04:19:31,889 --> 04:19:38,629 COGNITIVE NEURO NEUROSCIENTIST, 5977 04:19:38,696 --> 04:19:40,564 PEOPLE WITH HIV CAN EXPECT TO 5978 04:19:40,631 --> 04:19:45,670 LIVE CLOSE TO NORMAL LIFE 5979 04:19:45,736 --> 04:19:46,537 EXPECTANCY WITH ACCESS AND 5980 04:19:46,604 --> 04:19:47,972 ADHERENCE TO ART. 5981 04:19:48,039 --> 04:19:49,941 WHEN WE THINK ABOUT POLYPHARMACY 5982 04:19:50,007 --> 04:19:51,008 AND EFFECT ON COGNITIVE HEALTH 5983 04:19:51,075 --> 04:19:53,311 WE NEED TO TAKE A LIFESPAN 5984 04:19:53,377 --> 04:19:54,879 RESPECT TO THE PROBLEM. 5985 04:19:54,946 --> 04:19:58,282 AS WE HEARD WITH RESPECT TO ART 5986 04:19:58,349 --> 04:20:00,418 PEOPLE ARE LIVING LONGER, 5987 04:20:00,484 --> 04:20:01,385 DEVELOPING AGE-RELATED MEDICAL 5988 04:20:01,452 --> 04:20:02,586 COMORBIDITIES MORE FREQUENTLY 5989 04:20:02,653 --> 04:20:03,988 THAN THE GENERAL POPULATION, AND 5990 04:20:04,055 --> 04:20:05,222 OF COURSE IT'S NOT SURPRISING 5991 04:20:05,289 --> 04:20:09,727 THEY ARE TAKING MORE MEDICATIONS 5992 04:20:09,794 --> 04:20:11,028 THAN PEOPLE WITHOUT HIV. 5993 04:20:11,095 --> 04:20:13,097 IT'S JUST OF NOT JUST AN ISSUE 5994 04:20:13,164 --> 04:20:16,067 IN OLDER AGE. 5995 04:20:16,133 --> 04:20:19,804 PEOPLE WITH HIV, ESPECIALLY 5996 04:20:19,870 --> 04:20:24,642 WOMEN, ALSO EXPERIENCE OOCAN 5997 04:20:24,709 --> 04:20:25,710 CO-OCCURRING MENTAL HEALTH, 5998 04:20:25,776 --> 04:20:26,510 NON-ART MEDICATIONS ARE 5999 04:20:26,577 --> 04:20:29,080 PRESCRIBED FOR THESE CONDITIONS, 6000 04:20:29,146 --> 04:20:30,648 ALSO THIS CUMULATIVE BURDEN. 6001 04:20:30,715 --> 04:20:32,516 NEXT SLIDE. 6002 04:20:32,583 --> 04:20:33,918 ALL RIGHT. 6003 04:20:33,985 --> 04:20:36,020 POLYPHARMACY, WHAT IS IT? 6004 04:20:36,087 --> 04:20:40,758 THE MOST GENERAL DEFINITION OUT 6005 04:20:40,825 --> 04:20:44,328 THERE IS TAKING FIVE OR MORE 6006 04:20:44,395 --> 04:20:45,129 PRESCRIPTION MEDICATIONS. 6007 04:20:45,196 --> 04:20:48,099 AND SO, AGAIN, THAT COULD BE ANY 6008 04:20:48,165 --> 04:20:49,300 FIVE MEDICATIONS. 6009 04:20:49,367 --> 04:20:50,935 SO, THINKING ABOUT THIS KIND OF 6010 04:20:51,002 --> 04:20:53,337 GENERAL TERM, YOU CAN SEE THE 6011 04:20:53,404 --> 04:20:54,872 DEFINITION HERE IN THE 6012 04:20:54,939 --> 04:20:58,042 DICTIONARY, BUT IF YOU CAN HIT 6013 04:20:58,109 --> 04:20:59,176 THE NEXT SLIDE. 6014 04:20:59,243 --> 04:21:02,179 IN OUR WORK IN THE WOMEN'S 6015 04:21:02,246 --> 04:21:07,018 INTERAGENCY HIV STUDY, WORKING 6016 04:21:07,084 --> 04:21:10,221 CLOSELY WITH THE BRONX SITE, WE 6017 04:21:10,287 --> 04:21:14,025 FOCUSED ON POLYPHARMACY AND 6018 04:21:14,091 --> 04:21:15,359 COGNITION IN WOMEN OLDER THAN 50 6019 04:21:15,426 --> 04:21:17,194 YEARS OF AGE AND FOUND THAT IT'S 6020 04:21:17,261 --> 04:21:22,033 THE DEGREE OF POLYPHARMACY 6021 04:21:22,099 --> 04:21:23,000 RELATING TO COGNITION. 6022 04:21:23,067 --> 04:21:26,303 YOU CAN SEE IT'S PRIMARILY 6023 04:21:26,370 --> 04:21:28,339 INDIVIDUALS THAT ARE TAKING TEN 6024 04:21:28,406 --> 04:21:32,376 OR MORE MEDICATIONS, MORE SEVERE 6025 04:21:32,443 --> 04:21:35,179 POLYPHARMACY, VERSUS TAKING 0-3 6026 04:21:35,246 --> 04:21:37,214 MEDICATIONS, ASSOCIATED WITH 6027 04:21:37,281 --> 04:21:38,482 POORER EXECUTIVE FUNCTION, 6028 04:21:38,549 --> 04:21:40,117 PROCESSING SPEED, AS WELL AS 6029 04:21:40,184 --> 04:21:41,886 MOTOR FUNCTION IN WOMEN WITH HIV 6030 04:21:41,952 --> 04:21:44,055 GENERALLY AND THEN YOU CAN SEE 6031 04:21:44,121 --> 04:21:45,856 ON THE RIGHT-HAND SIDE IF YOU 6032 04:21:45,923 --> 04:21:48,959 FOCUS IN ON JUST VIRALLY 6033 04:21:49,026 --> 04:21:49,894 SUPPRESSED WOMEN WITH HIV, THE 6034 04:21:49,960 --> 04:21:51,962 MOTOR FALLS OUT BUT YOU STILL 6035 04:21:52,029 --> 04:21:55,332 SEE THE EXECUTIVE FUNCTION AND 6036 04:21:55,399 --> 04:21:56,333 PROCESSING SPEED. 6037 04:21:56,400 --> 04:21:59,437 THE OTHER THING TO NOTE HERE IS 6038 04:21:59,503 --> 04:22:01,639 THAT THE UNSTANDARDIZED DATA SO 6039 04:22:01,705 --> 04:22:03,174 EFFICIENTS, WE'RE TALKING ABOUT 6040 04:22:03,240 --> 04:22:05,876 T SCORES HERE, AND A T SCORE IS 6041 04:22:05,943 --> 04:22:09,647 A MEAN OF 50, STANDARD DEVIATION 6042 04:22:09,713 --> 04:22:11,816 OF 10, SO EFFECTS ARE THERE BUT 6043 04:22:11,882 --> 04:22:13,684 DEFINITELY SMALL. 6044 04:22:13,751 --> 04:22:16,420 AND TO ME THAT'S NOT SURPRISING 6045 04:22:16,487 --> 04:22:18,389 GIVEN THE HETEROGENEITY IF WE 6046 04:22:18,456 --> 04:22:20,091 THINK ABOUT POLYPHARMACY SO IF 6047 04:22:20,157 --> 04:22:21,826 YOU HIT THE NEXT SLIDE. 6048 04:22:21,892 --> 04:22:24,295 I THINK THE PROBLEM WITH THE 6049 04:22:24,361 --> 04:22:26,997 DEFINITION IN GENERAL IN PUSHING 6050 04:22:27,064 --> 04:22:29,300 THIS WORK FORWARD IS THAT 6051 04:22:29,366 --> 04:22:32,069 THAT -- THE DEFINITION OF 6052 04:22:32,136 --> 04:22:32,636 POLYPHARMACY ISN'T 6053 04:22:32,703 --> 04:22:33,871 NECESSARILY -- DOESN'T CARE 6054 04:22:33,938 --> 04:22:38,976 ABOUT WHAT THE EXACT MEDICATIONS 6055 04:22:39,043 --> 04:22:39,443 ARE. 6056 04:22:39,510 --> 04:22:45,716 IF WE START HONING IN, THIS IS 6057 04:22:45,783 --> 04:22:49,887 WORK BY KENDRA RADKE, RUTH 6058 04:22:49,954 --> 04:22:54,024 BRINGBLAT, AND THEY HAD -- SHE 6059 04:22:54,091 --> 04:22:55,025 WAS A PharmD. STUDENT, 6060 04:22:55,092 --> 04:22:57,728 INTERESTED IN PULLING OUT THE 6061 04:22:57,795 --> 04:23:00,831 NON-ART MEDICATION THAT HAD BEEN 6062 04:23:00,898 --> 04:23:03,601 ASSOCIATED WITH ADVERSE CENTRAL 6063 04:23:03,667 --> 04:23:04,568 NERVOUS SYSTEM EFFECTS, 6064 04:23:04,635 --> 04:23:05,369 COGNITIVE EFFECTS. 6065 04:23:05,436 --> 04:23:08,105 WHAT SHE FOUND IS THAT YOU CAN 6066 04:23:08,172 --> 04:23:09,940 SEE HERE WITHIN WOMEN WITH HIV, 6067 04:23:10,007 --> 04:23:16,080 THEY ARE MORE LIKELY TO BE ON 6068 04:23:16,147 --> 04:23:18,449 ANTI-ANXIETY MEDS, 6069 04:23:18,516 --> 04:23:19,283 ANTIDEPRESSANTS, ANTIHISTAMINES, 6070 04:23:19,350 --> 04:23:20,117 GASTROINTESTINAL MEDS, OPIOIDS 6071 04:23:20,184 --> 04:23:24,488 COMPARED TO WOMEN WITHOUT HIV. 6072 04:23:24,555 --> 04:23:28,792 MORE LIKELY TO BE ON MEDS WITH 6073 04:23:28,859 --> 04:23:30,094 NEGATIVE EFFECTS ON COGNITION, 6074 04:23:30,161 --> 04:23:34,565 AND WHEN WE'VE LOOKED AT IN A 6075 04:23:34,632 --> 04:23:36,534 SUBSEQUENT STUDY WITH KENDRA AND 6076 04:23:36,600 --> 04:23:37,868 COLLEAGUES WE'VE TAKEN KIND OF 6077 04:23:37,935 --> 04:23:39,570 THE COMBINATION OF ALL THOSE 6078 04:23:39,637 --> 04:23:42,973 MEDS, MEDS THAT HAVE KNOWN 6079 04:23:43,040 --> 04:23:45,042 ADVERSE CNS EFFECTS, AND IN 6080 04:23:45,109 --> 04:23:46,477 GENERAL THE SIGNAL WASN'T GREAT 6081 04:23:46,544 --> 04:23:48,679 WHEN WE LOOKED AT IT WITH 6082 04:23:48,746 --> 04:23:50,681 RESPECT TO ITS RELATIONSHIP WITH 6083 04:23:50,748 --> 04:23:50,948 COGNITION. 6084 04:23:51,015 --> 04:23:55,853 HOWEVER, IF YOU HIT THE NEXT 6085 04:23:55,920 --> 04:23:57,588 SLIDE, IF DON'T JUST LOOK AT 6086 04:23:57,655 --> 04:24:00,090 GLOBAL DEFINITION OF JUST 6087 04:24:00,157 --> 04:24:02,993 MEDICATIONS THAT HAVE NEGATIVE 6088 04:24:03,060 --> 04:24:03,928 ADVERSE EFFECTS ON COGNITION, 6089 04:24:03,994 --> 04:24:08,766 AND YOU START DIGGING IN A BIT 6090 04:24:08,832 --> 04:24:11,669 INTO THE MEDICATION OR DRUGS 6091 04:24:11,735 --> 04:24:13,437 THAT HAVE DIFFERENT SIDE EFFECT 6092 04:24:13,504 --> 04:24:18,409 PROFILES, SO WE'VE LOOKED AT 6093 04:24:18,475 --> 04:24:19,043 MEDICATIONS WITH ANTICHOLINERGIC 6094 04:24:19,109 --> 04:24:22,413 PROPERTIES, IN INDIVIDUALS WITH 6095 04:24:22,479 --> 04:24:24,949 PSYCHOSIS, YOU CAN SEE MY 6096 04:24:25,015 --> 04:24:29,887 COLLEAGUE JEFF BISHOP AND OTHER 6097 04:24:29,954 --> 04:24:31,722 FOLKS WITHIN THIS, THE CLINICAL 6098 04:24:31,789 --> 04:24:33,557 RATING SCARE HIGHER IS POORER 6099 04:24:33,624 --> 04:24:34,892 PERFORMANCE, WHAT YOU CAN SEE 6100 04:24:34,959 --> 04:24:38,295 HERE IS THAT WHEN IT COMES TO 6101 04:24:38,362 --> 04:24:48,539 TAKING ONE OR MORE MEDICATION, 6102 04:24:48,606 --> 04:24:55,913 THAT HAS THIS PROPERTY, WOMEN 6103 04:24:55,980 --> 04:24:57,581 PERFORM MORE POORLY. 6104 04:24:57,648 --> 04:25:00,651 SO AGAIN ALL OF THE PRIOR WORK 6105 04:25:00,718 --> 04:25:03,687 WE WERE DOING, POLYPHARMACY, 6106 04:25:03,754 --> 04:25:05,122 THIS MORE GENERAL TERM, WE'VE 6107 04:25:05,189 --> 04:25:09,159 LOOKED AT DRUGS WITH ADVERSE CNS 6108 04:25:09,226 --> 04:25:10,160 EFFECTS SPECIFICALLY, OR 6109 04:25:10,227 --> 04:25:16,200 MEDICATIONS, WE FOUND ONE BY ONE 6110 04:25:16,267 --> 04:25:16,934 LOOKING AT ANTIDEPRESSANTS, 6111 04:25:17,001 --> 04:25:17,801 ANGIOLYTICS, OPIOIDS, AGAIN 6112 04:25:17,868 --> 04:25:23,374 THAT'S A ONE BY ONE PERSPECTIVE. 6113 04:25:23,440 --> 04:25:25,776 WE KNOW THAT THERE'S 6114 04:25:25,843 --> 04:25:26,977 COMBINATIONS OF DRUGS THAT 6115 04:25:27,044 --> 04:25:30,814 INDIVIDUALS ARE ON, AND HOW THEY 6116 04:25:30,881 --> 04:25:31,081 CO-OCCUR. 6117 04:25:31,148 --> 04:25:33,584 AND SO IN TRYING TO THINK HOW TO 6118 04:25:33,651 --> 04:25:35,319 MOVE THIS WORK, THE FIELD 6119 04:25:35,386 --> 04:25:37,054 FORWARD IN THIS AREA, WE DO NEED 6120 04:25:37,121 --> 04:25:39,290 TO BE THINKING ABOUT ALTERNATIVE 6121 04:25:39,356 --> 04:25:41,859 APPROACHES TO EXAMINING THE LINK 6122 04:25:41,925 --> 04:25:44,328 BETWEEN POLY -- LIKE DRUG 6123 04:25:44,395 --> 04:25:47,464 CLASSES AND COGNITION, IN PEOPLE 6124 04:25:47,531 --> 04:25:48,465 WITH HIV. 6125 04:25:48,532 --> 04:25:51,568 WE'VE-- YOU CAN SEE ON THE TOP 6126 04:25:51,635 --> 04:25:53,070 HERE, IT'S NOT A 6127 04:25:53,137 --> 04:25:55,139 ONE-SIZE-FITS-ALL HAT WITH 6128 04:25:55,205 --> 04:25:56,340 RESPECT TO COGNITIVE PROFILES, 6129 04:25:56,407 --> 04:25:57,741 NOT JUST BEING IMPAIRED OR NOT. 6130 04:25:57,808 --> 04:26:08,285 YOU CAN SEE ON THE LEFT-HAND 6131 04:26:08,352 --> 04:26:10,487 SIDE THIS IS DATA AS PART OF A 6132 04:26:10,554 --> 04:26:15,492 GRANT ON POLYPHARMACY AND 6133 04:26:15,559 --> 04:26:16,493 COGNITION, YES, THERE'S A LARGE 6134 04:26:16,560 --> 04:26:19,763 PERCENTAGE OF PEOPLE THAT DON'T 6135 04:26:19,830 --> 04:26:21,432 SHOW COGNITIVE IMPAIRMENT ON ANY 6136 04:26:21,498 --> 04:26:22,966 GIVEN DOMAIN, YOU CAN SEE THERE 6137 04:26:23,033 --> 04:26:27,538 ARE DIFFERENT SUBGROUPS THAT 6138 04:26:27,604 --> 04:26:29,073 SHOW ISSUES, GLOBAL IMPAIRMENT 6139 04:26:29,139 --> 04:26:31,375 IS SECOND GROUP, 46% OF THOSE 6140 04:26:31,442 --> 04:26:33,243 INDIVIDUALS ARE FEMALE, AND YOU 6141 04:26:33,310 --> 04:26:36,380 CAN SEE GOING ACROSS THAT 6142 04:26:36,447 --> 04:26:37,548 THERE'S PROFILES THAT MAY HAVE 6143 04:26:37,614 --> 04:26:39,416 WEAK MOTOR SKILLS, LEARNING AND 6144 04:26:39,483 --> 04:26:40,784 MEMORY WITH MOTOR IMPAIRMENT. 6145 04:26:40,851 --> 04:26:46,523 WHAT WE HAD DONE LOOKING AT 6146 04:26:46,590 --> 04:26:47,658 THESE NON-ANTIRETROVIRAL DRUG 6147 04:26:47,725 --> 04:26:53,130 CLASSES WAS TO DO MORE OF A DATA 6148 04:26:53,197 --> 04:26:54,164 REDUCTION APPROACH, PRINCIPAL 6149 04:26:54,231 --> 04:27:00,070 COMPONENTS ANALYSIS TO IDENTIFY 6150 04:27:00,137 --> 04:27:02,005 KIND OF NON-ART DRUGS. 6151 04:27:02,072 --> 04:27:04,775 ON THE LEFT-HAND SIDE, THE 6152 04:27:04,842 --> 04:27:09,813 FACTOR SCORE WAS MORE OF DRUGS 6153 04:27:09,880 --> 04:27:12,816 THAT COMBINED TOGETHER, CNS 6154 04:27:12,883 --> 04:27:13,484 DRUGS, PSYCHOTHERAPEUTIC DRUGS, 6155 04:27:13,550 --> 04:27:14,385 ANTIDEPRESSANTS, ET CETERA, AND 6156 04:27:14,451 --> 04:27:16,887 WHAT WE HAD DONE USING MACHINE 6157 04:27:16,954 --> 04:27:21,392 LEARNING WAS TO IDENTIFY WHICH 6158 04:27:21,458 --> 04:27:24,328 OF THESE COMPONENTS CONTRIBUTE 6159 04:27:24,395 --> 04:27:26,997 TO, SAY, THAT GLOBAL IMPAIRMENT 6160 04:27:27,064 --> 04:27:28,799 PROFILE VERSUS SHOWS SHOWING NO 6161 04:27:28,866 --> 04:27:29,466 IMPAIRMENT. 6162 04:27:29,533 --> 04:27:30,534 SO UNDER THAT GLOBAL IMPAIRMENT 6163 04:27:30,601 --> 04:27:37,341 WHAT YOU'RE SEEING HERE IS THE 6164 04:27:37,408 --> 04:27:38,809 WEIGHTS FROM THE MACHINE 6165 04:27:38,876 --> 04:27:41,512 LEARNING ANALYSIS TO SHOW WHICH 6166 04:27:41,578 --> 04:27:43,180 OF THOSE COMPONENTS ARE REALLY 6167 04:27:43,247 --> 04:27:45,649 DISTINGUISHING, SO YOU SEE THAT 6168 04:27:45,716 --> 04:27:48,519 RC-1, THAT BLUE BOX ON THE LEFT, 6169 04:27:48,585 --> 04:27:53,891 THOSE ARE DRUGS THAT ARE MORE 6170 04:27:53,957 --> 04:27:56,660 LIKELY TO BE USED IN THOSE WITH 6171 04:27:56,727 --> 04:27:59,897 GLOBAL IMPAIRMENT VERSUS 6172 04:27:59,963 --> 04:28:00,330 UNIMPAIRED. 6173 04:28:00,397 --> 04:28:03,700 NEXT SLIDE. 6174 04:28:03,767 --> 04:28:05,269 OTHER APPROACHES AGAIN, STARTING 6175 04:28:05,335 --> 04:28:11,608 TO ADAPT COMMUNITY DETECTION 6176 04:28:11,675 --> 04:28:13,177 ALGORITHMS FOR PEOPLE WITH 6177 04:28:13,243 --> 04:28:16,013 SIMILAR COMBINATIONS, USED FOR 6178 04:28:16,079 --> 04:28:18,148 ANALYSIS OF COMPLEX NETWORKS, 6179 04:28:18,215 --> 04:28:20,684 AND USING THESE METHODS AS 6180 04:28:20,751 --> 04:28:21,919 OPPOSED TO TRADITIONAL 6181 04:28:21,985 --> 04:28:23,554 CLUSTERING METHODS OVERCOMES 6182 04:28:23,620 --> 04:28:26,190 ISSUES WE'VE OBSERVED IN 6183 04:28:26,256 --> 04:28:27,257 POLYPHARMACY DATA SUCH AS 6184 04:28:27,324 --> 04:28:28,792 SIMILAR DRUGS NOT BEING 6185 04:28:28,859 --> 04:28:30,060 CO-PRESCRIBED OR BEING PRESENT 6186 04:28:30,127 --> 04:28:30,894 IN DIFFERENT TIME PERIODS. 6187 04:28:30,961 --> 04:28:33,630 HOW THEY ARE ENTERING THE MARKET 6188 04:28:33,697 --> 04:28:36,600 OR FDA APPROVAL. 6189 04:28:36,667 --> 04:28:38,769 AND USING SPECIFIC NETWORK 6190 04:28:38,836 --> 04:28:41,638 DESIGNS, THAT CONSISTS OF NODES, 6191 04:28:41,705 --> 04:28:42,840 THOSE ARE PEOPLE, AND EDGES THAT 6192 04:28:42,906 --> 04:28:44,808 CONNECT THEM IF THEY ARE TAKING 6193 04:28:44,875 --> 04:28:45,409 SIMILAR DRUGS, THAT'S ON THE 6194 04:28:45,476 --> 04:28:47,110 LEFT-HAND SIDE. 6195 04:28:47,177 --> 04:28:53,050 YOU GET THESE CLUSTERS OF 6196 04:28:53,116 --> 04:28:54,551 INDIVIDUALS WHO ARE USING 6197 04:28:54,618 --> 04:28:56,320 SIMILAR COMBINATIONS OF DRUGS, 6198 04:28:56,386 --> 04:28:57,154 AND COMMUNITIES CONSIST OF 6199 04:28:57,221 --> 04:28:59,490 PEOPLE, YOU KNOW, THEY MAY NOT 6200 04:28:59,556 --> 04:29:00,924 BE PERFECTLY OVERLAPPING BUT 6201 04:29:00,991 --> 04:29:02,693 THEY ARE TAKING SIMILAR DRUGS. 6202 04:29:02,759 --> 04:29:04,394 AND OVER TIME, WE'RE GOING TO BE 6203 04:29:04,461 --> 04:29:13,203 LOOKING AT YOU WHO TO IMPROVE 6204 04:29:13,270 --> 04:29:16,507 THESE ADAPTATION OF THESE 6205 04:29:16,573 --> 04:29:17,508 METHODS AND LINKING TO 6206 04:29:17,574 --> 04:29:17,975 COGNITION. 6207 04:29:18,041 --> 04:29:19,476 ON THE LEFT SIDE ONE COMMUNITY 6208 04:29:19,543 --> 04:29:21,678 WAS IDENTIFIED WITH A LARGE 6209 04:29:21,745 --> 04:29:22,746 NUMBER OF INDIVIDUALS, AND 6210 04:29:22,813 --> 04:29:24,515 ANYTHING THAT'S IN BETWEEN THE 6211 04:29:24,581 --> 04:29:26,049 DOTTED LINES ARE DRUGS THAT ARE 6212 04:29:26,116 --> 04:29:28,619 KIND OF IN THE MIDDLE. 6213 04:29:28,685 --> 04:29:30,020 THERE'S REALLY NO DIFFERENCE. 6214 04:29:30,087 --> 04:29:33,657 WHAT YOU SEE ON THE TOP ARE 6215 04:29:33,724 --> 04:29:34,424 DRUGS THAT ARE OVERREPRESENTED 6216 04:29:34,491 --> 04:29:36,994 IN THIS COMMUNITY. 6217 04:29:37,060 --> 04:29:38,228 SO THINGS LIKE TRAZODONE MORE 6218 04:29:38,295 --> 04:29:40,330 LIKELY TO BE USED IN ANY 6219 04:29:40,397 --> 04:29:47,571 COMMUNITY OF INDIVIDUALS VERSUS 6220 04:29:47,638 --> 04:29:50,874 DRUGS THAT ARE UNDERREPRESENTED, 6221 04:29:50,941 --> 04:29:56,647 LIKE BUPROPION ON THE BOTTOM. 6222 04:29:56,713 --> 04:29:59,917 ALSO WORKING THROUGH NSF AN R01 6223 04:29:59,983 --> 04:30:02,286 RECENTLY RECEIVED IS LOOKING AT 6224 04:30:02,352 --> 04:30:03,153 MORE PRECISION MEDICATION 6225 04:30:03,220 --> 04:30:10,527 APPROACHES FOR EFFECTS OF DRUG 6226 04:30:10,594 --> 04:30:14,598 COMBINATIONS ON BRAIN HEALTH. 6227 04:30:14,665 --> 04:30:17,200 WE'RE NOW MOVING THIS TO NON-ART 6228 04:30:17,267 --> 04:30:21,505 MEDICATIONS AND EVENTUALLY 6229 04:30:21,572 --> 04:30:21,838 COMBINATIONS. 6230 04:30:21,905 --> 04:30:25,208 THE GOAL IS TO TAKE INFORMATION 6231 04:30:25,275 --> 04:30:26,610 BASEs ON AN INDIVIDUAL'S MASS, 6232 04:30:26,677 --> 04:30:28,579 BODY MASS, ALL THOSE THINGS, TO 6233 04:30:28,645 --> 04:30:34,151 BE IDENTIFYING WHAT IS OPTIMAL 6234 04:30:34,217 --> 04:30:36,453 SITUATION ON CNS OUTCOMES. 6235 04:30:36,520 --> 04:30:37,354 FINAL SLIDE. 6236 04:30:37,421 --> 04:30:39,456 KEY MESSAGES IS THAT MORE WORK 6237 04:30:39,523 --> 04:30:42,693 IS NEEDED IN THE AREA OF 6238 04:30:42,759 --> 04:30:43,327 POLYPHARMACY AND COMPLICATIONS 6239 04:30:43,393 --> 04:30:44,628 MORE GENERALLY IN WOMEN. 6240 04:30:44,695 --> 04:30:46,496 WE NEED TO SHIFT I THINK FROM 6241 04:30:46,563 --> 04:30:48,031 THAT DEFINITION OF POLYPHARMACY 6242 04:30:48,098 --> 04:30:50,233 TO MORE SPECIFIC DRUG 6243 04:30:50,300 --> 04:30:50,567 COMBINATIONS. 6244 04:30:50,634 --> 04:30:55,072 AND TAKING A MORE NUANCED 6245 04:30:55,138 --> 04:30:56,707 APPROACH TO UNDERSTAND THAT 6246 04:30:56,773 --> 04:30:58,141 HETEROGENEITY, AND, YOU KNOW, 6247 04:30:58,208 --> 04:30:59,943 THIS OTHER ISSUE IS THINKING 6248 04:31:00,010 --> 04:31:01,445 ABOUT HOW TO DISTINGUISH THE 6249 04:31:01,511 --> 04:31:02,379 DRUGS FROM THE UNDERLYING 6250 04:31:02,446 --> 04:31:04,114 CONDITIONS AND I THINK THAT'S A 6251 04:31:04,181 --> 04:31:06,216 MUCH MORE -- THAT'S A LARGER 6252 04:31:06,283 --> 04:31:06,416 ISSUE. 6253 04:31:06,483 --> 04:31:11,688 THEN THE LAST SLIDE JUST TO 6254 04:31:11,755 --> 04:31:15,125 ACKNOWLEDGE THE BRAIN HEALTH 6255 04:31:15,192 --> 04:31:18,161 PROGRAM, THE NIH AND NSF FOR 6256 04:31:18,228 --> 04:31:28,538 FUNDING THIS WORK. 6257 04:31:29,239 --> 04:31:29,573 THANK YOU. 6258 04:31:29,640 --> 04:31:30,841 >> PLEASE SEND QUESTIONS OR 6259 04:31:30,907 --> 04:31:34,277 COMMENTS VIA THE LIVE FEEDBACK 6260 04:31:34,344 --> 04:31:35,912 OPTION BELOW THE VIDEOCAST. 6261 04:31:35,979 --> 04:31:37,748 WE'LL NOW HEAR REMARKS FROM 6262 04:31:37,814 --> 04:31:41,151 MARTHA CAMERON. 6263 04:31:41,218 --> 04:31:45,455 THE VIRTUAL PODIUM IS YOURS. 6264 04:31:45,522 --> 04:31:45,889 >> HI, EVERYONE. 6265 04:31:45,956 --> 04:31:48,859 I WANT TO MAKE SURE YOU CAN ALL 6266 04:31:48,925 --> 04:31:50,060 HEAR ME. 6267 04:31:50,127 --> 04:31:52,062 >> YEP. 6268 04:31:52,129 --> 04:31:57,934 YES, WE CAN. 6269 04:31:58,001 --> 04:31:58,402 >> OKAY. 6270 04:31:58,468 --> 04:32:01,672 THANK YOU FOR THIS OPPORTUNITY, 6271 04:32:01,738 --> 04:32:03,073 QUITE EXHILARATING TO HEAR WHAT 6272 04:32:03,140 --> 04:32:05,042 SOME OF THE SPEAKERS HAVE SAID 6273 04:32:05,108 --> 04:32:06,343 OVER THE PAST TWO DAYS. 6274 04:32:06,410 --> 04:32:08,745 I THINK THE OTHER THING I JUST 6275 04:32:08,812 --> 04:32:14,451 WANTED TO SORT OF UPDATE OR 6276 04:32:14,518 --> 04:32:16,053 CORRECT IS THAT WHILE I STILL 6277 04:32:16,119 --> 04:32:18,822 WORK WITH INTERNATIONAL 6278 04:32:18,889 --> 04:32:20,157 COMMUNITY OF PEOPLE LIVING WITH 6279 04:32:20,223 --> 04:32:24,428 HIV MY DAY JOB IS HERE AT 6280 04:32:24,494 --> 04:32:26,396 GEORGETOWN UNIVERSITY WORKING 6281 04:32:26,463 --> 04:32:28,265 WITH THE MACS/WIHS AND STAR 6282 04:32:28,331 --> 04:32:28,765 STUDIES. 6283 04:32:28,832 --> 04:32:32,202 THAT HAS BEEN A REAL GREAT 6284 04:32:32,269 --> 04:32:33,770 OPPORTUNITY, IT HAS HELPED ME 6285 04:32:33,837 --> 04:32:35,505 EVEN HAVE, YOU KNOW, LIKE A 6286 04:32:35,572 --> 04:32:38,208 FRONT-ROW SEAT TO SOME OF THIS 6287 04:32:38,275 --> 04:32:40,510 RESEARCH AND SOME OF THE 6288 04:32:40,577 --> 04:32:41,712 FINDINGS THAT ARE HAPPENING. 6289 04:32:41,778 --> 04:32:44,448 I WAS ALSO GLAD TO SEE SOME OF 6290 04:32:44,514 --> 04:32:47,751 MY FELLOW WOMEN LIVING WITH HIV 6291 04:32:47,818 --> 04:32:50,253 BEING INCLUDED IN SOME OF THE 6292 04:32:50,320 --> 04:32:53,023 PANELS, I'M A PERSON LIVING WITH 6293 04:32:53,090 --> 04:32:56,159 HIV OF 20 YEARS. 6294 04:32:56,226 --> 04:32:58,862 I'VE ALSO HAD TWO CHILDREN, NOW 6295 04:32:58,929 --> 04:33:01,298 12 AND 14, SINCE I'VE BEEN 6296 04:33:01,364 --> 04:33:08,538 LIVING WITH HIV SO I HAVE A REAL 6297 04:33:08,605 --> 04:33:13,510 KEEN INTEREST IN ANYTHING TO DO 6298 04:33:13,577 --> 04:33:16,279 WITH BABIES, BREASTFEEDING, AND 6299 04:33:16,346 --> 04:33:18,281 ALSO SOME OF THE INFORMATION 6300 04:33:18,348 --> 04:33:21,918 THAT WE HAD HEARD RELATED TO 6301 04:33:21,985 --> 04:33:24,254 CURE, ESPECIALLY AS IT IS 6302 04:33:24,321 --> 04:33:25,422 HAPPENING OR REMISSION AS IT IS 6303 04:33:25,489 --> 04:33:27,657 HAPPENING IN BABIES THAT ARE IN 6304 04:33:27,724 --> 04:33:28,391 CURE TRIALS. 6305 04:33:28,458 --> 04:33:32,729 I JUST HAVE A LOT OF INTEREST IN 6306 04:33:32,796 --> 04:33:33,930 HIV IS OBVIOUSLY PERSONAL AND 6307 04:33:33,997 --> 04:33:35,699 PROFESSIONAL INTEREST TO ME. 6308 04:33:35,766 --> 04:33:38,635 BUT AS IT RELATES TO THIS PANEL, 6309 04:33:38,702 --> 04:33:41,571 THAT WE'RE ON, AND TALKING ABOUT 6310 04:33:41,638 --> 04:33:43,774 COMORBIDITIES AND TALKING ABOUT 6311 04:33:43,840 --> 04:33:48,945 HOW WE'RE AGING WITH HIV, I 6312 04:33:49,012 --> 04:33:51,214 THINK THERE'S A LOT TO DISCUSS 6313 04:33:51,281 --> 04:33:52,616 ON BEHALF OF THE COMMUNITY. 6314 04:33:52,682 --> 04:33:54,651 AND CERTAINLY SOME OF THE THINGS 6315 04:33:54,718 --> 04:33:58,054 THAT I WANTED TO ENCOURAGE ALL 6316 04:33:58,121 --> 04:33:59,689 OF THE RESEARCHERS THAT ARE 6317 04:33:59,756 --> 04:34:02,626 ESSENTIALLY WORKING ON THIS TO 6318 04:34:02,692 --> 04:34:04,194 BE HELPING, YOU KNOW, CONTRIBUTE 6319 04:34:04,261 --> 04:34:06,463 TO SOME OF THE POLICY AS IT 6320 04:34:06,530 --> 04:34:09,032 RELATED TO HEALTH CARE OF 6321 04:34:09,099 --> 04:34:09,900 PEOPLE. 6322 04:34:09,966 --> 04:34:12,936 SO, WE KNOW THAT PEOPLE OVER 50 6323 04:34:13,003 --> 04:34:15,906 YEARS OLD ARE MAKING UP MORE 6324 04:34:15,972 --> 04:34:17,974 THAN HALF OF THE PEOPLE LIVING 6325 04:34:18,041 --> 04:34:19,743 WITH HIV IN THE U.S. 6326 04:34:19,810 --> 04:34:22,946 AND SO IN A SENSE PEOPLE ARE 6327 04:34:23,013 --> 04:34:23,914 AGING WITH HIV. 6328 04:34:23,980 --> 04:34:24,381 WE KNOW THAT. 6329 04:34:24,447 --> 04:34:27,317 I THINK IN THE NEXT TEN YEARS OR 6330 04:34:27,384 --> 04:34:29,953 SO, OVER 50% OF PEOPLE LIVING 6331 04:34:30,020 --> 04:34:40,063 WITH LIVING WILL BE ABOVE 6 5. 6332 04:34:40,130 --> 04:34:43,099 I THINK DR. WOMACK SAID WE 6333 04:34:43,166 --> 04:34:45,869 HAVEN'T REALIZED THE FULL IMPACT 6334 04:34:45,936 --> 04:34:47,137 OF THE GERIATRIC SYNDROME ON 6335 04:34:47,204 --> 04:34:52,142 PEOPLE LIVING WITH HIV BECAUSE I 6336 04:34:52,209 --> 04:34:53,577 HAVE HEARD OTHER RESEARCH 6337 04:34:53,643 --> 04:35:01,418 RESULTS, OBVIOUSLY BEING PART OF 6338 04:35:01,484 --> 04:35:03,253 THESE STUDIES WE'RE ALREADY 6339 04:35:03,320 --> 04:35:04,054 SEEING IMPACTS, ESPECIALLY ON 6340 04:35:04,120 --> 04:35:05,655 WOMEN LIVING WITH HIV. 6341 04:35:05,722 --> 04:35:06,890 WE'VE KNOWN FOR OVER TEN YEARS 6342 04:35:06,957 --> 04:35:09,292 AS WE AGE WITH HIV WE'RE 6343 04:35:09,359 --> 04:35:10,293 EXPERIENCING MORE COMORBIDITIES 6344 04:35:10,360 --> 04:35:11,595 THAT HAVE BEEN MENTIONED IN 6345 04:35:11,661 --> 04:35:14,564 TERMS OF DIABETES AND HEART 6346 04:35:14,631 --> 04:35:18,602 DISEASE, WE'RE SEEING IMPACT ON 6347 04:35:18,668 --> 04:35:19,703 OUR LIVERS AND KIDNEYS. 6348 04:35:19,769 --> 04:35:24,341 ONE OF THE MOST CONCERNING 6349 04:35:24,407 --> 04:35:25,308 THINGS I'VE HEARD TOO IS AS 6350 04:35:25,375 --> 04:35:27,510 RELATES TO MENTAL HEALTH WHICH 6351 04:35:27,577 --> 04:35:34,751 FOR ME DIDN'T TAKE THE RESEARCH 6352 04:35:34,818 --> 04:35:35,919 TO TELL ME THAT. 6353 04:35:35,986 --> 04:35:37,721 IN THE COMMUNITY WE'RE DOING 6354 04:35:37,787 --> 04:35:39,522 TRAUMA INFORMED WORK, ADVOCATING 6355 04:35:39,589 --> 04:35:41,458 FOR SERVICES OVER 20 YEARS AGO 6356 04:35:41,524 --> 04:35:45,128 KNOWING THAT A LOT OF ISSUES 6357 04:35:45,195 --> 04:35:48,298 ASSOCIATED WITH, YOU KNOW, THE 6358 04:35:48,365 --> 04:35:49,199 ADVERSE CHILDHOOD EXPERIENCES AS 6359 04:35:49,266 --> 04:35:52,469 WELL AS JUST THE TRAUMA OF BEING 6360 04:35:52,536 --> 04:35:56,406 DIAGNOSED AND LIVING WITH HIV OR 6361 04:35:56,473 --> 04:35:59,376 ISSUES LIKE POVERTY AND 6362 04:35:59,442 --> 04:36:00,477 VIOLENCE, DISCUSSED HERE, 6363 04:36:00,543 --> 04:36:01,978 PREDISPOSE US TO LIVING WITH -- 6364 04:36:02,045 --> 04:36:04,881 TO HIV IN THE FIRST PLACE, AND 6365 04:36:04,948 --> 04:36:07,651 SO IT SHOULDN'T BE NEW THAT AS 6366 04:36:07,717 --> 04:36:11,488 WE'RE LIVING WITH HIV WE'RE 6367 04:36:11,554 --> 04:36:12,722 EXPERIENCING HEIGHTENED FORMS OF 6368 04:36:12,789 --> 04:36:13,924 VIOLENCE AND MENTAL HEALTH. 6369 04:36:13,990 --> 04:36:16,760 THAT'S ONE OF THE STUDIES THAT 6370 04:36:16,826 --> 04:36:23,967 I'VE SEEN FROM THE CCF, THE 6371 04:36:24,034 --> 04:36:25,368 MACS/WIHS COHORT SHOWS HOW WE 6372 04:36:25,435 --> 04:36:28,271 CAN DIE FROM MENTAL HEALTH, THE 6373 04:36:28,338 --> 04:36:30,206 TRAJECTORY OF EXPERIENCING 6374 04:36:30,273 --> 04:36:31,107 SYMPTOMS OF MENTAL HEALTH, 6375 04:36:31,174 --> 04:36:32,309 MENTAL HEALTH COVERS A LOT OF 6376 04:36:32,375 --> 04:36:35,712 THINGS, LET REALLY CAN KILL US 6377 04:36:35,779 --> 04:36:37,347 JUST AS -- LITERALLY CAN KILL US 6378 04:36:37,414 --> 04:36:38,982 AS IF WE'RE NOT ON ART 6379 04:36:39,049 --> 04:36:39,616 TREATMENT. 6380 04:36:39,683 --> 04:36:42,285 REGARDLESS OF TAKING ART, WE 6381 04:36:42,352 --> 04:36:45,021 HAVE THIS, YOU KNOW, MENTAL 6382 04:36:45,088 --> 04:36:46,156 HEALTH EPIDEMIC IN OUR 6383 04:36:46,222 --> 04:36:46,623 COMMUNITIES. 6384 04:36:46,690 --> 04:36:48,725 AND THE SAME THING WITH WHAT WE 6385 04:36:48,792 --> 04:36:50,994 HEARD, I DON'T NEED TO REPEAT, 6386 04:36:51,061 --> 04:36:53,363 WE KNOW THAT COVID IMPACTED OUR 6387 04:36:53,430 --> 04:36:54,898 COMMUNITY A LOT MORE THAN THE 6388 04:36:54,965 --> 04:36:57,567 REST OF THE COMMUNITY BECAUSE WE 6389 04:36:57,634 --> 04:37:01,838 KNEW THAT THE SAME FACTORS, SAME 6390 04:37:01,905 --> 04:37:04,007 POVERTY, PEOPLE LIVING UNDER 6391 04:37:04,074 --> 04:37:05,442 POVERTY, TRAUMA, VIOLENCE, ALL 6392 04:37:05,508 --> 04:37:06,943 THOSE THINGS WERE ALREADY 6393 04:37:07,010 --> 04:37:08,378 EXISTING AMONG US AS PEOPLE 6394 04:37:08,445 --> 04:37:10,347 LIVING WITH HIV SO WE KNEW IT 6395 04:37:10,413 --> 04:37:12,182 WOULD IMPACT US MORE. 6396 04:37:12,248 --> 04:37:14,250 WHAT CONCERNS US FOR THOSE THAT 6397 04:37:14,317 --> 04:37:18,421 DO ADVOCACY AND WORK IN HIV IS 6398 04:37:18,488 --> 04:37:21,591 HOW THIS INFORMATION THAT IS 6399 04:37:21,658 --> 04:37:26,396 KNOWN IN THE RESEARCH IN THIS 6400 04:37:26,463 --> 04:37:27,364 PUBLICATION DOES NOT TRANSLATE 6401 04:37:27,430 --> 04:37:30,000 TO CHANGING POLICY AND CHANGING 6402 04:37:30,066 --> 04:37:33,136 MORE ESPECIALLY HIV SERVICES. 6403 04:37:33,203 --> 04:37:34,871 FOR EXAMPLE, THE RYAN WHITE ACT 6404 04:37:34,938 --> 04:37:36,406 WHICH SERVES AS YOU ALREADY 6405 04:37:36,473 --> 04:37:37,607 HEARD PEOPLE LIVING WITH HIV, 6406 04:37:37,674 --> 04:37:41,778 ABOUT HALF OF THE PEOPLE LIVING 6407 04:37:41,845 --> 04:37:44,180 WITH HIV, ALL THESE PEOPLE 6408 04:37:44,247 --> 04:37:44,981 LIVING UNDER CERTAIN POVERTY 6409 04:37:45,048 --> 04:37:47,283 LINES FOR THEM TO BE ELIGIBLE 6410 04:37:47,350 --> 04:37:50,353 FOR THOSE SERVICES, YOU KNOW, 6411 04:37:50,420 --> 04:37:52,789 DON'T HAVE THEIR CARE, THOSE 6412 04:37:52,856 --> 04:37:53,957 SERVICES ONLY TREAT HIV. 6413 04:37:54,024 --> 04:37:58,695 IF THEY HAVE TO TREAT THEIR 6414 04:37:58,762 --> 04:38:00,030 DIABETES AND HEART DISEASE, 6415 04:38:00,096 --> 04:38:01,197 MENTAL HEALTH, ANY OF THESE 6416 04:38:01,264 --> 04:38:04,634 OTHERS, THEY HAVE TO BE REFERRED 6417 04:38:04,701 --> 04:38:08,038 OUT AND HIV FUNDING DOES NOT 6418 04:38:08,104 --> 04:38:10,340 COVER THE GERIATRIC OR 6419 04:38:10,407 --> 04:38:12,075 COMORBIDITIES, LET ME SAY, 6420 04:38:12,142 --> 04:38:12,342 SERVICES. 6421 04:38:12,409 --> 04:38:14,544 AND YOU WOULD THINK IF THE 6422 04:38:14,611 --> 04:38:15,412 RESEARCH IS REALLY SHOWING AND 6423 04:38:15,478 --> 04:38:17,013 HAS BEEN SHOWING FOR THE PAST 6424 04:38:17,080 --> 04:38:19,983 TEN YEARS THAT NOT ONLY ARE WE 6425 04:38:20,050 --> 04:38:20,717 MORE PRE-DISPOSED, WE'RE 6426 04:38:20,784 --> 04:38:21,751 EXPERIENCING THIS MORE, IT'S 6427 04:38:21,818 --> 04:38:24,921 HAPPENING AS WE AGE WITH HIV, 6428 04:38:24,988 --> 04:38:29,392 WHY HAVEN'T THEY STARTED 6429 04:38:29,459 --> 04:38:31,127 COMBINING GERIATRIC SERVICES, 6430 04:38:31,194 --> 04:38:32,328 YOU KNOW, AND SCREENINGS FOR 6431 04:38:32,395 --> 04:38:33,797 HEART DISEASE OR ALL THESE OTHER 6432 04:38:33,863 --> 04:38:36,733 THINGS, WHY CAN'T THEY BE 6433 04:38:36,800 --> 04:38:39,035 COMBINED IN THE HIV CARE AND NOT 6434 04:38:39,102 --> 04:38:41,671 HAVE PEOPLE LIVING WITH HIV 6435 04:38:41,738 --> 04:38:42,639 HAVING ALREADY TO NAVIGATE 6436 04:38:42,705 --> 04:38:47,343 SERVICES TO BE ABLE TO ENCOMPASS 6437 04:38:47,410 --> 04:38:48,144 ALL THE OTHER COMORBIDITIES. 6438 04:38:48,211 --> 04:38:51,648 THIS IS A REAL ISSUE. 6439 04:38:51,714 --> 04:38:53,450 I CAN SPEAK FROM A PERSONAL 6440 04:38:53,516 --> 04:38:56,086 EXPERIENCE WHERE I WAS ASKED TO 6441 04:38:56,152 --> 04:38:58,655 GET A COLONOSCOPY BEFORE I WAS 6442 04:38:58,721 --> 04:39:01,458 50 YEARS OLD BECAUSE IN THE HIV 6443 04:39:01,524 --> 04:39:02,826 CARE IT'S RECOMMENDED, I THINK 6444 04:39:02,892 --> 04:39:05,795 GENERALLY RECOMMENDED IN THE 6445 04:39:05,862 --> 04:39:06,563 REGULAR POPULATION, BUT MY 6446 04:39:06,629 --> 04:39:08,331 INSURANCE WOULDN'T COVER IT 6447 04:39:08,398 --> 04:39:09,299 BECAUSE I HAVEN'T HIT THE 6448 04:39:09,365 --> 04:39:09,999 RECOMMENDED AGE. 6449 04:39:10,066 --> 04:39:11,868 THEY HAD TO GET A WAIVER. 6450 04:39:11,935 --> 04:39:13,837 MY DOCTOR HAD TO INSIST THAT I 6451 04:39:13,903 --> 04:39:18,308 NEEDED TO GET THAT COLONOSCOPY, 6452 04:39:18,374 --> 04:39:19,809 AND THAT WAS WHEN, AND IT WAS 6453 04:39:19,876 --> 04:39:21,644 THE SAME THING WITH THE SHINGLES 6454 04:39:21,711 --> 04:39:21,911 VACCINES. 6455 04:39:21,978 --> 04:39:25,582 THEY ASKED ME HOW COME YOU'RE 6456 04:39:25,648 --> 04:39:26,483 GETTING SHINGLES VACCINES, 6457 04:39:26,549 --> 04:39:29,052 YOU'RE NOT AT THE AGE YOU'RE 6458 04:39:29,119 --> 04:39:30,920 SUPPOSED TO BE GETTING SHINGLES 6459 04:39:30,987 --> 04:39:31,187 VACCINES. 6460 04:39:31,254 --> 04:39:33,022 WELL, BECAUSE I'M HIV POSITIVE, 6461 04:39:33,089 --> 04:39:35,525 THIS HAS BEEN RECOMMENDED EVEN 6462 04:39:35,592 --> 04:39:37,060 BEFORE I REACHED THOSE AGES THAT 6463 04:39:37,127 --> 04:39:38,795 ARE NORMALLY RECOMMENDED FOR YOU 6464 04:39:38,862 --> 04:39:42,098 TO START GETTING SHINGLES OR 6465 04:39:42,165 --> 04:39:48,004 COLONOSCOPIES OR SOME OTHER 6466 04:39:48,071 --> 04:39:48,371 SCREENINGS. 6467 04:39:48,438 --> 04:39:49,739 THE RESEARCH IS NOT CATCHING UP 6468 04:39:49,806 --> 04:39:51,407 WITH THE CARE THAT WE SHOULD BE 6469 04:39:51,474 --> 04:39:53,343 GETTING AS PEOPLE LIVING WITH 6470 04:39:53,409 --> 04:39:53,810 HIV. 6471 04:39:53,877 --> 04:39:56,880 AND AS PEOPLE AGING WITH HIV. 6472 04:39:56,946 --> 04:40:00,984 AND AS PEOPLE EXPERIENCING THESE 6473 04:40:01,050 --> 04:40:05,255 CO-MORBIDITIES OF HIV. 6474 04:40:05,321 --> 04:40:07,423 ALREADY, BECAUSE OF CERVICAL 6475 04:40:07,490 --> 04:40:09,292 CANCER, WHAT WAS -- WHEN I HAD 6476 04:40:09,359 --> 04:40:12,061 MY PAP SMEAR AND SO ON, THEY 6477 04:40:12,128 --> 04:40:13,730 FOUND SOME STUFF THAT THEY WERE 6478 04:40:13,796 --> 04:40:15,064 SAYING, I CAN'T REMEMBER WHAT 6479 04:40:15,131 --> 04:40:17,066 THE CELLS ARE, THAT SHOW THIS 6480 04:40:17,133 --> 04:40:20,470 COULD TURN INTO CANCER, HAD A 6481 04:40:20,537 --> 04:40:21,571 HYSTERECTOMY, ALL THESE THINGS 6482 04:40:21,638 --> 04:40:23,873 THAT I THINK WE NEED TO BE MORE 6483 04:40:23,940 --> 04:40:25,308 AWARE OF. 6484 04:40:25,375 --> 04:40:28,711 THE OTHER THING THAT IS VERY 6485 04:40:28,778 --> 04:40:30,680 TOUCHING FOR ME, FOR THOSE 6486 04:40:30,747 --> 04:40:32,749 YOUNGER WOMEN THAT WERE BORN 6487 04:40:32,815 --> 04:40:37,787 WITH HIV, THAT HAVE LIVED THUS 6488 04:40:37,854 --> 04:40:40,623 FAR, WE HAVE LOST LIFE SOMETIME 6489 04:40:40,690 --> 04:40:43,359 SURVIVORS TO BREAST CANCER AND 6490 04:40:43,426 --> 04:40:50,366 TO I THINK THE OTHER ONE -- I'M 6491 04:40:50,433 --> 04:40:52,802 BLACKING OUT ON THE NAME OF A 6492 04:40:52,869 --> 04:40:53,703 COMMON CANCER, THESE YOUNG 6493 04:40:53,770 --> 04:40:55,338 PEOPLE WE LOST IN OUR COMMUNITY 6494 04:40:55,405 --> 04:40:58,408 ARE REALLY LOST TO DISEASES THAT 6495 04:40:58,474 --> 04:41:00,109 COULD HAVE BEEN TREATED, MAYBE 6496 04:41:00,176 --> 04:41:01,010 POTENTIALLY PREVENTED IF THEY 6497 04:41:01,077 --> 04:41:03,580 WERE BEING TREATED AS PEOPLE WHO 6498 04:41:03,646 --> 04:41:06,416 ARE MAYBE NOT OLDER WITH HIV BUT 6499 04:41:06,482 --> 04:41:07,951 LIFETIME, THEY WERE BORN WITH 6500 04:41:08,017 --> 04:41:12,088 HIV, MEANING THE IMPACT OF THE 6501 04:41:12,155 --> 04:41:13,089 DISEASE, OF THE MEDICATION, HAS 6502 04:41:13,156 --> 04:41:16,893 BEEN WORKING ON THEM LONGER THAN 6503 04:41:16,960 --> 04:41:17,994 OTHER PEOPLE. 6504 04:41:18,061 --> 04:41:20,830 AND SO, YOU KNOW, NOW I'M ON A 6505 04:41:20,897 --> 04:41:23,566 MISSION TO REALLY START SAYING, 6506 04:41:23,633 --> 04:41:25,301 WELL, WHEN IS THIS RESEARCH -- I 6507 04:41:25,368 --> 04:41:28,638 THINK THE SPEAKER BEFORE ME 6508 04:41:28,705 --> 04:41:30,807 TALKED ABOUT FRAILTY AND 6509 04:41:30,873 --> 04:41:32,442 FRACTURES, AND I KNOW, AGAIN, 6510 04:41:32,508 --> 04:41:33,910 FROM NOW BEING INSIDE THE 6511 04:41:33,977 --> 04:41:35,745 RESEARCH THAT THIS INFORMATION 6512 04:41:35,812 --> 04:41:37,146 HAS BEEN COLLECTED FOR OVER 30 6513 04:41:37,213 --> 04:41:38,481 YEARS FROM PEOPLE THAT ARE AGING 6514 04:41:38,548 --> 04:41:39,015 WITH HIV. 6515 04:41:39,082 --> 04:41:41,317 WE KNOW THAT WE'RE BECOMING MORE 6516 04:41:41,384 --> 04:41:43,419 FRAIL SOONER. 6517 04:41:43,486 --> 04:41:49,492 I MEAN, I AM ONLY 50, I HAVE TO 6518 04:41:49,559 --> 04:41:50,960 TRANSFORM IN THE MORNING TO GET 6519 04:41:51,027 --> 04:41:53,263 MY JOINTS AND BONES GOING. 6520 04:41:53,329 --> 04:41:56,099 THAT WOULD BE MY LAST CALL TO 6521 04:41:56,165 --> 04:41:57,066 ACTION, ESPECIALLY NOW AS WE 6522 04:41:57,133 --> 04:41:59,402 HAVE THE OPPORTUNITY TO SPEAK TO 6523 04:41:59,469 --> 04:42:00,370 OTHER RESEARCHERS, I KNOW 6524 04:42:00,436 --> 04:42:01,904 SOMETIMES IT TAKES LONG TO 6525 04:42:01,971 --> 04:42:03,773 PUBLISH RESULTS AND GET THOSE 6526 04:42:03,840 --> 04:42:07,443 RESULTS BUT WE'RE REALLY ASKING 6527 04:42:07,510 --> 04:42:09,078 THAT THESE FINDINGS CAN BE ADDED 6528 04:42:09,145 --> 04:42:10,747 TO POLICY THAT CAN CHANGE THE 6529 04:42:10,813 --> 04:42:15,818 CARE OF PEOPLE LIVING WITH HIV. 6530 04:42:15,885 --> 04:42:23,159 THANK YOU SO MUCH. 6531 04:42:23,226 --> 04:42:28,731 >> THANK YOU SO MUCH, MARTHA. 6532 04:42:28,798 --> 04:42:30,466 PLEASE SEND QUESTIONS OR 6533 04:42:30,533 --> 04:42:31,901 COMMENTS VIA LIVE FEEDBACK 6534 04:42:31,968 --> 04:42:33,836 OPTION BELOW THE VIDEOCAST. 6535 04:42:33,903 --> 04:42:43,713 FINAL SPEAKER TODAY IS KATHLEEN 6536 04:42:43,780 --> 04:42:43,946 SIKKEMA. 6537 04:42:44,013 --> 04:42:45,281 >> CAN YOU SEE ME? 6538 04:42:45,348 --> 04:42:47,450 I MAY BE HAVING A VIDEO PROBLEM. 6539 04:42:47,517 --> 04:42:48,217 >> WE CAN SEE YOU. 6540 04:42:48,284 --> 04:42:49,819 >> DIDN'T KNOW IF YOU COULD SEE 6541 04:42:49,886 --> 04:42:50,153 ME. 6542 04:42:50,219 --> 04:42:52,755 I CAN NO LONGER SEE PEOPLE, ONLY 6543 04:42:52,822 --> 04:42:53,056 THE SCREEN. 6544 04:42:53,122 --> 04:42:55,058 HELLO, EVERYONE. 6545 04:42:55,124 --> 04:42:57,260 IT'S A PLEASURE TO BE PART OF 6546 04:42:57,327 --> 04:42:57,727 THIS PANEL. 6547 04:42:57,794 --> 04:43:00,229 MARTHA, I WANT TO THANK YOU FOR 6548 04:43:00,296 --> 04:43:03,733 QUEUING ME UP, AND HOPEFULLY I 6549 04:43:03,800 --> 04:43:05,168 CAN TALK MORE ABOUT THE DECADES 6550 04:43:05,234 --> 04:43:07,670 OF WORK WE'VE BEEN TRYING TO DO 6551 04:43:07,737 --> 04:43:09,005 IN MENTAL HEALTH. 6552 04:43:09,072 --> 04:43:10,740 WHAT I'LL TALK ABOUT TODAY, I 6553 04:43:10,807 --> 04:43:15,878 WANT TO TRACK MY TIME, IS THE 6554 04:43:15,945 --> 04:43:17,780 DEVELOPMENT OF AN INTERVENTION 6555 04:43:17,847 --> 04:43:20,049 THAT'S ADDRESSING MENTAL HEALTH 6556 04:43:20,116 --> 04:43:21,818 AND TRAUMA, SEXUAL TRAUMA IN 6557 04:43:21,884 --> 04:43:23,786 PARTICULAR, AMONG WOMEN LIVING 6558 04:43:23,853 --> 04:43:25,555 WITH HIV IN CAPE TOWN, SOUTH 6559 04:43:25,621 --> 04:43:29,359 AFRICA, AND HOW THAT'S NOW BEING 6560 04:43:29,425 --> 04:43:30,793 TESTED IN A CLINICAL TRIAL, BUT 6561 04:43:30,860 --> 04:43:32,295 HOW IT'S ALSO BEEN BASED ON A 6562 04:43:32,362 --> 04:43:34,297 NUMBER OF STUDIES OVER TIME. 6563 04:43:34,364 --> 04:43:35,832 SO AS I SAID, THIS IS BEING DONE 6564 04:43:35,898 --> 04:43:37,500 IN CAPE TOWN. 6565 04:43:37,567 --> 04:43:38,468 I OBVIOUSLY HAVE COLLABORATORS 6566 04:43:38,534 --> 04:43:43,906 THERE AT THE UNIVERSITY OF CAPE 6567 04:43:43,973 --> 04:43:44,107 TOWN. 6568 04:43:44,173 --> 04:43:44,907 NEXT SLIDE. 6569 04:43:44,974 --> 04:43:47,043 A FEW POINTS I'LL MAKE FOR AN 6570 04:43:47,110 --> 04:43:48,845 OVERVIEW FOR CONTEXT, THIS IS 6571 04:43:48,911 --> 04:43:50,813 WHERE MARTHA SET ME UP FOR THIS, 6572 04:43:50,880 --> 04:43:53,049 THAT WE KNOW THAT MENTAL HEALTH 6573 04:43:53,116 --> 04:43:56,419 TRAUMA AND VIOLENCE IMPACT HIV 6574 04:43:56,486 --> 04:43:56,819 CARE ENGAGEMENT. 6575 04:43:56,886 --> 04:43:59,689 WE'VE OF COURSE KNOW THAT'S A 6576 04:43:59,756 --> 04:44:00,890 PSYCHOLOGICAL IMPACT BUT THERE'S 6577 04:44:00,957 --> 04:44:02,358 A BIOLOGICAL IMPACT AS WELL. 6578 04:44:02,425 --> 04:44:04,560 MY WORK LOOKS AT ADDRESSING 6579 04:44:04,627 --> 04:44:07,864 MENTAL HEALTH, AND THE 6580 04:44:07,930 --> 04:44:09,365 CONSEQUENCES OF TRAUMA BEING 6581 04:44:09,432 --> 04:44:12,435 AVOIDING COPING IN WAYS WE COULD 6582 04:44:12,502 --> 04:44:13,536 IMPROVE HIV ADHERENCE AMONG 6583 04:44:13,603 --> 04:44:16,339 WOMEN WITH SEXUAL TRAUMA AND IN 6584 04:44:16,406 --> 04:44:18,908 THIS PARTICULAR STUDY AS ART IS 6585 04:44:18,975 --> 04:44:19,175 INITIATED. 6586 04:44:19,242 --> 04:44:22,378 I WILL COME BACK TO WHY WE FOCUS 6587 04:44:22,445 --> 04:44:23,713 AT THAT POINT. 6588 04:44:23,780 --> 04:44:25,348 MY EXPERIENCE SO FAR ALTHOUGH 6589 04:44:25,415 --> 04:44:26,549 WE'RE IN THE MIDDLE OF A 6590 04:44:26,616 --> 04:44:28,818 CLINICAL TRIAL IS THAT EFFECTIVE 6591 04:44:28,885 --> 04:44:32,255 TREATMENT CAN BE WE CAN LOOK AT 6592 04:44:32,321 --> 04:44:35,057 PREVIOUS EVIDENCE-BASED 6593 04:44:35,124 --> 04:44:36,592 APPROACHES TO TRAUMA TREATMENT, 6594 04:44:36,659 --> 04:44:40,096 AND INCLUDING FOCUSED ON HIV OR 6595 04:44:40,163 --> 04:44:43,366 MORE BROADLY, CAN BE CULTURALLY 6596 04:44:43,433 --> 04:44:45,001 TAILORED AND USED IN COMMUNITY 6597 04:44:45,067 --> 04:44:47,170 SETTINGS BY WHAT WE OFTEN REFER 6598 04:44:47,236 --> 04:44:50,139 TO IN GLOBAL MENTAL HEALTH AS 6599 04:44:50,206 --> 04:44:50,506 NON-SPECIALISTS. 6600 04:44:50,573 --> 04:44:53,409 SO WE'RE TRYING TO DO MENTAL 6601 04:44:53,476 --> 04:44:55,178 HEALTH INTERVENTIONS IN SETTINGS 6602 04:44:55,244 --> 04:45:02,051 THAT OFTEN HAVE VERY FEW IF ANY 6603 04:45:02,118 --> 04:45:05,054 MENTAL HEALTH PROFESSIONALS, 6604 04:45:05,121 --> 04:45:05,788 PSYCHOLOGISTS, PSYCHIATRISTS, 6605 04:45:05,855 --> 04:45:07,423 SOCIAL WORKERS OR NURSES WITHOUT 6606 04:45:07,490 --> 04:45:09,892 PSYCHOLOGICAL TRAINING, SO IT'S 6607 04:45:09,959 --> 04:45:12,128 THE FOCUS OF MANY GLOBAL MENTAL 6608 04:45:12,195 --> 04:45:13,362 HEALTH EFFORTS TO SEE WHAT HOW 6609 04:45:13,429 --> 04:45:17,300 WE CAN MODIFY AND MAKE EFFECTIVE 6610 04:45:17,366 --> 04:45:21,003 INTERVENTIONS THAT ARE BASICALLY 6611 04:45:21,070 --> 04:45:22,004 IMPLEMENTABLE AND SUSTAINABLE 6612 04:45:22,071 --> 04:45:22,538 OVER TIME. 6613 04:45:22,605 --> 04:45:24,440 SO, ANOTHER POINT THAT I'LL TRY 6614 04:45:24,507 --> 04:45:27,410 TO MAKE WHEN I FOCUS ON THE 6615 04:45:27,477 --> 04:45:29,111 TRIAL DESIGN IS THE CHALLENGE, 6616 04:45:29,178 --> 04:45:31,881 THE IMPORTANCE AND THE CHALLENGE 6617 04:45:31,948 --> 04:45:33,783 OF CONDUCTING INTERVENTION 6618 04:45:33,850 --> 04:45:35,084 TRIALS IN COMMUNITY SETTINGS 6619 04:45:35,151 --> 04:45:37,186 THAT ADHERE TO HIGHEST ETHICAL 6620 04:45:37,253 --> 04:45:38,120 STANDARDS INCLUDING HOW THEY ARE 6621 04:45:38,187 --> 04:45:40,223 DESIGNED IN THE FIRST PLACE. 6622 04:45:40,289 --> 04:45:42,525 SO THAT WE CAN EVALUATE IF THESE 6623 04:45:42,592 --> 04:45:45,061 MENTAL HEALTH TREATMENTS CAN 6624 04:45:45,127 --> 04:45:46,629 ACTUALLY IMPROVE PSYCHOLOGICAL 6625 04:45:46,696 --> 04:45:52,068 WELLNESS AS WELL AS CLINICAL 6626 04:45:52,134 --> 04:45:52,702 OUTCOMES. 6627 04:45:52,768 --> 04:45:53,769 NEXT PLEASE. 6628 04:45:53,836 --> 04:45:54,504 MARTHA, I'LL SAY YOUR NAME FOR 6629 04:45:54,570 --> 04:45:55,571 THE LAST TIME. 6630 04:45:55,638 --> 04:45:56,906 IT'S INTERESTING, I SHOW THIS 6631 04:45:56,973 --> 04:46:00,076 SLIDE THAT WE KNOW THAT THE 6632 04:46:00,143 --> 04:46:01,644 IMPACT OF VIOLENCE, VIOLENCE AND 6633 04:46:01,711 --> 04:46:03,880 TRAUMA CAN IMPACT HIV CARE 6634 04:46:03,946 --> 04:46:04,247 ENGAGEMENT. 6635 04:46:04,313 --> 04:46:05,982 I DIDN'T PUT UP THIS ONE 6636 04:46:06,048 --> 04:46:07,717 PARTICULAR SLIDE BUT THERE HAVE 6637 04:46:07,783 --> 04:46:09,585 BEEN STUDIES OF ADHERENCE IN THE 6638 04:46:09,652 --> 04:46:10,786 PAST THAT TAKE INTO ACCOUNT A 6639 04:46:10,853 --> 04:46:13,089 LOT OF THINGS THAT WE THINK 6640 04:46:13,155 --> 04:46:16,292 MIGHT BE RELATED TO ADHERENCE, 6641 04:46:16,359 --> 04:46:19,028 AND AMONG WOMEN LIVING WITH HIV 6642 04:46:19,095 --> 04:46:20,363 ACTUALLY INTERPERSONAL VIOLENCE 6643 04:46:20,429 --> 04:46:23,132 IS THE STRONGEST PREDICTOR OF 6644 04:46:23,199 --> 04:46:23,900 NON-ADHERENCE. 6645 04:46:23,966 --> 04:46:25,535 SO, WE HAVE KNOWN, AND YOU'LL 6646 04:46:25,601 --> 04:46:27,837 SEE CITATIONS OVER 20 YEARS OLD, 6647 04:46:27,904 --> 04:46:29,372 THAT WE'VE KNOWN THIS 6648 04:46:29,438 --> 04:46:31,707 DESCRIPTIVELY FOR SOME TIME THAT 6649 04:46:31,774 --> 04:46:33,543 DEPRESSION AND ANXIETY AND 6650 04:46:33,609 --> 04:46:35,411 TRAUMATIC STRESS IS RELATED TO 6651 04:46:35,478 --> 04:46:36,679 AVOIDANCE AND SHAME AND STIGMA, 6652 04:46:36,746 --> 04:46:39,115 AND THAT THEY ARE RELATED TO 6653 04:46:39,181 --> 04:46:40,316 POOR RETENTION AND CARE, AND 6654 04:46:40,383 --> 04:46:42,084 POOR ADHERENCE. 6655 04:46:42,151 --> 04:46:44,587 SO WHAT MY WORK HAS ALWAYS BEEN 6656 04:46:44,654 --> 04:46:47,356 ON, HOW TO DEVELOP INTERVENTIONS 6657 04:46:47,423 --> 04:46:51,060 THAT ARE HOPEFULLY POSSIBLE TO 6658 04:46:51,127 --> 04:46:52,261 IMPLEMENT AND SERVICE, AND 6659 04:46:52,328 --> 04:46:54,263 CONDUCTED IN COMMUNITY SETTINGS 6660 04:46:54,330 --> 04:46:57,466 TO ENHANCE THAT LIKELIHOOD. 6661 04:46:57,533 --> 04:46:58,801 AND NOW MY FOCUS IS ON WHETHER 6662 04:46:58,868 --> 04:47:03,039 WE CAN SHOW A PSYCHOLOGICAL 6663 04:47:03,105 --> 04:47:09,879 INTERVENTION CAN RESULT IN VIRAL 6664 04:47:09,946 --> 04:47:10,913 LOAD SUPPRESSION. 6665 04:47:10,980 --> 04:47:13,449 THIS IS A CONCEPTUAL MODEL OF 6666 04:47:13,516 --> 04:47:14,784 WHAT'S GUIDING THE CURRENT STUDY 6667 04:47:14,850 --> 04:47:17,053 IN CAPE TOWN. 6668 04:47:17,119 --> 04:47:20,222 SO, IMPACT PLUS IS THE ENGLISH 6669 04:47:20,289 --> 04:47:21,991 NAME OF OUR INTERVENTION, WHICH 6670 04:47:22,058 --> 04:47:25,161 STANDS FOR IMPROVING AIDS CARE 6671 04:47:25,227 --> 04:47:26,495 AFTER TRAUMA. 6672 04:47:26,562 --> 04:47:29,498 AND ESSENTIALLY IT'S THE 6673 04:47:29,565 --> 04:47:31,133 QUESTION OF CAN WE THINK OF 6674 04:47:31,200 --> 04:47:34,136 MENTAL HEALTH IMPROVEMENT AS A 6675 04:47:34,203 --> 04:47:36,105 MEDIATOR, SO THE STUDY I'LL TALK 6676 04:47:36,172 --> 04:47:39,275 TO ABOUT IS FOCUSED ON REDUCING 6677 04:47:39,342 --> 04:47:40,910 TRAUMATIC STRESS AND REDUCING 6678 04:47:40,977 --> 04:47:44,313 AVOIDANT COPING WITH THE 6679 04:47:44,380 --> 04:47:45,081 INTENTION OF INCREASING ART 6680 04:47:45,147 --> 04:47:46,716 ADHERENCE AND RETENTION AND CARE 6681 04:47:46,782 --> 04:47:48,351 WITH PRIMARY OUTCOME OF VIRAL 6682 04:47:48,417 --> 04:47:50,219 LOAD SUPPRESSION. 6683 04:47:50,286 --> 04:47:52,521 SO ESSENTIALLY, WE HAVE AN 6684 04:47:52,588 --> 04:47:54,290 EXPERIMENTAL DESIGN WHICH IS 6685 04:47:54,357 --> 04:47:56,592 COMPARING TWO INTERVENTIONS, AND 6686 04:47:56,659 --> 04:47:58,961 OUTCOME IS WHAT'S THE PERCENTAGE 6687 04:47:59,028 --> 04:48:01,163 OF VIRAL LOAD SUPPRESSION IN ONE 6688 04:48:01,230 --> 04:48:02,932 INTERVENTION VERSUS ANOTHER. 6689 04:48:02,999 --> 04:48:05,868 SO THAT'S THE FRAMEWORK. 6690 04:48:05,935 --> 04:48:07,970 HONESTLY, IN SOME WAYS SADLY TO 6691 04:48:08,037 --> 04:48:09,505 SAY SOME VERY -- THERE'S BEEN 6692 04:48:09,572 --> 04:48:12,141 VERY LITTLE WORK IN LOOKING AT 6693 04:48:12,208 --> 04:48:13,843 CLINICAL TRIALS WITH THE MENTAL 6694 04:48:13,909 --> 04:48:16,045 HEALTH APPROACH AND VIRAL LOAD 6695 04:48:16,112 --> 04:48:16,579 SUPPRESSION. 6696 04:48:16,646 --> 04:48:18,714 RECENTLY A COUPLE YEARS AGO WE 6697 04:48:18,781 --> 04:48:21,517 HAVE LOTS OF ASSOCIATIONS, LOTS 6698 04:48:21,584 --> 04:48:25,354 OF IMPLICATIONS THAT THAT CAN BE 6699 04:48:25,421 --> 04:48:26,656 EFFECTIVE BUT WE RECENTLY THERE 6700 04:48:26,722 --> 04:48:28,658 WAS A STUDY, MAYBE A COUPLE 6701 04:48:28,724 --> 04:48:30,760 YEARS AGO, PUBLISHED WITH THE 6702 04:48:30,826 --> 04:48:32,528 SIMILAR APPROACH BUT FOCUSED ON 6703 04:48:32,595 --> 04:48:32,828 DEPRESSION. 6704 04:48:32,895 --> 04:48:34,030 I'M HAPPY TO TALK MORE ABOUT HOW 6705 04:48:34,096 --> 04:48:38,300 OBVIOUSLY THEY ARE NOT MUTUALLY 6706 04:48:38,367 --> 04:48:38,834 EXCLUSIVE, DEPRESSION AND 6707 04:48:38,901 --> 04:48:40,536 TRAUMA, WITH THE FOCUS OF VIRAL 6708 04:48:40,603 --> 04:48:44,006 LOAD SUPPRESSION AS THE OUTCOME. 6709 04:48:44,073 --> 04:48:45,341 NEXT PLEASE. 6710 04:48:45,408 --> 04:48:47,076 JUST BRIEFLY, I WOULD SAY I WANT 6711 04:48:47,143 --> 04:48:50,279 TO GIVE A SENSE OF HOW I CAME TO 6712 04:48:50,346 --> 04:48:52,448 DEVELOP THIS INTERVENTION, 6713 04:48:52,515 --> 04:48:54,617 WHAT'S GUIDED MY THINKING. 6714 04:48:54,684 --> 04:48:55,818 THIS HONESTLY WAS A CLINICAL 6715 04:48:55,885 --> 04:48:58,154 TRIAL I GOT FUNDED I THINK IN 6716 04:48:58,220 --> 04:49:00,556 1999 OR 2000, SO ALMOST 25 YEARS 6717 04:49:00,623 --> 04:49:01,023 AGO. 6718 04:49:01,090 --> 04:49:03,192 AND IT WAS REALLY THE IDEA THAT 6719 04:49:03,259 --> 04:49:06,228 WHAT WE ALREADY KNEW ABOUT THE 6720 04:49:06,295 --> 04:49:07,496 IMPACTS OF SEXUAL TRAUMA IN 6721 04:49:07,563 --> 04:49:10,199 PREVIOUS RESEARCH THAT WAS NOT 6722 04:49:10,266 --> 04:49:12,802 HIV SPECIFIC, THE QUESTION WAS 6723 04:49:12,868 --> 04:49:15,671 WHETHER WE DID A TRAUMA COPING 6724 04:49:15,738 --> 04:49:17,306 ORIENTED INTERVENTION, COULD WE 6725 04:49:17,373 --> 04:49:19,075 ACTUALLY -- IT WAS PREVENTION 6726 04:49:19,141 --> 04:49:21,010 FOCUSED AT THE TIME. 6727 04:49:21,077 --> 04:49:22,244 IT BECAME AN EVIDENCE-BASED 6728 04:49:22,311 --> 04:49:23,846 INTERVENTION FOR CDC AND SAMHSA 6729 04:49:23,913 --> 04:49:26,482 BECAUSE WE WERE ABLE TO SHOW 6730 04:49:26,549 --> 04:49:28,918 THAT FOCUSING ON SEXUAL TRAUMA 6731 04:49:28,984 --> 04:49:30,786 AND PARTICULARLY MORE EFFECTIVE 6732 04:49:30,853 --> 04:49:32,755 COPING ACTUALLY RESULTED IN LESS 6733 04:49:32,822 --> 04:49:34,623 SEXUAL RISK BEHAVIOR, LESS 6734 04:49:34,690 --> 04:49:36,258 COCAINE USE, LESS ALCOHOL, AND A 6735 04:49:36,325 --> 04:49:37,793 NUMBER OF SEXUAL AND SUBSTANCE 6736 04:49:37,860 --> 04:49:40,329 USE OUTCOMES AS WELL AS 6737 04:49:40,396 --> 04:49:42,431 PSYCHOLOGICAL ONES NOT SHOWN 6738 04:49:42,498 --> 04:49:45,101 HERE, REDUCTIONS OF PTSD 6739 04:49:45,167 --> 04:49:46,368 SYMPTOMS, ACTUALLY FULLY 6740 04:49:46,435 --> 04:49:48,537 MEDIATED BY AVOIDANT COPING. 6741 04:49:48,604 --> 04:49:50,005 THAT'S WHY CONCEPTUALLY I 6742 04:49:50,072 --> 04:49:52,775 FOCUSED ON THE PSYCHOLOGICAL END 6743 04:49:52,842 --> 04:49:54,310 OF TRAUMATIC STRESS AND AVOIDANT 6744 04:49:54,376 --> 04:49:54,877 COPING. 6745 04:49:54,944 --> 04:49:56,979 JUST AS A REMINDER, THIS WAS 6746 04:49:57,046 --> 04:49:59,148 FUNDED IN 1999, AND WE ACTUALLY 6747 04:49:59,215 --> 04:50:01,784 GOT TREATMENT IN I BELIEVE 1996, 6748 04:50:01,851 --> 04:50:03,519 AND SO WE MEASURED ADHERENCE BUT 6749 04:50:03,586 --> 04:50:05,154 ADHERENCE WAS NOT THE FOCUS OF 6750 04:50:05,221 --> 04:50:07,256 THESE STUDIES. 6751 04:50:07,323 --> 04:50:08,791 THEY ALSO WERE VERY -- WHAT I 6752 04:50:08,858 --> 04:50:10,359 WOULD CALL U.S. FOCUSED IN 6753 04:50:10,426 --> 04:50:13,262 NATURE, IT WAS A VERY INTENSIVE 6754 04:50:13,329 --> 04:50:14,897 GROUP INTERVENTION OF COPING 6755 04:50:14,964 --> 04:50:17,700 COMPARED TO A SOCIAL SUPPORT 6756 04:50:17,767 --> 04:50:18,334 INTERVENTION. 6757 04:50:18,400 --> 04:50:19,201 SO, EVERYONE GOT AN 6758 04:50:19,268 --> 04:50:19,535 INTERVENTION. 6759 04:50:19,602 --> 04:50:21,937 THIS WILL BE A THEME OF WHAT MY 6760 04:50:22,004 --> 04:50:24,573 POINT I WANT TO MAKE, THAT I DO 6761 04:50:24,640 --> 04:50:26,342 FEEL THAT WHEN YOU DO 6762 04:50:26,408 --> 04:50:29,178 INTERVENTIONS OF THIS NATURE, 6763 04:50:29,245 --> 04:50:32,081 THAT IT'S NOT EVEN PROBABLY NO 6764 04:50:32,148 --> 04:50:33,983 LONGER REALLY ACCEPTABLE TO DO 6765 04:50:34,049 --> 04:50:36,786 TREATMENT AS USUAL IF TREATMENT 6766 04:50:36,852 --> 04:50:38,387 AS USUAL DOES NOT INVOLVE SOME 6767 04:50:38,454 --> 04:50:39,388 TYPE OF MENTAL HEALTH 6768 04:50:39,455 --> 04:50:39,722 INTERVENTION. 6769 04:50:39,789 --> 04:50:41,824 NEXT SLIDE PLEASE. 6770 04:50:41,891 --> 04:50:47,963 SO THAT LED US TO FOCUS, I'VE 6771 04:50:48,030 --> 04:50:51,033 WORKED IN IN SOUTH AFRICA SINCE 6772 04:50:51,100 --> 04:50:52,034 2000, GENDER-BASED VIOLENCE 6773 04:50:52,101 --> 04:50:54,537 ISSUES FOR HIV AND WOMEN THERE. 6774 04:50:54,603 --> 04:50:56,505 ABOUT TEN YEARS AGO WE GOT A 6775 04:50:56,572 --> 04:50:59,675 PILOT GRANT TO LOOK AT THE 6776 04:50:59,742 --> 04:51:01,043 CO-OCCURRING EPIGENETIC OF 6777 04:51:01,110 --> 04:51:06,248 SEXUAL TRAUMA AND HIV AMONG 6778 04:51:06,315 --> 04:51:08,918 SOUTH AFRICAN WOMEN BASED ON 6779 04:51:08,984 --> 04:51:09,785 QUALITATIVE INTERVIEWS, PILOTED 6780 04:51:09,852 --> 04:51:13,956 THE INTERVENTION, AND WERE ABLE 6781 04:51:14,023 --> 04:51:15,257 TO SHOW THAT -- I'LL TELL YOU 6782 04:51:15,324 --> 04:51:19,128 MORE IN A MOMENT BUT ESSENTIALLY 6783 04:51:19,195 --> 04:51:20,996 COULD WE ADDRESS TRAUMATIC 6784 04:51:21,063 --> 04:51:22,431 STRESS TO IMPROVE CARE 6785 04:51:22,498 --> 04:51:23,666 ENGAGEMENT IN GOVERNMENT CLINICS 6786 04:51:23,732 --> 04:51:28,037 IN THE CONTEXT OF HIV CAR USING 6787 04:51:28,103 --> 04:51:30,005 THIS TASK-SHARING APPROACH, SO 6788 04:51:30,072 --> 04:51:34,677 NOT MENTAL HEALTH SPECIALISTS. 6789 04:51:34,743 --> 04:51:35,010 NEXT. 6790 04:51:35,077 --> 04:51:38,147 SO, THIS ACTUALLY -- I LIKE TO 6791 04:51:38,214 --> 04:51:41,016 SHOW THESE VISUALS, DEVELOPMENT 6792 04:51:41,083 --> 04:51:42,318 OF CRITICAL EFFECTIVE 6793 04:51:42,384 --> 04:51:44,186 COMPONENTS, IN THE INTERVENTION 6794 04:51:44,253 --> 04:51:46,722 THAT IS THE EXPERIMENTAL IMPACT 6795 04:51:46,789 --> 04:51:49,124 PLUS THAT WE'RE TESTING ACTUALLY 6796 04:51:49,191 --> 04:51:50,659 REPRESENT WELL KNOWN 6797 04:51:50,726 --> 04:51:51,260 EVIDENCE-BASED TREATMENT 6798 04:51:51,327 --> 04:51:52,661 INTERVENTIONS, OR APPROACHES TO 6799 04:51:52,728 --> 04:51:53,863 THEM, SO THE PICTURE ON THE LEFT 6800 04:51:53,929 --> 04:51:56,899 OF WHAT WE CALL THE COPING 6801 04:51:56,966 --> 04:51:58,234 PEBBLES COMES FROM A THEORY OF 6802 04:51:58,300 --> 04:52:00,569 STRESS AND COPING THAT'S VERY 6803 04:52:00,636 --> 04:52:02,605 COGNITIVE, ONE THING WE LEARNED 6804 04:52:02,671 --> 04:52:05,241 THAT WE WANTED TO EMPHASIZE 6805 04:52:05,307 --> 04:52:08,444 AFFECTIVE AND RELATIONAL ASPECTS 6806 04:52:08,510 --> 04:52:09,445 OF PSYCHOLOGICAL INTERVENTION. 6807 04:52:09,511 --> 04:52:11,647 AND SO WE INSTEAD OF A COGNITIVE 6808 04:52:11,714 --> 04:52:13,382 MODEL AND EXPLAINING ALL THESE 6809 04:52:13,449 --> 04:52:14,483 PROCESSES LIKE HONESTLY WE HAD 6810 04:52:14,550 --> 04:52:17,453 DONE IN THE ORIGINAL LIST STUDY, 6811 04:52:17,519 --> 04:52:19,655 WE LITERALLY USE A BIG BAG OF 6812 04:52:19,722 --> 04:52:23,025 PEBBLES AND WE TALK ABOUT IT AS 6813 04:52:23,092 --> 04:52:24,126 A GLOBAL STRESSOR, THAT ONE 6814 04:52:24,193 --> 04:52:28,764 SEPARATES OUT THE CHANGEABLE AND 6815 04:52:28,831 --> 04:52:29,098 UNCHANGEABLE. 6816 04:52:29,164 --> 04:52:30,833 WE FOLLOW THIS THEORY IN AN 6817 04:52:30,900 --> 04:52:32,468 INTERACTIVE WAY NOT HIGHLY 6818 04:52:32,534 --> 04:52:32,735 COGNITIVE. 6819 04:52:32,801 --> 04:52:34,003 THE MIDDLE VISUAL TALKS ABOUT 6820 04:52:34,069 --> 04:52:35,738 THE IMPORTANCE OF BOTH WHAT YOU 6821 04:52:35,804 --> 04:52:38,173 THINK AND WHAT YOU FEEL, THE 6822 04:52:38,240 --> 04:52:40,075 HANDS MEAN INTERACTION WITH 6823 04:52:40,142 --> 04:52:40,709 OTHERS. 6824 04:52:40,776 --> 04:52:43,779 IT'S INTENDED TO MEAN SOCIAL 6825 04:52:43,846 --> 04:52:44,113 RELATIONSHIPS. 6826 04:52:44,179 --> 04:52:50,586 AND THE PICTURE ON THE RIGHT IS 6827 04:52:50,653 --> 04:52:52,421 CALLED THE IMBIZA POT, A COMMON 6828 04:52:52,488 --> 04:52:53,489 COOKING POT USED IN COMMUNITIES 6829 04:52:53,555 --> 04:52:58,661 WHERE THE WOMEN LIVE IN OUR 6830 04:52:58,727 --> 04:52:59,862 PROJECTS, RESEARCH PROJECTS, 6831 04:52:59,929 --> 04:53:02,364 THAT IS VERY OFTEN USED FOR 6832 04:53:02,431 --> 04:53:04,733 COMMUNAL COOKING, AND THE FOUR 6833 04:53:04,800 --> 04:53:06,368 FACTORS OF POWER, TRUST, SELF 6834 04:53:06,435 --> 04:53:08,771 ESTEEM AND SAFETY ARE FROM 6835 04:53:08,837 --> 04:53:11,040 COGNITIVE PROCESSING THERAPY, A 6836 04:53:11,106 --> 04:53:12,474 WELL-DOCUMENTED EVIDENCE-BASED 6837 04:53:12,541 --> 04:53:13,108 TREATMENT THAT THROUGHOUT 6838 04:53:13,175 --> 04:53:15,577 QUALITATIVE WORK WE THEN USE 6839 04:53:15,644 --> 04:53:19,715 THIS AS A REPRESENTATION OF 6840 04:53:19,782 --> 04:53:22,918 THOSE EXPERIENCES BECAUSE THE 6841 04:53:22,985 --> 04:53:24,186 INTERPRETATION AND TRANSLATION 6842 04:53:24,253 --> 04:53:26,922 IN BOTH LANGUAGE AND CULTURE WAS 6843 04:53:26,989 --> 04:53:29,792 IMPORTANT TO DO SOMETHING MORE 6844 04:53:29,858 --> 04:53:31,327 RELATIONAL TO THE POTENTIAL 6845 04:53:31,393 --> 04:53:31,660 PARTICIPANTS. 6846 04:53:31,727 --> 04:53:33,495 SO JUST A FEW EXAMPLES OF THE 6847 04:53:33,562 --> 04:53:35,230 PROCESS WE WENT THROUGH OVER A 6848 04:53:35,297 --> 04:53:36,899 COUPLE YEARS TAKING WHAT WE 6849 04:53:36,966 --> 04:53:37,499 THOUGHT WERE EFFECTIVE 6850 04:53:37,566 --> 04:53:38,934 COMPONENTS FROM THE U.S. MODEL 6851 04:53:39,001 --> 04:53:42,237 AND GETTING THEM INTO THIS 6852 04:53:42,304 --> 04:53:42,671 MODEL. 6853 04:53:42,738 --> 04:53:43,739 SO NEXT PLEASE. 6854 04:53:43,806 --> 04:53:45,374 SO THIS IS THE STUDY DESIGN FOR 6855 04:53:45,441 --> 04:53:47,042 THIS CURRENT TRIAL. 6856 04:53:47,109 --> 04:53:49,345 I KNOW I ONLY HAVE A FEW MORE 6857 04:53:49,411 --> 04:53:49,578 MINUTES. 6858 04:53:49,645 --> 04:53:52,514 THE POINTS I WANT TO MAKE ARE 6859 04:53:52,581 --> 04:53:55,818 THAT WE DECIDED TO FOCUS ON 6860 04:53:55,884 --> 04:53:57,686 WOMEN AS THEY INITIATE ART, THE 6861 04:53:57,753 --> 04:53:59,722 LIST STUDY IN THE U.S. AT ANY 6862 04:53:59,788 --> 04:54:02,057 TIME DIDN'T HAVE TO BE 6863 04:54:02,124 --> 04:54:03,826 INITIATING ART BUT WE CHOSE TO 6864 04:54:03,892 --> 04:54:06,462 DO THIS WITH THE IDEA OF HAVING 6865 04:54:06,528 --> 04:54:09,631 VIRAL LOAD SUPPRESSION AS OUR 6866 04:54:09,698 --> 04:54:11,033 OUTCOME BECAUSE FIRST WE SAW IT 6867 04:54:11,100 --> 04:54:12,601 AS A WINDOW OF OPPORTUNITY LIKE 6868 04:54:12,668 --> 04:54:14,003 SOMETIMES WE SAY PREGNANCY IS A 6869 04:54:14,069 --> 04:54:16,071 WINDOW OF OPPORTUNITY. 6870 04:54:16,138 --> 04:54:18,907 WE SAW INITIATING ART AS A WAY 6871 04:54:18,974 --> 04:54:23,479 ONE CAN REFLECT ON THEIR VALUES, 6872 04:54:23,545 --> 04:54:25,014 WHAT THEY WOULD LIKE TO ACHIEVE 6873 04:54:25,080 --> 04:54:32,287 BY TAKING ART AND USING THAT IN 6874 04:54:32,354 --> 04:54:37,826 A MOTION VACCINATIONAL WAY -- 6875 04:54:37,893 --> 04:54:39,261 MOTIVATIONAL WAY. 6876 04:54:39,328 --> 04:54:40,562 THE IMPACT PLUS VERSUS THE 6877 04:54:40,629 --> 04:54:42,197 CONTROL CONDITION BUT IT'S 6878 04:54:42,264 --> 04:54:44,299 IMPORTANT TO POINT OUT THAT THIS 6879 04:54:44,366 --> 04:54:46,035 IS A BRIEFER VERSION OF PROBLEM 6880 04:54:46,101 --> 04:54:47,803 SOLVING THERAPY WHICH IS FULLY 6881 04:54:47,870 --> 04:54:54,376 ENDORSED BY THE W.H.O. AND BEING 6882 04:54:54,443 --> 04:54:55,878 IMPLEMENTED IN MANY COUNTRIES 6883 04:54:55,944 --> 04:54:59,181 AROUND THE WORLD, ESSENTIALLY 6884 04:54:59,248 --> 04:55:00,716 COMPARING TWO PSYCHOLOGICAL 6885 04:55:00,783 --> 04:55:01,850 INTERVENTIONS, AND THE 6886 04:55:01,917 --> 04:55:02,451 EXPERIMENTAL INTERVENTION 6887 04:55:02,518 --> 04:55:04,720 FOCUSES MUCH MORE ON SEXUAL 6888 04:55:04,787 --> 04:55:06,288 TRAUMA AND ADAPTIVE COPING. 6889 04:55:06,355 --> 04:55:07,289 AND THEY ARE FOLLOWED FOR A 6890 04:55:07,356 --> 04:55:07,990 YEAR. 6891 04:55:08,057 --> 04:55:10,125 DID I DO THAT? 6892 04:55:10,192 --> 04:55:10,692 OTHER DIRECTION. 6893 04:55:10,759 --> 04:55:12,795 THERE YOU GO. 6894 04:55:12,861 --> 04:55:15,597 SO JUST BRIEFLY IT'S SUCCESSION, 6895 04:55:15,664 --> 04:55:17,066 THERE ARE INDIVIDUALS SESSIONS 6896 04:55:17,132 --> 04:55:19,034 CONSIDERED THE MOST FEASIBLE TO 6897 04:55:19,101 --> 04:55:20,269 BE IMPLEMENTED, HOPEFULLY WE 6898 04:55:20,335 --> 04:55:22,071 THINK IN PRIMARY CARE CLINICS. 6899 04:55:22,137 --> 04:55:23,105 THAT'S WHERE THE STUDY IS. 6900 04:55:23,172 --> 04:55:24,640 WE HOPE IF IT'S SHOWN TO BE 6901 04:55:24,706 --> 04:55:25,741 EFFECTIVE IT COULD BE 6902 04:55:25,808 --> 04:55:27,476 IMPLEMENTED IN THESE SAME 6903 04:55:27,543 --> 04:55:27,876 SETTINGS. 6904 04:55:27,943 --> 04:55:32,614 WE HAVE A SYSTEMATIC WAY OF 6905 04:55:32,681 --> 04:55:33,382 SCREENING EVERYONE INITIATING 6906 04:55:33,449 --> 04:55:35,017 ART, AND THEN THEY FIND OUT IF 6907 04:55:35,084 --> 04:55:36,218 THEY ARE ELIGIBLE, IF THEY WANT 6908 04:55:36,285 --> 04:55:37,886 TO BE INVOLVED THEY GET 6909 04:55:37,953 --> 04:55:38,787 RANDOMIZED TO ONE OF THE TWO 6910 04:55:38,854 --> 04:55:39,955 CONDITIONS AND THEY ARE FOLLOWED 6911 04:55:40,022 --> 04:55:46,195 FOR A YEAR OVER TIME, WITH 6912 04:55:46,261 --> 04:55:46,962 BIOMARKERS FOR ADHERENCE, WE 6913 04:55:47,029 --> 04:55:49,798 TAKE BLOODS FOR VIRAL LOAD AND 6914 04:55:49,865 --> 04:55:52,334 GIVE PSYCHOLOGICAL ASSESSMENTS. 6915 04:55:52,401 --> 04:55:52,568 NEXT. 6916 04:55:52,634 --> 04:55:55,137 SO JUST A LITTLE PIECE OF DATA 6917 04:55:55,204 --> 04:55:57,773 SINCE WE'RE ALMOST TO THE 6918 04:55:57,840 --> 04:55:59,641 CONCLUSION OF OUR ENROLLMENT. 6919 04:55:59,708 --> 04:56:02,811 OUR SAMPLE SIZE TARGET IS 350 6920 04:56:02,878 --> 04:56:04,046 WOMEN, AFTER OVER A YEAR OF 6921 04:56:04,113 --> 04:56:06,482 COVID DELAY WE'RE GOING TO MAKE 6922 04:56:06,548 --> 04:56:06,648 IT. 6923 04:56:06,715 --> 04:56:07,883 WE'RE AT 340. 6924 04:56:07,950 --> 04:56:09,618 WE HAVE A REMARKABLE 6925 04:56:09,685 --> 04:56:10,419 COMMUNITY-BASED FIELD TEAM IN 6926 04:56:10,486 --> 04:56:12,654 CAPE TOWN THAT'S JUST BEEN 6927 04:56:12,721 --> 04:56:13,789 PHENOMENAL IN GETTING -- BEING 6928 04:56:13,856 --> 04:56:16,725 ABLE TO DO THE FIELD WORK 6929 04:56:16,792 --> 04:56:19,328 EFFECTIVELY IN A CONTEXT AS A 6930 04:56:19,394 --> 04:56:22,498 REMINDER IS VERY FULL OF OTHER 6931 04:56:22,564 --> 04:56:24,566 TRAUMATIC ISSUES HAPPENING IN 6932 04:56:24,633 --> 04:56:26,335 COMMUNITIES AND EXTREME POVERTY 6933 04:56:26,401 --> 04:56:27,536 AND LIMITED ACCESS TO RESOURCES. 6934 04:56:27,603 --> 04:56:29,905 SO THIS IS JUST QUICKLY A VISUAL 6935 04:56:29,972 --> 04:56:31,707 TO SHOW THAT THIS IS TRAUMATIC 6936 04:56:31,773 --> 04:56:33,775 STRESS ON THE LEFT, IN THE 6937 04:56:33,842 --> 04:56:35,210 GREEN, DEPRESSION ON THE RIGHT. 6938 04:56:35,277 --> 04:56:42,417 DOT TEL LINES ARE A CLINICAL 6939 04:56:42,484 --> 04:56:42,651 CUTOFF. 6940 04:56:42,718 --> 04:56:44,620 AVERAGES ABOVE, SUGGESTING A 6941 04:56:44,686 --> 04:56:46,588 DIAGNOSIS OF PTSD OR DEPRESSION. 6942 04:56:46,655 --> 04:56:49,024 BUT MY OWN APPROACH TO DOING -- 6943 04:56:49,091 --> 04:56:52,361 OUR APPROACH IS NOT TO MAKE IT 6944 04:56:52,427 --> 04:56:52,861 DIAGNOSTICALLY ORIENTED. 6945 04:56:52,928 --> 04:56:56,832 I DON'T THINK ANY OF US BELIEVE 6946 04:56:56,899 --> 04:56:58,367 TWO MORE POINTS ON A TRAUMATIC 6947 04:56:58,433 --> 04:57:00,002 STRESS SCALE DOESN'T MEAN YOU 6948 04:57:00,068 --> 04:57:02,404 DON'T HAVE TRAUMATIC STRESS IF 6949 04:57:02,471 --> 04:57:03,405 YOU DON'T MEET DIAGNOSTIC 6950 04:57:03,472 --> 04:57:03,839 CRITERIA. 6951 04:57:03,906 --> 04:57:06,575 WE THINK THAT WILL BE 6952 04:57:06,642 --> 04:57:07,976 POTENTIALLY MORE SUSTAINABLE AND 6953 04:57:08,043 --> 04:57:13,382 REACH MORE WOMEN HOPEFULLY IF 6954 04:57:13,448 --> 04:57:14,917 IT GOES INTO SERVICE. 6955 04:57:14,983 --> 04:57:19,488 AND SO JUST IN SUMMARY, WE DO 6956 04:57:19,555 --> 04:57:21,156 FEEL DOING THIS INTERVENTION 6957 04:57:21,223 --> 04:57:22,457 RESEARCH TO ADDRESS SEXUAL 6958 04:57:22,524 --> 04:57:23,892 TRAUMA SPECIFICALLY IN THE 6959 04:57:23,959 --> 04:57:26,328 CONTEXT OF OTHER STRESSORS AND 6960 04:57:26,395 --> 04:57:28,230 TRAUMA IS NEEDED TO ACHIEVE 6961 04:57:28,297 --> 04:57:30,566 VIRAL LOAD SUPPRESSION THAT WE 6962 04:57:30,632 --> 04:57:33,302 CAN ACTUALLY DO THESE TRIALS 6963 04:57:33,368 --> 04:57:34,836 WITH VERY STRONG ETHICAL FOCUS 6964 04:57:34,903 --> 04:57:38,006 AS LONG AS THEY ARE COMMUNITY 6965 04:57:38,073 --> 04:57:40,175 ENGAGED AND REALLY DEVELOPED 6966 04:57:40,242 --> 04:57:41,810 COLLABORATIVELY WITH CLINIC AND 6967 04:57:41,877 --> 04:57:42,678 COMMUNITY PARTNERS. 6968 04:57:42,744 --> 04:57:44,546 WE HAVE HIGH LEVELS OF MENTAL 6969 04:57:44,613 --> 04:57:48,450 HEALTH SYMPTOMS REPORTED BUT WE 6970 04:57:48,517 --> 04:57:52,087 HAVE STRONG ATTENDANCE IN THE 6971 04:57:52,154 --> 04:57:52,688 INTERVENTION SESSIONS OVER 75% 6972 04:57:52,754 --> 04:57:54,289 COME TO 2/3 OR MORE OF THE 6973 04:57:54,356 --> 04:57:57,626 SESSIONS, AND WE HAVE RETENTION 6974 04:57:57,693 --> 04:58:00,095 THAT'S APPROACHING 80%, 75 TO 6975 04:58:00,162 --> 04:58:01,730 80% AT ONE-YEAR FOLLOW-UP. 6976 04:58:01,797 --> 04:58:03,465 WE THEY'LL THESE MENTAL HEALTH 6977 04:58:03,532 --> 04:58:06,535 INTERVENTIONS CAN BE CULTURALLY 6978 04:58:06,602 --> 04:58:08,437 ADAPTED, IMPLEMENTED BY 6979 04:58:08,503 --> 04:58:09,071 NON-SPECIALISTS, WHICH HOPEFULLY 6980 04:58:09,137 --> 04:58:10,505 NOT THAT WE DON'T HAVE TO BE 6981 04:58:10,572 --> 04:58:12,507 VERY AWARE OF IMPACT OF TRAUMA 6982 04:58:12,574 --> 04:58:14,176 ON THE INTERVENTIONIST AS WELL 6983 04:58:14,243 --> 04:58:15,677 FOR SECONDARY TRAUMA BUT THAT IF 6984 04:58:15,744 --> 04:58:21,083 WE THINK IF WE APPROACH THIS, IN 6985 04:58:21,149 --> 04:58:23,285 A WAY THAT'S CONSIDERATE OF 6986 04:58:23,352 --> 04:58:24,686 THOSE ISSUES, COULD BE DELIVERED 6987 04:58:24,753 --> 04:58:25,988 AND SUSTAINABLE. 6988 04:58:26,054 --> 04:58:27,089 LAST SLIDE. 6989 04:58:27,155 --> 04:58:29,057 WHICH IS THE NUMEROUS PEOPLE 6990 04:58:29,124 --> 04:58:30,659 THAT I MUST THANK FOR WHICH WE 6991 04:58:30,726 --> 04:58:32,661 WOULDN'T BE ABLE TO DO THE STUDY 6992 04:58:32,728 --> 04:58:34,563 BOTH IN THE STATES AND UCT. 6993 04:58:34,630 --> 04:58:37,366 SO THANK YOU. 6994 04:58:44,640 --> 04:58:46,508 >> I'M UP. 6995 04:58:46,575 --> 04:58:49,244 THANK YOU, CATHY, AND TO ALL THE 6996 04:58:49,311 --> 04:58:54,082 SPEAKERS FOR AN EXCELLENT AND 6997 04:58:54,149 --> 04:58:55,851 ENGAGING SET OF PRESENTATIONS. 6998 04:58:55,917 --> 04:58:58,654 I HAVE SOME COMMENTS COMING IN. 6999 04:58:58,720 --> 04:59:00,422 ONE FROM -- I'M READING THIS IN 7000 04:59:00,489 --> 04:59:01,556 THE PANEL HERE. 7001 04:59:01,623 --> 04:59:05,127 SO ONE COMMENT FROM THE GROUP 7002 04:59:05,193 --> 04:59:06,495 WAS FOR MARTHA. 7003 04:59:06,561 --> 04:59:09,998 THANK YOU FOR TRANSLATING THE 7004 04:59:10,065 --> 04:59:17,339 RESEARCH IMPLICATIONS FOR OUR 7005 04:59:17,406 --> 04:59:21,877 LIVED EXPERIENCE, I WOULD ADD I 7006 04:59:21,943 --> 04:59:23,312 THINK IT'S AWESOME THAT YOU ARE 7007 04:59:23,378 --> 04:59:24,946 FILLING THE CYCLE BY 7008 04:59:25,013 --> 04:59:26,915 PARTICIPATING IN THE RESEARCH AS 7009 04:59:26,982 --> 04:59:31,386 A RESEARCHER AND APPLYING IT AND 7010 04:59:31,453 --> 04:59:33,689 TRULY UNDERSTAND SORT OF THE 7011 04:59:33,755 --> 04:59:35,190 CONTEXT AS A RESEARCHER AND AS 7012 04:59:35,257 --> 04:59:36,925 THE SUBJECT OF RESEARCH. 7013 04:59:36,992 --> 04:59:37,993 THAT'S AWESOME. 7014 04:59:38,060 --> 04:59:45,667 AND WE HAVE A QUESTION HERE, 7015 04:59:45,734 --> 04:59:47,836 I'LL POP THEM UP. 7016 04:59:47,903 --> 04:59:48,503 FIRST FOR NADA. 7017 04:59:48,570 --> 04:59:51,540 THIS HAS TO DO WITH THE QUESTION 7018 04:59:51,606 --> 04:59:52,908 AROUND VACCINE HESITATION. 7019 04:59:52,974 --> 04:59:55,277 COULD YOU PLEASE TELL US MORE 7020 04:59:55,344 --> 04:59:56,478 ABOUT THE IMPORTANCE OF TRUST 7021 04:59:56,545 --> 04:59:58,246 FOR WOMEN AND PEOPLE LIVING WITH 7022 04:59:58,313 --> 05:00:01,183 HIV PARTICULARLY IN THE CONTEXT 7023 05:00:01,249 --> 05:00:02,284 OF COMORBIDITY AND 7024 05:00:02,351 --> 05:00:04,052 MULTI-MORBIDITY, AS RELATES TO 7025 05:00:04,119 --> 05:00:06,154 TRUST AND I WOULD ADD WHAT ARE 7026 05:00:06,221 --> 05:00:07,656 THE PEARLS OF WISDOM YOU'VE 7027 05:00:07,723 --> 05:00:10,158 LEARNED FROM STUDYING THE SPACE 7028 05:00:10,225 --> 05:00:12,260 AROUND TRUST OR MISTRUST OR 7029 05:00:12,327 --> 05:00:13,128 DISTRUST, AS RELATES TO 7030 05:00:13,195 --> 05:00:15,297 VACCINATION AND HOW MIGHT THAT 7031 05:00:15,364 --> 05:00:17,199 APPLY TO OTHER MEDICATIONS OR 7032 05:00:17,265 --> 05:00:18,266 OTHER CLINICAL SETTINGS, WHAT 7033 05:00:18,333 --> 05:00:22,337 CAN WE LEARN FROM THAT? 7034 05:00:22,404 --> 05:00:23,405 >> YEAH, GREAT QUESTION. 7035 05:00:23,472 --> 05:00:25,507 I WISH I HAD AN ANSWER TO THAT 7036 05:00:25,574 --> 05:00:25,974 QUESTION. 7037 05:00:26,041 --> 05:00:30,412 I THINK TRUST IS A VERY 7038 05:00:30,479 --> 05:00:31,747 COMPLICATED WORD, VERY DIVERSE. 7039 05:00:31,813 --> 05:00:35,117 IT'S NOT REALLY ALWAYS A 7040 05:00:35,183 --> 05:00:35,717 PROVIDER/PATIENT RELATIONSHIP 7041 05:00:35,784 --> 05:00:41,022 TRUST BECAUSE IT COULD BE TRUST 7042 05:00:41,089 --> 05:00:42,691 IN MEDICAL SYSTEM, POLICY 7043 05:00:42,758 --> 05:00:44,493 ESTABLISHMENT, POLICY SYSTEM IN 7044 05:00:44,559 --> 05:00:47,729 THE GOVERNMENT, COULD BE A 7045 05:00:47,796 --> 05:00:48,497 MULTI-DIMENSIONAL CONCEPT. 7046 05:00:48,563 --> 05:00:50,165 THAT SHOWED UP DURING THE COVID 7047 05:00:50,232 --> 05:00:50,999 PANDEMIC. 7048 05:00:51,066 --> 05:00:52,768 WE SAW THIS DISTRUST IN SCIENCE 7049 05:00:52,834 --> 05:00:53,201 IN GENERAL. 7050 05:00:53,268 --> 05:00:55,604 A LOT OF PEOPLE TRUST SCIENTISTS 7051 05:00:55,670 --> 05:00:57,205 BUT DON'T TRUST SCIENCE. 7052 05:00:57,272 --> 05:00:59,541 IT WAS HARD TO KIND OF ENTANGLE 7053 05:00:59,608 --> 05:01:03,478 THAT AND BRING THAT DOWN TO THE 7054 05:01:03,545 --> 05:01:04,079 PROVIDER/PATIENT RELATIONSHIP 7055 05:01:04,146 --> 05:01:05,347 LEVEL BECAUSE I HAVE PATIENTS 7056 05:01:05,414 --> 05:01:06,748 WHOM I HAD WONDERFUL 7057 05:01:06,815 --> 05:01:09,184 RELATIONSHIP WITH, THEY TRUST ME 7058 05:01:09,251 --> 05:01:11,153 WITH THEIR HIV MEDICATION, WITH 7059 05:01:11,219 --> 05:01:13,688 CARE OF HIV, BUT WHEN IT CAME TO 7060 05:01:13,755 --> 05:01:14,956 VACCINES IT WAS REALLY HARD TO 7061 05:01:15,023 --> 05:01:16,625 EXPLAIN THAT CONCEPT AND WHY ARE 7062 05:01:16,691 --> 05:01:17,592 THESE PATIENTS NOT TRUSTING ME 7063 05:01:17,659 --> 05:01:19,060 WHEN IT CAME TO THAT. 7064 05:01:19,127 --> 05:01:21,196 THAT'S WHEN IT BECAME CLEAR TO 7065 05:01:21,263 --> 05:01:23,064 ME THIS IS NOT ABOUT THAT 7066 05:01:23,131 --> 05:01:24,166 RELATIONSHIP. 7067 05:01:24,232 --> 05:01:26,134 THIS IS A MULTI-DIMENSIONAL 7068 05:01:26,201 --> 05:01:26,368 CONCEPT. 7069 05:01:26,435 --> 05:01:29,438 THESE ARE PATIENTS WHO ARE VERY 7070 05:01:29,504 --> 05:01:30,705 VULNERABLE TO DISTRUST BECAUSE 7071 05:01:30,772 --> 05:01:32,474 THEY HAVE BEEN MISTREATED BY THE 7072 05:01:32,541 --> 05:01:35,410 SYSTEM OVER AND OVER AND OVER 7073 05:01:35,477 --> 05:01:36,244 WHETHER IT'S CRIMINALIZATION 7074 05:01:36,311 --> 05:01:39,281 LAWS, THIS LAW OR THAT LAW THAT 7075 05:01:39,347 --> 05:01:41,850 KEPT TARGETING THEM, AND WITH 7076 05:01:41,917 --> 05:01:43,618 BEING IN A RACIAL/ETHNIC 7077 05:01:43,685 --> 05:01:44,653 MINORITY EXPERIENCING IMPACT OF 7078 05:01:44,719 --> 05:01:45,887 SYSTEMIC RACISM, SOCIAL 7079 05:01:45,954 --> 05:01:48,323 DETERMINANTS OF HEALTH, ET 7080 05:01:48,390 --> 05:01:49,591 CETERA, THEY ARE REALLY 7081 05:01:49,658 --> 05:01:50,125 VULNERABLE. 7082 05:01:50,192 --> 05:01:53,295 THE OTHER PART OF THIS, ACCESS 7083 05:01:53,361 --> 05:01:56,431 IN ADDITION TO DISTRUST, NOT 7084 05:01:56,498 --> 05:01:58,266 ALWAYS DISTRUST, I DON'T WANT 7085 05:01:58,333 --> 05:02:00,235 PEOPLE TO THINK THAT WAS ONLY 7086 05:02:00,302 --> 05:02:00,535 THE REASON. 7087 05:02:00,602 --> 05:02:05,607 A LOT OF PATIENTS WANTED TO GET 7088 05:02:05,674 --> 05:02:07,709 THE VACCINES, THEY WERE THINKING 7089 05:02:07,776 --> 05:02:10,212 ACCESS WAS NOT MADE AVAILABLE 7090 05:02:10,278 --> 05:02:11,780 EARLY ON, LIMITING EXPOSURE IN 7091 05:02:11,847 --> 05:02:14,516 THE COMMUNITY, PEOPLE THEY KNOW 7092 05:02:14,583 --> 05:02:15,250 AND TRUST. 7093 05:02:15,317 --> 05:02:16,785 IN MY COMMUNITY IS NOT 7094 05:02:16,852 --> 05:02:17,385 VACCINATED BECAUSE THEY DON'T 7095 05:02:17,452 --> 05:02:18,787 HAVE ACCESS I DON'T HAVE GOOD 7096 05:02:18,854 --> 05:02:23,358 EXPERIENCE, I DON'T KNOW WHAT 7097 05:02:23,425 --> 05:02:24,826 SIDE EFFECTS THAT HE EXPERIENCE, 7098 05:02:24,893 --> 05:02:25,093 ET CETERA. 7099 05:02:25,160 --> 05:02:28,763 THANK YOU FOR BRINGING THAT UP. 7100 05:02:28,830 --> 05:02:31,233 >> IT REMINDS ME OF DIFFERENCE 7101 05:02:31,299 --> 05:02:33,468 BETWEEN LOOKING AT ISSUES OF 7102 05:02:33,535 --> 05:02:36,571 RACISM AS A MATTER OF IDEOLOGY 7103 05:02:36,638 --> 05:02:37,339 VERSUS STRUCTURAL PROBLEM. 7104 05:02:37,405 --> 05:02:39,774 I THINK THAT IDEA THAT YOU CAN 7105 05:02:39,841 --> 05:02:41,142 TRUST SCIENTISTS OR CLINICIAN 7106 05:02:41,209 --> 05:02:45,881 BUT NOT THE HEALTH SYSTEM OR 7107 05:02:45,947 --> 05:02:47,148 SCIENCE AS AN ESTABLISHMENT. 7108 05:02:47,215 --> 05:02:49,384 >> CAN I ADD REAL QUICK TOO, WE 7109 05:02:49,451 --> 05:02:52,888 KNOW A LOT OF THE YOUNGER WOMEN 7110 05:02:52,954 --> 05:02:55,056 AMONG PEOPLE LIVING WITH HIV IN 7111 05:02:55,123 --> 05:02:57,692 GENERAL WERE WORRIED ABOUT 7112 05:02:57,759 --> 05:02:59,361 REPRODUCTIVE -- IMPACT ON 7113 05:02:59,427 --> 05:03:00,128 REPRODUCTIVE OUTCOMES FOR 7114 05:03:00,195 --> 05:03:01,863 PREGNANCIES AND SO ON. 7115 05:03:01,930 --> 05:03:04,733 AND THEN IN ADDITION TO THAT 7116 05:03:04,799 --> 05:03:07,035 THERE WERE QUESTIONS AMONG OUR 7117 05:03:07,102 --> 05:03:08,236 COMMUNITY, HOW COME THIS 7118 05:03:08,303 --> 05:03:09,004 HAPPENED SO FAST. 7119 05:03:09,070 --> 05:03:11,840 YET THEY HAVEN'T COME UP WITH AN 7120 05:03:11,907 --> 05:03:13,074 HIV VACCINE YET. 7121 05:03:13,141 --> 05:03:17,245 SO THOSE QUESTIONS HAVE BEEN 7122 05:03:17,312 --> 05:03:19,414 COMING UP I KNOW. 7123 05:03:19,481 --> 05:03:20,415 >> GREAT POINTS. 7124 05:03:20,482 --> 05:03:26,555 TO PRESS YOU MORE, ANY 7125 05:03:26,621 --> 05:03:27,656 MODIFIABLE FACTORS THAT OUR 7126 05:03:27,722 --> 05:03:30,792 COMMUNITY SHOULD FOCUS ON WHEN 7127 05:03:30,859 --> 05:03:35,163 TRYING TO IMPROVE SORT OF 7128 05:03:35,230 --> 05:03:37,165 TRUSTWORTHINESS OR, MARTHA, 7129 05:03:37,232 --> 05:03:39,668 PLEASE JUMP IN WITH IDEAS, WHAT 7130 05:03:39,734 --> 05:03:41,503 SHOULD WE TAKE AWAY, AREAS WE 7131 05:03:41,570 --> 05:03:46,007 SHOULD FOCUS ON. 7132 05:03:46,074 --> 05:03:46,541 >> GREAT QUESTION. 7133 05:03:46,608 --> 05:03:48,677 WE NEED TO UNDERSTAND THE ISSUE 7134 05:03:48,743 --> 05:03:50,946 A LITTLE DEEPER BECAUSE THERE IS 7135 05:03:51,012 --> 05:03:53,281 SO MANY DIMENSIONS, AND MARTHA 7136 05:03:53,348 --> 05:03:55,250 MENTIONED AN IMPORTANT POINT. 7137 05:03:55,317 --> 05:03:57,018 SO, WE REALLY NEED TO GET A 7138 05:03:57,085 --> 05:03:57,886 BETTER UNDERSTAND. 7139 05:03:57,953 --> 05:03:59,821 STUDIES JUST ON THAT BY ITSELF 7140 05:03:59,888 --> 05:04:02,223 WILL BE VERY HELPFUL TO FORM THE 7141 05:04:02,290 --> 05:04:02,557 INTERVENTION. 7142 05:04:02,624 --> 05:04:06,394 AND THIS IS A SPACE WHERE NOT 7143 05:04:06,461 --> 05:04:06,962 ONLY CLINICIANS, RESEARCHERS 7144 05:04:07,028 --> 05:04:10,799 NEED TO BE INVOLVED BUT EVEN 7145 05:04:10,865 --> 05:04:12,767 PEOPLE IN POLICY AND POLICY AND 7146 05:04:12,834 --> 05:04:14,836 ECONOMICS NEED TO BE INVOLVED TO 7147 05:04:14,903 --> 05:04:17,472 FIGURE OUT HOW TO EXPLAIN THIS 7148 05:04:17,539 --> 05:04:19,040 PHENOMENA BECAUSE IT'S REALLY 7149 05:04:19,107 --> 05:04:21,543 BEYOND JUST THE DIRECT 7150 05:04:21,610 --> 05:04:23,545 PATIENT-PROVIDER RELATIONSHIP. 7151 05:04:23,612 --> 05:04:26,581 I WOULD SAY STUDIES LOOKING AT 7152 05:04:26,648 --> 05:04:28,216 UNDERSTANDING THE ISSUE, BUT 7153 05:04:28,283 --> 05:04:30,752 ALSO IMPLEMENTING SOLUTIONS FOR 7154 05:04:30,819 --> 05:04:31,086 US. 7155 05:04:31,152 --> 05:04:36,191 >> YEAH, AND I WOULD JUST ADD 7156 05:04:36,257 --> 05:04:38,193 THAT EDUCATION, I THINK ONE -- 7157 05:04:38,259 --> 05:04:39,861 THINGS NOW WE'VE SEEN, HOW 7158 05:04:39,928 --> 05:04:41,830 PEOPLE AMONG PEOPLE LIVING WITH 7159 05:04:41,896 --> 05:04:45,367 HIV ARE NOTICING THEY ARE HAVING 7160 05:04:45,433 --> 05:04:47,135 A WORSE IMPACT. 7161 05:04:47,202 --> 05:04:50,372 I THINK MY COLLEAGUE J.D. SPOKE 7162 05:04:50,438 --> 05:04:52,007 ABOUT LONG COVID AND WE KNOW 7163 05:04:52,073 --> 05:04:54,776 THAT AMONG PEOPLE LIVING WITH 7164 05:04:54,843 --> 05:04:55,944 HIV WHO ARE EXPERIENCING 7165 05:04:56,011 --> 05:04:58,713 SYMPTOMS THAT ARE NEW OR 7166 05:04:58,780 --> 05:04:59,881 ELONGATED OR EMPHASIZED, SO 7167 05:04:59,948 --> 05:05:02,817 EDUCATION IN THE COMMUNITY IS 7168 05:05:02,884 --> 05:05:05,754 REALLY, REALLY IMPORTANT. 7169 05:05:05,820 --> 05:05:06,521 >> LOVE IT. 7170 05:05:06,588 --> 05:05:09,991 NEXT QUESTION UP IS FOR JULIE. 7171 05:05:10,058 --> 05:05:11,793 SO WE LEARNED FROM YOUR TALK 7172 05:05:11,860 --> 05:05:14,162 ALTHOUGH RISK FACTORS ARE 7173 05:05:14,229 --> 05:05:15,263 SIMILAR ACROSS SECTS, WOMEN 7174 05:05:15,330 --> 05:05:16,564 EXPERIENCE HIGHER RATES OF 7175 05:05:16,631 --> 05:05:18,166 SERIOUS FALLS AND FRACTURES THAN 7176 05:05:18,233 --> 05:05:19,134 MALE COUNTERPARTS. 7177 05:05:19,200 --> 05:05:21,770 CAN YOU TELL US MORE ABOUT 7178 05:05:21,836 --> 05:05:23,371 POTENTIAL PROTECTIVE FACTORS OF 7179 05:05:23,438 --> 05:05:26,875 FALLS AND FRACTURES FOR THIS 7180 05:05:26,941 --> 05:05:33,915 POPULATION? 7181 05:05:33,982 --> 05:05:37,318 YOU'RE MUTED. 7182 05:05:37,385 --> 05:05:40,555 >> HOW MANY YEARS ON ZOOM AND I 7183 05:05:40,622 --> 05:05:42,791 STILL FORGET TO UNMUTE MYSELF? 7184 05:05:42,857 --> 05:05:44,192 YEAH, SO WHAT'S GREAT ABOUT 7185 05:05:44,259 --> 05:05:47,762 FALLS AND FRACTURES, IF YOU CAN 7186 05:05:47,829 --> 05:05:48,596 SAY THERE'S ANYTHING GREAT, THEY 7187 05:05:48,663 --> 05:05:49,464 ARE TRACKED TOGETHER. 7188 05:05:49,531 --> 05:05:52,200 WHAT YOU DO TO DECREASE RISK FOR 7189 05:05:52,267 --> 05:05:57,172 FALLS WILL OFTEN HELP DECREASE 7190 05:05:57,238 --> 05:05:58,640 RISK FOR FRAGILITY FRACTURES. 7191 05:05:58,707 --> 05:05:59,841 EXERCISE IS THE BIG THING THAT 7192 05:05:59,908 --> 05:06:01,176 STANDS OUT. 7193 05:06:01,242 --> 05:06:04,145 IF YOU CAN GO FOR A WALK, 7194 05:06:04,212 --> 05:06:05,580 STRENGTH TRAINING IS GREAT, BUT 7195 05:06:05,647 --> 05:06:06,748 REALLY IT'S ANYTHING THAT YOU 7196 05:06:06,815 --> 05:06:10,151 CAN DO TO MOVE MORE IS GOING TO 7197 05:06:10,218 --> 05:06:11,352 BE HELPFUL. 7198 05:06:11,419 --> 05:06:13,488 WITH FRACTURES OF COURSE GETTING 7199 05:06:13,555 --> 05:06:15,223 ADEQUATE AMOUNTS OF CALCIUM AND 7200 05:06:15,290 --> 05:06:17,659 VITAMIN D IN YOUR DIET. 7201 05:06:17,726 --> 05:06:20,028 YOU KNOW, GREEN LEAFY 7202 05:06:20,095 --> 05:06:22,130 VEGETABLES, DAIRY PRODUCTS, IF 7203 05:06:22,197 --> 05:06:23,031 YOU CAN CONSUME THEM. 7204 05:06:23,098 --> 05:06:24,966 ALL OF THOSE THINGS ARE GOING TO 7205 05:06:25,033 --> 05:06:29,804 HELP. 7206 05:06:29,871 --> 05:06:31,473 >> ONE AREA TO CONTINUE ON, I 7207 05:06:31,539 --> 05:06:34,576 WAS THINKING AND SPEAKING WITH A 7208 05:06:34,642 --> 05:06:36,945 COLLEAGUE RECENTLY IS ON DEEP -- 7209 05:06:37,011 --> 05:06:41,683 IS THE RIGHT TERM DEPRESCRIBING? 7210 05:06:41,750 --> 05:06:43,918 SOME CHALLENGES, SHE'S A 7211 05:06:43,985 --> 05:06:45,453 PSYCHIATRIST, SOME CHALLENGES 7212 05:06:45,520 --> 05:06:47,555 AROUND DEPRESCRIBING AS IT COMES 7213 05:06:47,622 --> 05:06:48,556 TO LONGSTANDING PRESCRIPTIONS 7214 05:06:48,623 --> 05:06:53,561 FOR SOME MEDICATIONS LIKE A 7215 05:06:53,628 --> 05:06:55,430 BENZODIAZEPINE TO GO TO SLEEP 7216 05:06:55,497 --> 05:06:59,234 EVERY NIGHT, THAT SEEMS LIKE ONE 7217 05:06:59,300 --> 05:07:01,503 OF THE MORE NUANCED CHALLENGING 7218 05:07:01,569 --> 05:07:03,071 OR PROVOCATIVE AREAS OF THE WORK 7219 05:07:03,138 --> 05:07:04,105 THAT YOU PRESENTED, MAYBE YOU 7220 05:07:04,172 --> 05:07:05,573 CAN EXPLORE THAT A LITTLE BIT 7221 05:07:05,640 --> 05:07:08,977 MORE DEEPLY FOR THE COMMUNITY 7222 05:07:09,043 --> 05:07:12,147 AND EXPLAIN WHAT YOUR WISDOM IS 7223 05:07:12,213 --> 05:07:13,715 ON HOW TO APPROACH IT? 7224 05:07:13,782 --> 05:07:16,017 >> THAT'S A REALLY IMPORTANT 7225 05:07:16,084 --> 05:07:16,518 QUESTION. 7226 05:07:16,584 --> 05:07:18,052 SO DEPRESCRIBING, SO TRYING TO 7227 05:07:18,119 --> 05:07:19,821 DECREASE THE NUMBER OF 7228 05:07:19,888 --> 05:07:21,589 MEDICATIONS THAT PEOPLE ARE ON, 7229 05:07:21,656 --> 05:07:23,858 ALTHOUGH IT'S ALSO IMPORTANT TO 7230 05:07:23,925 --> 05:07:24,959 REMEMBER THAT WHILE DECREASING 7231 05:07:25,026 --> 05:07:26,928 TOTAL NUMBER IS IMPORTANT, YOU 7232 05:07:26,995 --> 05:07:30,832 CAN ALSO DECREASE THE DOSE. 7233 05:07:30,899 --> 05:07:33,401 THAT'S HELPFUL AS WELL. 7234 05:07:33,468 --> 05:07:35,837 SO, I THINK ANOTHER ISSUE THAT 7235 05:07:35,904 --> 05:07:39,874 SPEAKING AS A PROVIDER THAT WE 7236 05:07:39,941 --> 05:07:43,244 RUN INTO IS THAT YOU'RE LOOKING 7237 05:07:43,311 --> 05:07:44,412 AT MEDICATION LISTS, 20 7238 05:07:44,479 --> 05:07:46,381 MEDICATIONS LONG, YOU FEEL LIKE 7239 05:07:46,447 --> 05:07:48,416 HOW AM I GOING TO GET DOWN TO A 7240 05:07:48,483 --> 05:07:50,051 NUMBER THAT'S GOING TO HAVE AN 7241 05:07:50,118 --> 05:07:51,920 IMPACT ON FALL RISK AND FRACTURE 7242 05:07:51,986 --> 05:07:52,120 RISK? 7243 05:07:52,187 --> 05:07:54,389 THE GREAT NEWS IS FROM THE WORK 7244 05:07:54,455 --> 05:07:57,525 THAT WE'VE DONE WE SEE THAT THE 7245 05:07:57,592 --> 05:07:59,494 ASSOCIATION BETWEEN NUMBER OF 7246 05:07:59,561 --> 05:08:00,995 MEDICATIONS AND FALL RISK AND 7247 05:08:01,062 --> 05:08:03,798 FRACTURE RISK IS PRETTY MUCH 7248 05:08:03,865 --> 05:08:06,100 LINEAR, SO EVERY DECREASE IN 7249 05:08:06,167 --> 05:08:08,203 MEDICATION NUMBER IS GOING TO 7250 05:08:08,269 --> 05:08:10,471 DECREASE BY AT LEAST A SMALL 7251 05:08:10,538 --> 05:08:13,341 AMOUNT YOUR RISK OF FALL OR 7252 05:08:13,408 --> 05:08:14,008 FRACTURE. 7253 05:08:14,075 --> 05:08:16,744 SO, IT'S A REALLY IMPORTANT 7254 05:08:16,811 --> 05:08:19,781 THING, DOING -- ALL PROVIDERS 7255 05:08:19,848 --> 05:08:22,550 DOING THEIR DUE DILIGENCE, GOING 7256 05:08:22,617 --> 05:08:23,384 THROUGH MEDICATION LISTS, 7257 05:08:23,451 --> 05:08:24,352 UNDERSTANDING EXACTLY WHAT ALL 7258 05:08:24,419 --> 05:08:27,121 OF OUR PATIENTS ARE ON AND WHAT 7259 05:08:27,188 --> 05:08:28,623 THEY ARE TAKING, AWARE OF WHAT 7260 05:08:28,690 --> 05:08:31,192 THEY ARE TAKING THAT WE'RE NOT 7261 05:08:31,259 --> 05:08:32,794 PRESCRIBING AND HAVING A 7262 05:08:32,861 --> 05:08:34,095 CONVERSATION ABOUT WHERE CAN WE 7263 05:08:34,162 --> 05:08:36,231 CUT BACK, WHERE CAN WE DECREASE 7264 05:08:36,297 --> 05:08:37,832 THE DOSE. 7265 05:08:37,899 --> 05:08:39,634 I MEAN, YOU KNOW, DOWN THE LINE 7266 05:08:39,701 --> 05:08:42,203 HOPEFULLY WE CAN GET MORE WITH 7267 05:08:42,270 --> 05:08:42,971 PRECISION MEDICINE AND 7268 05:08:43,037 --> 05:08:45,273 UNDERSTAND, OKAY, WHO IS REALLY 7269 05:08:45,340 --> 05:08:46,808 AT RISK FOR CARDIOVASCULAR 7270 05:08:46,875 --> 05:08:48,009 DISEASE? 7271 05:08:48,076 --> 05:08:52,614 YOU KNOW, WHERE CAN WE CUT BACK 7272 05:08:52,680 --> 05:08:53,081 ON THOSE MEDICATIONS? 7273 05:08:53,147 --> 05:08:54,716 A NUMBER OF OTHER OUTCOMES. 7274 05:08:54,782 --> 05:08:57,018 AND REALLY BEING ABLE TO PICK 7275 05:08:57,085 --> 05:08:59,053 AND CHOOSE WHO ABSOLUTELY NEEDS 7276 05:08:59,120 --> 05:09:01,389 TO BE ON CARDIOVASCULAR 7277 05:09:01,456 --> 05:09:02,123 PREVENTION AND WHO PROBABLY 7278 05:09:02,190 --> 05:09:03,391 DOESN'T NEED IT OR DOESN'T NEED 7279 05:09:03,458 --> 05:09:06,527 IT AS MUCH OR DOESN'T NEED IT AS 7280 05:09:06,594 --> 05:09:07,829 EARLY AS SOMEBODY ELSE. 7281 05:09:07,896 --> 05:09:09,597 UNFORTUNATELY WE'RE NOT THERE 7282 05:09:09,664 --> 05:09:09,931 YET. 7283 05:09:09,998 --> 05:09:11,733 BUT I THINK KNOWING WHAT OUR 7284 05:09:11,799 --> 05:09:15,303 PATIENTS ARE ON AND HAVING THOSE 7285 05:09:15,370 --> 05:09:16,504 CONVERSATIONS ABOUT, YOU KNOW, 7286 05:09:16,571 --> 05:09:18,806 STOPPING MEDICATION IF YOU CAN 7287 05:09:18,873 --> 05:09:21,309 OR JUST DECREASING THE DOSE OR 7288 05:09:21,376 --> 05:09:22,644 FREQUENCY IF YOU CAN'T GET RID 7289 05:09:22,710 --> 05:09:29,117 OF THE MED, THOSE ARE REALLY 7290 05:09:29,183 --> 05:09:30,518 IMPORTANT CONVERSATIONS TO HAVE. 7291 05:09:30,585 --> 05:09:32,220 >> SEEING PATIENTS AT A 7292 05:09:32,287 --> 05:09:32,954 HOSPITAL, IT'S SO CHALLENGING 7293 05:09:33,021 --> 05:09:34,589 WHEN PEOPLE DON'T HAVE A MEDICAL 7294 05:09:34,656 --> 05:09:37,892 HOME AND THERE'S NOBODY STEERING 7295 05:09:37,959 --> 05:09:38,526 THE SHIP. 7296 05:09:38,593 --> 05:09:40,929 AND YOU WANT TO STEP ON THE TOES 7297 05:09:40,995 --> 05:09:42,430 OF OTHER CLINICIANS WHO HAVE 7298 05:09:42,497 --> 05:09:46,634 GOOD REASONS FOR STARTING 7299 05:09:46,701 --> 05:09:47,135 MEDICATIONS, THERAPEUTIC 7300 05:09:47,201 --> 05:09:48,136 ALLIANCE OF THE PATIENT RELATED 7301 05:09:48,202 --> 05:09:52,073 TO AN ISSUE, AT THE SAME TIME 7302 05:09:52,140 --> 05:09:55,176 THE CUMULATIVE PICTURE BECOMES 7303 05:09:55,243 --> 05:09:57,879 EITHER UNSUSTAINABLE OR HAVING 7304 05:09:57,946 --> 05:10:02,050 LIABILITIES OF IT'S OWN 7305 05:10:02,116 --> 05:10:02,583 DANGEROUS INTRODUCING NEW 7306 05:10:02,650 --> 05:10:04,485 PROBLEMS IS THE NEW BIGGEST 7307 05:10:04,552 --> 05:10:08,990 PROBLEM, THE FRACTURE IS NOW THE 7308 05:10:09,057 --> 05:10:09,791 LIFE-THREATENING THING. 7309 05:10:09,857 --> 05:10:13,127 IT MAKES SENSE. 7310 05:10:13,194 --> 05:10:16,431 THERE'S NO GOOD ANSWER. 7311 05:10:16,497 --> 05:10:17,465 JUST TO PRESS FURTHER, -- 7312 05:10:17,532 --> 05:10:19,167 >> I WOULD LIKE TO CONTRIBUTE 7313 05:10:19,233 --> 05:10:21,803 SOMETHING AS WELL. 7314 05:10:21,869 --> 05:10:24,172 >> PLEASE. 7315 05:10:24,238 --> 05:10:26,808 MY QUESTION, SEE IF THIS 7316 05:10:26,874 --> 05:10:28,443 DOVETAILS, MARTHA, WHAT ABOUT 7317 05:10:28,509 --> 05:10:29,544 THOSE BENZOS SPECIFICALLY. 7318 05:10:29,610 --> 05:10:30,845 ARE THOSE REALLY SOME OF THE 7319 05:10:30,912 --> 05:10:34,382 HIGHEST RISK AND ARE THOSE THE 7320 05:10:34,449 --> 05:10:36,117 ONES HARDER TO DEPRESCRIBE? 7321 05:10:36,184 --> 05:10:39,087 AND ARE THERE ANY PARTICULAR 7322 05:10:39,153 --> 05:10:40,455 CONSIDERATIONS AROUND THAT? 7323 05:10:40,521 --> 05:10:46,160 MARTHA, PLEASE JUMP IN AS WELL. 7324 05:10:46,227 --> 05:10:48,496 >> YES, SO, YES, I MEAN, YOU 7325 05:10:48,563 --> 05:10:49,697 KNOW, WE'VE LOOKED AT 7326 05:10:49,764 --> 05:10:51,332 BENZODIAZEPINES A NUMBER OF 7327 05:10:51,399 --> 05:10:52,967 DIFFERENT WAYS, THEY ARE HUGELY 7328 05:10:53,034 --> 05:10:55,470 PROBLEMATIC BUT THEN YOU HAVE A 7329 05:10:55,536 --> 05:10:56,671 CONVERSATION WITH YOUR PATIENT, 7330 05:10:56,738 --> 05:11:00,408 HEY, CAN WE GET RID OF THIS, AND 7331 05:11:00,475 --> 05:11:02,577 THEN YOU START ON THE 7332 05:11:02,643 --> 05:11:04,679 CONVERSATION ABOUT HOW IS YOUR 7333 05:11:04,746 --> 05:11:05,780 SLEEP AND ARE YOU SLEEPING, AND 7334 05:11:05,847 --> 05:11:08,249 WHAT TIME DO YOU GO TO BED, HOW 7335 05:11:08,316 --> 05:11:10,618 LONG DOES IT TAKE YOU TO FALL 7336 05:11:10,685 --> 05:11:11,652 ASLEEP? 7337 05:11:11,719 --> 05:11:15,656 MOST OF MY PATIENTS WHO ON A 7338 05:11:15,723 --> 05:11:16,624 BENZOWERE PRESCRIBED IT MANY 7339 05:11:16,691 --> 05:11:19,694 YEARS US A BECAUSE THEY COULDN'T 7340 05:11:19,761 --> 05:11:20,228 FALL ASLEEP. 7341 05:11:20,294 --> 05:11:23,431 BUT, YOU KNOW, AT THAT POINT IN 7342 05:11:23,498 --> 05:11:25,299 TIME THE WHOLE PROCESS ENDED 7343 05:11:25,366 --> 05:11:26,300 WITH PRESCRIBING A BENZO, AND 7344 05:11:26,367 --> 05:11:32,874 THEN YOU FIND OUT LATER ON THAT 7345 05:11:32,940 --> 05:11:35,410 BENZOS CAN ERUPT YOUR SLEEP MORE 7346 05:11:35,476 --> 05:11:36,010 THAN HELP. 7347 05:11:36,077 --> 05:11:37,145 YOU GET STUCK ON THEM. 7348 05:11:37,211 --> 05:11:42,316 IT'S REALLY LARD TO GET OFF OF 7349 05:11:42,383 --> 05:11:42,550 THEM. 7350 05:11:42,617 --> 05:11:45,686 YOU HAVE THE -- IT'S HARD TO GET 7351 05:11:45,753 --> 05:11:46,454 OFF OF THEM. 7352 05:11:46,521 --> 05:11:48,756 I WANT TO GET OFF OF IT BUT 7353 05:11:48,823 --> 05:11:51,793 WE'VE GOT TO WEAN YOU OFF SO YOU 7354 05:11:51,859 --> 05:11:52,894 DON'T HAVE ADDITIONAL PROBLEMS 7355 05:11:52,960 --> 05:11:53,461 FROM IT. 7356 05:11:53,528 --> 05:11:55,630 BUT I THINK ONE OF THE THINGS, 7357 05:11:55,696 --> 05:11:57,732 WE'RE DOING INTERVENTION IN THE 7358 05:11:57,799 --> 05:12:01,269 CLINIC WHERE I WORK, TRYING TO 7359 05:12:01,335 --> 05:12:02,970 OPTIMIZE, YOU KNOW, FALL AND 7360 05:12:03,037 --> 05:12:03,938 FRACTURE PREVENTION FOR ALL OF 7361 05:12:04,005 --> 05:12:05,940 OUR PEOPLE WHO ARE OVER THE AGE 7362 05:12:06,007 --> 05:12:08,676 OF 50, AND WE'RE FINDING THAT 7363 05:12:08,743 --> 05:12:10,511 SLEEP DISTURBANCE IS A HUGE 7364 05:12:10,578 --> 05:12:12,713 DRIVER OF MEDICATIONS AND HUGE 7365 05:12:12,780 --> 05:12:15,349 DRIVER OF A NUMBER OF VERY 7366 05:12:15,416 --> 05:12:15,983 NEGATIVE OUTCOMES. 7367 05:12:16,050 --> 05:12:19,253 IF I COULD PUT IN A PLUG FOR 7368 05:12:19,320 --> 05:12:20,621 ASSESSING PEOPLE FOR SLEEP, 7369 05:12:20,688 --> 05:12:26,394 THAT'S A HUGE ISSUE. 7370 05:12:26,461 --> 05:12:32,733 >> AND, YOU KNOW, I ABOUT TEN 7371 05:12:32,800 --> 05:12:34,368 YEARS AGO WAS DIAGNOSED WITH A 7372 05:12:34,435 --> 05:12:36,337 THING THAT MIMICKED A HEART 7373 05:12:36,404 --> 05:12:45,246 ATTACK, AT LEAST TO KNOW HISTORY 7374 05:12:45,313 --> 05:12:47,115 OF PRE-EXPOSURE, MY DOCTOR WAS 7375 05:12:47,181 --> 05:12:50,284 TALKING, SOMETHING DO WITH A 7376 05:12:50,351 --> 05:12:51,285 COUPLE MEDICATIONS I WAS 7377 05:12:51,352 --> 05:12:52,186 PRESCRIBED WHICH AS PEOPLE 7378 05:12:52,253 --> 05:12:54,956 LIVING WITH HIV WHEN WE COMPARE 7379 05:12:55,022 --> 05:12:57,658 NOTES WE'RE TAKING ONE PILL FOR 7380 05:12:57,725 --> 05:12:58,993 HIV, TWENTY PILLS FOR ALL THOSE 7381 05:12:59,060 --> 05:13:01,863 OTHER THINGS GOING ON WITH US. 7382 05:13:01,929 --> 05:13:06,033 BUT SO, AGAIN, I KIND OF WANT TO 7383 05:13:06,100 --> 05:13:08,035 DIFFER IN THE SENSE I FEEL LIKE 7384 05:13:08,102 --> 05:13:11,939 YOU ALREADY DO KNOW THOSE PEOPLE 7385 05:13:12,006 --> 05:13:13,541 THAT ARE PRE-DISPOSED TO 7386 05:13:13,608 --> 05:13:15,376 CARDIOVASCULAR FROM THEIR 7387 05:13:15,443 --> 05:13:16,878 RESEARCH AND SOMETIMES IT'S 7388 05:13:16,944 --> 05:13:18,412 CONNECTED WITH INCOME, CONNECTED 7389 05:13:18,479 --> 05:13:21,249 WITH OUR RACE AND ETHNICITY, 7390 05:13:21,315 --> 05:13:25,720 THAT WE CAN ALMOST PREDICT AND 7391 05:13:25,786 --> 05:13:28,789 KNOW THOSE COMMUNITIES THAT ARE 7392 05:13:28,856 --> 05:13:30,658 PRE-DISPOSED AND WE'VE HEARD 7393 05:13:30,725 --> 05:13:35,062 ABOUT RESEARCH, FOR EXAMPLE, AT 7394 05:13:35,129 --> 05:13:39,767 JOHNS HOPKINS THAT USED OZEMPIC 7395 05:13:39,834 --> 05:13:41,869 TIED WITH LIVER DISEASE BUT 7396 05:13:41,936 --> 05:13:45,540 IMPROVED OBVIOUSLY WEIGHT LOSS 7397 05:13:45,606 --> 05:13:46,908 AND PREDISPOSURE TO DIABETES, I 7398 05:13:46,974 --> 05:13:48,743 WANT TO EMPHASIZE THIS POINT, WE 7399 05:13:48,809 --> 05:13:49,944 HAVE ALL THIS INFORMATION, YOU 7400 05:13:50,011 --> 05:13:52,580 ALL HAVE, AND I FEEL LIKE IF IT 7401 05:13:52,647 --> 05:13:55,183 DID COME TOGETHER WE COULD HAVE 7402 05:13:55,249 --> 05:13:55,950 BETTER INTERVENTIONS FOR PEOPLE 7403 05:13:56,017 --> 05:13:57,051 BECAUSE THERE ARE PEOPLE WHO 7404 05:13:57,118 --> 05:13:58,619 ALREADY KNOW THIS AND PEOPLE WHO 7405 05:13:58,686 --> 05:14:00,354 ALREADY KNOW THIS AND PEOPLE MAY 7406 05:14:00,421 --> 05:14:02,323 HAVE TESTED THIS OUT, BUT IT'S 7407 05:14:02,390 --> 05:14:03,124 NOT HELPING US. 7408 05:14:03,191 --> 05:14:07,261 WE ALREADY KNOW THAT IN OUR 7409 05:14:07,328 --> 05:14:09,197 COMMUNITY WE'RE OBESE, A LOT OF 7410 05:14:09,263 --> 05:14:11,332 US HYPERTENSION AND SO ON, IF 7411 05:14:11,399 --> 05:14:13,901 THEY COULD JUST INCLUDE IN OUR 7412 05:14:13,968 --> 05:14:17,104 CARE FREE MEMBERSHIP TO THE GYM, 7413 05:14:17,171 --> 05:14:19,640 ENCOURAGEMENT TO SEE NUTRITION 7414 05:14:19,707 --> 05:14:20,975 SPECIALIST, SMALL THINGS THAT 7415 05:14:21,042 --> 05:14:23,444 CAN START IMPROVING OUR CARE AS 7416 05:14:23,511 --> 05:14:27,582 RELATES TO THESE THINGS IT WOULD 7417 05:14:27,648 --> 05:14:28,149 SHALL HELPFUL. 7418 05:14:28,216 --> 05:14:30,751 >> I THINK THAT'S A REALLY GOOD 7419 05:14:30,818 --> 05:14:31,686 POINT TO END ON. 7420 05:14:31,752 --> 05:14:34,488 I'M GOING TO READ OUT THE OTHER 7421 05:14:34,555 --> 05:14:35,990 QUESTIONS TO STIMULATE THOUGHTS 7422 05:14:36,057 --> 05:14:38,826 AND MAYBE FUTURE DISCUSSIONS 7423 05:14:38,893 --> 05:14:42,663 AMONG THE GROUP, WHICH ARE WE 7424 05:14:42,730 --> 05:14:46,701 DIDN'T GET TO, AROUND FOR KATHY 7425 05:14:46,767 --> 05:14:48,336 AROUND SUSTAINABILITY OF 7426 05:14:48,402 --> 05:14:49,770 INTERVENTION THAT LEVERAGE 7427 05:14:49,837 --> 05:14:52,940 NON-SPECIALISTS AS A WORKFORCE, 7428 05:14:53,007 --> 05:14:56,744 NEXT STEPS FOR THE NETWORK 7429 05:14:56,811 --> 05:14:57,211 APPROACH THAT LEAH WAS 7430 05:14:57,278 --> 05:14:58,179 DESCRIBING, THAT WAS SOMETHING 7431 05:14:58,246 --> 05:15:00,481 NEW FOR A LOT OF US TO HEAR 7432 05:15:00,548 --> 05:15:01,015 ABOUT. 7433 05:15:01,082 --> 05:15:02,016 THERE SEEMS TO BE A LOT OF 7434 05:15:02,083 --> 05:15:03,017 INTEREST IN LEARNING MORE ABOUT 7435 05:15:03,084 --> 05:15:05,419 WHAT ELSE WE CAN DO WITH THOSE 7436 05:15:05,486 --> 05:15:08,356 TECHNOLOGIES AND THAT APPROACH. 7437 05:15:08,422 --> 05:15:16,130 AND THEN THE LAST QUESTION HERE 7438 05:15:16,197 --> 05:15:17,932 IS -- I'M FORGETTING WHAT IT 7439 05:15:17,999 --> 05:15:20,401 STOOD FOR, THE QUESTION ABOUT 7440 05:15:20,468 --> 05:15:23,604 VAX, LOOKING AT HOW TO IMPROVE 7441 05:15:23,671 --> 05:15:25,906 COLLABORATION AND REPRESENTATION 7442 05:15:25,973 --> 05:15:28,843 IN THOSE POPULATIONS BEING 7443 05:15:28,909 --> 05:15:30,411 STUDIED. 7444 05:15:30,478 --> 05:15:32,013 AND LAST QUESTION HERE, FOR 7445 05:15:32,079 --> 05:15:33,314 MARTHA, WHAT YOU WOULD LIKE TO 7446 05:15:33,381 --> 05:15:36,384 SEE MORE OF IN TERMS OF POLICY 7447 05:15:36,450 --> 05:15:38,052 CHANGES AND HOW DO WE WORK TO 7448 05:15:38,119 --> 05:15:38,819 ACHIEVING THEM. 7449 05:15:38,886 --> 05:15:42,423 WE'LL END ON IN A NOTE, WITH A 7450 05:15:42,490 --> 05:15:44,058 QUESTION MARK, BUT I THINK I'M 7451 05:15:44,125 --> 05:15:45,826 EXCITED FOR THE PEOPLE IN THIS 7452 05:15:45,893 --> 05:15:46,927 ROOM TO CONTINUE THE 7453 05:15:46,994 --> 05:15:47,762 CONVERSATION AND THIS WAS REALLY 7454 05:15:47,828 --> 05:15:50,698 THE TIP OF THE ICEBERG AND SUCH 7455 05:15:50,765 --> 05:15:52,033 A GREAT OPPORTUNITY TO LEARN 7456 05:15:52,099 --> 05:15:53,000 ABOUT THE WORK THAT EVERYBODY 7457 05:15:53,067 --> 05:15:58,039 HAS BEEN DOING TO DEVELOP THIS 7458 05:15:58,105 --> 05:15:59,140 SPACE. 7459 05:15:59,206 --> 05:16:01,809 THANKS, EVERYONE. 7460 05:16:30,404 --> 05:16:31,839 >> GO AHEAD, REBECCA. 7461 05:16:31,906 --> 05:16:34,141 >> YOU WANT US TO START? 7462 05:16:34,208 --> 05:16:35,810 >> YES, THANK YOU. 7463 05:16:35,876 --> 05:16:36,544 >> OKAY. 7464 05:16:36,610 --> 05:16:36,811 WELCOME. 7465 05:16:36,877 --> 05:16:39,180 THANK YOU FOR JOINING US TODAY 7466 05:16:39,246 --> 05:16:42,516 VIA NIH VIDEOCAST FOR TODAY'S 7467 05:16:42,583 --> 05:16:49,156 SESSION ON CANCER AND HIV. 7468 05:16:49,223 --> 05:16:52,493 I'M REBECCA HUPPI, CO-MODDAT 7469 05:16:52,560 --> 05:16:54,362 RATER IS GERALDINE DOMINGUEZ, 7470 05:16:54,428 --> 05:16:58,699 FROM THE NATIONAL CANCER 7471 05:16:58,766 --> 05:16:59,066 INSTITUTE. 7472 05:16:59,133 --> 05:17:00,501 TODAY'S SPEAKERS ARE SHOWN HERE, 7473 05:17:00,568 --> 05:17:04,939 FULL BIOS CAN BE FOUND ON THE 7474 05:17:05,005 --> 05:17:08,909 EVENT WEB PAGE. 7475 05:17:08,976 --> 05:17:10,978 DR. CARLA CHIBWESHA, ASSOCIATE 7476 05:17:11,045 --> 05:17:13,280 PROFESSOR AT UNIVERSITY OF NORTH 7477 05:17:13,347 --> 05:17:15,182 CAROLINA AT CHAPEL HILL UNC. 7478 05:17:15,249 --> 05:17:19,120 MAJORITY OF HER WORK IS FOCUSED 7479 05:17:19,186 --> 05:17:23,824 ON CERVICAL CANCER PREVENTION, 7480 05:17:23,891 --> 05:17:26,961 SPECIAL INTEREST IN INTERVENTION 7481 05:17:27,027 --> 05:17:29,830 BETWEEN HPV AND HIV. 7482 05:17:29,897 --> 05:17:32,767 DR. JOEL PALEFSKY TRAINED IN 7483 05:17:32,833 --> 05:17:37,938 MEDICINE AND INTERNAL MEDICINE 7484 05:17:38,005 --> 05:17:40,007 AT MCGILL UNIVERSITY, AND IN 7485 05:17:40,074 --> 05:17:41,709 INFECTIOUS DISEASE AT STANFORD, 7486 05:17:41,776 --> 05:17:43,411 INTERNATIONALLY RECOGNIZED 7487 05:17:43,477 --> 05:17:45,913 EXPERT ON THE MOLECULAR BIOLOGY, 7488 05:17:45,980 --> 05:17:51,919 TREATMENT, PATHOGENESIS AND 7489 05:17:51,986 --> 05:17:57,425 NATURAL HISTORY OF HPV INFECTION 7490 05:17:57,491 --> 05:18:01,595 IN HIV. 7491 05:18:01,662 --> 05:18:04,565 DR. ANNA COGHILL, MOFFITT CANCER 7492 05:18:04,632 --> 05:18:05,766 CENTER AND RESEARCH INSTITUTE, 7493 05:18:05,833 --> 05:18:16,343 PRINCIPAL INVESTIGATOR FOR THE 7494 05:18:24,685 --> 05:18:27,621 MOFFITT SITE. 7495 05:18:27,688 --> 05:18:28,189 DR. KIMBERLY LEVINSON, JOHNS 7496 05:18:28,255 --> 05:18:29,723 HOPKINS SCHOOL OF MEDICINE IN 7497 05:18:29,790 --> 05:18:33,561 BALTIMORE, DIRECTOR OF JOHNS 7498 05:18:33,627 --> 05:18:35,629 HOPKINS GYNECOLOGIC ONCOLOGY 7499 05:18:35,696 --> 05:18:38,065 GREATER BALTIMORE MEDICAL 7500 05:18:38,132 --> 05:18:39,633 CENTER, FOCUSING ON LOWER 7501 05:18:39,700 --> 05:18:46,607 GENITAL TRACT DISEASE 7502 05:18:46,674 --> 05:18:54,515 SPECIFICALLY CERVICAL CANCER. 7503 05:18:54,582 --> 05:18:56,250 BENDA KITHAKA USES POWER OF 7504 05:18:56,317 --> 05:19:02,690 STORY TELLING TO HARNESS LIVED 7505 05:19:02,756 --> 05:19:12,032 EXPERIENCES AS TOOLS FOR 7506 05:19:12,099 --> 05:19:13,567 ADVOCACY, HIGHLIGHTING CANCER 7507 05:19:13,634 --> 05:19:16,637 SURVIVOR 14*EU7 CHALLENGES AND 7508 05:19:16,704 --> 05:19:25,079 ADVOCATE FOR POST TREATMENT 7509 05:19:25,145 --> 05:19:26,714 EMPOWERMENT OF CANCER SURVIVORS. 7510 05:19:26,780 --> 05:19:29,383 GIRLS AND WOMEN MAKE OF HALF THE 7511 05:19:29,450 --> 05:19:31,552 PEOPLE LIVING WITH HIV. 7512 05:19:31,619 --> 05:19:33,721 THESE GIRLS AND WOMEN AGE WITH 7513 05:19:33,787 --> 05:19:36,724 HIV, THE RESPONSE MUST ALSO 7514 05:19:36,790 --> 05:19:39,994 INCLUDE FOCUS ON CANCER 7515 05:19:40,060 --> 05:19:41,328 PREVENTION AND TREATMENT 7516 05:19:41,395 --> 05:19:42,296 PARTICULARLY GYNECOLOGIC CANCER. 7517 05:19:42,363 --> 05:19:47,368 AFRICA HAS THE LARGEST NUMBER OF 7518 05:19:47,434 --> 05:19:49,870 WOMEN LIVING WITH HIV. 7519 05:19:49,937 --> 05:19:51,238 CANCER HAS BEEN A MANIFESTATION 7520 05:19:51,305 --> 05:19:52,907 OF HIV/AIDS SINCE THE BEGINNING 7521 05:19:52,973 --> 05:19:58,746 OF THE EPIGENETIC, AND IS A 7522 05:19:58,812 --> 05:19:59,947 LEADING CAUSE OF MORBIDITY, 7523 05:20:00,014 --> 05:20:09,023 PRIOR TO THE USE OF HIGHLY 7524 05:20:09,089 --> 05:20:10,891 ACTIVE ANTIRETROVIRAL CANCER 7525 05:20:10,958 --> 05:20:17,131 THERE WAS A RISE IN KAPOSI 7526 05:20:17,197 --> 05:20:17,998 SARCOMA SUGGESTING A PERSON 7527 05:20:18,065 --> 05:20:25,873 MIGHT HAVE AIDS, THEY TERMED 7528 05:20:25,940 --> 05:20:30,945 THESE AIDS DEFINING, AS MORE 7529 05:20:31,011 --> 05:20:34,148 WOMEN WERE DIAGNOSED CANCER WAS 7530 05:20:34,214 --> 05:20:35,449 RECOGNIZED AS AIDS DEFINING, 7531 05:20:35,516 --> 05:20:40,387 WITH SUCCESSFUL USE OF HAART 7532 05:20:40,454 --> 05:20:47,161 THERE'S BEEN A DECREASE, PEOPLE 7533 05:20:47,227 --> 05:20:50,564 WITH HIV LIVING LONGER, I'VE 7534 05:20:50,631 --> 05:20:57,338 HIGHLIGHTED THREE TYPES OF 7535 05:20:57,404 --> 05:20:59,073 CANCER, CERVICAL, ANAL, AND HEAD 7536 05:20:59,139 --> 05:21:02,810 AND NECK, ALL THREE CAUSED BY A 7537 05:21:02,876 --> 05:21:05,145 VIRUS, THE HUMAN PAPILLOMAVIRUS, 7538 05:21:05,212 --> 05:21:10,584 AND HPV IS A MAJOR ASPECT OF THE 7539 05:21:10,651 --> 05:21:13,087 TALK IN THIS SESSION. 7540 05:21:13,153 --> 05:21:14,855 HUMAN PAPILLOMA -- I'M SURE EACH 7541 05:21:14,922 --> 05:21:17,458 SPEAKER IS GOING TO GO MORE IN 7542 05:21:17,524 --> 05:21:19,093 DEPTH IN THEIR TALKS BUT I WANT 7543 05:21:19,159 --> 05:21:23,931 TO GIVE A BRIEF OVERVIEW OF 7544 05:21:23,998 --> 05:21:25,032 HPV-ASSOCIATED CANCERS. 7545 05:21:25,099 --> 05:21:28,435 HPV IS A GROUP OF 200 RELATED 7546 05:21:28,502 --> 05:21:30,938 VIRUSES OF WHICH ABOUT 12 TYPES 7547 05:21:31,005 --> 05:21:33,474 ARE CONSIDERED HIGH RISK, CAN 7548 05:21:33,540 --> 05:21:34,775 CAUSE CANCER. 7549 05:21:34,842 --> 05:21:37,878 HOWEVER, TWO HIGH RISK TYPES, 16 7550 05:21:37,945 --> 05:21:42,616 AND 18, ARE RESPONSIBLE FOR MOST 7551 05:21:42,683 --> 05:21:43,150 CANCERS. 7552 05:21:43,217 --> 05:21:44,551 INFECTION IS COMMON AND MOST 7553 05:21:44,618 --> 05:21:46,620 SEXUALLY ACTIVE PEOPLE ARE 7554 05:21:46,687 --> 05:21:48,255 INFECTED WITH HPV. 7555 05:21:48,322 --> 05:21:49,890 FOR THE MOST PART, HPV 7556 05:21:49,957 --> 05:21:52,960 INFECTIONS GO AWAY ON THEIR OWN 7557 05:21:53,027 --> 05:21:56,463 WITHOUT CAUSING CANCER. 7558 05:21:56,530 --> 05:21:58,365 HOWEVER, WHEN HPV INFECTIONS ARE 7559 05:21:58,432 --> 05:22:01,769 NOT SUCCESSFULLY CONTROLLED BY 7560 05:22:01,835 --> 05:22:04,505 YOUR IMMUNE SYSTEM, HIGH RISK 7561 05:22:04,571 --> 05:22:06,040 HPV INFECTION PERSISTS FOR MANY 7562 05:22:06,106 --> 05:22:07,474 YEARS, IT CAN LEAD TO CELL 7563 05:22:07,541 --> 05:22:10,344 CHANGES, SHOWN IN THE PICTURE TO 7564 05:22:10,411 --> 05:22:12,279 THE RIGHT, IF UNTREATED CAN GET 7565 05:22:12,346 --> 05:22:15,816 WORSE OVER TIME AND BECOME 7566 05:22:15,883 --> 05:22:17,918 PRE-CANCEROUS AND THEN CANCER. 7567 05:22:17,985 --> 05:22:19,953 CANCER CAN OCCUR IN ANY TISSUE 7568 05:22:20,020 --> 05:22:22,256 THAT BECOMES EXPOSED TO HPV, IN 7569 05:22:22,322 --> 05:22:24,391 THE TALKS YOU'LL BE HEARING 7570 05:22:24,458 --> 05:22:30,064 TODAY, FOCUS WILL BE ON CERVICAL 7571 05:22:30,130 --> 05:22:36,737 CANCER, ANAL AND GYNECOLOGIC. 7572 05:22:36,804 --> 05:22:39,173 FIRST SPEAKER IS DR. CHIBWESHA. 7573 05:22:39,239 --> 05:22:42,309 >> THANKS FOR THE INTRODUCTION. 7574 05:22:42,376 --> 05:22:43,343 HELLO. 7575 05:22:43,410 --> 05:22:46,580 AGAIN I'M CARLA CHIBWESHA, 7576 05:22:46,647 --> 05:22:47,114 OBSTETRICIAN GYNECOLOGIST, 7577 05:22:47,181 --> 05:22:48,248 ASSOCIATE PROFESSOR OF GLOBAL 7578 05:22:48,315 --> 05:22:48,982 WOMEN'S HEALTH UNIVERSITY OF 7579 05:22:49,049 --> 05:22:52,052 NORTH CAROLINA AT CHAPEL HILL. 7580 05:22:52,119 --> 05:22:54,221 I LIVE AND WORK IN SOUTH AFRICA 7581 05:22:54,288 --> 05:22:58,492 WHERE MY RESEARCH IS FOCUSED ON 7582 05:22:58,559 --> 05:23:00,527 CERVICAL CANCER PRESERVE. 7583 05:23:00,594 --> 05:23:02,362 I'LL SHARE AN OVERVIEW IN WOMEN 7584 05:23:02,429 --> 05:23:06,734 LIVING WITH HIV. 7585 05:23:06,800 --> 05:23:08,669 NEXT SLIDE PLEASE. 7586 05:23:08,736 --> 05:23:12,973 SO, IT'S ESTIMATED THAT NEARLY 7587 05:23:13,040 --> 05:23:15,242 98% OF CERVICAL CANCERS ARE 7588 05:23:15,309 --> 05:23:17,444 CAUSED BY HPV, WHICH IS 7589 05:23:17,511 --> 05:23:19,513 TRANSMITTED SEXUALLY AS DR. 7590 05:23:19,580 --> 05:23:20,614 HUPPI MENTIONED. 7591 05:23:20,681 --> 05:23:24,218 AND AFFECTS CELLS OF THE SKIN, 7592 05:23:24,284 --> 05:23:27,187 GENITAL AREA, THROAT. 7593 05:23:27,254 --> 05:23:28,689 HPV INFECTION IS EXTREMELY 7594 05:23:28,756 --> 05:23:31,225 COMMON, AS YOU'VE JUST HEARD. 7595 05:23:31,291 --> 05:23:33,127 ABOUT 60% OF SEXUALLY ACTIVE 7596 05:23:33,193 --> 05:23:34,895 WOMEN WILL BECOME INFECTED WITH 7597 05:23:34,962 --> 05:23:37,798 HPV WITHIN FIVE YEARS OF 7598 05:23:37,865 --> 05:23:40,801 BECOMING SEXUALLY ACTIVE. 7599 05:23:40,868 --> 05:23:42,736 THERE ARE APPROXIMATELY 200 7600 05:23:42,803 --> 05:23:44,171 TYPES, CLASSIFIED AS HIGH RISK 7601 05:23:44,238 --> 05:23:49,877 OR LOW RISK. 7602 05:23:49,943 --> 05:23:52,880 THERE ARE THOUGHT TO BE 12 HIGH 7603 05:23:52,946 --> 05:23:56,250 RISK TIMES WHICH CAUSE CERVICAL 7604 05:23:56,316 --> 05:23:57,317 CANCER, 16 AND 18 RESPONSIBLE 7605 05:23:57,384 --> 05:24:01,955 FOR 2/3 OF CERVICAL CANCERS 7606 05:24:02,022 --> 05:24:03,157 GLOBALLY. 7607 05:24:03,223 --> 05:24:06,460 NEXT SLIDE PLEASE. 7608 05:24:06,527 --> 05:24:08,996 ALTHOUGH HPV INFECTION IS COMMON 7609 05:24:09,062 --> 05:24:09,863 AS MENTIONED PREVIOUSLY IT'S 7610 05:24:09,930 --> 05:24:11,598 OFTEN CLEARED BY THE IMMUNE 7611 05:24:11,665 --> 05:24:11,832 SYSTEM. 7612 05:24:11,899 --> 05:24:14,802 IF IT'S NOT WE ALSO HAVE SEVERAL 7613 05:24:14,868 --> 05:24:16,737 EFFECTIVE WAYS TO PREVENT HPV 7614 05:24:16,804 --> 05:24:19,039 AND CERVICAL CANCER. 7615 05:24:19,106 --> 05:24:20,908 FIRSTLY IN THE PINK BOX 7616 05:24:20,974 --> 05:24:23,110 INFECTION CAN BE PREVENTED 7617 05:24:23,177 --> 05:24:26,747 THROUGH VACCINATION. 7618 05:24:26,814 --> 05:24:27,581 AND SEVERAL VACCINES HAVE BEEN 7619 05:24:27,648 --> 05:24:30,584 ON THE MARKET FOR NEARLY 20 7620 05:24:30,651 --> 05:24:35,989 YEARS NOW, TARGETING 16 AND 18, 7621 05:24:36,056 --> 05:24:42,896 INCLUDING GARDASIL AND CERVARIX, 7622 05:24:42,963 --> 05:24:44,832 ALL SAFE, HIGHLY EFFECTIVE. 7623 05:24:44,898 --> 05:24:46,500 VACCINATION IS RECOMMENDED PRIOR 7624 05:24:46,567 --> 05:24:48,168 TO SEXUAL DEBUT BUT CATCH-UP 7625 05:24:48,235 --> 05:24:52,105 VACCINES CAN BE GIVEN UP TO AGE 7626 05:24:52,172 --> 05:24:52,472 46. 7627 05:24:52,539 --> 05:24:58,812 AND IF WE HAVE COVERAGE RATES 7628 05:24:58,879 --> 05:25:01,682 APPROACHING 90% SET BY W.H.O. 7629 05:25:01,748 --> 05:25:04,051 HALF OF ALL CERVICAL CANCERS 7630 05:25:04,117 --> 05:25:06,253 COULD BE PREVENTED. 7631 05:25:06,320 --> 05:25:07,921 SECONDLY IN THE GRAY BOX 7632 05:25:07,988 --> 05:25:10,524 CERVICAL CANCER CAN BE PREVENTED 7633 05:25:10,591 --> 05:25:11,725 BY SCREENING FOR PRE-CANCEROUS 7634 05:25:11,792 --> 05:25:21,368 CHANGES IN THER CERVIX OR 7635 05:25:21,435 --> 05:25:21,869 TREATING. 7636 05:25:21,935 --> 05:25:29,042 PAP SMEARS SCREEN, AND IN 7637 05:25:29,109 --> 05:25:29,676 WELL-ORGANIZE SYSTEMS SCREENING 7638 05:25:29,743 --> 05:25:31,979 AND ATTENDANT TREATMENT HAS 7639 05:25:32,045 --> 05:25:33,747 BROUGHT RATES OF CERVICAL CANCER 7640 05:25:33,814 --> 05:25:37,651 DOWN DRAMATICALLY. 7641 05:25:37,718 --> 05:25:39,319 NEXT SLIDE PLEASE. 7642 05:25:39,386 --> 05:25:40,721 UNFORTUNATELY, ACCESS TO 7643 05:25:40,787 --> 05:25:41,288 CERVICAL CANCER SCREENING 7644 05:25:41,355 --> 05:25:43,357 INITIALLY WITH PAP SMEARS AND 7645 05:25:43,423 --> 05:25:45,692 NOW HPV TESTS IS HIGHLY VARIABLE 7646 05:25:45,759 --> 05:25:47,561 AROUND THE WORLD. 7647 05:25:47,628 --> 05:25:49,429 AND DESPITE HAVING TWO EXCELLENT 7648 05:25:49,496 --> 05:25:53,800 WAYS TO PREVENT IT, NEARLY 7649 05:25:53,867 --> 05:25:58,405 700,000 WOMEN ARE STILL NEWLY 7650 05:25:58,472 --> 05:25:59,273 DIAGNOSED EACH YEAR. 7651 05:25:59,339 --> 05:26:01,341 THIS IS A DISEASE OF INEQUALITY, 7652 05:26:01,408 --> 05:26:03,343 AND THE HIGHEST BURDEN OF 7653 05:26:03,410 --> 05:26:06,179 CERVICAL CANCER CASES ARE SHOWN 7654 05:26:06,246 --> 05:26:08,849 IN DARK BLUE, BOLD ON POOREST 7655 05:26:08,916 --> 05:26:10,717 REGIONS, IN AFRICA, ASIA, PARTS 7656 05:26:10,784 --> 05:26:13,754 OF LATIN AMERICA. 7657 05:26:13,820 --> 05:26:14,855 THESE GEOGRAPHIC VARIATIONS IN 7658 05:26:14,922 --> 05:26:17,724 RATES ARE DUE TO DIFFERENCES IN 7659 05:26:17,791 --> 05:26:18,959 AVAILABILITY OF HPV VACCINATION 7660 05:26:19,026 --> 05:26:20,127 AND CERVICAL SCREENING AS WELL 7661 05:26:20,193 --> 05:26:23,363 AS DIFFERENCES IN THE PREVALENCE 7662 05:26:23,430 --> 05:26:27,935 OF HPV AND HIV. 7663 05:26:28,001 --> 05:26:30,404 NEXT SLIDE PLEASE. 7664 05:26:30,470 --> 05:26:31,738 SIMILARLY CERVICAL CANCER DEATHS 7665 05:26:31,805 --> 05:26:32,739 ARE HIGHEST IN AREAS OF THE 7666 05:26:32,806 --> 05:26:35,676 WORLD WHERE WOMEN DON'T HAVE 7667 05:26:35,742 --> 05:26:37,210 ACCESS TO SURGICAL CARE OR 7668 05:26:37,277 --> 05:26:42,549 RADIATION AS SHOWN IN DARK RED. 7669 05:26:42,616 --> 05:26:50,557 AND CANCER THAT'S PREVENT 7670 05:26:50,624 --> 05:26:51,758 ANDABLE CURABLE KILLS 400,000 7671 05:26:51,825 --> 05:26:52,960 EACH YEAR. 7672 05:26:53,026 --> 05:26:54,161 I'D LIKE TO SPEND REMAINING TIME 7673 05:26:54,227 --> 05:26:55,929 DRILLING DOWN ON SOME OF THE 7674 05:26:55,996 --> 05:26:57,497 ISSUES THAT MAKE CERVICAL CANCER 7675 05:26:57,564 --> 05:26:59,266 SO DEADLY FOR WOMEN WHO DON'T 7676 05:26:59,333 --> 05:27:00,600 HAVE ACCESS TO GOOD HEALTH CARE 7677 05:27:00,667 --> 05:27:04,538 WHETHER IN THE U.S. OR GLOBALLY. 7678 05:27:04,604 --> 05:27:06,506 LOOKING AT THE LEFT-HAND SIDE OF 7679 05:27:06,573 --> 05:27:09,343 THE SLIDE THERE'S A LOT OF MYTHS 7680 05:27:09,409 --> 05:27:10,644 AND MISCONCEPTIONS, MOST 7681 05:27:10,711 --> 05:27:12,412 COMMONLY IN OUR SETTING IN SOUTH 7682 05:27:12,479 --> 05:27:14,915 AFRICA I FOUND MANY TYPES OF 7683 05:27:14,982 --> 05:27:17,317 CANCER GET LUMPED TOGETHER, AS 7684 05:27:17,384 --> 05:27:18,785 EITHER HEREDITARY, 7685 05:27:18,852 --> 05:27:20,487 ENVIRONMENTAL, OR LIFESTYLE 7686 05:27:20,554 --> 05:27:20,821 DISEASES. 7687 05:27:20,887 --> 05:27:22,689 MOST OF OUR PATIENTS AND 7688 05:27:22,756 --> 05:27:24,558 PARTICIPANTS ARE SURPRISED TO 7689 05:27:24,624 --> 05:27:25,325 LEARN CERVICAL CANCER IS CAUSED 7690 05:27:25,392 --> 05:27:29,830 BY A VIRUS AND CAN BE PREVENTED 7691 05:27:29,896 --> 05:27:31,698 BY VACCINATING YOUNG PEOPLE. 7692 05:27:31,765 --> 05:27:33,633 WITH RARE EXCEPTIONS IN SOME 7693 05:27:33,700 --> 05:27:34,634 HIGH-INCOME COUNTRIES HEALTH 7694 05:27:34,701 --> 05:27:37,804 SYSTEMS HAVE DONE A TERRIBLE JOB 7695 05:27:37,871 --> 05:27:40,874 WITH HPV VACCINATION SO FAR. 7696 05:27:40,941 --> 05:27:48,782 60% OF YOUNG PEOPLE IN THE U.S. 7697 05:27:48,849 --> 05:27:51,985 HAVE BEEN VACCINATED, 20% OF 7698 05:27:52,052 --> 05:27:53,086 BOYS, NEARLY NO BOYS IN THE 7699 05:27:53,153 --> 05:27:55,155 HIGHEST REGIONS THE WORLD HAVE 7700 05:27:55,222 --> 05:27:59,893 BEEN VACCINATED WITH THE HPV 7701 05:27:59,960 --> 05:28:00,127 VACCINE. 7702 05:28:00,193 --> 05:28:01,928 IF YOU THINK CANCER IS 7703 05:28:01,995 --> 05:28:03,330 HEREDITARY THERE'S A FATALISM 7704 05:28:03,397 --> 05:28:04,197 AROUND SCREENING AND PREVENTION, 7705 05:28:04,264 --> 05:28:06,199 FIT RUNS IN YOUR FAMILY YOU 7706 05:28:06,266 --> 05:28:07,000 CAN'T ESCAPE IT. 7707 05:28:07,067 --> 05:28:08,702 TURNING TO THE RIGHT-HAND SIDE 7708 05:28:08,769 --> 05:28:10,570 OF THE SLIDE IF WE CONSIDER 7709 05:28:10,637 --> 05:28:12,639 SCREENING AND TREATMENT FOR 7710 05:28:12,706 --> 05:28:15,275 CERVICAL PRE-CANCER ACCESS TO 7711 05:28:15,342 --> 05:28:16,576 CARE IS HUGELY IMPORTANT. 7712 05:28:16,643 --> 05:28:17,544 THERE ARE SPECIAL CONSIDERATIONS 7713 05:28:17,611 --> 05:28:23,216 FOR WOMEN LIVING WITH HIV. 7714 05:28:23,283 --> 05:28:24,684 NEXT SLIDE PLEASE. 7715 05:28:24,751 --> 05:28:27,087 BECAUSE OF THE BIOLOGICAL AND 7716 05:28:27,154 --> 05:28:28,955 BEHAVIORAL OVERLAP BETWEEN HPV 7717 05:28:29,022 --> 05:28:31,358 AND HIV, WE SEE MUCH HIGHER 7718 05:28:31,425 --> 05:28:35,595 RATES OF HIV INFECTION AMONG 7719 05:28:35,662 --> 05:28:38,732 WOMEN LIVING WITH HIV. 7720 05:28:38,799 --> 05:28:41,334 SYSTEMS ARE LESS EFFICIENT, 7721 05:28:41,401 --> 05:28:41,935 RATES OF CERVICAL PRE-CANCER, 7722 05:28:42,002 --> 05:28:44,337 FOR EXAMPLE, IN WOMEN LIVING 7723 05:28:44,404 --> 05:28:45,872 WITH HIV ARE TWO TO THREE TIMES 7724 05:28:45,939 --> 05:28:49,242 HIGHER THAN WOMEN WHO DON'T HAVE 7725 05:28:49,309 --> 05:28:49,609 HIV. 7726 05:28:49,676 --> 05:28:53,080 PRE-CANCER IS HARDER TO TREAT 7727 05:28:53,146 --> 05:28:54,614 AND PROGRESSES MORE QUICKLY TO 7728 05:28:54,681 --> 05:28:58,819 INVASIVE CANCER. 7729 05:28:58,885 --> 05:29:00,087 NEXT SLIDE PLEASE. 7730 05:29:00,153 --> 05:29:04,991 OF COURSE EVERYONE IS FAMILIAR 7731 05:29:05,058 --> 05:29:06,960 WITH THIS SLIDE, A VISUAL 7732 05:29:07,027 --> 05:29:09,029 REMINDER THAT HIV IS MOST 7733 05:29:09,096 --> 05:29:11,531 PREVALENT, SAME REGIONS OF THE 7734 05:29:11,598 --> 05:29:13,400 WORLD, WHERE THE CERVICAL CANCER 7735 05:29:13,467 --> 05:29:17,237 BURDEN IS HIGHEST. 7736 05:29:17,304 --> 05:29:18,672 NEXT SLIDE PLEASE. 7737 05:29:18,738 --> 05:29:19,773 THE STORY OF CERVICAL CANCER IN 7738 05:29:19,840 --> 05:29:24,077 SOUTH AFRICA WHERE I LIVE AND 7739 05:29:24,144 --> 05:29:25,812 WORK REALLY ILLUSTRATES THE 7740 05:29:25,879 --> 05:29:26,113 INEQUALITY. 7741 05:29:26,179 --> 05:29:29,416 SOUTH AFRICA IS ONE OF JUST 37 7742 05:29:29,483 --> 05:29:30,817 COUNTRIES IN WHICH CERVICAL 7743 05:29:30,884 --> 05:29:32,486 CANCER REMAINS THE LEADING CAUSE 7744 05:29:32,552 --> 05:29:35,255 OF CANCER DEATH AMONG WOMEN. 7745 05:29:35,322 --> 05:29:38,625 SOUTH AFRICA ISN'T NECESSARILY 7746 05:29:38,692 --> 05:29:43,263 POOR. 7747 05:29:43,330 --> 05:29:45,899 SOCIOECONOMIC AND RACIAL 7748 05:29:45,966 --> 05:29:47,868 INEQUALITY TRACK TOGETHER WITH 7749 05:29:47,934 --> 05:29:50,303 RISK FOR BOTH HPV AND HIV IN 7750 05:29:50,370 --> 05:29:51,771 SOUTH AFRICA AND POOR WOMEN HAVE 7751 05:29:51,838 --> 05:29:53,707 THE FEWEST CHOICES WHEN IT COMES 7752 05:29:53,773 --> 05:29:56,042 TO THEIR HEALTH CARE, OFTEN 7753 05:29:56,109 --> 05:29:57,878 FACING YEAR-LONG WAITING TIMES 7754 05:29:57,944 --> 05:29:59,813 FOR CARE OR RECEIVING 7755 05:29:59,880 --> 05:30:00,480 SUBSTANDARD CARE. 7756 05:30:00,547 --> 05:30:03,683 THE RESULT IS THAT CERVICAL 7757 05:30:03,750 --> 05:30:06,186 CANCER RATES FOR BLACK SOUTH 7758 05:30:06,253 --> 05:30:08,054 AFRICANS ARE TWO TIMES HIGHER 7759 05:30:08,121 --> 05:30:11,591 THAN WHITE, AND TREATMENT 7760 05:30:11,658 --> 05:30:14,794 OUTCOMES ARE EQUALLY DISPARATE. 7761 05:30:14,861 --> 05:30:17,264 SKIP TWO SLIDES PLEASE. 7762 05:30:17,330 --> 05:30:18,598 THANK YOU. 7763 05:30:18,665 --> 05:30:20,066 RETURNING TO A MORE GENERAL 7764 05:30:20,133 --> 05:30:22,836 DISCUSSION OF SCREENING AND 7765 05:30:22,903 --> 05:30:24,471 PRE-CANCER TREATMENTS, CERVICAL 7766 05:30:24,538 --> 05:30:27,240 CANCER SCREENING APPROACHES AND 7767 05:30:27,307 --> 05:30:28,041 SCREENING RECOMMENDATIONS 7768 05:30:28,108 --> 05:30:30,410 PARTICULARLY FOR PAP SMEARS AND 7769 05:30:30,477 --> 05:30:33,880 HPV TESTS ARE SIMILAR REGARDLESS 7770 05:30:33,947 --> 05:30:38,118 OF A WOMAN'S HIV STATUS, SOME 7771 05:30:38,185 --> 05:30:40,954 DIFFERENCES IN THE FREQUENCY OF 7772 05:30:41,021 --> 05:30:43,590 SCREENING BUT OTHER THAN THAT 7773 05:30:43,657 --> 05:30:45,392 APPROACHES DON'T DIFFER MUCH. 7774 05:30:45,458 --> 05:30:47,761 WE STILL NEED ACTIVE RESEARCH 7775 05:30:47,827 --> 05:30:48,962 AND HOW TO IMPROVE PRE-CANCER 7776 05:30:49,029 --> 05:30:53,033 TREATMENT FOR WOMEN LIVING WITH 7777 05:30:53,099 --> 05:30:53,200 HIV. 7778 05:30:53,266 --> 05:30:56,670 AS I MENTIONED, IT IS QUITE A 7779 05:30:56,736 --> 05:30:59,940 LOT HARDER TO CURE PRE-CANCER IN 7780 05:31:00,006 --> 05:31:01,775 WOMEN LIVING WITH HIV, WITH THE 7781 05:31:01,841 --> 05:31:03,343 EXISTING SURGICAL TREATMENTS WE 7782 05:31:03,410 --> 05:31:05,779 HAVE WOMEN LIVING WITH HIV 7783 05:31:05,845 --> 05:31:07,514 EXPERIENCE PRE-CANCER TREATMENT 7784 05:31:07,581 --> 05:31:08,815 FAILURE OR RECURRENT CERVICAL 7785 05:31:08,882 --> 05:31:11,718 DISEASE IN UP TO 50% OF CASES. 7786 05:31:11,785 --> 05:31:13,954 THIS IS THOUGHT TO BE DUE TO 7787 05:31:14,020 --> 05:31:16,856 RESIDUAL DISEASE THAT'S NOT 7788 05:31:16,923 --> 05:31:18,391 COMPLETELY REMOVED DURING 7789 05:31:18,458 --> 05:31:20,894 SURGERY, TO REINFECTION WITH 7790 05:31:20,961 --> 05:31:23,330 ANOTHER HPV TYPE OR REACTIVATION 7791 05:31:23,396 --> 05:31:25,865 OF UNDERLYING HPV INFECTION IN 7792 05:31:25,932 --> 05:31:32,005 THE GENITAL TRACT. 7793 05:31:32,072 --> 05:31:35,408 NEXT SLIDE PLEASE. 7794 05:31:35,475 --> 05:31:36,576 SEVERAL GROUPS ARE WORKING ON 7795 05:31:36,643 --> 05:31:39,980 THE IMPORTANT TASK OF IMPROVING 7796 05:31:40,046 --> 05:31:41,181 CERVICAL CANCER, CERVICAL 7797 05:31:41,248 --> 05:31:41,781 PRE-CANCER TREATMENT IN WOMEN 7798 05:31:41,848 --> 05:31:43,250 LIVING WITH HIV. 7799 05:31:43,316 --> 05:31:46,319 ON THIS SLIDE I'VE INCLUDED TWO 7800 05:31:46,386 --> 05:31:48,922 EXAMPLES OF STUDIES MY TEAM IS 7801 05:31:48,989 --> 05:31:50,457 PARTICIPATING IN. 7802 05:31:50,523 --> 05:31:50,957 FIRST INCORPORATION HPV 7803 05:31:51,024 --> 05:31:52,892 VACCINATION AT THE TIME OF 7804 05:31:52,959 --> 05:31:54,261 TREATMENT FOR CERVICAL 7805 05:31:54,327 --> 05:31:54,761 PRE-CANCER. 7806 05:31:54,828 --> 05:31:57,397 AND IS AIMED AT PREVENTING NEW 7807 05:31:57,464 --> 05:32:00,567 HPV INFECTIONS, AND THE SECOND 7808 05:32:00,634 --> 05:32:02,702 USES A CHEMOTHERAPY CREAM IN 7809 05:32:02,769 --> 05:32:05,071 COMBINATION OF STANDARD SURGICAL 7810 05:32:05,138 --> 05:32:07,540 TREATMENT WITH PURPOSE OF 7811 05:32:07,607 --> 05:32:08,775 TREATING RESIDUAL DISEASE. 7812 05:32:08,842 --> 05:32:12,045 BOTH OF THESE STUDIES ARE FUNDED 7813 05:32:12,112 --> 05:32:13,813 BY THE NIH, WHICH WE'RE GRATEFUL 7814 05:32:13,880 --> 05:32:16,983 FOR AND LOOK FORWARD TO RESULTS 7815 05:32:17,050 --> 05:32:18,184 IN ABOUT 2026. 7816 05:32:18,251 --> 05:32:24,424 NEXT SLIDE PLEASE. 7817 05:32:24,491 --> 05:32:27,060 SO SUMMARY, THE 7818 05:32:27,127 --> 05:32:28,762 SOCIODEMOGRAPHIC, BEHAVIORAL AND 7819 05:32:28,828 --> 05:32:29,863 BIOLOGICAL OVERLAP BETWEEN HPV 7820 05:32:29,929 --> 05:32:35,302 AND HIV RESULTS IN A HIGH 7821 05:32:35,368 --> 05:32:35,568 BURDEN. 7822 05:32:35,635 --> 05:32:38,438 VACCINATION IS SAFE AND 7823 05:32:38,505 --> 05:32:39,973 EFFECTIVE IN INDIVIDUALS WITH 7824 05:32:40,040 --> 05:32:41,341 HIV AND SHOULD BE DOING MORE TO 7825 05:32:41,408 --> 05:32:43,777 SCALE UP VACCINATION FOR YOUNG 7826 05:32:43,843 --> 05:32:45,111 PEOPLE GLOBALLY. 7827 05:32:45,178 --> 05:32:47,914 WHEN COUPLED WITH TREATMENT FOR 7828 05:32:47,981 --> 05:32:48,948 PRE-CANCEROUS CELLS, SCREENING 7829 05:32:49,015 --> 05:32:56,690 WITH PAP SMEARS AND/OR HPV 7830 05:32:56,756 --> 05:32:57,924 PREVENT CANCER, WE SHOULD DO 7831 05:32:57,991 --> 05:32:59,759 MORE TO ACCESS SCREENING. 7832 05:32:59,826 --> 05:33:01,194 HOWEVER, ADDITIONAL RESEARCH IS 7833 05:33:01,261 --> 05:33:03,163 NEEDED TO DEVELOP MORE EFFECTIVE 7834 05:33:03,229 --> 05:33:04,798 PRE-CANCER TREATMENTS FOR WOMEN 7835 05:33:04,864 --> 05:33:05,699 LIVING WITH HIV. 7836 05:33:05,765 --> 05:33:09,202 OF COURSE IT GOES WITHOUT SAYING 7837 05:33:09,269 --> 05:33:10,270 THAT CERVICAL CANCER PREVENTION 7838 05:33:10,337 --> 05:33:12,872 SERVICES OUGHT TO BE INTEGRATED 7839 05:33:12,939 --> 05:33:14,641 INTO HIV CARE, AS A WAY TO 7840 05:33:14,708 --> 05:33:17,477 EXPAND ACCESS FOR WOMEN LIVING 7841 05:33:17,544 --> 05:33:18,244 WITH HIV. 7842 05:33:18,311 --> 05:33:21,448 I THINK THAT'S MY LAST SLIDE. 7843 05:33:21,514 --> 05:33:25,919 >> THANK YOU SO MUCH, DR. 7844 05:33:25,985 --> 05:33:26,720 CHIBWESHA. 7845 05:33:26,786 --> 05:33:27,821 PLEASE SUBMIT QUESTIONS, 7846 05:33:27,887 --> 05:33:29,956 COMMENTS, VIA THE "LIVE 7847 05:33:30,023 --> 05:33:31,157 FEEDBACK" OPTION BELOW THE 7848 05:33:31,224 --> 05:33:31,458 VIDEOCAST. 7849 05:33:31,524 --> 05:33:35,862 NOW WE'LL HEAR FROM DR. JOEL 7850 05:33:35,929 --> 05:33:37,063 PALEFSKY. 7851 05:33:37,130 --> 05:33:37,764 PLEASE GO AHEAD. 7852 05:33:37,831 --> 05:33:39,366 >> THANK YOU VERY MUCH FOR 7853 05:33:39,432 --> 05:33:42,202 INCLUDING ME IN THIS VERY 7854 05:33:42,268 --> 05:33:42,936 IMPORTANT WEBINAR. 7855 05:33:43,002 --> 05:33:45,939 I'M GOING TO TALK ABOUT THE 7856 05:33:46,005 --> 05:33:50,744 ANCHOR STUDY WHERE ANCHOR STANDS 7857 05:33:50,810 --> 05:33:52,712 FOR ANAL CANCER RESEARCH STUDY, 7858 05:33:52,779 --> 05:33:54,581 THE REASON FOR THIS PRESENTATION 7859 05:33:54,647 --> 05:33:57,784 AND THE WORK WAS NICELY OUTLINED 7860 05:33:57,851 --> 05:34:00,553 BY DR. HUPPI IN THE 7861 05:34:00,620 --> 05:34:01,521 INTRODUCTION, THAT ALTHOUGH 7862 05:34:01,588 --> 05:34:03,456 CERVICAL CANCER IS THE MOST 7863 05:34:03,523 --> 05:34:05,091 IMPORTANT CANCER CAUSED BY HPV, 7864 05:34:05,158 --> 05:34:08,027 THERE ARE SEVERAL OTHER CANCERS 7865 05:34:08,094 --> 05:34:10,764 THAT ARE CAUSED BY HPV THAT MAY 7866 05:34:10,830 --> 05:34:12,399 POTENTIALLY BE AMENABLE TO 7867 05:34:12,465 --> 05:34:13,633 PREVENTION AND THESE CANCERS 7868 05:34:13,700 --> 05:34:15,235 HAPPEN TO BE MORE COMMON IN THE 7869 05:34:15,301 --> 05:34:19,672 SETTING OF PEOPLE LIVING WITH 7870 05:34:19,739 --> 05:34:20,607 HIV THAN THOSE WITHOUT. 7871 05:34:20,673 --> 05:34:24,043 JUST A LITTLE WORD ABOUT THE 7872 05:34:24,110 --> 05:34:26,980 DIFFERENCE BETWEEN CERVICAL AND 7873 05:34:27,046 --> 05:34:29,416 ANAL CANCER, TWO DIFFERENT 7874 05:34:29,482 --> 05:34:31,017 ANATOMIC ORGANS, CERVICAL CANCER 7875 05:34:31,084 --> 05:34:33,420 IS THE MOST COMMON OF THE 7876 05:34:33,486 --> 05:34:34,187 HPV-ASSOCIATED CANCERS, AND YOU 7877 05:34:34,254 --> 05:34:36,923 CAN SEE IN THIS GRAPH ON THE 7878 05:34:36,990 --> 05:34:42,595 LEFT THAT THE PREVALENCE OF 7879 05:34:42,662 --> 05:34:44,030 CERVICAL CANCER IS LATE 40s, 7880 05:34:44,097 --> 05:34:46,833 EARLY 50s, STARTS TO DECLINE. 7881 05:34:46,900 --> 05:34:49,235 ANAL CANCER IS LESS COMMON IN 7882 05:34:49,302 --> 05:34:50,437 THE GENERAL POPULATION, BUT I 7883 05:34:50,503 --> 05:34:52,605 WILL SHOW YOU SOME DATA ABOUT 7884 05:34:52,672 --> 05:34:55,175 THE INCIDENCE OF THIS CANCER IN 7885 05:34:55,241 --> 05:34:56,443 PEOPLE LIVING WITH HIV. 7886 05:34:56,509 --> 05:34:58,478 THIS IS A CANCER THAT CAN AFFECT 7887 05:34:58,545 --> 05:35:00,780 ANYBODY, AND SO WE SEE IT IN 7888 05:35:00,847 --> 05:35:02,816 BOTH MEN AND WOMEN, AND HERE YOU 7889 05:35:02,882 --> 05:35:05,452 CAN SEE ON THIS SLIDE THAT 7890 05:35:05,518 --> 05:35:06,986 UNLIKE CERVICAL CANCER WHICH 7891 05:35:07,053 --> 05:35:10,890 PEAKED AT THAT EARLIER AGE, ANAL 7892 05:35:10,957 --> 05:35:12,091 CANCER CONTINUES TO INCREASE IN 7893 05:35:12,158 --> 05:35:13,860 INCIDENCE AS WOMEN GET OLDER 7894 05:35:13,927 --> 05:35:21,267 SHOWN IN BLUE GRAPH AND THEN IN 7895 05:35:21,334 --> 05:35:27,106 MEN ANAL CANCER INCREASES WITH 7896 05:35:27,173 --> 05:35:27,574 AGE, PLATEAUS OFF. 7897 05:35:27,640 --> 05:35:28,174 TWO IMPORTANT POINTS ON THIS, 7898 05:35:28,241 --> 05:35:29,242 ONE IS YOU'LL SEE HERE THAT 7899 05:35:29,309 --> 05:35:39,786 ANNAL CANCER IS MORE COMMON 7900 05:42:06,739 --> 05:42:10,877 THIS IS A GROUP OF PEOPLE WHO 7901 05:42:10,943 --> 05:42:13,946 RESEMBLED U.S. HIV POPULATION 7902 05:42:14,013 --> 05:42:16,449 DEMOGRAPHICS, AND TO IDENTIFY 7903 05:42:16,515 --> 05:42:21,754 THE 4400 OR SO PEOPLE RANDOMIZED 7904 05:42:21,821 --> 05:42:24,757 WE SCREENED 10,723 PEOPLE LIVING 7905 05:42:24,824 --> 05:42:27,260 WITH HIV, AND WHAT THIS SHOWS IS 7906 05:42:27,326 --> 05:42:28,928 THE EXTRAORDINARILY HIGH 7907 05:42:28,995 --> 05:42:34,533 PREVALENCE OF THESE 7908 05:42:34,600 --> 05:42:38,137 PRE-CANCEROUS LESIONS, 53 OF 7909 05:42:38,204 --> 05:42:41,641 MEN, 47% OF WOMEN, EARLIER 7910 05:42:41,707 --> 05:42:43,175 STUDIES HAVE SHOWN WOMEN WERE 7911 05:42:43,242 --> 05:42:44,710 SUBSTANTIALLY LOWER RATES THAN 7912 05:42:44,777 --> 05:42:47,113 AMONGST MEN, HERE THAT WASN'T 7913 05:42:47,179 --> 05:42:56,989 THE CASE, ALMOST AS MUCH HSIL 7914 05:42:57,056 --> 05:42:57,657 WOMEN AS MEN. 7915 05:42:57,723 --> 05:42:58,858 , TRANSGENDER HIGHEST RATES OF 7916 05:42:58,925 --> 05:42:59,425 ALL. 7917 05:42:59,492 --> 05:43:00,593 WHEN YOU SCREEN MORE THAN 10,000 7918 05:43:00,660 --> 05:43:05,298 YOU EXPECT TO FIND PREVALENT 7919 05:43:05,364 --> 05:43:11,604 CASES OF ANAL CANCER, WE DID, 17 7920 05:43:11,671 --> 05:43:12,672 INDIVIDUALS, 160 PER 100,000. 7921 05:43:12,738 --> 05:43:18,577 NEXT SLIDE. 7922 05:43:18,644 --> 05:43:23,716 THE MAIN RESULTS WERE SHOWN 7923 05:43:23,783 --> 05:43:25,584 AFTER DEMOGRAPHICS, MEDIAN AGE 7924 05:43:25,651 --> 05:43:28,754 OF 51 YEARS, AND THEY WERE 17 7925 05:43:28,821 --> 05:43:31,824 YEARS OUT ON AVERAGE, AFTER HIV 7926 05:43:31,891 --> 05:43:34,226 INFECTION. 7927 05:43:34,293 --> 05:43:36,762 WE FOLLOWED FOR 2 1/2 YEARS ON 7928 05:43:36,829 --> 05:43:38,965 AVERAGE, 17% OR SO OF THE 7929 05:43:39,031 --> 05:43:40,933 POPULATION WERE FEMALE. 7930 05:43:41,000 --> 05:43:45,504 AND 3.1% WERE IDENTIFIED AS 7931 05:43:45,571 --> 05:43:47,473 TRANSGENDER. 7932 05:43:47,540 --> 05:43:48,474 NEXT SLIDE PLEASE. 7933 05:43:48,541 --> 05:43:51,610 A THIRD OF THE POPULATION 7934 05:43:51,677 --> 05:43:54,480 NON-HISPANIC WHITE, 42% AFRICAN 7935 05:43:54,547 --> 05:44:01,954 AMERICAN, 15% WERE HISPANIC 7936 05:44:02,021 --> 05:44:05,024 NON-AFRICAN AMERICAN. 7937 05:44:05,091 --> 05:44:07,994 23% HETEROSEXUAL, 78.5% 7938 05:44:08,060 --> 05:44:18,537 HOMOSEXUAL, AND 8% REPORTED 7939 05:44:22,575 --> 05:44:28,047 INJECTION DRUG USE. 7940 05:44:28,114 --> 05:44:28,781 57% REDUCTION, STATISTICALLY 7941 05:44:28,848 --> 05:44:29,648 SIGNIFICANT. 7942 05:44:29,715 --> 05:44:40,259 YOU CAN SEE PROGRESSION RATES IN 7943 05:44:42,061 --> 05:44:45,231 HSIL TO CANCER, 173 IN THE 7944 05:44:45,297 --> 05:44:46,532 TREATMENT ARM, THE DELTA 7945 05:44:46,599 --> 05:44:52,972 RESULTED IN THE STATISTICAL 7946 05:44:53,039 --> 05:44:54,607 SIGNIFICANCE, WHILE WE CAN 7947 05:44:54,673 --> 05:44:57,143 PREVENT ANAL CANCER WE CAN DO 7948 05:44:57,209 --> 05:45:00,746 EVEN BETTER WITH BETTER 7949 05:45:00,813 --> 05:45:02,281 TREATMENT FOR ANAL HSIL GIVEN 7950 05:45:02,348 --> 05:45:05,985 HIGH RATES OF PROJECTION IN 7951 05:45:06,052 --> 05:45:06,385 TREATMENT ARM. 7952 05:45:06,452 --> 05:45:12,024 ALMOST ALL OF THEM WERE TREATED 7953 05:45:12,091 --> 05:45:13,426 WITH AN OFFICE-BASED TECHNIQUE, 7954 05:45:13,492 --> 05:45:16,762 A FORM OF ELECTRIC CAUTERY, AND 7955 05:45:16,829 --> 05:45:18,697 RELATIVELY STRAIGHTFORWARD, DONE 7956 05:45:18,764 --> 05:45:20,299 IN THE OFFICE, IN 10 TO 15 7957 05:45:20,366 --> 05:45:22,735 MINUTES, AND THE NEXT SLIDE 7958 05:45:22,802 --> 05:45:24,703 SHOWS YOU THAT THE ADVERSE EVENT 7959 05:45:24,770 --> 05:45:27,873 RATE WAS VERY, VERY LOW, AND 7960 05:45:27,940 --> 05:45:29,508 TREATMENT ARM DESPITE MANY 7961 05:45:29,575 --> 05:45:31,911 THOUSANDS OF PROCEDURES, WE HAD 7962 05:45:31,977 --> 05:45:33,913 ONLY 7 STUDY-RELATED SERIOUS 7963 05:45:33,979 --> 05:45:34,980 ADVERSE EVENTS, THAT CLEARED UP 7964 05:45:35,047 --> 05:45:37,950 OVER A WEEK TO TWO WEEKS, 7965 05:45:38,017 --> 05:45:40,019 PRIMARILY BLEEDING OTHER PAIN. 7966 05:45:40,086 --> 05:45:41,754 THIS IS A PROCEDURE THAT CAN BE 7967 05:45:41,821 --> 05:45:43,622 DONE EASILY IN THE OFFICE, AND 7968 05:45:43,689 --> 05:45:47,326 IS QUITE SAFE. 7969 05:45:47,393 --> 05:45:47,993 NEXT SLIDE. 7970 05:45:48,060 --> 05:45:53,132 WOMEN HAVE A HIGH PREVALENCE OF 7971 05:45:53,199 --> 05:45:57,770 ANAL HSIL, AT RISK OF ANAL IN 7972 05:45:57,837 --> 05:45:59,705 ADDITION TO CERVICAL CANCER. 7973 05:45:59,772 --> 05:46:02,741 WE CAN REDUCE THE RISK AMONGST 7974 05:46:02,808 --> 05:46:05,044 THOSE WITH ANAL HSIL AND SEVERAL 7975 05:46:05,111 --> 05:46:07,446 ENTITIES HAVE PUT OUT A 7976 05:46:07,513 --> 05:46:10,649 GUIDELINE THAT MAKES SCREEN FOR 7977 05:46:10,716 --> 05:46:13,052 AND TRAINING STANDARD OFCARE IN 7978 05:46:13,119 --> 05:46:15,254 THE UNITED STATES, FOR PEOPLE 7979 05:46:15,321 --> 05:46:16,322 LIVING WITH HIV. 7980 05:46:16,388 --> 05:46:19,291 AND FOR WOMEN LIVING WITH HIV 7981 05:46:19,358 --> 05:46:21,127 SPECIFICALLY, WE RECOMMEND 7982 05:46:21,193 --> 05:46:24,630 STARTING AT AGE 45 YEARS FOR THE 7983 05:46:24,697 --> 05:46:26,732 SCREENING THAT MAY LEAD TO 7984 05:46:26,799 --> 05:46:27,500 IDENTIFICATION OF LESIONS. 7985 05:46:27,566 --> 05:46:30,569 FIRST ENTITY THAT CAME OUT WITH 7986 05:46:30,636 --> 05:46:33,839 THESE GUIDELINES IS 7987 05:46:33,906 --> 05:46:34,940 INTERNATIONAL ANAL NEOPLASIA 7988 05:46:35,007 --> 05:46:36,308 SOCIETY, WE EXPECT CDC 7989 05:46:36,375 --> 05:46:37,243 GUIDELINES SOON. 7990 05:46:37,309 --> 05:46:38,544 NEXT SLIDE PLEASE. 7991 05:46:38,611 --> 05:46:43,149 WHAT DOES THAT SCREENING LOOK 7992 05:46:43,215 --> 05:46:43,449 LIKE? 7993 05:46:43,516 --> 05:46:45,851 IT WILL INCLUDE DIGITAL EXAM TO 7994 05:46:45,918 --> 05:46:47,953 FEEL FOR LESIONS THAT MAY BE 7995 05:46:48,020 --> 05:46:50,122 CANCEROUS AND A COMBINATION 7996 05:46:50,189 --> 05:46:53,859 USING SWAB OF EITHER CYTOLOGY 7997 05:46:53,926 --> 05:46:56,162 LIKE PAP SMEAR OR HPV TESTING OR 7998 05:46:56,228 --> 05:46:58,230 BOTH AGAIN STARTING AT AGE 45 7999 05:46:58,297 --> 05:47:00,566 YEARS, AND THEN CDC GUIDELINES 8000 05:47:00,633 --> 05:47:03,936 FOR THOSE SHOWN TO HAVE A BIOPSY 8001 05:47:04,003 --> 05:47:09,642 PROVEN HIGH GRADE LESION 8002 05:47:09,708 --> 05:47:10,509 RECOMMEND TARGETED ABLATION AS 8003 05:47:10,576 --> 05:47:11,443 FIRST LINE THERAPY. 8004 05:47:11,510 --> 05:47:18,651 WE HAVE A LOT OF WORK TO DO. 8005 05:47:18,717 --> 05:47:20,920 THIS IS STILL NEW. 8006 05:47:20,986 --> 05:47:22,221 WE'VE LEARNED WHATS THAT TAKEN 8007 05:47:22,288 --> 05:47:25,958 THOSE INVOLVED IN PREVENTION OF 8008 05:47:26,025 --> 05:47:27,026 CERVICAL CANCER MANY DECADES TO 8009 05:47:27,092 --> 05:47:27,693 FIGURE OUT. 8010 05:47:27,760 --> 05:47:30,196 WE'RE STILL YOUNG AT THIS. 8011 05:47:30,262 --> 05:47:35,167 WE NEED TO OPTIMIZE SCREENING 8012 05:47:35,234 --> 05:47:35,501 ALGORITHMS. 8013 05:47:35,568 --> 05:47:37,169 WE NEED TO IDENTIFY MARKERS, 8014 05:47:37,236 --> 05:47:39,271 HAVE MARKERS OF WHO IS LIKELY TO 8015 05:47:39,338 --> 05:47:40,539 PROGRESS, SO THAT IN THE FUTURE 8016 05:47:40,606 --> 05:47:44,376 PERHAPS WE DON'T HAVE TO TREAT 8017 05:47:44,443 --> 05:47:44,843 EVERYBODY. 8018 05:47:44,910 --> 05:47:47,213 WHO HAS A HIGH GRADE LESION. 8019 05:47:47,279 --> 05:47:48,847 WE NEED TO DETERMINE BEST 8020 05:47:48,914 --> 05:47:49,548 FOLLOW-UP METHODS AFTER 8021 05:47:49,615 --> 05:47:51,817 TREATMENT AND BECAUSE SO MANY 8022 05:47:51,884 --> 05:47:53,152 PEOPLE HAVE THESE PRE-CANCEROUS 8023 05:47:53,219 --> 05:47:54,220 LESIONS THAT MEANS MANY PEOPLE 8024 05:47:54,286 --> 05:47:57,356 ARE GOING TO NEED AN HRA AND 8025 05:47:57,423 --> 05:47:59,925 TREATMENT AND WE NEED TO ADDRESS 8026 05:47:59,992 --> 05:48:02,561 A HUGE GAP IN NEED AND NUMBER OF 8027 05:48:02,628 --> 05:48:05,197 PEOPLE CURRENTLY TRAINED TO DO 8028 05:48:05,264 --> 05:48:06,165 THIS TECHNIQUE WHICH TAKES QUITE 8029 05:48:06,232 --> 05:48:09,435 A BIT OF TIME AND DETERMINATION 8030 05:48:09,501 --> 05:48:10,970 TO ACQUIRE NECESSARY LEVEL OF 8031 05:48:11,036 --> 05:48:11,437 COMPETENCE. 8032 05:48:11,503 --> 05:48:14,740 SO WE NEED TO LEARN HOW TO TRAIN 8033 05:48:14,807 --> 05:48:16,041 MORE PEOPLE MORE QUICKLY. 8034 05:48:16,108 --> 05:48:18,777 BECAUSE I SHOWED THAT WE HAD 8035 05:48:18,844 --> 05:48:19,979 LEVELS OF PROGRESSION DESPITE 8036 05:48:20,045 --> 05:48:21,847 TREATMENT THAT WERE STILL TOO 8037 05:48:21,914 --> 05:48:25,784 HIGH WE NEED BETTER TREATMENT 8038 05:48:25,851 --> 05:48:28,420 METHODS FOR ANAL HSIL IN THE 8039 05:48:28,487 --> 05:48:28,654 FUTURE. 8040 05:48:28,721 --> 05:48:30,322 WITH THAT, AGAIN, THANK YOU VERY 8041 05:48:30,389 --> 05:48:31,290 MUCH FOR LISTENING. 8042 05:48:31,357 --> 05:48:32,324 AND LOOK FORWARD TO AN 8043 05:48:32,391 --> 05:48:40,766 INTERESTING DISCUSSION. 8044 05:48:43,636 --> 05:48:44,870 NEXT DR. ANNA COGHILL. 8045 05:48:44,937 --> 05:48:47,172 PLEASE GO AHEAD. 8046 05:48:47,239 --> 05:48:49,575 >> THANK YOU, REBECCA. 8047 05:48:49,642 --> 05:48:50,876 I'M AT MOFFITT CANCER CENTER. 8048 05:48:50,943 --> 05:48:59,418 YOU CAN GO TO THE NEXT SLIDE. 8049 05:48:59,485 --> 05:49:01,587 AND TODAY WE'LL FOCUS ON 8050 05:49:01,654 --> 05:49:04,857 ESSENTIAL TREATMENT DOES MEAN 8051 05:49:04,923 --> 05:49:07,493 PEOPLE WITH HIV ARE LIVING 8052 05:49:07,559 --> 05:49:08,394 LONGER, UNINTENDED CONSEQUENCE 8053 05:49:08,460 --> 05:49:10,129 THOSE INDIVIDUALS ARE DEVELOPING 8054 05:49:10,195 --> 05:49:12,197 DISEASES OF OLD AGE, CHRONIC 8055 05:49:12,264 --> 05:49:15,401 CONDITIONS LIKE CANCER MORE 8056 05:49:15,467 --> 05:49:15,701 FREQUENTLY. 8057 05:49:15,768 --> 05:49:17,269 WE'VE DONE RESEARCH TO 8058 05:49:17,336 --> 05:49:19,238 DEMONSTRATE PEOPLE WITH HIV DO 8059 05:49:19,305 --> 05:49:25,010 NOT ALWAYS RECEIVE APPROPRIATE 8060 05:49:25,077 --> 05:49:35,587 LEVELS OF TREATMENT, AND HAVE 8061 05:49:54,039 --> 05:49:55,941 OUTCOME DISPARITY. 8062 05:49:56,008 --> 05:50:00,713 THIS PROJECTS THROUGH 2030, 8063 05:50:00,779 --> 05:50:01,447 REPRESENTING DIFFERENT AGE 8064 05:50:01,513 --> 05:50:01,847 GROUPS. 8065 05:50:01,914 --> 05:50:03,849 YOU CAN SEE THE RED AND PURPLE 8066 05:50:03,916 --> 05:50:06,585 BARS ARE INCREASING OVER TIME. 8067 05:50:06,652 --> 05:50:11,724 THOSE BARS REPRESENT INDIVIDUALS 8068 05:50:11,790 --> 05:50:14,693 AGED 65+ IN RED, TO 64 IN 8069 05:50:14,760 --> 05:50:25,304 PURPLE, TAKE HOME MESSAGE LIFE 8070 05:50:27,306 --> 05:50:28,273 EXPECTANCY IS INCREASING. 8071 05:50:28,340 --> 05:50:29,341 THERE ARE CANCERS THAT 8072 05:50:29,408 --> 05:50:33,078 INDIVIDUALS WITH HIV DEVELOP 8073 05:50:33,145 --> 05:50:33,946 MORE FREQUENTLY, HPV-RELATED 8074 05:50:34,012 --> 05:50:35,347 CANCERS, HIV DOES NOT INCREASE 8075 05:50:35,414 --> 05:50:38,317 RISK OF EVERY CANCER TYPE. 8076 05:50:38,384 --> 05:50:39,785 MANY CANCERS NOT ASSOCIATED WITH 8077 05:50:39,852 --> 05:50:41,487 INFECTION DO NOT NECESSARILY 8078 05:50:41,553 --> 05:50:43,389 HAPPEN MORE FREQUENTLY. 8079 05:50:43,455 --> 05:50:44,890 HOWEVER, AS THE POPULATION WITH 8080 05:50:44,957 --> 05:50:48,427 HIV AGES AND THERE ARE MORE 8081 05:50:48,494 --> 05:50:49,628 INDIVIDUALS REACHING AGES WHERE 8082 05:50:49,695 --> 05:50:51,363 THOSE DISEASES LIKE BREAST 8083 05:50:51,430 --> 05:51:01,940 CANCER WOULD BE DIAGNOSED, THE 8084 05:51:02,474 --> 05:51:03,342 BURDEN INCREASED. 8085 05:51:03,409 --> 05:51:05,844 MOVING FORWARD, IN THE UNITED 8086 05:51:05,911 --> 05:51:07,713 STATES, YOU'LL SEE A RATHER 8087 05:51:07,780 --> 05:51:09,014 LARGE CHANGE EVEN OVER COURSES 8088 05:51:09,081 --> 05:51:11,650 OF TWO DECADES FROM THE BAR IN 8089 05:51:11,717 --> 05:51:14,486 2010 ON THE LEFT WHERE 8090 05:51:14,553 --> 05:51:15,654 NON-HODGKIN'S LYMPHOMA WAS MOST 8091 05:51:15,721 --> 05:51:16,822 COMMON CANCER DIAGNOSED IN THE 8092 05:51:16,889 --> 05:51:23,695 SETTING OF HIV IN THE U.S., TO 8093 05:51:23,762 --> 05:51:25,164 2030 PROJECTIONS, YOU STILL SEE 8094 05:51:25,230 --> 05:51:28,167 THE RED SECTION OF THE BAR ON 8095 05:51:28,233 --> 05:51:32,037 THE RIGHT, CANCERS OF AGING LIKE 8096 05:51:32,104 --> 05:51:33,772 PROSTATE, LUNG, LIVER CANCER ARE 8097 05:51:33,839 --> 05:51:35,574 GOING TO BECOME MORE COMMON, 8098 05:51:35,641 --> 05:51:36,375 CANCERS OF AGING. 8099 05:51:36,442 --> 05:51:38,143 AND YOU CAN SEE ALL THE 8100 05:51:38,210 --> 05:51:39,144 DIFFERENT CANCERS THAT ARE 8101 05:51:39,211 --> 05:51:49,721 PULLED OUT BY THEIR COLORS ON 8102 05:51:50,756 --> 05:51:57,062 THE RIGHT ANAL IN PURPLE, 8103 05:51:57,129 --> 05:51:58,831 OROPHARYNGEAL, HEAD AND NECK 8104 05:51:58,897 --> 05:52:00,999 SHOWING UP, LONGER LIFE 8105 05:52:01,066 --> 05:52:07,473 EXPECTANCY, INCREASING CANCER 8106 05:52:07,539 --> 05:52:07,806 BURDEN. 8107 05:52:07,873 --> 05:52:09,341 NEXT SLIDE. 8108 05:52:09,408 --> 05:52:10,676 WHY THAT'S IMPORTANT, WE'VE 8109 05:52:10,742 --> 05:52:12,644 DEMONSTRATED IN THE SETTING OF 8110 05:52:12,711 --> 05:52:16,248 HIV CANCER MORTALITY IS HIGHER. 8111 05:52:16,315 --> 05:52:19,418 SO, THESE DATA ARE FROM A 8112 05:52:19,485 --> 05:52:21,186 ARTICLE PUBLISHED WHEN I WAS AT 8113 05:52:21,253 --> 05:52:23,455 NCI A FEW YEARS AGO, THE GRAPH 8114 05:52:23,522 --> 05:52:27,192 ON THE RIGHT WE LOOKED AT THE 8115 05:52:27,259 --> 05:52:28,527 HIV/AIDS CANCER MATCH STUDY, 8116 05:52:28,594 --> 05:52:31,697 OVER 6,000 CANCER PATIENTS WITH 8117 05:52:31,763 --> 05:52:35,000 HIV, AND WE COMPARED MORTALITY 8118 05:52:35,067 --> 05:52:36,969 RATES, ON THE Y-AXIS, TO THE 8119 05:52:37,035 --> 05:52:38,704 MORTALITY RATE IN CANCER 8120 05:52:38,770 --> 05:52:39,805 PATIENTS WITHOUT HIV. 8121 05:52:39,872 --> 05:52:42,107 YOU CAN SEE ALONG THE BOTTOM 8122 05:52:42,174 --> 05:52:43,742 THERE'S EACH DIFFERENT CANCER 8123 05:52:43,809 --> 05:52:45,377 TYPE LISTED OUT, WITH TWO BARS, 8124 05:52:45,444 --> 05:52:47,579 SO THE BAR ON THE LEFT ARE 8125 05:52:47,646 --> 05:52:50,415 PATIENTS WITH, BAR ON THE RIGHT 8126 05:52:50,482 --> 05:52:51,617 PATIENTS WITHOUT HIV. 8127 05:52:51,683 --> 05:52:53,485 TAKE HOME MESSAGE, THE BAR ON 8128 05:52:53,552 --> 05:52:55,220 THE LEFT IS HIGHER, MORTALITY 8129 05:52:55,287 --> 05:52:57,623 RATE IS ALWAYS HIGHER IN CANCER 8130 05:52:57,689 --> 05:52:59,591 PATIENTS WITH HIV. 8131 05:52:59,658 --> 05:53:01,026 BUT EVEN MORE IMPORTANTLY, THE 8132 05:53:01,093 --> 05:53:03,529 BLUE SECTION OF THAT BAR WHICH 8133 05:53:03,595 --> 05:53:05,130 REPRESENTS MORTALITY DUE TO 8134 05:53:05,197 --> 05:53:06,064 CANCER IS ALSO HIGHER. 8135 05:53:06,131 --> 05:53:09,234 IF YOU GO TO THE TABLE ON THE 8136 05:53:09,301 --> 05:53:12,337 LEFT, THIS IS ILLUSTRATED, WE'LL 8137 05:53:12,404 --> 05:53:14,373 USE BREAST CANCER, THIRD ROW 8138 05:53:14,439 --> 05:53:19,645 HERE, THAT HAZARD RATIO OF 2.61, 8139 05:53:19,711 --> 05:53:21,046 THAT CAN BE INTERPRETED AS A 8140 05:53:21,113 --> 05:53:23,148 WOMAN WITH BREAST CANCER 8141 05:53:23,215 --> 05:53:24,349 PRESENTING BUT HAS UNDERLYING 8142 05:53:24,416 --> 05:53:26,451 HIV INFECTION EVEN IF SHE HAS 8143 05:53:26,518 --> 05:53:27,986 THE SAME STAGE DISEASE, SAME 8144 05:53:28,053 --> 05:53:28,820 RACE, SAME AGE FROM THE SAME 8145 05:53:28,887 --> 05:53:31,557 AREA OF THE UNITED STATES, SHE 8146 05:53:31,623 --> 05:53:34,092 STILL IS 2.6 TIMES MORE LIKELY 8147 05:53:34,159 --> 05:53:38,830 TO DIE AFTER BREAST CANCER 8148 05:53:38,897 --> 05:53:39,898 DIAGNOSIS OF BREAST CANCER, NOT 8149 05:53:39,965 --> 05:53:41,767 JUST OVERALL. 8150 05:53:41,833 --> 05:53:45,938 WE SEE ELEVATED CANCER-SPECIFIC 8151 05:53:46,004 --> 05:53:47,773 MORTALITY. 8152 05:53:47,839 --> 05:53:50,742 THAT'S NOT LIMITED TO THE UNITED 8153 05:53:50,809 --> 05:53:52,611 STATES, EXAMPLE FROM BRAZIL, 8154 05:53:52,678 --> 05:53:55,113 HPV-RELATED CANCER THE OTHER 8155 05:53:55,180 --> 05:53:56,515 SPEAKERS MENTIONED, AND THIS WAS 8156 05:53:56,582 --> 05:53:58,383 A COLLABORATION WITH THE 8157 05:53:58,450 --> 05:53:59,051 BRAZILIAN NATIONAL CANCER 8158 05:53:59,117 --> 05:54:00,819 INSTITUTE. 8159 05:54:00,886 --> 05:54:02,754 WE COMPARED RATES OF RELAPSE IN 8160 05:54:02,821 --> 05:54:04,523 CERVICAL CANCER PATIENTS WITH 8161 05:54:04,590 --> 05:54:06,391 AND WITHOUT HIV, ALL TREATED IN 8162 05:54:06,458 --> 05:54:08,460 THE SAME HEALTH SYSTEM, HAD THE 8163 05:54:08,527 --> 05:54:10,329 SAME STAGE OF DISEASE, AND THESE 8164 05:54:10,395 --> 05:54:12,531 WOMEN WERE WOMEN WHO HAD 8165 05:54:12,598 --> 05:54:13,198 RESPONDED TO TREATMENT 8166 05:54:13,265 --> 05:54:16,034 INITIALLY, BUT ON THE GRAPH YOU 8167 05:54:16,101 --> 05:54:17,936 CAN SEE DURING FOLLOW-UP AFTER 8168 05:54:18,003 --> 05:54:18,770 THEIR TREATMENT HAS BEEN 8169 05:54:18,837 --> 05:54:20,939 COMPLETED YOU SEE THE TWO BARS 8170 05:54:21,006 --> 05:54:22,708 DIVERGING AND THERE WAS A HIGHER 8171 05:54:22,774 --> 05:54:25,210 RATE OF RELAPSE FOR WOMEN WITH 8172 05:54:25,277 --> 05:54:25,444 HIV. 8173 05:54:25,510 --> 05:54:28,046 THE WOMEN WITH HIV WERE ALMOST 8174 05:54:28,113 --> 05:54:29,348 FOUR-FOLD MORE LIKELY TO RELAPSE 8175 05:54:29,414 --> 05:54:31,450 AFTER THEY HAD INITIALLY 8176 05:54:31,516 --> 05:54:31,883 RESPONDED. 8177 05:54:31,950 --> 05:54:39,091 SO, AGAIN, MORE EVIDENCE OF AN 8178 05:54:39,157 --> 05:54:42,928 OUTCOME DISPARITY. 8179 05:54:42,995 --> 05:54:44,062 ONE REASON, WE HYPOTHESIZED 8180 05:54:44,129 --> 05:54:52,804 DIFFERENCES IN DISPARITIES AND 8181 05:54:52,871 --> 05:54:53,338 TREATMENT. 8182 05:54:53,405 --> 05:54:54,873 THIS IS THE SAME POPULATION AS 8183 05:54:54,940 --> 05:54:56,742 THE FIRST MORTALITY SLIDE I 8184 05:54:56,808 --> 05:54:59,011 SHOWED WITH DIFFERENT BARS. 8185 05:54:59,077 --> 05:55:00,545 SO, SAME POPULATION, SAME YEARS, 8186 05:55:00,612 --> 05:55:02,414 AND THE QUESTION HERE WAS ARE 8187 05:55:02,481 --> 05:55:04,583 PATIENTS WITH HIV MORE LIKELY TO 8188 05:55:04,650 --> 05:55:07,552 NOT GET ANY CANCER TREATMENT, 8189 05:55:07,619 --> 05:55:10,489 NOT EVEN GUIDELINE CONCORDANT, 8190 05:55:10,555 --> 05:55:12,357 JUST ANYTHING. 8191 05:55:12,424 --> 05:55:15,661 ODDS RATIOS ACROSS THE BOARD WE 8192 05:55:15,727 --> 05:55:17,729 DO SEE, FOR EXAMPLE, LUNG 8193 05:55:17,796 --> 05:55:20,465 CANCER, PATIENTS WITH HIV WERE 8194 05:55:20,532 --> 05:55:21,933 MORE THAN TWICE AS LIKELY TO 8195 05:55:22,000 --> 05:55:28,573 HAVE NOT RECEIVED TREATMENT. 8196 05:55:28,640 --> 05:55:29,608 COLORECTAL, PROSTATE, LYMPHOMA, 8197 05:55:29,675 --> 05:55:30,976 NOT RECEIVING TREATMENT AS 8198 05:55:31,043 --> 05:55:31,376 OFTEN. 8199 05:55:31,443 --> 05:55:33,045 NEXT SLIDE. 8200 05:55:33,111 --> 05:55:35,447 AND WE'VE ALSO LOOKED AT THIS 8201 05:55:35,514 --> 05:55:37,416 MORE RECENTLY WITH JESSICA ISLAM 8202 05:55:37,482 --> 05:55:39,184 AND NATIONAL CANCER DATABASE 8203 05:55:39,251 --> 05:55:41,586 USING MORE RECENT YEARS, SO 8204 05:55:41,653 --> 05:55:44,022 THROUGH 2018, WE HAD OVER 50,000 8205 05:55:44,089 --> 05:55:45,891 PATIENTS WITH HIV IN THE STUDY 8206 05:55:45,957 --> 05:55:47,859 AND WE WERE ASKING THE QUESTION 8207 05:55:47,926 --> 05:55:49,695 ARE WE STILL SEEING DIFFERENCES 8208 05:55:49,761 --> 05:55:51,897 OR DISPARITIES IN THE WAY CANCER 8209 05:55:51,963 --> 05:55:55,934 TREATMENT IS BEING APPLIED TO 8210 05:55:56,001 --> 05:55:58,036 PATIENTS WITH HIV, NOT JUST ANY 8211 05:55:58,103 --> 05:56:01,306 TREATMENT BUT APPROPRIATE 8212 05:56:01,373 --> 05:56:01,707 TREATMENT. 8213 05:56:01,773 --> 05:56:02,741 THERE'S CURATIVE TREATMENT, IF A 8214 05:56:02,808 --> 05:56:04,810 PATIENT IS DIAGNOSED WITH STAGE 8215 05:56:04,876 --> 05:56:06,378 1 TO 3 DISEASE, THE TREATMENT 8216 05:56:06,445 --> 05:56:08,180 PLAN WILL COME TOGETHER AND IT 8217 05:56:08,246 --> 05:56:09,514 HAS CURATIVE INTENT. 8218 05:56:09,581 --> 05:56:11,149 INTENT IS TO COMPLETELY 8219 05:56:11,216 --> 05:56:13,585 ERADICATE THE CANCER. 8220 05:56:13,652 --> 05:56:14,519 THERE'S ALSO PALLIATIVE 8221 05:56:14,586 --> 05:56:15,821 TREATMENT, OFTEN GIVEN IN THE 8222 05:56:15,887 --> 05:56:17,389 SETTING OF STAGE 4 DISEASE, 8223 05:56:17,456 --> 05:56:19,357 WHERE THE THOUGHT IS THAT CANCER 8224 05:56:19,424 --> 05:56:21,259 PROBABLY CANNOT BE CURED OR 8225 05:56:21,326 --> 05:56:24,096 ERADICATED SO TREATMENT IS GIVEN 8226 05:56:24,162 --> 05:56:26,398 TO MAINTAIN FOR SYMPTOM 8227 05:56:26,465 --> 05:56:28,400 MANAGEMENT, NOT ESSENTIALLY TO 8228 05:56:28,467 --> 05:56:29,568 CURE DISEASE. 8229 05:56:29,634 --> 05:56:32,971 WE LOOKED AT STAGE 1 TO 3 CANCER 8230 05:56:33,038 --> 05:56:34,606 PATIENTS AND COMPARED THOSE WITH 8231 05:56:34,673 --> 05:56:37,142 VERSUS WITHOUT HIV, TO SEE IF 8232 05:56:37,209 --> 05:56:39,678 THEY WERE RECEIVING CURATIVE OR 8233 05:56:39,745 --> 05:56:40,412 PALLIATIVE TREATMENT. 8234 05:56:40,479 --> 05:56:42,414 WE FOUND EVEN THOUGH THEY SHOULD 8235 05:56:42,481 --> 05:56:43,348 BE RECEIVING CURATIVE TREATMENT, 8236 05:56:43,415 --> 05:56:45,217 THEY WERE ONLY HALF AS LIKELY TO 8237 05:56:45,283 --> 05:56:48,320 IF THEY HAD HIV COMPARED TO THE 8238 05:56:48,386 --> 05:56:49,187 HIV UNINFECTED PATIENTS. 8239 05:56:49,254 --> 05:56:51,156 SO THEY WERE MORE THAN TWICE AS 8240 05:56:51,223 --> 05:56:52,791 LIKELY TO BE GIVEN, YEAH, SOME 8241 05:56:52,858 --> 05:56:54,593 CANCER TREATMENT BUT MAYBE NOT 8242 05:56:54,659 --> 05:56:55,894 THE APPROPRIATE CANCER 8243 05:56:55,961 --> 05:56:56,261 TREATMENT. 8244 05:56:56,328 --> 05:56:57,863 SO, AGAIN, WE SEE OUTCOMEDIES 8245 05:56:57,929 --> 05:57:06,605 PARTIES AND WE ALSO SEE 8246 05:57:06,671 --> 05:57:17,115 TREATMENT O SEE TREATMENT 8247 05:57:17,449 --> 05:57:20,485 DISPARITIES, AND MOVING FORWARD 8248 05:57:20,552 --> 05:57:21,686 PATIENTS DO REPORT DIFFERENT 8249 05:57:21,753 --> 05:57:22,554 SYMPTOMS DURING TREATMENT. 8250 05:57:22,621 --> 05:57:29,361 DATA FROM A MOFFITT DATABASE, 8251 05:57:29,427 --> 05:57:32,230 PATIENTS RATE A SCALE 0-10 8252 05:57:32,297 --> 05:57:33,198 SYMPTOMS DURING CANCER 8253 05:57:33,265 --> 05:57:33,498 TREATMENT. 8254 05:57:33,565 --> 05:57:44,009 AND WE LINK THAT WITH HIV 8255 05:57:49,614 --> 05:57:49,881 DATABASE. 8256 05:57:49,948 --> 05:57:51,216 SHIFTING TO THE RIGHT FOR 8257 05:57:51,283 --> 05:57:52,651 PATIENTS WITH HIV, SHIFT TO 8258 05:57:52,717 --> 05:57:53,418 HIGHER SCORES. 8259 05:57:53,485 --> 05:57:56,254 I'VE PULLED OUT EXAMPLE HERE OF 8260 05:57:56,321 --> 05:57:56,688 PAIN. 8261 05:57:56,755 --> 05:57:58,323 SO, THESE ARE SIGNIFICANT 8262 05:57:58,390 --> 05:57:59,758 DIFFERENCES, THESE ARE PATIENTS 8263 05:57:59,825 --> 05:58:01,493 WITH THE SAME DISEASE, TREATED 8264 05:58:01,560 --> 05:58:03,562 THE SAME CANCER CENTER, DURING 8265 05:58:03,628 --> 05:58:05,463 THE SAME YEARS, BUT EXPERIENCE 8266 05:58:05,530 --> 05:58:07,866 WITH CANCER TREATMENT IS MORE 8267 05:58:07,933 --> 05:58:10,268 SEVERE SYMPTOM SET, MORE SEVERE 8268 05:58:10,335 --> 05:58:11,903 PAIN, UNFORTUNATELY AS THE GRAPH 8269 05:58:11,970 --> 05:58:15,073 ON THE RIGHT SHOWS, THESE 8270 05:58:15,140 --> 05:58:16,508 SYMPTOMS ARE RELATED TO -- 8271 05:58:16,575 --> 05:58:18,543 HIGHER IN PATIENTS WHO ARE 8272 05:58:18,610 --> 05:58:19,778 DECEASED DURING THEIR FOLLOW-UP. 8273 05:58:19,845 --> 05:58:22,848 SO AS WE THINK ABOUT ADDRESSING 8274 05:58:22,914 --> 05:58:24,382 TREATMENT DISPARITIES TO IMPROVE 8275 05:58:24,449 --> 05:58:26,017 OUTCOMES, WE DO NEED TO BE 8276 05:58:26,084 --> 05:58:28,987 COGNIZANT OF THE FACT THAT 8277 05:58:29,054 --> 05:58:30,956 PATIENTS DO APPEAR TO EXPERIENCE 8278 05:58:31,022 --> 05:58:32,057 CANCER TREATMENT DIFFERENTLY AND 8279 05:58:32,123 --> 05:58:33,925 THAT NEEDS TO BE SOMETHING THAT 8280 05:58:33,992 --> 05:58:37,329 THE ONCOLOGIST IS AWARE OF. 8281 05:58:37,395 --> 05:58:37,896 NEXT SLIDE. 8282 05:58:37,963 --> 05:58:39,731 LASTLY, JUST AS A BASIC FIRST 8283 05:58:39,798 --> 05:58:42,767 STEP, WE NEED TO MAKE SURE ALL 8284 05:58:42,834 --> 05:58:44,469 ONCOLOGISTS ARE AWARE OF PATIENT 8285 05:58:44,536 --> 05:58:44,903 HIV STATUS. 8286 05:58:44,970 --> 05:58:46,872 IN THE UNITED STATES HIV CARE 8287 05:58:46,938 --> 05:58:50,709 AND CANCER CARE ARE SILOED, 8288 05:58:50,775 --> 05:58:53,879 THESE DATA ARE FROM MOFFITT. 8289 05:58:53,945 --> 05:58:56,514 WE HAVE OUR HIV DATABASE, WE 8290 05:58:56,581 --> 05:59:00,085 KNOW WHO HAS HIV, AND SETTING, 8291 05:59:00,151 --> 05:59:01,453 THERE'S A PATIENT INTAKE 8292 05:59:01,519 --> 05:59:04,756 QUESTIONNAIRE ADMINISTERED SO WE 8293 05:59:04,823 --> 05:59:06,057 LOOKED AT THE SURVEY THAT DOES 8294 05:59:06,124 --> 05:59:08,093 HAVE A QUESTION ON HIV STATUS TO 8295 05:59:08,159 --> 05:59:09,794 SEE IF THIS WOULD BE SOMETHING 8296 05:59:09,861 --> 05:59:13,531 THAT'S ACTUALLY FILLED OUT AND 8297 05:59:13,598 --> 05:59:14,199 ANSWERED DURING THE INTAKE VISIT 8298 05:59:14,266 --> 05:59:15,600 SO THAT WHILE THE TREATMENT PLAN 8299 05:59:15,667 --> 05:59:17,802 IS BEING MADE THE ONCOLOGIST IS 8300 05:59:17,869 --> 05:59:18,670 AWARE OF THEIR STATUS, MAYBE 8301 05:59:18,737 --> 05:59:20,639 BEFORE THE RECORDS ARE 8302 05:59:20,705 --> 05:59:21,973 TRANSFERRED OVER, FROM THEIR 8303 05:59:22,040 --> 05:59:22,941 INFECTIOUS DISEASE DOCTOR, AND 8304 05:59:23,008 --> 05:59:30,715 WHAT YOU CAN SEE HERE, HEIGHT OF 8305 05:59:30,782 --> 05:59:33,018 THE BAR REPRESENTS CANCER 8306 05:59:33,084 --> 05:59:36,087 BURDEN, AND HIV STATUS WAS ON 8307 05:59:36,154 --> 05:59:41,059 THE INTAKE QUESTIONNAIRE, LESS 8308 05:59:41,126 --> 05:59:42,794 THAN A THIRD ARE ANSWERING THIS 8309 05:59:42,861 --> 05:59:44,596 QUESTION, IT'S BEING FILLED OUT, 8310 05:59:44,663 --> 05:59:45,997 OFTEN MISSING, SO THAT'S A REAL 8311 05:59:46,064 --> 05:59:48,867 FIRST STEP TO MAKE SURE THAT 8312 05:59:48,934 --> 05:59:53,405 STATUS IS KNOWN, HIV TESTING IS 8313 05:59:53,471 --> 05:59:55,874 NOT UNIFORMLY DONE IN THE UNITED 8314 05:59:55,941 --> 06:00:00,512 STATES, THAT'S A FIRST STEP TO 8315 06:00:00,578 --> 06:00:02,314 ADDRESS OUTCOMEDIES PARTIES. 8316 06:00:02,380 --> 06:00:06,051 KEY MESSAGES, CANCER IS NOW 8317 06:00:06,117 --> 06:00:10,088 LEADING CAUSE OF DEATH IN 8318 06:00:10,155 --> 06:00:11,957 PATIENTS WITH HIV, PARTICULARLY 8319 06:00:12,023 --> 06:00:14,159 RELATED TO AGING, INCREASING 8320 06:00:14,225 --> 06:00:15,660 PATIENTS WITH HIV DO EXPERIENCE 8321 06:00:15,727 --> 06:00:20,065 POOR OUTCOMES, RELAPSE AND 8322 06:00:20,131 --> 06:00:20,432 SURVIVAL. 8323 06:00:20,498 --> 06:00:21,499 DEMONSTRATED INEQUITIES AND 8324 06:00:21,566 --> 06:00:26,838 RECEIPT OF CANCER CARE AS WELL 8325 06:00:26,905 --> 06:00:28,473 AS PATIENT-REPORTED SYMPTOMS, 8326 06:00:28,540 --> 06:00:29,708 COORDINATING HIV AND CARE IS AN 8327 06:00:29,774 --> 06:00:40,318 IMPORTANT FIRST STEP TO ADDRESS 8328 06:00:42,854 --> 06:00:45,090 THESE DISPARITIES. 8329 06:00:45,156 --> 06:00:47,192 >> THANK YOU. 8330 06:00:47,258 --> 06:00:48,526 PLEASE SUBMIT QUESTIONS AND 8331 06:00:48,593 --> 06:00:53,031 COMMENTS VIA THE "LIVE FEEDBACK" 8332 06:00:53,098 --> 06:00:55,467 BOX. 8333 06:00:55,533 --> 06:00:56,401 NEXT DR. KIMBERLY LEVINSON. 8334 06:00:56,468 --> 06:00:57,736 >> I WANT TO THANK THE 8335 06:00:57,802 --> 06:00:59,170 ORGANIZING COMMITTEE FOR THE 8336 06:00:59,237 --> 06:01:07,912 OPPORTUNITY TO BE WITH YOU TODAY 8337 06:01:07,979 --> 06:01:09,881 AND TALK ABOUT A TOPIC I FEEL 8338 06:01:09,948 --> 06:01:10,749 PASSIONATE ABOUT. 8339 06:01:10,815 --> 06:01:19,791 I'M GOING TO ECHO WHAT SOME 8340 06:01:19,858 --> 06:01:22,460 OTHER SPEAKERS TALKED ABOUT. 8341 06:01:22,527 --> 06:01:24,662 WOMEN WITH HIV ARE AT INCREASED 8342 06:01:24,729 --> 06:01:25,864 RISK FOR CERVICAL CANCER AND 8343 06:01:25,930 --> 06:01:27,632 OTHER DISEASES THAT ARE RELATED 8344 06:01:27,699 --> 06:01:31,970 TO THE HUMAN PAPILLOMAVIRUS OR 8345 06:01:32,037 --> 06:01:32,404 HPV. 8346 06:01:32,470 --> 06:01:34,739 CERVICAL CANCER IS MOST COMMON 8347 06:01:34,806 --> 06:01:37,942 IN WOMEN LIVING IN HIV, BURDEN 8348 06:01:38,009 --> 06:01:39,144 IN LOW- AND MIDDLE-INCOME 8349 06:01:39,210 --> 06:01:41,813 COUNTRIES, PRIMARILY IN AFRICA. 8350 06:01:41,880 --> 06:01:44,449 WITH REGARD TO OTHER GYNECOLOGIC 8351 06:01:44,516 --> 06:01:52,590 CAN SERIES INCLUDING VULVAR AND 8352 06:01:52,657 --> 06:01:53,758 VAGINAL THERE'S MINIMAL 8353 06:01:53,825 --> 06:01:54,192 RESEARCH. 8354 06:01:54,259 --> 06:01:57,128 FOR THOSE CANCERS NOT RELATED TO 8355 06:01:57,195 --> 06:01:58,463 HPV SPECIFICALLY, IT IS 8356 06:01:58,530 --> 06:02:03,735 IMPORTANT TO RECOGNIZE AS OTHERS 8357 06:02:03,802 --> 06:02:05,703 HAVE DISCUSSED THAT WOMEN WITH 8358 06:02:05,770 --> 06:02:07,772 HIV ARE LIVING LONGER PUTTING 8359 06:02:07,839 --> 06:02:12,143 THEM AT RISK FOR OVARIAN AND 8360 06:02:12,210 --> 06:02:13,244 ENDOMETRIAL CANCERS, FURTHER 8361 06:02:13,311 --> 06:02:14,245 RESEARCH NEEDED IN THESE AREAS 8362 06:02:14,312 --> 06:02:15,213 AS WELL. 8363 06:02:15,280 --> 06:02:19,384 IN WOMEN LIVING WITH HIV DUE TO 8364 06:02:19,451 --> 06:02:20,518 ALTERED CELL MEDIATED IMMUNITY, 8365 06:02:20,585 --> 06:02:22,987 HPV IS MORE LIKELY TO PERSIST IN 8366 06:02:23,054 --> 06:02:24,756 INFECTIONS THAT PERSIST ARE MORE 8367 06:02:24,823 --> 06:02:26,724 LIKELY TO PROGRESS TO 8368 06:02:26,791 --> 06:02:27,792 HPV-RELATED CANCERS. 8369 06:02:27,859 --> 06:02:31,629 WE KNOW THAT THE VAST MAJORITY, 8370 06:02:31,696 --> 06:02:33,164 APPROXIMATELY 98% OF CERVICAL 8371 06:02:33,231 --> 06:02:42,907 CANCERS ARE RELATED TO HPV, AN 8372 06:02:42,974 --> 06:02:45,276 AIDS DEFINING ILLNESS. 8373 06:02:45,343 --> 06:02:47,645 VULVAR IS ALSO RELATED. 8374 06:02:47,712 --> 06:02:54,319 WE HAVE THE NON-HPV RELATED 8375 06:02:54,385 --> 06:02:58,356 GYNECOLOGIC CANCERS, UTERINE AND 8376 06:02:58,423 --> 06:03:00,458 OVARIAN. 8377 06:03:00,525 --> 06:03:01,459 THIS SHOWS INCIDENCE WORLDWIDE. 8378 06:03:01,526 --> 06:03:03,628 THIS HAS BEEN ECHOED IN PREVIOUS 8379 06:03:03,695 --> 06:03:05,463 TALKS, BUT I THINK IT'S 8380 06:03:05,530 --> 06:03:07,532 IMPORTANT TO UNDERSTAND THAT 8381 06:03:07,599 --> 06:03:11,269 CERVICAL CANCER IS MOST COMMON 8382 06:03:11,336 --> 06:03:12,670 HPV-RELATED CANCER WITH 8383 06:03:12,737 --> 06:03:14,372 INCIDENCE OF OVER 650,000 PER 8384 06:03:14,439 --> 06:03:17,075 YEAR AT THIS POINT. 8385 06:03:17,142 --> 06:03:20,445 AND THE GEOGRAPHIC MAPS 8386 06:03:20,512 --> 06:03:22,547 SYMBOLIZE SINCE IN 8387 06:03:22,614 --> 06:03:23,081 MORTALITY-RELATED CERVICAL 8388 06:03:23,148 --> 06:03:26,784 CANCER, HIGHEST INCIDENCE OF 8389 06:03:26,851 --> 06:03:29,220 MORTALITY IN LOW- AND 8390 06:03:29,287 --> 06:03:29,921 MIDDLE-INCOME COUNTRIES, 8391 06:03:29,988 --> 06:03:30,121 LMICs. 8392 06:03:30,188 --> 06:03:32,824 NINE OUT OF TEN WOMEN WHO DIE 8393 06:03:32,891 --> 06:03:33,424 FROM CERVICAL CANCER LIVE IN 8394 06:03:33,491 --> 06:03:34,993 LOW- AND MIDDLE-INCOME COUNTRIES 8395 06:03:35,059 --> 06:03:36,027 AS PREVIOUSLY DISCUSSED. 8396 06:03:36,094 --> 06:03:37,962 I THINK IT'S VERY IMPORTANT TO 8397 06:03:38,029 --> 06:03:39,063 UNDERSTAND THIS GLOBAL 8398 06:03:39,130 --> 06:03:42,567 PERSPECTIVE AS WE TALK ABOUT 8399 06:03:42,634 --> 06:03:44,636 THIS DISEASE AND OTHER GYN 8400 06:03:44,702 --> 06:03:50,875 CANCERS IN WOMEN LIVING WITH 8401 06:03:50,942 --> 06:03:51,109 HIV. 8402 06:03:51,176 --> 06:03:53,845 NEXT SLIDE. 8403 06:03:53,912 --> 06:03:55,280 ON THE RIGHT SIDE OF THE GREEN 8404 06:03:55,346 --> 06:03:58,016 IS A FIGURE WHICH SHOWS THE 8405 06:03:58,082 --> 06:04:00,318 VARIOUS STUDIES DONE TO ESTIMATE 8406 06:04:00,385 --> 06:04:02,754 INCIDENCE OF CERVICAL CANCER IN 8407 06:04:02,820 --> 06:04:07,859 WOMEN LIVING WITH HIV. 8408 06:04:07,926 --> 06:04:08,626 THESE DEMONSTRATE POOLED RISK 8409 06:04:08,693 --> 06:04:13,131 SIX TIMES THAT OF THE GENERAL 8410 06:04:13,198 --> 06:04:13,431 POPULATION. 8411 06:04:13,498 --> 06:04:15,433 THIS FOUND ALMOST 6% OF NEW 8412 06:04:15,500 --> 06:04:16,935 CERVICAL CANCER CASES ARE IN 8413 06:04:17,001 --> 06:04:19,771 WOMEN LIVING WITH HIV, AND 8414 06:04:19,837 --> 06:04:21,639 ALMOST 5% ARE SPECIFICALLY 8415 06:04:21,706 --> 06:04:22,941 ATTRIBUTED TO HIV. 8416 06:04:23,007 --> 06:04:25,043 AND I THINK THAT SOME OF THE 8417 06:04:25,109 --> 06:04:26,878 STATISTICS HERE ARE PRETTY 8418 06:04:26,945 --> 06:04:28,012 ASTONISHING SUCH THAT IN 8419 06:04:28,079 --> 06:04:30,682 SOUTHERN AFRICA 64% OF CERVICAL 8420 06:04:30,748 --> 06:04:32,517 CANCERS CASES OCCUR IN WOMEN 8421 06:04:32,584 --> 06:04:35,053 LIVING WITH HIV, AND IN EASTERN 8422 06:04:35,119 --> 06:04:37,889 AFRICA ABOUT 27% OF CERVICAL 8423 06:04:37,956 --> 06:04:39,190 CANCER CASES OCCURRING IN WOMEN 8424 06:04:39,257 --> 06:04:41,392 LIVING WITH HIV. 8425 06:04:41,459 --> 06:04:42,260 NEXT SLIDE. 8426 06:04:42,327 --> 06:04:44,229 SO THIS BURDEN IS REALLY QUITE 8427 06:04:44,295 --> 06:04:45,964 ASTONISHING BUT I THINK WHAT'S 8428 06:04:46,030 --> 06:04:47,832 EVEN MORE ASTOUNDING IS THE 8429 06:04:47,899 --> 06:04:50,034 LIMITED ACCESS TO TREATMENT IN 8430 06:04:50,101 --> 06:04:51,002 THESE SAME AREAS. 8431 06:04:51,069 --> 06:04:54,272 SO AS SEEN IN FIGURES HERE, 8432 06:04:54,339 --> 06:04:56,574 ACCESS TO SURGERY OR RADIATION 8433 06:04:56,641 --> 06:04:58,243 THERAPY IS REALLY SIGNIFICANTLY 8434 06:04:58,309 --> 06:05:00,578 LIMITED IN THESE AREAS, WHERE 8435 06:05:00,645 --> 06:05:04,482 THE VAST MAJORITY OF THE BURDEN 8436 06:05:04,549 --> 06:05:04,682 LIES. 8437 06:05:04,749 --> 06:05:09,554 THIS LIMITED ACCESS TO BASIC 8438 06:05:09,621 --> 06:05:10,855 STANDARD THERAPY IMPACTS WOMEN 8439 06:05:10,922 --> 06:05:13,825 WITH HIV DIAGNOSED WITH CERVICAL 8440 06:05:13,891 --> 06:05:15,126 CANCER, ABILITY TO GET 8441 06:05:15,193 --> 06:05:19,631 APPROPRIATE TREATMENT. 8442 06:05:19,697 --> 06:05:20,164 NEXT SLIDE. 8443 06:05:20,231 --> 06:05:21,933 WHEN WOMEN ARE ABLE TO GET 8444 06:05:22,000 --> 06:05:24,435 ACCESS, DATA SUGGESTS FOR THOSE 8445 06:05:24,502 --> 06:05:26,437 WHO ARE ON ANTIRETROVIRAL 8446 06:05:26,504 --> 06:05:28,373 THERAPY, THERE MAY BE DIFFERENCE 8447 06:05:28,439 --> 06:05:34,145 IN TOXICITIES BUT OVERALL WOMEN 8448 06:05:34,212 --> 06:05:34,946 TOLERATE TREATMENT WELL. 8449 06:05:35,013 --> 06:05:37,882 ONE OF THE MOST CRITICAL POINTS 8450 06:05:37,949 --> 06:05:40,952 ABOUT THIS DISEASE IN WOMEN 8451 06:05:41,019 --> 06:05:43,788 LIVING WITH HIV IS THE STORY IS 8452 06:05:43,855 --> 06:05:45,323 SIMILAR TO WHAT WE'RE SEEING 8453 06:05:45,390 --> 06:05:45,723 OVERALL. 8454 06:05:45,790 --> 06:05:50,094 WE'VE GOT TO FOCUS ON 8455 06:05:50,161 --> 06:05:54,299 PREVENTION AND EARLY DETECTION. 8456 06:05:54,365 --> 06:05:55,967 THE VAST MAJORITY ARE IN LOW- 8457 06:05:56,034 --> 06:05:56,768 AND MIDDLE-INCOME COUNTRIES AND 8458 06:05:56,834 --> 06:06:04,242 ACCESS TO TREATMENT IS CRITICAL 8459 06:06:04,309 --> 06:06:05,576 BUT EXTREMELY LIMITED. 8460 06:06:05,643 --> 06:06:07,412 IT'S IMPORTANT TO RECOGNIZE VAST 8461 06:06:07,478 --> 06:06:09,380 MAJORITY OF RESEARCH IN 8462 06:06:09,447 --> 06:06:11,049 GYNECOLOGIC CANCER HAS BEEN DONE 8463 06:06:11,115 --> 06:06:13,584 IN CERVICAL CANCER. 8464 06:06:13,651 --> 06:06:15,853 IN RECOGNIZING MY GROUP WENT TO 8465 06:06:15,920 --> 06:06:18,323 DO A META-ANALYSIS TO EVALUATE 8466 06:06:18,389 --> 06:06:21,125 WHAT LITERATURE EXISTS IN THE 8467 06:06:21,192 --> 06:06:22,760 OTHER GYN CANCERS IN WOMEN WITH 8468 06:06:22,827 --> 06:06:25,163 HIV, AS YOU CAN SEE WE FOUND 8469 06:06:25,229 --> 06:06:26,597 VERY LIMITED ARTICLES WHICH 8470 06:06:26,664 --> 06:06:29,901 REALLY FOCUS ON THIS RESEARCH, 8471 06:06:29,967 --> 06:06:40,511 ONLY THREE ON ENDOMETRIAL, FOUR 8472 06:06:48,720 --> 06:06:48,820 OVARIAN. 8473 06:06:48,886 --> 06:06:54,525 I THINK ONE SLIDE BACK. 8474 06:06:54,592 --> 06:06:57,462 THEY DID NOTE THERE HAS BEEN 8475 06:06:57,528 --> 06:07:00,098 INCREASED INCIDENCE OVERALL OF 8476 06:07:00,164 --> 06:07:01,399 NON-AIDS DEFINING CANCERS, 8477 06:07:01,466 --> 06:07:03,368 THAT'S INCREASING OVERALL. 8478 06:07:03,434 --> 06:07:05,870 SO IN OUR REVIEW WE FOUND THAT 8479 06:07:05,937 --> 06:07:09,741 THERE WAS AN INCREASED INCIDENCE 8480 06:07:09,807 --> 06:07:10,775 OF ENDOMETRIAL CANCER FOUR TIMES 8481 06:07:10,842 --> 06:07:13,044 THAT OF THE POPULATION. 8482 06:07:13,111 --> 06:07:14,779 THE RISK OF OVARIAN CANCER IS 8483 06:07:14,846 --> 06:07:16,214 INCREASED TO THREE TIMES THAT OF 8484 06:07:16,280 --> 06:07:17,315 THE POPULATION. 8485 06:07:17,382 --> 06:07:20,385 AND THE RISK OF VULVAR AND 8486 06:07:20,451 --> 06:07:22,286 VAGINAL AS HIGH AS 22 TIMES 8487 06:07:22,353 --> 06:07:31,763 THAT, ALMOST 22 TIMES THAT OF 8488 06:07:31,829 --> 06:07:36,868 THE GENERAL POPULATION. 8489 06:07:36,934 --> 06:07:47,445 HALF HAD EARLY STAGE DISEASE, 8490 06:07:48,346 --> 06:07:58,790 43% ON ANTIRETROVIRAL THERAPY. 8491 06:08:04,061 --> 06:08:07,632 AGE OF DIAGNOSIS WAS QUITE 8492 06:08:07,698 --> 06:08:08,065 YOUNG. 8493 06:08:08,132 --> 06:08:11,602 NEXT SLIDE. 8494 06:08:11,669 --> 06:08:13,571 TO FURTHER UNDERSTAND TREATMENT, 8495 06:08:13,638 --> 06:08:15,973 OUR GROUP PERFORMED STUDY AT TWO 8496 06:08:16,040 --> 06:08:17,842 INSTITUTIONS TO EVALUATE 8497 06:08:17,909 --> 06:08:18,810 ADHERENCE TO GUIDELINE 8498 06:08:18,876 --> 06:08:20,044 CONCORDANT CARE. 8499 06:08:20,111 --> 06:08:22,880 WE HEARD ABOUT TREATMENT 8500 06:08:22,947 --> 06:08:23,514 DISPARITIES AND TREATMENT 8501 06:08:23,581 --> 06:08:25,817 INEQUALITIES, WE'LL TALK MORE 8502 06:08:25,883 --> 06:08:27,118 ABOUT THAT HERE. 8503 06:08:27,185 --> 06:08:28,319 BUT ESSENTIALLY WE FOUND ONLY 8504 06:08:28,386 --> 06:08:30,755 HALF OF THE WOMEN LIVING WITH 8505 06:08:30,822 --> 06:08:34,125 HIV INCLUDED IN THIS STUDY DID 8506 06:08:34,192 --> 06:08:34,792 RECEIVE GUIDELINE CONCORDANT 8507 06:08:34,859 --> 06:08:36,861 CARE, AND WHILE THE MAJORITY OF 8508 06:08:36,928 --> 06:08:39,697 WOMEN WITH EARLY STAGE OR STAGE 8509 06:08:39,764 --> 06:08:42,433 1 DISEASE RECEIVED GUIDELINE 8510 06:08:42,500 --> 06:08:43,868 CONCORDANT CARE, MAJORITY WITH 8511 06:08:43,935 --> 06:08:45,503 ADVANCED STAGE DISEASE DID NOT. 8512 06:08:45,570 --> 06:08:47,738 THE MOST COMMON REASON WE FOUND 8513 06:08:47,805 --> 06:08:50,141 FOR NOT RECEIVING GUIDELINE 8514 06:08:50,208 --> 06:08:51,776 CONCORDANT CARE WERE 8515 06:08:51,843 --> 06:08:52,977 PATIENT-RELATED FACTORS SO 8516 06:08:53,044 --> 06:09:03,521 INCLUDING COMORBIDITIES OR 8517 06:09:05,389 --> 06:09:06,457 SPECIFIC BARRIERS TO CARE, 8518 06:09:06,524 --> 06:09:07,758 DEPENDING ON BARRIERS THAT MAY 8519 06:09:07,825 --> 06:09:09,393 EXIST, THOSE THINGS ARE CRITICAL 8520 06:09:09,460 --> 06:09:12,997 TO IMPROVING OUTCOMES IN THIS 8521 06:09:13,064 --> 06:09:15,433 POPULATION, AND FURTHER 8522 06:09:15,500 --> 06:09:16,067 UNDERSTANDING PHYSICIAN-RELATED 8523 06:09:16,133 --> 06:09:26,644 BIAS IN TREATMENT IS CRITICAL. 8524 06:09:29,480 --> 06:09:34,852 OVERALL BY CANCER TYPE, UTERINE 8525 06:09:34,919 --> 06:09:37,321 CANCER DID VERY WELL. 8526 06:09:37,388 --> 06:09:44,762 OVARIAN CANCER DID QUITE POORLY, 8527 06:09:44,829 --> 06:09:45,763 CONSISTENT WITH EXPECTATION. 8528 06:09:45,830 --> 06:09:47,298 ON THE RIGHT-HAND SIDE WHEN WE 8529 06:09:47,365 --> 06:09:50,034 LOOK AT SURVIVAL BY GUIDELINE 8530 06:09:50,101 --> 06:09:52,203 ADHERENCE, WE FOUND FOR PATIENTS 8531 06:09:52,270 --> 06:09:53,804 WITH ADVANCED STAGE DISEASE SO 8532 06:09:53,871 --> 06:09:57,141 THAT INCLUDED STAGE 2 TO STAGE 8533 06:09:57,208 --> 06:09:58,442 4, TWO YEAR SURVIVAL WAS 8534 06:09:58,509 --> 06:10:00,645 IMPROVED FOR THOSE WHO DID 8535 06:10:00,711 --> 06:10:01,546 RECEIVE GUIDELINE CONCORDANT 8536 06:10:01,612 --> 06:10:06,918 CARE, SO COMPARE A ACTIVELY 60% 8537 06:10:06,984 --> 06:10:09,153 VERSUS 28%. 8538 06:10:09,220 --> 06:10:10,454 THERE ARE CONFOUNDING FACTORS 8539 06:10:10,521 --> 06:10:11,889 HERE RELATED TO REASONS WHY 8540 06:10:11,956 --> 06:10:14,725 PATIENTS DID OR DID NOT RECEIVE 8541 06:10:14,792 --> 06:10:15,760 GUIDELINE CONCORDANT CARE THIS 8542 06:10:15,826 --> 06:10:17,828 DATA SUGGESTS WHEN WE'RE ABLE TO 8543 06:10:17,895 --> 06:10:20,131 GET WOMEN LIVING WITH HIV THE 8544 06:10:20,197 --> 06:10:25,803 APPROPRIATE TREATMENTS, THEY DO 8545 06:10:25,870 --> 06:10:26,037 BETTER. 8546 06:10:26,103 --> 06:10:26,470 NEXT SLIDE. 8547 06:10:26,537 --> 06:10:28,773 BASED ON AVAILABLE DATA WE HAVE, 8548 06:10:28,839 --> 06:10:30,841 THE CALL TO ACTION THAT I WANT 8549 06:10:30,908 --> 06:10:35,046 TO FOCUS ON HERE IS THAT THE 8550 06:10:35,112 --> 06:10:36,647 RISK OF CERVICAL CANCER IS 8551 06:10:36,714 --> 06:10:38,182 SIGNIFICANTLY INCREASED IN WOMEN 8552 06:10:38,249 --> 06:10:41,185 LIVING WITH HIV, VAST MAJORITY 8553 06:10:41,252 --> 06:10:41,786 OF DISEASE IN LOW- AND 8554 06:10:41,852 --> 06:10:43,020 MIDDLE-INCOME COUNTRIES. 8555 06:10:43,087 --> 06:10:44,322 THEREFORE ACCESS TO PREVENTION 8556 06:10:44,388 --> 06:10:45,756 AND TREATMENT ARE CRITICAL AND I 8557 06:10:45,823 --> 06:10:49,694 THINK WE NEED TO FOCUS ON 8558 06:10:49,760 --> 06:10:52,296 IMPLEMENTATION STRATEGIES TO GET 8559 06:10:52,363 --> 06:10:53,064 PREVENTION AND TREATMENT 8560 06:10:53,130 --> 06:10:56,233 MODALITIES TO WOMEN WHO NEED 8561 06:10:56,300 --> 06:10:56,567 THEM. 8562 06:10:56,634 --> 06:10:58,636 FOR OTHER HPV CANCERS OF THE 8563 06:10:58,703 --> 06:11:01,372 LOWER GENITAL TRACT THERE NEEDS 8564 06:11:01,439 --> 06:11:02,940 TO BE RECOGNITION OF INCREASED 8565 06:11:03,007 --> 06:11:06,210 RISK, FOCUS ON EARLY DETECTION 8566 06:11:06,277 --> 06:11:07,845 WITH REGULAR EXAMS TO DETECT 8567 06:11:07,912 --> 06:11:10,381 LESIONS EARLY. 8568 06:11:10,448 --> 06:11:12,216 AND FINALLY FOR NON-HPV RELATED 8569 06:11:12,283 --> 06:11:14,518 GYNECOLOGIC CANCERS AS WOMEN 8570 06:11:14,585 --> 06:11:15,720 LIVING WITH HIV ARE LIVING 8571 06:11:15,786 --> 06:11:17,355 LONGER INCIDENCE OF THESE 8572 06:11:17,421 --> 06:11:18,789 CANCERS ARE INCREASING, AND THEY 8573 06:11:18,856 --> 06:11:20,858 ARE OCCURRING AT YOUNGER AGES 8574 06:11:20,925 --> 06:11:22,393 COMPARED TO GENERAL POPULATION, 8575 06:11:22,460 --> 06:11:24,495 AT LEAST THAT'S WHAT EVIDENCE 8576 06:11:24,562 --> 06:11:24,962 SUGGESTS. 8577 06:11:25,029 --> 06:11:27,431 MORE RESEARCH IS NEEDED TO 8578 06:11:27,498 --> 06:11:29,400 BETTER UNDERSTAND INCIDENCE, 8579 06:11:29,467 --> 06:11:30,501 TREATMENT, TOXICITY, SURVIVAL, 8580 06:11:30,568 --> 06:11:33,004 AND TO BETTER UNDERSTAND IMPACT 8581 06:11:33,070 --> 06:11:34,772 OF PROVIDER BIAS AND TREATMENT 8582 06:11:34,839 --> 06:11:36,974 OF WOMEN LIVING WITH HIV 8583 06:11:37,041 --> 06:11:40,678 DIAGNOSED WITH GYNECOLOGIC 8584 06:11:40,745 --> 06:11:40,911 CANCERS. 8585 06:11:40,978 --> 06:11:41,879 NEXT SLIDE. 8586 06:11:41,946 --> 06:11:43,514 THANK YOU FOR YOUR ATTENTION AND 8587 06:11:43,581 --> 06:11:44,915 OPPORTUNITY TO DISCUSS THIS 8588 06:11:44,982 --> 06:11:46,150 IMPORTANT TOPIC. 8589 06:11:46,217 --> 06:11:47,818 THANK YOU. 8590 06:11:47,885 --> 06:11:49,654 >> THANK YOU, DR. LEVINSON. 8591 06:11:49,720 --> 06:11:52,490 REMINDER, AGAIN, TO THE 8592 06:11:52,556 --> 06:11:54,992 AUDIENCE, PLEASE SUBMIT 8593 06:11:55,059 --> 06:11:55,626 QUESTIONS OR COMMENTS THROUGH 8594 06:11:55,693 --> 06:11:58,295 THE "LIVE FEEDBACK" OPTION BELOW 8595 06:11:58,362 --> 06:12:06,170 THE VIDEOCAST. 8596 06:12:06,237 --> 06:12:12,943 OUR FINAL PRESENTATION IS FROM 8597 06:12:13,010 --> 06:12:14,145 BENDA KITHAKA. 8598 06:12:14,211 --> 06:12:17,648 HAVE YOU BEEN ABLE TO JOIN US, 8599 06:12:17,715 --> 06:12:17,848 BENDA? 8600 06:12:17,915 --> 06:12:23,654 >> YES, I'M HERE NOW. 8601 06:12:23,721 --> 06:12:24,055 >> GREAT. 8602 06:12:24,121 --> 06:12:26,290 >> HI, EVERYBODY. 8603 06:12:26,357 --> 06:12:29,760 I'M JOINING FROM NAIROBI, KENYA, 8604 06:12:29,827 --> 06:12:31,362 QUITE LATE HERE, 23 HOURS IN THE 8605 06:12:31,429 --> 06:12:31,595 EVENING. 8606 06:12:31,662 --> 06:12:32,930 GOOD EVENING, GOOD NIGHT TO ALL 8607 06:12:32,997 --> 06:12:34,231 OF YOU. 8608 06:12:34,298 --> 06:12:41,105 I INVITE YOU TO JOIN ME AS WE 8609 06:12:41,172 --> 06:12:42,740 DISCUSS CERVICAL CANCER AND 8610 06:12:42,807 --> 06:12:43,240 AIDS. 8611 06:12:43,307 --> 06:12:48,879 I WORK IN THE COMMUNITY, I CAME 8612 06:12:48,946 --> 06:12:51,882 INTO THIS SPACE BECAUSE MY 8613 06:12:51,949 --> 06:12:54,085 SISTER WAS TOLD SHE HAD CANCER, 8614 06:12:54,151 --> 06:12:59,857 IT WAS PRE-CANCER OF THE SERVE 8615 06:12:59,924 --> 06:13:01,826 -- CERVIX. 8616 06:13:01,892 --> 06:13:05,429 IN THE VILLAGE, I WAS IN 8617 06:13:05,496 --> 06:13:07,631 NAIROBI, INVITED HER TO SEEK 8618 06:13:07,698 --> 06:13:08,265 TREATMENT. 8619 06:13:08,332 --> 06:13:10,134 WITH THIS, IT WAS AN AWAKENING 8620 06:13:10,201 --> 06:13:11,869 BECAUSE MY SISTER WAS TREATED, 8621 06:13:11,936 --> 06:13:14,405 SHE RECOVERED, SHE GOT BETTER, 8622 06:13:14,472 --> 06:13:19,009 SHE HAD A BABY. 8623 06:13:19,076 --> 06:13:21,378 HER FERTILITY WAS PRESERVED. 8624 06:13:21,445 --> 06:13:23,581 I COULD NOT SAY IN MY JOB 8625 06:13:23,647 --> 06:13:25,015 SETTING BECAUSE WHEN THERE WAS A 8626 06:13:25,082 --> 06:13:28,719 MESSAGE THAT NEEDED TO REACH 8627 06:13:28,786 --> 06:13:31,589 EVERY WOMAN NOT EVERY CANCER 8628 06:13:31,655 --> 06:13:33,758 LEADS TO FATAL OUTCOMES, WE HAVE 8629 06:13:33,824 --> 06:13:34,859 TO TAKE CHARGE. 8630 06:13:34,925 --> 06:13:37,161 HAVING LISTENED TO OTHER 8631 06:13:37,228 --> 06:13:38,896 SPEAKERS, NEXT PLEASE, I WOULD 8632 06:13:38,963 --> 06:13:42,099 LIKE TO FOCUS ON WHAT WE CAN DO 8633 06:13:42,166 --> 06:13:44,635 FROM A COMMUNITY PERSPECTIVE. 8634 06:13:44,702 --> 06:13:46,370 I THINK ALL THE EXPERTS WHO HAVE 8635 06:13:46,437 --> 06:13:48,239 SPOKEN BEFORE ME HAVE SPOKEN HOW 8636 06:13:48,305 --> 06:13:51,075 TO HIV AND AIDS MOVEMENT HAS 8637 06:13:51,142 --> 06:13:52,176 MOVED AND GOTTEN TOGETHER AND 8638 06:13:52,243 --> 06:13:53,644 DONE A LOT OF RESEARCH AND 8639 06:13:53,711 --> 06:13:55,880 BROUGHT A LOT OF CHANGES TO THE 8640 06:13:55,946 --> 06:13:59,483 COMMUNITY, TO ENSURE THE PEOPLE 8641 06:13:59,550 --> 06:14:03,120 ARE BEING SEARCHED WELL WITH 8642 06:14:03,187 --> 06:14:04,321 INTERVENTIONS AVAILABLE AND MORE 8643 06:14:04,388 --> 06:14:05,256 RESEARCH. 8644 06:14:05,322 --> 06:14:06,190 IN THE CANCER SPACE WE'RE 8645 06:14:06,257 --> 06:14:07,491 LAGGING HOW TO GO TOGETHER. 8646 06:14:07,558 --> 06:14:09,226 AS YOU HEARD FROM THE 8647 06:14:09,293 --> 06:14:11,328 INTRODUCTION, MY TEAM AND I 8648 06:14:11,395 --> 06:14:13,731 CLIMB MOUNTAINS, LITERALLY AND 8649 06:14:13,798 --> 06:14:15,833 FIGURATIVELY TO ENSURE WE CAN 8650 06:14:15,900 --> 06:14:21,238 BRING UNUSUAL METHODS OF 8651 06:14:21,305 --> 06:14:22,206 CREATING AWARENESS IN THE 8652 06:14:22,273 --> 06:14:24,175 COMMUNITY, AND YOU CAN SEE US ON 8653 06:14:24,241 --> 06:14:25,276 MOUNT KENYA HIGHLIGHTING THE 8654 06:14:25,342 --> 06:14:33,818 NEED FOR QUALITY OF LIFE CARE IN 8655 06:14:33,884 --> 06:14:34,118 CANCER. 8656 06:14:34,185 --> 06:14:35,452 NEXT PLEASE. 8657 06:14:35,519 --> 06:14:38,622 WE HAVE FOUR PROGRAMS, STARTS 8658 06:14:38,689 --> 06:14:40,024 WITH CHALLENGING PERCEPTION BY 8659 06:14:40,090 --> 06:14:41,158 CLIMBING MOUNTAINS, ALSO DEALING 8660 06:14:41,225 --> 06:14:43,327 WITH QUALITY OF LIFE WHERE WE 8661 06:14:43,394 --> 06:14:45,629 TAKE HOME EXERCISE AND PHYSICAL 8662 06:14:45,696 --> 06:14:47,164 FITNESS AS WELL AS MENTAL 8663 06:14:47,231 --> 06:14:48,999 WELLNESS TO EQUIP SURVIVORS AND 8664 06:14:49,066 --> 06:14:52,736 CAREGIVERS WITH KNOWLEDGE AND 8665 06:14:52,803 --> 06:14:53,070 SKILL. 8666 06:14:53,137 --> 06:14:57,541 THEN WE GO TO DEPCASS, TRAINING 8667 06:14:57,608 --> 06:14:59,210 ON ADVOCACY, LETTING PEOPLE KNOW 8668 06:14:59,276 --> 06:15:00,611 LIVED EXPERIENCES WE CAN TAKE TO 8669 06:15:00,678 --> 06:15:02,813 THE FIELD TO EQUIP OTHERS WITH 8670 06:15:02,880 --> 06:15:04,448 KNOWLEDGE OF PREVENTION AND 8671 06:15:04,515 --> 06:15:06,650 EARLY DETECTION. 8672 06:15:06,717 --> 06:15:17,261 AFTER THAT WE EQUIP, DEPLOY THE 8673 06:15:18,929 --> 06:15:19,797 SURVIVORS, THAMANI IS SWAHILI 8674 06:15:19,864 --> 06:15:22,499 FOR VALUE, TO GET EVERY WOMAN TO 8675 06:15:22,566 --> 06:15:23,801 APPRECIATE THEIR VALUE AND EVERY 8676 06:15:23,868 --> 06:15:26,770 GIRL IS APPRECIATE THEY HAVE THE 8677 06:15:26,837 --> 06:15:28,305 TOOLS. 8678 06:15:28,372 --> 06:15:30,941 AND WE'VE COALESCED AN 8679 06:15:31,008 --> 06:15:35,846 ORGANIZATION, ACHA, AFRICAN 8680 06:15:35,913 --> 06:15:37,047 CERVICAL HEALTH ALLIANCE. 8681 06:15:37,114 --> 06:15:40,251 IN OUR PROGRAMS WE'RE LOOKING AT 8682 06:15:40,317 --> 06:15:41,652 ADDRESSING THE TRIPLE VAGINAL 8683 06:15:41,719 --> 06:15:41,986 DISEASE. 8684 06:15:42,052 --> 06:15:48,225 YES, MOST PEOPLE TALK ABOUT THE 8685 06:15:48,292 --> 06:15:51,161 NON-COMMUNICABLE DISEASES BUT 8686 06:15:51,228 --> 06:15:53,030 WE'RE DEALING WITH 8687 06:15:53,097 --> 06:15:54,164 COMORBIDITIES, AND I LIKE TO SAY 8688 06:15:54,231 --> 06:15:55,866 POVERTY IS ONE OF OUR BIGGEST 8689 06:15:55,933 --> 06:15:57,635 ISSUES THAT WE HAVE TO ADDRESS 8690 06:15:57,701 --> 06:15:59,603 BECAUSE IT'S NOT JUST ABOUT 8691 06:15:59,670 --> 06:16:01,672 POVERTY OF RESOURCES BUT ALSO 8692 06:16:01,739 --> 06:16:03,440 POVERTY OF AN UNDERSTANDING OF 8693 06:16:03,507 --> 06:16:06,277 THE NEEDS THAT ARE EXISTING IN 8694 06:16:06,343 --> 06:16:10,581 OUR COMMUNITY, ALSO THE 8695 06:16:10,648 --> 06:16:13,484 UNDERSTANDING OF INTERVENTIONS 8696 06:16:13,550 --> 06:16:14,518 THAT COULD POTENTIALLY IMPROVE 8697 06:16:14,585 --> 06:16:16,587 THE QUALITY OF LIFE FOR ALL OF 8698 06:16:16,654 --> 06:16:17,354 OUR PEOPLE. 8699 06:16:17,421 --> 06:16:19,890 AND WHEN WE TALK ABOUT RISK AND 8700 06:16:19,957 --> 06:16:22,026 WE TALK ABOUT THE CHALLENGES 8701 06:16:22,092 --> 06:16:23,694 THAT WE FACE, FOR EXAMPLE IN HIV 8702 06:16:23,761 --> 06:16:26,030 AND AIDS AS WELL AS IN CANCER 8703 06:16:26,096 --> 06:16:29,833 WE'RE DEALING WITH A LOT OF 8704 06:16:29,900 --> 06:16:31,468 STIGMA, MISCONCEPTIONS, AND ALSO 8705 06:16:31,535 --> 06:16:35,072 FAKE NEWS THAT OFTEN TENDS TO BE 8706 06:16:35,139 --> 06:16:36,640 DETRIMENTAL IN INTERVENTIONS 8707 06:16:36,707 --> 06:16:37,174 WE'RE DOING. 8708 06:16:37,241 --> 06:16:39,276 SECONDLY, QUITE A NUMBER OF 8709 06:16:39,343 --> 06:16:44,615 SPEAKERS HAVE SPOKEN ABOUT 8710 06:16:44,682 --> 06:16:45,182 ACCESS, FINANCIAL ISSUES, 8711 06:16:45,249 --> 06:16:47,117 ADHERENCE, ALL LEADS TO POORER 8712 06:16:47,184 --> 06:16:48,552 OUTCOMES FOR OUR PEOPLE THAT 8713 06:16:48,619 --> 06:16:49,887 WE'RE SERVING. 8714 06:16:49,954 --> 06:16:53,624 SO BECAUSE OF THAT WE'VE COME TO 8715 06:16:53,691 --> 06:16:54,892 REALIZE BEHAVIOR CHANGE, 8716 06:16:54,959 --> 06:16:55,359 COMMUNICATION 8717 06:16:55,426 --> 06:16:55,960 CREATING AWARENESS LEADING TO 8718 06:16:56,026 --> 06:16:57,795 ACTION IS THE WAY TO GO FOR US 8719 06:16:57,861 --> 06:17:01,332 TO BE ABLE TO COMBAT THE ISSUES 8720 06:17:01,398 --> 06:17:02,700 THAT PLAGUE OUR PEOPLE. 8721 06:17:02,766 --> 06:17:03,600 NEXT. 8722 06:17:03,667 --> 06:17:05,769 SO HOW DO WE ADVOCATE? 8723 06:17:05,836 --> 06:17:09,273 WHAT WE'RE DOING IS UTILIZING 8724 06:17:09,340 --> 06:17:13,010 OUR LIVED EXPERIENCES AS TOOLS 8725 06:17:13,077 --> 06:17:14,912 FOR EDUCATION. 8726 06:17:14,979 --> 06:17:17,081 IN THAT THIRTEEN YEARS WHEN I 8727 06:17:17,147 --> 06:17:19,149 SPEAK TO A COMMUNITY, I TELL 8728 06:17:19,216 --> 06:17:20,617 THEM ABOUT MY SISTER, I TELL 8729 06:17:20,684 --> 06:17:21,885 THEM ABOUT ALL THE THINGS WE'VE 8730 06:17:21,952 --> 06:17:25,789 HAD TO DO IN THE COMMUNITY, AS A 8731 06:17:25,856 --> 06:17:28,192 PERSON WHO HAS LIVED EXPERIENCE, 8732 06:17:28,258 --> 06:17:29,693 LITERALLY A CANCER SURVIVOR OR 8733 06:17:29,760 --> 06:17:32,162 SOMEONE LIVING WITH HIV AND AIDS 8734 06:17:32,229 --> 06:17:33,030 AND ALSO CERVICAL CANCER COMES 8735 06:17:33,097 --> 06:17:35,432 TO THE TABLE AND SPEAKS ABOUT 8736 06:17:35,499 --> 06:17:37,968 IT, THEY WILL GET MORE NOTICE 8737 06:17:38,035 --> 06:17:39,603 BECAUSE THEY ARE SPEAKING FROM 8738 06:17:39,670 --> 06:17:41,905 EXPERIENCING THE ISSUES THAT 8739 06:17:41,972 --> 06:17:43,107 WE'RE TALKING ABOUT HERE, 8740 06:17:43,173 --> 06:17:44,308 SCIENTIFIC KNOWLEDGE, SPEAKING 8741 06:17:44,375 --> 06:17:45,709 FROM EXPERIENCES OF THE HEALTH 8742 06:17:45,776 --> 06:17:48,112 CARE SYSTEM, AND THEREFORE WE 8743 06:17:48,178 --> 06:17:50,414 UTILIZE OUR LIVED EXPERIENCES TO 8744 06:17:50,481 --> 06:17:51,615 DISPEL MYTHS, ENCOURAGE BETTER 8745 06:17:51,682 --> 06:17:54,485 OUTCOMES TO BE ABLE TO GET 8746 06:17:54,551 --> 06:17:55,586 PEOPLE TO UNDERSTAND THAT THIS 8747 06:17:55,652 --> 06:17:57,788 MAY BE MY STORY BUT IT NEED NOT 8748 06:17:57,855 --> 06:17:59,857 BE YOURS. 8749 06:17:59,923 --> 06:18:02,926 THEREFORE WE ARE ADVOCATING FOR 8750 06:18:02,993 --> 06:18:04,895 ACCESS TO INFORMATION TO 8751 06:18:04,962 --> 06:18:06,330 RESOURCES BUT ALSO FOR POLICY 8752 06:18:06,397 --> 06:18:07,998 THAT CAN CHANGE THE TRAJECTORY 8753 06:18:08,065 --> 06:18:15,472 FOR THE TWO DISEASES IN OUR 8754 06:18:15,539 --> 06:18:16,540 COMMUNITIES. 8755 06:18:16,607 --> 06:18:20,377 SOME OF THE THINGS THAT WE'VE 8756 06:18:20,444 --> 06:18:22,780 DONE SUPPORTED BY AMERICAN 8757 06:18:22,846 --> 06:18:24,648 CANCER SOCIETY OR PREVENT CANCER 8758 06:18:24,715 --> 06:18:26,617 FOUNDATION WE'VE BEEN ABLE TO 8759 06:18:26,683 --> 06:18:29,453 BRING POLICYMAKERS TO THE TABLE 8760 06:18:29,520 --> 06:18:32,623 WITH COMMON KNOWLEDGE WE ALL 8761 06:18:32,689 --> 06:18:34,391 WANT THE SAME THING, ENHANCE 8762 06:18:34,458 --> 06:18:36,360 ACCESS TO SERVICES, TO SHOW 8763 06:18:36,427 --> 06:18:41,131 WOMEN HAVE BETTER OUTCOMES, BUT 8764 06:18:41,198 --> 06:18:43,801 WARNS HEALTHY PEOPLE CAN BE ABLE 8765 06:18:43,867 --> 06:18:44,868 TO GOVERN, BETTER CONTRIBUTORS 8766 06:18:44,935 --> 06:18:45,569 TO THE ECONOMY. 8767 06:18:45,636 --> 06:18:47,604 AND SO SOME OF THE MESSAGES THAT 8768 06:18:47,671 --> 06:18:51,775 WE BRING TO THE TABLE IS, ONE, 8769 06:18:51,842 --> 06:18:52,776 PRIORITIZE WOMEN-CENTRIC 8770 06:18:52,843 --> 06:18:53,510 SERVICES. 8771 06:18:53,577 --> 06:18:54,611 HERE WE'RE TALKING ABOUT, FOR 8772 06:18:54,678 --> 06:18:56,914 EXAMPLE, HIV AND AIDS MOVEMENT 8773 06:18:56,980 --> 06:19:00,184 YOU WERE EQUIPPED TO BRING ON 8774 06:19:00,250 --> 06:19:04,254 THE ESSENCE OF RAPID TESTING, IN 8775 06:19:04,321 --> 06:19:08,158 CERVICAL SANER IS FOR OVER 60 8776 06:19:08,225 --> 06:19:11,361 YEARS WE'VE HAD PAP SMEARS THE 8777 06:19:11,428 --> 06:19:13,564 BEST TOUTED METHOD AND NOW HPV 8778 06:19:13,630 --> 06:19:15,632 TESTING AND CAN STILL SEE 8779 06:19:15,699 --> 06:19:17,434 ELEMENTS OF RESISTANCE TO 8780 06:19:17,501 --> 06:19:18,368 SELF-SAMPLE COLLECTION, SOME OF 8781 06:19:18,435 --> 06:19:20,104 THE ISSUES THAT WE BRING TO THE 8782 06:19:20,170 --> 06:19:21,972 TABLE IN SAYING WOMEN ARE 8783 06:19:22,039 --> 06:19:23,407 DEMANDING AND ASKING THEY BE 8784 06:19:23,474 --> 06:19:25,375 GIVEN POWER TO BE ABLE TO ACCESS 8785 06:19:25,442 --> 06:19:27,711 THESE SERVICES SO THAT WE CAN 8786 06:19:27,778 --> 06:19:30,514 REDUCE INCIDENCE OF DISEASE. 8787 06:19:30,581 --> 06:19:31,615 SECONDLY, INTEGRATION. 8788 06:19:31,682 --> 06:19:36,086 IT'S A PITY WE GOAT HAVE 8789 06:19:36,153 --> 06:19:37,821 SPECIALIZED FOR CANCER CARE FOR 8790 06:19:37,888 --> 06:19:41,191 HIV AND AIDS CARE, MATERNAL AND 8791 06:19:41,258 --> 06:19:42,259 REPRODUCTIVE HEALTH CARE, THE 8792 06:19:42,326 --> 06:19:43,460 SAME WOMAN COMES TO THE 8793 06:19:43,527 --> 06:19:46,263 FACILITIES AND HAS TO DO ALL 8794 06:19:46,330 --> 06:19:47,664 THESE THINGS IN TANDEM, WHY NOT 8795 06:19:47,731 --> 06:19:48,665 BRING SERVICES TOGETHER SO THE 8796 06:19:48,732 --> 06:19:51,568 WOMAN CAN BE ABLE TO BENEFIT 8797 06:19:51,635 --> 06:19:54,271 FROM ALL INTERVENTIONS TOGETHER? 8798 06:19:54,338 --> 06:19:57,007 LASTLY, HOLISTIC SUPPORT TO OUR 8799 06:19:57,074 --> 06:20:00,577 INDIVIDUALS WITH MULTIPLE HEALTH 8800 06:20:00,644 --> 06:20:01,812 CONDITIONS AND CHALLENGES. 8801 06:20:01,879 --> 06:20:03,013 MENTAL WELLNESS WAS MENTIONED 8802 06:20:03,080 --> 06:20:06,083 TODAY, QUITE A NUMBER OF THE 8803 06:20:06,150 --> 06:20:08,051 TOPICS DISCUSSED TODAY, AND 8804 06:20:08,118 --> 06:20:10,721 MENTAL WELLNESS IS ONE OF THE 8805 06:20:10,787 --> 06:20:12,222 ISSUES WE SEE OFTEN. 8806 06:20:12,289 --> 06:20:14,057 WITH STIGMA COMES FEAR OF 8807 06:20:14,124 --> 06:20:15,292 TALKING ABOUT DISEASE AND 8808 06:20:15,359 --> 06:20:15,626 COMORBIDITIES. 8809 06:20:15,692 --> 06:20:19,096 WE KNOW IF A WOMAN HAS HIV AND 8810 06:20:19,163 --> 06:20:22,733 AIDS, AND SHE GETS CERVICAL 8811 06:20:22,799 --> 06:20:24,234 CANCER, RISK OF PROGRESSION, IF 8812 06:20:24,301 --> 06:20:26,069 IT WAS DIAGNOSED EARLY, RISK OF 8813 06:20:26,136 --> 06:20:28,405 HIGHER PROGRESSION IS SO MUCH 8814 06:20:28,472 --> 06:20:29,506 HIGHER YET WE'RE AFRAID TO TALK 8815 06:20:29,573 --> 06:20:34,077 ABOUT THESE CONDITIONS BECAUSE 8816 06:20:34,144 --> 06:20:35,279 OF STIGMA. 8817 06:20:35,345 --> 06:20:36,613 THINGS WE'RE LOOKING FOR, 8818 06:20:36,680 --> 06:20:37,614 PARTNERSHIPS FOR CHANGE. 8819 06:20:37,681 --> 06:20:39,783 I'M HERE TODAY TO APPEAL TO ALL 8820 06:20:39,850 --> 06:20:40,751 OF YOU. 8821 06:20:40,817 --> 06:20:42,386 I'VE LISTENED TO QUITE A NUMBER 8822 06:20:42,452 --> 06:20:44,354 OF SCIENCE AND QUITE A NUMBER OF 8823 06:20:44,421 --> 06:20:46,323 RESEARCHERS THAT HAVE BEEN DONE, 8824 06:20:46,390 --> 06:20:48,625 SOME OF THE PILOTS THAT HAVE 8825 06:20:48,692 --> 06:20:50,928 BEEN DONE THAT ARE GREAT, 8826 06:20:50,994 --> 06:20:55,732 BRINGING GREAT INTERVENTIONS TO 8827 06:20:55,799 --> 06:20:57,034 THE CONTINENT. 8828 06:20:57,100 --> 06:20:59,036 HOW WELL ARE THESE IMPLEMENTED 8829 06:20:59,102 --> 06:20:59,770 IN THE COMMUNITY? 8830 06:20:59,836 --> 06:21:02,105 MY COMMUNITY, FOR EXAMPLE, IN 8831 06:21:02,172 --> 06:21:04,541 KENYA ALONE WORKING WITH OVER 8832 06:21:04,608 --> 06:21:05,475 200 SURVIVORS AND CAREGIVERS. 8833 06:21:05,542 --> 06:21:07,344 YET WE DON'T HAVE A RESEARCH 8834 06:21:07,411 --> 06:21:09,746 THAT IS ADDRESSING QUALITY OF 8835 06:21:09,813 --> 06:21:10,847 LIFE BEYOND THE TREATMENT THAT 8836 06:21:10,914 --> 06:21:11,415 WE GET. 8837 06:21:11,481 --> 06:21:14,151 SOME OF THEM ARE LIVING WITH 8838 06:21:14,218 --> 06:21:17,321 BOTH HIV AS WELL AS CANCER, AND 8839 06:21:17,387 --> 06:21:18,855 YET THEY ALSO HAVE TO DEAL WITH 8840 06:21:18,922 --> 06:21:21,158 ISSUES OF QUALITY OF LIFE. 8841 06:21:21,225 --> 06:21:22,826 NO ONE IS ADDRESSING THAT. 8842 06:21:22,893 --> 06:21:24,561 HOW ABOUT WE PARTNER TO BRING 8843 06:21:24,628 --> 06:21:25,963 SOME OF THE INTERVENTIONS THAT 8844 06:21:26,029 --> 06:21:27,097 YOU ALREADY HAVE TO THE 8845 06:21:27,164 --> 06:21:28,732 COMMUNITIES THAT REALLY NEED IT? 8846 06:21:28,799 --> 06:21:31,235 IN TERMS OF YOUR EXPERTISE, IN 8847 06:21:31,301 --> 06:21:33,103 TERMS OF THE RESOURCES, AS WELL 8848 06:21:33,170 --> 06:21:35,839 AS TO ENSURE THAT YOUR 8849 06:21:35,906 --> 06:21:39,009 INTERVENTIONS ARE SUSTAINABLE. 8850 06:21:39,076 --> 06:21:41,211 LASTLY, POLICY CHANGE, I KNOW 8851 06:21:41,278 --> 06:21:42,846 WHEN WE HAVE SCIENCE THAT'S BEEN 8852 06:21:42,913 --> 06:21:44,848 PROVEN TO WORK AND WE BRING IT 8853 06:21:44,915 --> 06:21:47,551 TO THE TABLE FOR DECISION 8854 06:21:47,618 --> 06:21:50,854 MAKERS, IT'S AN EASY TOOL TO 8855 06:21:50,921 --> 06:21:54,458 UTILIZE COUPLED WITH LIVED 8856 06:21:54,524 --> 06:21:56,760 EXPERIENCES, SO HOW CAN WE 8857 06:21:56,827 --> 06:21:58,161 WELCOME COMMUNITY LEVERS IN OUR 8858 06:21:58,228 --> 06:22:00,364 REGION TO REMOVE THE BARRIERS 8859 06:22:00,430 --> 06:22:02,566 AND THAT HINDER CARE BUT ALSO 8860 06:22:02,633 --> 06:22:09,273 BRING SYSTEMIC CHANGE THAT IS 8861 06:22:09,339 --> 06:22:09,873 SUSTAINABLE. 8862 06:22:09,940 --> 06:22:10,073 NEXT. 8863 06:22:10,140 --> 06:22:14,811 LASTLY I WANT TO TALK ABOUT THE 8864 06:22:14,878 --> 06:22:16,813 CERVICAL HEALTH ALLIANCE, 8865 06:22:16,880 --> 06:22:18,882 LOOKING AT BEYOND KENYA, BEYOND 8866 06:22:18,949 --> 06:22:20,884 ONE COUNTRY, WE KNOW FOR 8867 06:22:20,951 --> 06:22:23,287 CERVICAL HEALTH AND FOR HIV THE 8868 06:22:23,353 --> 06:22:25,255 MESSAGING IS SIMILAR, AND WE CAN 8869 06:22:25,322 --> 06:22:27,324 BE ABLE TO AMPLIFY THIS 8870 06:22:27,391 --> 06:22:28,425 MESSAGING ACROSS COMMUNITIES. 8871 06:22:28,492 --> 06:22:29,660 LET'S GO TO THE NEXT SLIDE. 8872 06:22:29,726 --> 06:22:31,828 AND SO SOME OF THE THINGS WE'RE 8873 06:22:31,895 --> 06:22:34,231 SAYING IS THAT AS WE BRING 8874 06:22:34,298 --> 06:22:39,069 EQUITY, WE LOOK AT BOTH ADVOCACY 8875 06:22:39,136 --> 06:22:40,937 AND RESEARCHERS JOINT TOOL 8876 06:22:41,004 --> 06:22:42,673 BECAUSE WITH EVIDENCE BASE WILL 8877 06:22:42,739 --> 06:22:44,041 BE BETTER ABLE TO ADVOCATE FOR 8878 06:22:44,107 --> 06:22:49,012 ISSUES WE'RE BRINGING TO THE 8879 06:22:49,079 --> 06:22:52,416 TABLE, AGAIN CIVIL SOCIETY AS A 8880 06:22:52,482 --> 06:22:53,283 CONTRIBUTOR, IN CLINICAL TRIALS 8881 06:22:53,350 --> 06:22:55,786 AS MUCH AS WE DON'T HAVE AS MANY 8882 06:22:55,852 --> 06:22:57,988 IN OUR REGION FOR THE ONES WE 8883 06:22:58,055 --> 06:23:00,190 HAVE ENGAGE US TO BRING THE 8884 06:23:00,257 --> 06:23:01,058 PEOPLE THAT WE'RE WORKING WITH 8885 06:23:01,124 --> 06:23:03,360 FOR THEM TO BE ABLE TO BENEFIT 8886 06:23:03,427 --> 06:23:05,996 FROM THE INTERVENTIONS THAT YOU 8887 06:23:06,063 --> 06:23:06,330 HAVE. 8888 06:23:06,396 --> 06:23:09,399 AND LASTLY, WHEN WE'RE LOOKING 8889 06:23:09,466 --> 06:23:10,901 AT COMMUNITY ENGAGEMENT, I THINK 8890 06:23:10,967 --> 06:23:13,103 WE'RE THE LAST MILE TO THE 8891 06:23:13,170 --> 06:23:14,304 COMMUNITY AND HIV MOVEMENT HAS 8892 06:23:14,371 --> 06:23:15,739 SHOWN THAT. 8893 06:23:15,806 --> 06:23:17,274 WE CAN BE ABLE TO WORK TO BRING 8894 06:23:17,341 --> 06:23:19,676 CHANGE WHERE IT IS NEEDED. 8895 06:23:19,743 --> 06:23:22,679 SO MY INVITATION TO ALL OF US, 8896 06:23:22,746 --> 06:23:23,513 DON'T DROP THE BALL. 8897 06:23:23,580 --> 06:23:25,048 AM THE BALL IS IN OUR COURT. 8898 06:23:25,115 --> 06:23:26,917 LET'S MAKE SURE WE CAN BE ABLE 8899 06:23:26,983 --> 06:23:29,119 TO WORK TOGETHER BOTH IN CANCER 8900 06:23:29,186 --> 06:23:33,256 AS WELL AS HIV, TO REDUCE 8901 06:23:33,323 --> 06:23:34,257 STIGMA, BRING INTERVENTIONS THAT 8902 06:23:34,324 --> 06:23:35,659 WORK AND IMPROVE ON THE 8903 06:23:35,726 --> 06:23:37,160 IMPLEMENTATION OF THE SCIENCE 8904 06:23:37,227 --> 06:23:37,794 THAT IS ALREADY ONGOING. 8905 06:23:37,861 --> 06:23:42,232 THANK YOU SO MUCH FOR YOUR TIME. 8906 06:23:42,299 --> 06:23:43,667 THANK YOU FOR INVITING US TO 8907 06:23:43,734 --> 06:23:44,267 SPEAK WITH YOU. 8908 06:23:44,334 --> 06:23:52,709 THANK YOU. 8909 06:24:06,623 --> 06:24:11,161 >> I'LL BE MODERATING THIS PART 8910 06:24:11,228 --> 06:24:12,929 OF THE SESSION. 8911 06:24:12,996 --> 06:24:14,464 I DON'T SEE ANY QUESTIONS. 8912 06:24:14,531 --> 06:24:16,199 YOU STILL HAVE TIME TO PUT SOME 8913 06:24:16,266 --> 06:24:16,633 IN. 8914 06:24:16,700 --> 06:24:18,802 I'LL TAKE THE PREROGATIVE OF THE 8915 06:24:18,869 --> 06:24:21,004 MODERATOR AND I HAVE A COUPLE OF 8916 06:24:21,071 --> 06:24:26,143 QUESTIONS THAT I CAN ADD. 8917 06:24:26,209 --> 06:24:29,646 BOTH TO CARLA, JOEL, AND AS WELL 8918 06:24:29,713 --> 06:24:32,082 AS ANNA, YOU MENTIONED THAT ONE 8919 06:24:32,149 --> 06:24:34,451 OF THE PROBLEMS THAT PEOPLE 8920 06:24:34,518 --> 06:24:39,289 LIVING WITH HIV AND FOCUS FOR 8921 06:24:39,356 --> 06:24:41,258 THIS WORKSHOP IS WOMEN, THEY DO 8922 06:24:41,324 --> 06:24:42,592 NOT RECEIVE APPROPRIATE 8923 06:24:42,659 --> 06:24:45,429 TREATMENT FOR CANCER. 8924 06:24:45,495 --> 06:24:47,564 AND SO IS THIS REALLY -- HAS 8925 06:24:47,631 --> 06:24:49,166 ANYBODY LOOKED TO SEE WHETHER 8926 06:24:49,232 --> 06:24:51,768 THIS IS DUE TO THEY CAN'T AFFORD 8927 06:24:51,835 --> 06:24:53,637 THE CANCER CARE, HIV CARE, THERE 8928 06:24:53,703 --> 06:24:56,173 ARE MANY PROGRAMS THAT SUPPORTS 8929 06:24:56,239 --> 06:24:59,209 THEIR HIV TREATMENT, ONCE YOU 8930 06:24:59,276 --> 06:25:03,046 GET A CANCER IT JUST BECOMES 8931 06:25:03,113 --> 06:25:04,181 VERY DIFFICULT AND SOMETIMES 8932 06:25:04,247 --> 06:25:06,016 HARD TO NAVIGATE TO GET THE 8933 06:25:06,082 --> 06:25:06,550 APPROPRIATE CARE. 8934 06:25:06,616 --> 06:25:09,186 AND I GUESS I'LL START WITH 8935 06:25:09,252 --> 06:25:14,424 CARLA AND THEN IF ANY OF THE 8936 06:25:14,491 --> 06:25:15,559 OTHER PANELISTS HAVE ANYTHING TO 8937 06:25:15,625 --> 06:25:17,861 ADD I WOULD LOVE TO HEAR YOUR 8938 06:25:17,928 --> 06:25:21,565 COMMENTS. 8939 06:25:21,631 --> 06:25:23,099 >> THANKS. 8940 06:25:23,166 --> 06:25:27,270 I THINK IT'S MULTI-FACTORIAL AS 8941 06:25:27,337 --> 06:25:31,441 MANY OF THE INTRACTABLE THINGS 8942 06:25:31,508 --> 06:25:34,845 ARE, CERTAINLY CANCER CARE IS 8943 06:25:34,911 --> 06:25:36,480 MORE COSTLY AND COMPLEX, AS YOU 8944 06:25:36,546 --> 06:25:39,649 POINT OUT MAY NOT BE COVERED OR 8945 06:25:39,716 --> 06:25:43,153 COVERED IN FULL THROUGH NATIONAL 8946 06:25:43,220 --> 06:25:43,520 PROGRAMS. 8947 06:25:43,587 --> 06:25:48,992 SO I THINK THAT'S ONE PART OF 8948 06:25:49,059 --> 06:25:49,159 IT. 8949 06:25:49,226 --> 06:25:52,496 ADJACENT TO THAT IS THE FACT 8950 06:25:52,562 --> 06:25:56,867 THAT IN MANY LMICs, YOU WOULD 8951 06:25:56,933 --> 06:26:00,804 NEED TO TRAVEL VAST, VAST 8952 06:26:00,871 --> 06:26:02,906 DISTANCES, TO BE ABLE TO ACCESS 8953 06:26:02,973 --> 06:26:05,509 CANCER CARE. 8954 06:26:05,575 --> 06:26:07,143 SO THERE'S THE COST ASSOCIATED 8955 06:26:07,210 --> 06:26:09,246 WITH TRAVEL, EVEN IF CARE ITSELF 8956 06:26:09,312 --> 06:26:13,950 IS PROVIDED IN THE PUBLIC 8957 06:26:14,017 --> 06:26:14,518 SYSTEM. 8958 06:26:14,584 --> 06:26:17,888 AND THEN I THINK AS WAS 8959 06:26:17,954 --> 06:26:20,857 MENTIONED PREVIOUSLY, THERE IS A 8960 06:26:20,924 --> 06:26:26,296 FAIR AMOUNT OF PROVIDER BIAS, 8961 06:26:26,363 --> 06:26:36,473 AND, YOU KNOW, OPTING OUT OF 8962 06:26:36,540 --> 06:26:39,209 CURATIVE TREATMENT PROTOCOLS 8963 06:26:39,276 --> 06:26:41,411 WITHOUT INITIALLY BEGINNING A 8964 06:26:41,478 --> 06:26:42,846 CURATIVE TREATMENT PROTOCOL AND 8965 06:26:42,913 --> 06:26:48,885 UNDERSTANDING WHETHER OR NOT THE 8966 06:26:48,952 --> 06:26:49,953 PATIENT CAN TOLERATE THAT. 8967 06:26:50,020 --> 06:26:52,355 I'M SURE THERE ARE PERSPECTIVES 8968 06:26:52,422 --> 06:26:53,023 FROM OTHERS. 8969 06:26:53,089 --> 06:26:53,990 >> ACTUALLY THERE'S ONE THAT 8970 06:26:54,057 --> 06:26:55,692 CAME FROM THE AUDIENCE THAT I'M 8971 06:26:55,759 --> 06:26:57,928 GOING TO -- THIS WAS MAINLY FOR 8972 06:26:57,994 --> 06:27:00,530 BRENDA, HOW MUCH OF CERVICAL 8973 06:27:00,597 --> 06:27:04,067 CANCER IN AFRICA IS ASSOCIATED 8974 06:27:04,134 --> 06:27:05,068 WITH TRADITIONAL GENITAL 8975 06:27:05,135 --> 06:27:07,003 MUTILATION AND OTHER PRACTICES? 8976 06:27:07,070 --> 06:27:09,072 I GUESS CARLA OR BRENDA CAN 8977 06:27:09,139 --> 06:27:12,142 ADDRESS THIS BECAUSE YOU HAVE 8978 06:27:12,208 --> 06:27:19,916 PROBABLY THE CLOSEST LOOK INTO 8979 06:27:19,983 --> 06:27:20,150 AFRICA. 8980 06:27:20,216 --> 06:27:21,785 >> I CAN GO FIRST. 8981 06:27:21,851 --> 06:27:23,520 AND SO THIS IS ONE OF THE AREAS 8982 06:27:23,587 --> 06:27:27,023 THAT I WOULD WANT FOR US TO ALSO 8983 06:27:27,090 --> 06:27:29,559 LOOK INTO AS PART OF THE 8984 06:27:29,626 --> 06:27:30,760 RESEARCH THAT CAN BE CARRIED 8985 06:27:30,827 --> 06:27:31,294 OUT. 8986 06:27:31,361 --> 06:27:37,334 ONE OR TWO STUDIES MENTIONED 8987 06:27:37,400 --> 06:27:40,937 ABOUT THE INFLAMMATION, RISK OF 8988 06:27:41,004 --> 06:27:42,606 INFLAMMATION IN FEMALE GENITAL 8989 06:27:42,672 --> 06:27:42,906 MUTILATION. 8990 06:27:42,973 --> 06:27:44,441 I'M LOOK FOR THAT AND POST IT ON 8991 06:27:44,507 --> 06:27:46,676 THE CHAT RIGHT NOW BUT EVEN AS 8992 06:27:46,743 --> 06:27:48,812 WE'RE DOING SO I THINK LIKE FOR 8993 06:27:48,878 --> 06:27:54,985 EXAMPLE WE HAVE A DEMONSTRATION 8994 06:27:55,051 --> 06:27:55,685 PROGRAM IN (INDISCERNIBLE) 8995 06:27:55,752 --> 06:27:58,822 COUNTY WHERE THAT'S ONE OF THE 8996 06:27:58,888 --> 06:27:59,456 TRADITIONAL CULTURAL PRACTICES 8997 06:27:59,522 --> 06:27:59,990 CARRIED OUT. 8998 06:28:00,056 --> 06:28:01,958 WE DON'T WANT TO GO TO THE 8999 06:28:02,025 --> 06:28:03,293 COMMUNITY AND START STIGMATIZING 9000 06:28:03,360 --> 06:28:07,130 WOMEN AND SAYING BECAUSE YOU'VE 9001 06:28:07,197 --> 06:28:09,532 GOTTEN A CULTURAL PRACTICE THAT, 9002 06:28:09,599 --> 06:28:10,433 YES, IT'S REPRESSIVE BUT 9003 06:28:10,500 --> 06:28:11,968 AFFECTED YOUR HEALTH THAT YOU 9004 06:28:12,035 --> 06:28:13,370 ALSO ARE PUTTING YOURSELF AT 9005 06:28:13,436 --> 06:28:16,806 RISK BECAUSE SOMETIMES WOMEN 9006 06:28:16,873 --> 06:28:18,174 DON'T HAVE THE CHOICE. 9007 06:28:18,241 --> 06:28:20,243 IT IS A CULTURAL THING. 9008 06:28:20,310 --> 06:28:23,313 SO PROBABLY IF WE HAD A STUDY 9009 06:28:23,380 --> 06:28:25,382 THAT COULD LOOK AT WOMEN WE'RE 9010 06:28:25,448 --> 06:28:27,484 FINDING AS POSITIVE WE HAVE A 9011 06:28:27,550 --> 06:28:29,119 QUESTIONNAIRE THAT ASKS THEM 9012 06:28:29,185 --> 06:28:32,489 ABOUT THEIR HEALTH STATUS IN 9013 06:28:32,555 --> 06:28:34,157 TERMS OF FGM, THEN WE COULD SAY 9014 06:28:34,224 --> 06:28:38,395 THAT CORRELATION IS REAL AND 9015 06:28:38,461 --> 06:28:40,497 ALSO START MESSAGES THAT CAN 9016 06:28:40,563 --> 06:28:42,565 BRING WOMEN TO UNDERSTAND RISK 9017 06:28:42,632 --> 06:28:43,767 FACTOR FOR OUT. 9018 06:28:43,833 --> 06:28:44,868 RIGHT NOW SPEAKING FROM THE 9019 06:28:44,934 --> 06:28:46,603 HEART I WOULD HESITATE TO GO TO 9020 06:28:46,670 --> 06:28:47,804 THE COMMUNITY THAT WE'RE 9021 06:28:47,871 --> 06:28:49,239 TELLING, BRING YOUR GIRLS TO BE 9022 06:28:49,305 --> 06:28:54,144 VACCINATED, AND AT THE SAME TIME 9023 06:28:54,210 --> 06:28:57,447 ALSO TELLING THEM YOUR CULTURAL 9024 06:28:57,514 --> 06:28:59,516 PRACTICES ARE PUTTING WOMEN AT 9025 06:28:59,582 --> 06:29:03,353 RISK OF CARVEEL IS CANCER, 9026 06:29:03,420 --> 06:29:04,888 THAT'S DOUBLE STIGMA, THEY ARE 9027 06:29:04,954 --> 06:29:09,025 DOUBTING THE VACCINE AND WE'RE 9028 06:29:09,092 --> 06:29:11,361 TELLING THEM ABOUT FGM, THEY 9029 06:29:11,428 --> 06:29:13,530 HOLD DEARLY, WITHOUT EVIDENCE I 9030 06:29:13,596 --> 06:29:14,631 WOULD HESITATE. 9031 06:29:14,698 --> 06:29:17,600 I INVITE YOU LET'S WORK 9032 06:29:17,667 --> 06:29:18,101 TOGETHER. 9033 06:29:18,168 --> 06:29:20,036 THANK YOU. 9034 06:29:20,103 --> 06:29:23,173 >> CARLA, ANYTHING TO ADD? 9035 06:29:23,239 --> 06:29:26,876 >> JUST TO ADD OR JUST TO ECHO 9036 06:29:26,943 --> 06:29:31,114 THERE ISN'T A LOT OF RESEARCH ON 9037 06:29:31,181 --> 06:29:32,849 FGM AND ITS ASSOCIATION, 9038 06:29:32,916 --> 06:29:34,818 POTENTIAL ASSOCIATION WITH RISK 9039 06:29:34,884 --> 06:29:37,754 FOR HPV INFECTION. 9040 06:29:37,821 --> 06:29:41,591 BUT THERE'S SOME RESEARCH ON 9041 06:29:41,658 --> 06:29:44,661 VAGINAL DRYING PRACTICES, YOU 9042 06:29:44,728 --> 06:29:46,096 KNOW, WHICH TAKE DIFFERENT 9043 06:29:46,162 --> 06:29:48,598 FLAVORS ACROSS THE CONTINENT BUT 9044 06:29:48,665 --> 06:29:49,566 ARE RELATIVELY COMMON AND ARE 9045 06:29:49,632 --> 06:29:57,674 THOUGHT TO CHANGE THE VAGINAL 9046 06:29:57,741 --> 06:30:02,278 MICROBIOME. 9047 06:30:02,345 --> 06:30:07,717 >> WE HAVE SOME QUESTIONS NOW. 9048 06:30:07,784 --> 06:30:09,486 HIGH RISK HPV COMMON AMONG A 9049 06:30:09,552 --> 06:30:12,789 COHORT OF WOMEN WITH FEMALE -- 9050 06:30:12,856 --> 06:30:13,957 OH, OKAY. 9051 06:30:14,023 --> 06:30:16,593 THERE'S A CITATION THERE WHERE 9052 06:30:16,659 --> 06:30:18,795 IT SHOWS WOMEN WHO HAD FEMALE 9053 06:30:18,862 --> 06:30:23,399 GENITAL MUTILATION HAD HIGHER 9054 06:30:23,466 --> 06:30:24,501 RISK OF HPV. 9055 06:30:24,567 --> 06:30:26,703 AND I APPRECIATE THE IDEA OF 9056 06:30:26,770 --> 06:30:29,205 DOUBLE STIGMA BUT OUR YOUNG 9057 06:30:29,272 --> 06:30:33,276 GIRLS ARE DEFINITELY BEING 9058 06:30:33,343 --> 06:30:34,577 EXPOSED MORE BECAUSE OF MANY 9059 06:30:34,644 --> 06:30:36,412 PRACTICES, THIS IS AN ISSUE WE 9060 06:30:36,479 --> 06:30:39,716 DON'T REALLY NORMALLY TALK ABOUT 9061 06:30:39,783 --> 06:30:44,721 WHEN IT COMES TO CERVICAL CANCER 9062 06:30:44,788 --> 06:30:45,855 PREVENTION, CERTAINLY IS ONE 9063 06:30:45,922 --> 06:30:46,823 THAT'S QUITE INTERESTING. 9064 06:30:46,890 --> 06:30:49,125 I DON'T KNOW IF WE'RE RUNNING 9065 06:30:49,192 --> 06:30:51,628 OUT OF TIME, IF NOT I CAN ASK 9066 06:30:51,694 --> 06:30:52,529 MORE QUESTIONS. 9067 06:30:52,595 --> 06:30:56,232 I DON'T SEE ANY ON THE CHAT. 9068 06:30:56,299 --> 06:30:59,302 ACTUALLY, I HAD ONE QUESTION FOR 9069 06:30:59,369 --> 06:31:01,871 JOEL PALEFSKY IF YOU'RE STILL 9070 06:31:01,938 --> 06:31:02,038 ON. 9071 06:31:02,105 --> 06:31:02,839 >> I'M STILL ON. 9072 06:31:02,906 --> 06:31:06,309 >> YOU KNOW, ONE OF THE THINGS I 9073 06:31:06,376 --> 06:31:09,379 NOTED WAS THERE WAS QUITE -- IN 9074 06:31:09,445 --> 06:31:11,714 BOTH GROUPS, DO YOU KNOW WHAT 9075 06:31:11,781 --> 06:31:13,516 DEATHS WERE DUE TO? 9076 06:31:13,583 --> 06:31:14,951 >> YEAH, ON THE DEATH RATES, 9077 06:31:15,018 --> 06:31:17,887 THEY WERE HIGH BUT NONE RELATED 9078 06:31:17,954 --> 06:31:18,988 TO THE STUDY. 9079 06:31:19,055 --> 06:31:21,057 AND THIS IS A POPULATION THAT 9080 06:31:21,124 --> 06:31:26,296 HAD A LOT OF LIFE CHALLENGES, I 9081 06:31:26,362 --> 06:31:28,398 THINK DEATH RATES WERE IN LINE 9082 06:31:28,464 --> 06:31:30,567 WITH WHAT WOULD HAVE BEEN 9083 06:31:30,633 --> 06:31:31,367 EXPECTED GIVEN THE CHALLENGING 9084 06:31:31,434 --> 06:31:32,802 LIFE CIRCUMSTANCES OF MANY OF 9085 06:31:32,869 --> 06:31:35,171 OUR PARTICIPANTS. 9086 06:31:35,238 --> 06:31:38,007 >> SO, IN THE ANCHOR TRIAL YOU 9087 06:31:38,074 --> 06:31:41,978 SHOWED ON YOUR SLIDES YOU HAD A 9088 06:31:42,045 --> 06:31:45,248 GROUP THAT WAS TRANS, BUT DIDN'T 9089 06:31:45,315 --> 06:31:48,418 BREAK IT DOWN TO TRANSWOMEN OR 9090 06:31:48,484 --> 06:31:48,685 TRANSMEN. 9091 06:31:48,751 --> 06:31:52,355 >> ALMOST ALL BORN MALE. 9092 06:31:52,422 --> 06:31:53,356 TRANSITIONED TO FEMALE. 9093 06:31:53,423 --> 06:31:53,623 >> OKAY. 9094 06:31:53,690 --> 06:31:56,359 I THINK WE'RE ASKED TO CUT OFF, 9095 06:31:56,426 --> 06:31:58,161 RIGHT? 9096 06:31:58,228 --> 06:32:00,196 >> YES, I WAS JUST EXTENDING MY 9097 06:32:00,263 --> 06:32:01,264 THANKS ALSO. 9098 06:32:01,331 --> 06:32:02,131 >> THANK YOU, EVERYONE. 9099 06:32:02,198 --> 06:32:04,868 IT WAS A GREAT SESSION. 9100 06:32:04,934 --> 06:32:08,238 AND THANK YOU FOR STAYING ON. 9101 06:32:11,741 --> 06:32:17,680 >> WE'LL HAND IT OVER TO CORETTÉ 9102 06:32:17,747 --> 06:32:19,682 BIRD AND MELISSA HERRERA TO 9103 06:32:19,749 --> 06:32:21,951 MODERATE OUR CONCLUDING SESSION. 9104 06:32:22,018 --> 06:32:22,819 >> SO WONDERFUL. 9105 06:32:22,886 --> 06:32:25,255 THANK YOU ALL. 9106 06:32:25,321 --> 06:32:26,322 GOOD AFTERNOON, AND EVENING. 9107 06:32:26,389 --> 06:32:28,925 I JUST THANK YOU FOR YOUR 9108 06:32:28,992 --> 06:32:30,727 PATIENCE, AS WE HAVE MADE IT TO 9109 06:32:30,793 --> 06:32:34,731 THE FINAL SESSION OF THE HIV AND 9110 06:32:34,797 --> 06:32:36,199 WOMEN SCIENTIFIC WORKSHOP, 9111 06:32:36,266 --> 06:32:37,367 HEALTH DISPARITIES AND EQUITY. 9112 06:32:37,433 --> 06:32:39,435 I DO WANT TO THANK OUR SPEAKERS 9113 06:32:39,502 --> 06:32:41,404 AND VIEWERS FOR YOUR FLEXIBILITY 9114 06:32:41,471 --> 06:32:48,511 AS WE'VE HAD SOME VERY RICH 9115 06:32:48,578 --> 06:32:48,945 DISCUSSIONS. 9116 06:32:49,012 --> 06:32:52,348 WE'VE GOTTEN BEHIND SCHEDULE FOR 9117 06:32:52,415 --> 06:32:55,985 THE LAST SESSION, I THANK YOU IN 9118 06:32:56,052 --> 06:32:56,586 ADVANCE. 9119 06:32:56,653 --> 06:32:58,488 AS I'M CORETTÉ BYRD, WITH THE 9120 06:32:58,554 --> 06:33:01,224 NIH OFFICE OF AIDS RESEARCH, I'M 9121 06:33:01,291 --> 06:33:04,494 JOINED BY MY COLLEAGUE, MELISSA 9122 06:33:04,560 --> 06:33:06,796 HERRERA, ALSO FROM OAR, TO 9123 06:33:06,863 --> 06:33:10,533 MODERATE THIS SESSION. 9124 06:33:10,600 --> 06:33:12,936 AS WAS NOTED IN THE WORKSHOP 9125 06:33:13,002 --> 06:33:13,569 INTRODUCTION YESTERDAY THIS 9126 06:33:13,636 --> 06:33:17,140 WORKSHOP IS PART OF A SIGNATURE 9127 06:33:17,206 --> 06:33:18,608 PROGRAM ON HIV AND WOMEN. 9128 06:33:18,675 --> 06:33:21,778 THE CORNERSTONE OF THE PROGRAM 9129 06:33:21,844 --> 06:33:23,479 IS AN INTERSECTIONAL 9130 06:33:23,546 --> 06:33:24,948 EQUITY-INFORMED AND DATA-DRIVEN 9131 06:33:25,014 --> 06:33:26,950 APPROACH TO RESEARCH ON HIV IN 9132 06:33:27,016 --> 06:33:27,517 WOMEN. 9133 06:33:27,583 --> 06:33:30,987 IT HAS BEEN WELL DOCUMENTED THAT 9134 06:33:31,054 --> 06:33:33,389 SOCIAL AND STRUCTURAL FACTORS 9135 06:33:33,456 --> 06:33:35,491 INTERACTED WITH BIOLOGICAL 9136 06:33:35,558 --> 06:33:37,560 FACTORS TO CREATE INEQUALITIES 9137 06:33:37,627 --> 06:33:39,295 FOR TRANSGENDER WOMEN, WOMEN OF 9138 06:33:39,362 --> 06:33:42,899 COLOR, AND THE OTHER COMMUNITIES 9139 06:33:42,966 --> 06:33:44,801 OF WOMEN DISPROPORTIONATELY 9140 06:33:44,867 --> 06:33:48,171 IMPACTED BY HIV. 9141 06:33:48,237 --> 06:33:49,439 STRUCTURAL RACISM, RESTRICTIONS 9142 06:33:49,505 --> 06:33:51,641 ON HEALTH CARE, AND OTHER SOCIAL 9143 06:33:51,708 --> 06:33:56,145 AND STRUCTURAL BARRIERS TO 9144 06:33:56,212 --> 06:33:58,114 PREVENTION, DIAGNOSIS, AND CARE, 9145 06:33:58,181 --> 06:34:00,516 EXACERBATE RACIAL AND GENDER 9146 06:34:00,583 --> 06:34:02,819 IDENTITY AND INEQUITIES IN THE 9147 06:34:02,885 --> 06:34:03,486 HIV EPIDEMIC. 9148 06:34:03,553 --> 06:34:06,422 WE'RE HONORED TO BE JOINED BY 9149 06:34:06,489 --> 06:34:09,625 LEADERS FROM ADVOCACY, HELD 9150 06:34:09,692 --> 06:34:12,028 CARE, AND RESEARCH SECTORS TO 9151 06:34:12,095 --> 06:34:13,463 HIGHLIGHT PROMISING STRATEGIES 9152 06:34:13,529 --> 06:34:15,198 TO ADDRESS HEALTH DISPARITIES 9153 06:34:15,264 --> 06:34:18,267 AND PROMOTE HEALTH EQUITY FOR 9154 06:34:18,334 --> 06:34:24,741 ALL WOMEN AND GENDER DIVERSE 9155 06:34:24,807 --> 06:34:24,974 PEOPLE. 9156 06:34:25,041 --> 06:34:27,143 TODAY SPEAKERS ARE SHOWN HERE, 9157 06:34:27,210 --> 06:34:31,514 FULL BIOS ON THE EVENT WEB PAGE. 9158 06:34:31,581 --> 06:34:34,050 KARIE STEWART IS A PRACTICING 9159 06:34:34,117 --> 06:34:37,353 MIDWIFE, UNIVERSITY OF ILLINOIS 9160 06:34:37,420 --> 06:34:38,721 HEALTH CENTER AND DEPARTMENT OF 9161 06:34:38,788 --> 06:34:49,198 ON THE -- OBSTETRICS AND 9162 06:35:00,643 --> 06:35:01,444 GYNECOLOGY. 9163 06:35:01,511 --> 06:35:03,279 SARI REISNER IS TENURED 9164 06:35:03,346 --> 06:35:05,648 ASSOCIATE PROFESSOR, DEPARTMENT 9165 06:35:05,715 --> 06:35:07,417 OF EPIDEMIOLOGY, UNIVERSITY OF 9166 06:35:07,483 --> 06:35:09,819 MICHIGAN SCHOOL OF PUBLIC 9167 06:35:09,886 --> 06:35:10,119 HEALTH. 9168 06:35:10,186 --> 06:35:12,455 TRAINED AS SOCIAL AND 9169 06:35:12,522 --> 06:35:14,090 PSYCHIATRIC EPIDEMIOLOGIST, HIS 9170 06:35:14,157 --> 06:35:17,460 RESEARCH SEEKS TO IDENTIFY AND 9171 06:35:17,527 --> 06:35:18,795 MITIGATE HEALTH INEQUITIES WITH 9172 06:35:18,861 --> 06:35:22,765 FOCUS ON TRANSGENDER AND GENDER 9173 06:35:22,832 --> 06:35:26,903 DIVERSE POPULATIONS, AND 9174 06:35:26,969 --> 06:35:36,746 ADOLESCENTS. 9175 06:35:36,813 --> 06:35:39,482 HIV PREVENTION. 9176 06:35:39,549 --> 06:35:46,722 MALLERJ JENNA ROBINSON IS 9177 06:35:46,789 --> 06:35:48,691 TRANSGENDER ADVOCATE, CREATOR OF 9178 06:35:48,758 --> 06:35:52,862 HATEFUL HOMICIDE, TRUE CRIME, 9179 06:35:52,929 --> 06:36:02,505 INVESTIGATIVE JOURNALISM PODCAST 9180 06:36:02,572 --> 06:36:03,606 COVERING HATE CRIMES, IN THE 9181 06:36:03,673 --> 06:36:06,776 UNITED STATES AND ABROAD. 9182 06:36:06,843 --> 06:36:09,512 MARTHA THOLANAH IS A HUMAN 9183 06:36:09,579 --> 06:36:11,147 RIGHTS ACTIVIST, HAS 9184 06:36:11,214 --> 06:36:13,883 DEMONSTRATED ABILITY TO ENGAGE 9185 06:36:13,950 --> 06:36:16,619 INFLUENCE, SHAPE POLICY AND 9186 06:36:16,686 --> 06:36:20,456 PRACTICE, GRASS ROOT AND GRASS 9187 06:36:20,523 --> 06:36:26,129 TOP LEVELS IN ZIMBABWE, HAS 9188 06:36:26,195 --> 06:36:31,000 HELPED LEADERSHIP ROLES IN THE 9189 06:36:31,067 --> 06:36:33,669 AIDS MALIGNANCY CONSORTIUM 9190 06:36:33,736 --> 06:36:35,471 INTERNATIONAL COMMUNITY ADVISORY 9191 06:36:35,538 --> 06:36:35,671 BOARD. 9192 06:36:35,738 --> 06:36:38,307 AND THE AIDS CLINICAL TRIALS 9193 06:36:38,374 --> 06:36:40,376 GROUP'S GLOBAL COMMUNITY 9194 06:36:40,443 --> 06:36:42,578 ADVISORY BOARD AND GAY AND 9195 06:36:42,645 --> 06:36:46,616 LESBIAN ASSOCIATION OF ZIMBABWE. 9196 06:36:46,682 --> 06:36:49,118 WE'VE JUST LEARNED MARTHA'S 9197 06:36:49,185 --> 06:36:50,253 HAVING NETWORK CHALLENGES FROM 9198 06:36:50,319 --> 06:36:51,988 ZIMBABWE AND MAY NOT BE ABLE TO 9199 06:36:52,054 --> 06:36:53,189 JOIN US TODAY. 9200 06:36:53,256 --> 06:36:54,390 HOWEVER, WE'RE KEEPING OUR 9201 06:36:54,457 --> 06:36:58,494 FINGERS CROSSED THAT SHE WILL BE 9202 06:36:58,561 --> 06:37:00,129 ABLE TO JOIN US. 9203 06:37:00,196 --> 06:37:03,633 AND AS I TURN IT OVER TO KARIE, 9204 06:37:03,699 --> 06:37:06,235 A REMINDER TO SUBMIT YOUR 9205 06:37:06,302 --> 06:37:09,872 QUESTIONS USING THE "LIVE 9206 06:37:09,939 --> 06:37:12,175 FEEDBACK" FORM AND WE'LL ANSWER 9207 06:37:12,241 --> 06:37:14,944 THEM AS POSSIBLE. 9208 06:37:15,011 --> 06:37:15,878 KARIE, PLEASE GO AHEAD. 9209 06:37:15,945 --> 06:37:20,149 >> THANK YOU FOR HAVING ME. 9210 06:37:20,216 --> 06:37:26,289 I'M A CERTIFIED NURSED MY WIFE, 9211 06:37:26,355 --> 06:37:29,025 FOUNDER AND OWNER CEO, A FULL 9212 06:37:29,091 --> 06:37:33,396 SCOPE MIDWIFE UNIVERSITY OF 9213 06:37:33,462 --> 06:37:34,163 ILLINOIS CHICAGO. 9214 06:37:34,230 --> 06:37:36,599 I WOULD LIKE FOR US TO EXAMINE 9215 06:37:36,666 --> 06:37:39,202 MATERNAL MORTALITY RATES IN THE 9216 06:37:39,268 --> 06:37:40,203 UNITED STATES. 9217 06:37:40,269 --> 06:37:44,240 EXAMINE HIV RATES AMONG WOMEN IN 9218 06:37:44,307 --> 06:37:49,145 THE UNITED STATES AS WELL. 9219 06:37:49,212 --> 06:37:52,014 ALSO EXAMINE INFLUENCE HIV, 9220 06:37:52,081 --> 06:37:54,650 RATES AND INFLUENCES ON BOTH 9221 06:37:54,717 --> 06:37:56,285 RATES AS WELL AS DISCUSS CALLS 9222 06:37:56,352 --> 06:38:04,060 TO ACTION. 9223 06:38:04,126 --> 06:38:05,361 NEXT SLIDE PLEASE. 9224 06:38:05,428 --> 06:38:07,129 IF YOU'VE NOT SEEN THIS SLIDE, 9225 06:38:07,196 --> 06:38:11,167 THIS IS THE CURRENT U.S. 9226 06:38:11,234 --> 06:38:12,268 MATERNAL MORTALITY RATES, THE 9227 06:38:12,335 --> 06:38:13,936 MATERNAL DEATH IS DEFINED BY THE 9228 06:38:14,003 --> 06:38:15,438 WORLD HEALTH ORGANIZATION AS 9229 06:38:15,504 --> 06:38:19,842 DEATH OF A WOMAN WHILE PREGNANT 9230 06:38:19,909 --> 06:38:26,415 OR WITHIN 42 DAYS OF TERMINATION 9231 06:38:26,482 --> 06:38:27,617 OF PREGNANCY IRRESPECTIVE OF 9232 06:38:27,683 --> 06:38:29,352 DURATION AND SITE OF PREGNANCY. 9233 06:38:29,418 --> 06:38:32,121 THE NUMBER OF MATERNAL DEATHS 9234 06:38:32,188 --> 06:38:33,422 PER 100,000 LIVE BIRTHS ARE 9235 06:38:33,489 --> 06:38:36,025 SHOWN IN THIS REPORT BY AGE 9236 06:38:36,092 --> 06:38:43,065 GROUP AND RACE AND HISPANIC 9237 06:38:43,132 --> 06:38:45,468 ORIGIN. 9238 06:38:45,534 --> 06:38:47,203 THIS UPDATES A PREVIOUS ONE, 9239 06:38:47,270 --> 06:38:56,078 2018 TO 2020. 9240 06:38:56,145 --> 06:39:03,185 IN 2021, 861 IN 2020, 754 IN 9241 06:39:03,252 --> 06:39:03,519 2019. 9242 06:39:03,586 --> 06:39:07,023 THE RATE FOR 20201 WAS 32.9 PER 9243 06:39:07,089 --> 06:39:08,491 100,000 LIVE BIRTHS COMPARED 9244 06:39:08,557 --> 06:39:13,562 WITH RATE OF 23.78 IN 2020 AND 9245 06:39:13,629 --> 06:39:15,331 20.1 IN 2009. 9246 06:39:15,398 --> 06:39:18,267 IN 2020 THE RATE FOR 9247 06:39:18,334 --> 06:39:23,539 NON-HISPANIC BLACK WOMEN WAS 9248 06:39:23,606 --> 06:39:25,708 69.9 DEATHS PER 100,000 LIVE 9249 06:39:25,775 --> 06:39:29,545 BIRTHS, DRASTIC INCREASE FROM 9250 06:39:29,612 --> 06:39:33,049 PREVIOUS YEAR FROM 55.3. 9251 06:39:33,115 --> 06:39:34,917 SO RATES INCREASE ALSO, WHICH 9252 06:39:34,984 --> 06:39:38,087 ISN'T DISPLAYED, WITH MATERNAL 9253 06:39:38,154 --> 06:39:38,254 AGE. 9254 06:39:38,321 --> 06:39:41,457 THOSE RATES IN 2021 WERE 20.4 9255 06:39:41,524 --> 06:39:45,094 DEATHS PER LIVE BIRTHS, AND 9256 06:39:45,161 --> 06:39:50,032 INCREASED TO 31.3. 9257 06:39:50,099 --> 06:39:51,801 NEXT SLIDE PLEASE. 9258 06:39:51,867 --> 06:39:52,968 THIS SHOWS THAT THERE'S SPECIFIC 9259 06:39:53,035 --> 06:39:56,572 TIMING THAT CAN BE EXAMINED AS 9260 06:39:56,639 --> 06:39:59,241 WELL, EVEN FURTHER, AND THIS IS 9261 06:39:59,308 --> 06:40:01,610 COURTESY OF NIH AND CDC, SOME OF 9262 06:40:01,677 --> 06:40:03,479 THE INFORMATION, WE CAN LOOK AT 9263 06:40:03,546 --> 06:40:06,215 THIS SLIDE AND DETERMINES THAT 9264 06:40:06,282 --> 06:40:10,286 IT SHOWS THAT 31% OF THOSE THAT 9265 06:40:10,353 --> 06:40:12,154 PASS AWAY, THAT OCCURS DURING 9266 06:40:12,221 --> 06:40:14,323 PREGNANCY, BUT THE MAJORITY OF 9267 06:40:14,390 --> 06:40:18,327 THAT OCCURS IN THE POSTPARTUM 9268 06:40:18,394 --> 06:40:20,329 PERIOD, AND SO, YOU KNOW, 9269 06:40:20,396 --> 06:40:21,997 PREVIOUSLY WE HAD PROGRAMS IN 9270 06:40:22,064 --> 06:40:27,002 UNDERSTANDING AND THINGS THAT 9271 06:40:27,069 --> 06:40:28,304 WOULD OCCUR, EVENTS OR 9272 06:40:28,371 --> 06:40:29,638 IMPLEMENTATION PROGRAMS I SHOULD 9273 06:40:29,705 --> 06:40:32,808 SAY THAT FOCUSED ON ONE ENTITY. 9274 06:40:32,875 --> 06:40:38,948 OR FOCUSED ON PREGNANCY, HOW WE 9275 06:40:39,014 --> 06:40:40,149 FIX MORTALITY THROUGH PREGNANCY 9276 06:40:40,216 --> 06:40:41,650 OR AT DELIVERY BUT WE SHOULD 9277 06:40:41,717 --> 06:40:47,123 FOCUS ON THE ENTIRE PROCESS BUT 9278 06:40:47,189 --> 06:40:48,290 NOTICING POSTPARTUM IS WHEN THEY 9279 06:40:48,357 --> 06:40:51,093 ARE OCCURRING AND WHAT ARE WE 9280 06:40:51,160 --> 06:40:52,928 DOING DURING THAT PERIOD. 9281 06:40:52,995 --> 06:40:59,034 APPROXIMATELY 700 WOMEN DIE, 9282 06:40:59,101 --> 06:40:59,535 ANNUALLY, FROM PREGNANCY 9283 06:40:59,602 --> 06:41:01,670 COMPLICATIONS IN THE UNITED 9284 06:41:01,737 --> 06:41:04,607 STATES, YOU CAN SEE HOW THEY ARE 9285 06:41:04,673 --> 06:41:06,041 DISTRIBUTED HERE. 9286 06:41:06,108 --> 06:41:09,345 AND I WOULD HAVE TO -- I WOULD 9287 06:41:09,412 --> 06:41:13,616 BE REMISS IF I DIDN'T SAY MOST 9288 06:41:13,682 --> 06:41:15,384 PREGNANCY-RELATED DEATHS ARE 9289 06:41:15,451 --> 06:41:16,685 PREVENTIBLE. 9290 06:41:16,752 --> 06:41:18,554 WE NEED TO DEMONSTRATE NEED TO 9291 06:41:18,621 --> 06:41:21,357 IDENTIFY STRATEGIES TO ADDRESS 9292 06:41:21,424 --> 06:41:29,165 THE MULTIPLE CONTRIBUTING 9293 06:41:29,231 --> 06:41:29,698 FACTORS. 9294 06:41:29,765 --> 06:41:30,332 NEXT SLIDE. 9295 06:41:30,399 --> 06:41:32,001 MATERNITY CARE IS FAILING BLACK 9296 06:41:32,067 --> 06:41:34,270 WOMEN. 9297 06:41:34,336 --> 06:41:39,375 BLACK WOMEN ARE EXPRESSING THEIR 9298 06:41:39,442 --> 06:41:41,277 EXPERIENCES AND DISCRIMINATORY 9299 06:41:41,343 --> 06:41:41,710 CARE. 9300 06:41:41,777 --> 06:41:44,013 WOMEN ARE PASSING AWAY AT 9301 06:41:44,079 --> 06:41:45,981 ALARMING RATES. 9302 06:41:46,048 --> 06:41:49,051 AND THEY ARE HAVING INSUFFICIENT 9303 06:41:49,118 --> 06:41:52,221 CARE, INSUFFICIENT CARE OF 9304 06:41:52,288 --> 06:41:52,988 COORDINATION WRAPAROUND 9305 06:41:53,055 --> 06:41:54,156 SERVICES, AGAIN AS WE SHOWED IN 9306 06:41:54,223 --> 06:41:57,159 THE PREVIOUS SLIDE A THIRD OF 9307 06:41:57,226 --> 06:42:02,097 THOSE DEATHS OCCUR IN THAT 9308 06:42:02,164 --> 06:42:03,065 POSTPARTUM PERIOD SPECIFICALLY. 9309 06:42:03,132 --> 06:42:07,236 WE NEED TO FOCUS ON 9310 06:42:07,303 --> 06:42:08,871 INTERVENTIONS THAT TARGET 9311 06:42:08,938 --> 06:42:09,839 INDIVIDUAL LEVEL COMPLICATIONS 9312 06:42:09,905 --> 06:42:14,777 FOCUSING ON POSTPARTUM PERIOD. 9313 06:42:14,844 --> 06:42:17,112 80% OF MATERNAL DEATHS ARE 9314 06:42:17,179 --> 06:42:17,413 PREVENTIBLE. 9315 06:42:17,480 --> 06:42:21,283 FOR EACH ONE WHO DIES, 50 TO 100 9316 06:42:21,350 --> 06:42:22,918 EXPERIENCE A NEAR-DEATH 9317 06:42:22,985 --> 06:42:29,592 EXPERIENCE, THAT'S UNACCEPTABLE. 9318 06:42:29,658 --> 06:42:30,893 NEXT SLIDE PLEASE. 9319 06:42:30,960 --> 06:42:34,730 IN THE DATA IT SHOWS CDC JUST 9320 06:42:34,797 --> 06:42:35,731 REPORTED LAST YEAR THAT, YOU 9321 06:42:35,798 --> 06:42:38,601 KNOW, WHAT WOMEN ARE ACTUALLY 9322 06:42:38,667 --> 06:42:40,202 SAYING, WHAT THEIR EXPERIENCES 9323 06:42:40,269 --> 06:42:42,004 ARE, WHEN THEY GIVE BIRTH, WHEN 9324 06:42:42,071 --> 06:42:43,973 THEY ARE PREGNANT, AND 9325 06:42:44,039 --> 06:42:45,207 SPECIFICALLY ABOUT THEIR 9326 06:42:45,274 --> 06:42:46,809 MISTREATMENT DURING THIS TIME 9327 06:42:46,876 --> 06:42:47,343 PERIOD. 9328 06:42:47,409 --> 06:42:50,112 ABOUT 20% OF WOMEN REPORTED 9329 06:42:50,179 --> 06:42:51,614 MISTREATMENT WHILE RECEIVING 9330 06:42:51,680 --> 06:42:53,816 MATERNITY CARE. 9331 06:42:53,883 --> 06:42:57,653 ABOUT 30% OF BLACK WOMEN, BLACK 9332 06:42:57,720 --> 06:43:00,956 HISPANIC AND MULTI-RACIAL WOMEN 9333 06:43:01,023 --> 06:43:03,893 REPORTED MISTREATMENT. 9334 06:43:03,959 --> 06:43:06,095 AND ABOUT ALMOST HALF, 45%, HELD 9335 06:43:06,161 --> 06:43:08,264 BACK FROM ASKING QUESTIONS AND 9336 06:43:08,330 --> 06:43:10,566 SHARING CONCERNS DURING 9337 06:43:10,633 --> 06:43:13,302 MATERNITY CARE PERIOD. 9338 06:43:13,369 --> 06:43:15,504 SO YOU CAN SEE, YOU KNOW, THESE 9339 06:43:15,571 --> 06:43:16,839 EXPERIENCES ARE CAUSING SOME 9340 06:43:16,906 --> 06:43:18,140 BARRIERS TO THEIR CARE. 9341 06:43:18,207 --> 06:43:23,045 AND SO WHAT DO WE NEED TO DO 9342 06:43:23,112 --> 06:43:24,380 ABOUT IT? 9343 06:43:24,446 --> 06:43:26,015 LET'S TAKE THE CORRELATION AND 9344 06:43:26,081 --> 06:43:27,216 TALK ABOUT HIV. 9345 06:43:27,283 --> 06:43:27,883 NEXT SLIDE. 9346 06:43:27,950 --> 06:43:32,354 SO, AS YOU CAN SEE HERE, IN 2019 9347 06:43:32,421 --> 06:43:33,889 IN THE UNITED STATES BLACK 9348 06:43:33,956 --> 06:43:35,624 AFRICAN AMERICAN FEMALE ADULTS 9349 06:43:35,691 --> 06:43:37,960 AND ADOLESCENTS MADE UP 13% OF 9350 06:43:38,027 --> 06:43:40,029 THE FEMALE POPULATION, BUT 9351 06:43:40,095 --> 06:43:42,331 ACCOUNTED FOR 55% OF DIAGNOSIS 9352 06:43:42,398 --> 06:43:44,733 OF HIV INFECTION AMONG FEMALES. 9353 06:43:44,800 --> 06:43:46,468 WHITE FEMALE ADULTS AND 9354 06:43:46,535 --> 06:43:50,072 ADOLESCENTS MADE UP 62% OF THE 9355 06:43:50,139 --> 06:43:51,073 FEMALE POPULATION, ACCOUNTED FOR 9356 06:43:51,140 --> 06:43:55,210 22% OF DIAGNOSIS OF HIV 9357 06:43:55,277 --> 06:43:56,312 INFECTION. 9358 06:43:56,378 --> 06:44:02,217 HISPANIC LATINA FEMALE ADULTS 9359 06:44:02,284 --> 06:44:12,194 ANDED AND -- ADOLESCENTS 17%. 9360 06:44:12,261 --> 06:44:21,070 YOU CAN SEE WHO IT AFFECTS. 9361 06:44:21,136 --> 06:44:22,938 NEXT SLIDE. 9362 06:44:23,005 --> 06:44:24,239 SPECIFICALLY, PEOPLE, PREGNANT 9363 06:44:24,306 --> 06:44:27,643 PEOPLE WITH HIV, ARE 9364 06:44:27,710 --> 06:44:29,511 EXPERIENCING SOCIAL AND ECONOMIC 9365 06:44:29,578 --> 06:44:32,314 FACTORS, ESPECIALLY POVERTY. 9366 06:44:32,381 --> 06:44:34,116 THERE'S STIGMA ASSOCIATED WITH 9367 06:44:34,183 --> 06:44:36,819 HIV, PEOPLE WITH HIV. 9368 06:44:36,885 --> 06:44:40,856 BUT MORE IMPORTANTLY WE'RE 9369 06:44:40,923 --> 06:44:42,291 NOTICING PREGNANT PEOPLE ARE 9370 06:44:42,358 --> 06:44:47,429 FACING MORE BARRIERS, WITH HIV. 9371 06:44:47,496 --> 06:44:49,198 BLACK AND BROWN INDIVIDUALS VERY 9372 06:44:49,264 --> 06:44:50,833 VULNERABLE POPULATIONS ARE 9373 06:44:50,899 --> 06:44:52,034 ALREADY EXPERIENCING BARRIERS, 9374 06:44:52,101 --> 06:44:54,003 BUT THIS POPULATION IS 9375 06:44:54,069 --> 06:44:56,405 EXPERIENCING EVEN MORE OF THOSE 9376 06:44:56,472 --> 06:44:56,739 BARRIERS. 9377 06:44:56,805 --> 06:44:59,742 AND THAT CAN BE, YOU KNOW, 9378 06:44:59,808 --> 06:45:02,678 ATTRIBUTED TO STAYING 9379 06:45:02,745 --> 06:45:04,213 SPECIFICALLY ASSESSING HEALTH 9380 06:45:04,279 --> 06:45:05,514 CARE, STAYING ON TREATMENT, IF 9381 06:45:05,581 --> 06:45:08,917 THEY INJECT DRUGS, USE OF 9382 06:45:08,984 --> 06:45:13,288 SUBSTANCES, EXPERIENCE WITH 9383 06:45:13,355 --> 06:45:14,523 HOMELESSNESS, INCARCERATION, 9384 06:45:14,590 --> 06:45:17,292 MENTAL ILLNESS AND UNINSURED. 9385 06:45:17,359 --> 06:45:18,994 HOW DOES RACISM PLAY? 9386 06:45:19,061 --> 06:45:20,429 THERE ARE BIASES AND 9387 06:45:20,496 --> 06:45:21,630 DISCRIMINATION IN MATERNITY CARE 9388 06:45:21,697 --> 06:45:23,465 SETTINGS THAT IMPACT CARE. 9389 06:45:23,532 --> 06:45:25,868 AND AS WE JUST SHOWED YOU, THERE 9390 06:45:25,934 --> 06:45:27,936 ARE POOR COMMUNICATION, CAN 9391 06:45:28,003 --> 06:45:29,838 WORSEN MATERNAL OUTCOMES. 9392 06:45:29,905 --> 06:45:33,342 WE NEED TO UNDERSTAND HOW WE 9393 06:45:33,409 --> 06:45:34,109 ADDRESS THAT SPECIFICALLY 9394 06:45:34,176 --> 06:45:37,146 MISTREATMENT BY MATERNITY CARE 9395 06:45:37,212 --> 06:45:38,947 PROVIDERS WAS REPORTED MOST 9396 06:45:39,014 --> 06:45:40,783 OFTEN BY BLACK, HISPANIC, 9397 06:45:40,849 --> 06:45:43,519 MULTI-RACIAL MOMS. 9398 06:45:43,585 --> 06:45:46,689 PEOPLE WITH NO INSURANCE 9399 06:45:46,755 --> 06:45:48,057 EXPERIENCE MORE MISTREATMENT 9400 06:45:48,123 --> 06:45:52,027 THAN PEOPLE PRIVATELY INSURED. 9401 06:45:52,094 --> 06:45:54,363 AND SO SOMETIMES IT'S HARD FOR 9402 06:45:54,430 --> 06:45:56,765 PREGNANT PEOPLE TO ASK QUESTIONS 9403 06:45:56,832 --> 06:45:58,167 OR SHARE CONCERNS, MATERNITY 9404 06:45:58,233 --> 06:46:00,102 CARE PROVIDERS CAN IMPROVE THEIR 9405 06:46:00,169 --> 06:46:05,074 COMMUNICATION BY CREATING AN 9406 06:46:05,140 --> 06:46:06,375 ENVIRONMENT OF TRUST. 9407 06:46:06,442 --> 06:46:09,978 PROVIDERS CAN TAKE TIME TO HEAR 9408 06:46:10,045 --> 06:46:11,513 CONCERNS AND OFTEN HAVE OPEN 9409 06:46:11,580 --> 06:46:13,082 CONVERSATIONS TO MAKE SURE 9410 06:46:13,148 --> 06:46:14,917 ISSUES ARE ADEQUATELY ADDRESSED. 9411 06:46:14,983 --> 06:46:16,785 AND WHEN THERE'S GOOD 9412 06:46:16,852 --> 06:46:17,419 COMMUNICATION ABOUT HEALTH 9413 06:46:17,486 --> 06:46:19,388 CONCERNS BETWEEN MOMS AND 9414 06:46:19,455 --> 06:46:21,223 PROVIDERS IT IS MORE LIKELY 9415 06:46:21,290 --> 06:46:24,526 THERE WILL BE ACCURATE TIMELY 9416 06:46:24,593 --> 06:46:28,030 DIAGNOSIS AND TREATMENT AND 9417 06:46:28,097 --> 06:46:28,931 POTENTIAL LIFE-THREATENING 9418 06:46:28,997 --> 06:46:29,998 COMPLICATIONS ARE PREVENTED. 9419 06:46:30,065 --> 06:46:32,668 SO FROM THIS SLIDE HERE YOU CAN 9420 06:46:32,735 --> 06:46:36,238 SEE SPECIFICALLY HOW IT WAS 9421 06:46:36,305 --> 06:46:38,540 BROKEN DOWN, COMMUNITY 9422 06:46:38,607 --> 06:46:40,509 DETERMINATION ON DISCRIMINATION 9423 06:46:40,576 --> 06:46:44,480 CONTRIBUTING TO DEATHS. 9424 06:46:44,546 --> 06:46:45,013 NEXT SLIDE. 9425 06:46:45,080 --> 06:46:49,618 AND SO WHAT CAN WE DO? 9426 06:46:49,685 --> 06:46:51,053 WE NEED TO RALLY AROUND 9427 06:46:51,120 --> 06:46:51,954 RESPECTFUL CARE. 9428 06:46:52,020 --> 06:46:54,456 SO THE CDC HAS PUT OUT 9429 06:46:54,523 --> 06:46:56,358 SPECIFICALLY AREAS THAT CAN 9430 06:46:56,425 --> 06:46:57,760 ADDRESS THIS, HEALTH CARE 9431 06:46:57,826 --> 06:46:59,027 SYSTEMS, MATERNITY CARE 9432 06:46:59,094 --> 06:47:00,796 PROVIDERS, AND EVERYONE AS A 9433 06:47:00,863 --> 06:47:01,130 WHOLE. 9434 06:47:01,196 --> 06:47:04,399 AND SO THESE ARE JUST SOME 9435 06:47:04,466 --> 06:47:08,670 IDEAS, YOU KNOW, HIRING DIVERSE 9436 06:47:08,737 --> 06:47:12,841 WORKFORCE, ENCOURAGING SUPPORT 9437 06:47:12,908 --> 06:47:14,309 WITH CARE, DOULAS, LISTENING 9438 06:47:14,376 --> 06:47:15,677 PATIENTS, ALLOWING THEM TO BE 9439 06:47:15,744 --> 06:47:16,612 HEARD, FOLLOWING THROUGH ON 9440 06:47:16,678 --> 06:47:18,747 THEIR CONCERNS THEY ARE BRINGING 9441 06:47:18,814 --> 06:47:22,151 TO US, AND REALLY ENCOURAGING 9442 06:47:22,217 --> 06:47:24,453 WOMEN TO SEEK CARE, AND 9443 06:47:24,520 --> 06:47:26,555 SUPPORTIVE CARE, GETTING SECOND 9444 06:47:26,622 --> 06:47:28,390 OPINIONS, GOING PLACES WHERE 9445 06:47:28,457 --> 06:47:31,126 THEY FEEL SUPPORTED, RACIAL 9446 06:47:31,193 --> 06:47:32,561 CONCORDANT CARE, THESE THINGS 9447 06:47:32,628 --> 06:47:34,296 TOGETHER COLLABORATIVE CARE IS 9448 06:47:34,363 --> 06:47:37,266 GOING TO ADDRESS OR SUPPORT 9449 06:47:37,332 --> 06:47:40,435 ADDRESSING THESE CONDITIONS. 9450 06:47:40,502 --> 06:47:40,869 NEXT SLIDE. 9451 06:47:40,936 --> 06:47:43,172 AND SO MY CALL TO ACTION IS 9452 06:47:43,238 --> 06:47:45,340 RECOGNIZING THAT RACE IS NOT A 9453 06:47:45,407 --> 06:47:46,475 BIOLOGICAL REALITY. 9454 06:47:46,542 --> 06:47:48,944 RACISM IS A PROBLEM. 9455 06:47:49,011 --> 06:47:50,913 SPECIFICALLY HERE IN ILLINOIS, 9456 06:47:50,979 --> 06:47:52,247 WE ARE ADDRESSING THINGS THROUGH 9457 06:47:52,314 --> 06:47:53,782 POLICY SYSTEMS AND STRUCTURAL 9458 06:47:53,849 --> 06:47:55,984 CHANGES AND WE HAVE, YOU KNOW, 9459 06:47:56,051 --> 06:47:57,319 ADDRESSED MEDICARE BENEFITS AND 9460 06:47:57,386 --> 06:47:59,354 CONTINUING THAT OVER 12 MONTHS, 9461 06:47:59,421 --> 06:48:01,223 WE'VE PASSED LEGISLATION TO 9462 06:48:01,290 --> 06:48:11,834 COVER IN-HOME POST PARTUM VISITS 9463 06:48:13,335 --> 06:48:16,672 UNDER MEDICAID, SUPPORTIVE OF 9464 06:48:16,738 --> 06:48:18,340 MOMNIBUS, GOVERNOR SUPPORTED A 9465 06:48:18,407 --> 06:48:19,842 BILL TO PUT $20 MILLION TO 9466 06:48:19,908 --> 06:48:21,176 MATERNAL HEALTH CARE AND SUPPORT 9467 06:48:21,243 --> 06:48:23,145 BIRTH CENTERS SO WE'RE TRYING TO 9468 06:48:23,212 --> 06:48:24,213 BE PRO-ACTIVE IN OUR STATE AND 9469 06:48:24,279 --> 06:48:27,282 IT SHOULD BE DONE IN EVERY STATE 9470 06:48:27,349 --> 06:48:28,717 TO REALLY HIGHLIGHT THE THINGS 9471 06:48:28,784 --> 06:48:30,485 THAT NEED TO BE DONE TO SUPPORT 9472 06:48:30,552 --> 06:48:34,289 OUR MOMS OF COLOR. 9473 06:48:34,356 --> 06:48:34,923 NEXT SLIDE. 9474 06:48:34,990 --> 06:48:38,460 AND SO I WANT TO THANK NIH FOR 9475 06:48:38,527 --> 06:48:39,995 INVITING ME HERE. 9476 06:48:40,062 --> 06:48:42,197 UNIVERSITY OF ILLINOIS AND 9477 06:48:42,264 --> 06:48:43,398 OBSTETRICS DEPARTMENT, THE TEAM, 9478 06:48:43,465 --> 06:48:48,637 AS WELL AS MY RESEARCH TEAM, 9479 06:48:48,704 --> 06:48:49,938 MIDWIFERY CARE TEAM. 9480 06:48:50,005 --> 06:48:51,607 THANK YOU. 9481 06:48:51,673 --> 06:48:54,209 >> THANK YOU SO MUCH FOR YOUR 9482 06:48:54,276 --> 06:48:54,543 PRESENTATION. 9483 06:48:54,610 --> 06:49:05,120 SO NOW WE WILL MOVE ON TO HEAR 9484 06:49:09,458 --> 06:49:10,859 FROM SARI REISNER. 9485 06:49:10,926 --> 06:49:16,531 >> I'M GOING TO SHARE SOME WORK, 9486 06:49:16,598 --> 06:49:18,433 SPEAKING ABOUT VULNERABILITY IN 9487 06:49:18,500 --> 06:49:24,473 THE LATIN AMERICA CONTEXT. 9488 06:49:24,539 --> 06:49:26,642 THE FIRST THING TO SET THE STAGE 9489 06:49:26,708 --> 06:49:30,345 LOOKING AT TRANSGENDER WOMEN AND 9490 06:49:30,412 --> 06:49:34,516 PEOPLE OF TRANSFEMININE 9491 06:49:34,583 --> 06:49:35,384 EXPERIENCE, A META-ANALYSIS 9492 06:49:35,450 --> 06:49:36,818 SHOWS HIGH RATES IN THE 9493 06:49:36,885 --> 06:49:38,787 POPULATION, YOU CAN SEE ON THE 9494 06:49:38,854 --> 06:49:42,591 FINAL ROW STUDIES IN LATIN 9495 06:49:42,658 --> 06:49:44,026 AMERICAN CONTEXT, PREVALENCE IS 9496 06:49:44,092 --> 06:49:46,328 26%, IF YOU COMPARE THAT TO 9497 06:49:46,395 --> 06:49:48,864 ADULTS OF TEENAGE OR OLDER IN 9498 06:49:48,931 --> 06:49:50,499 REPRODUCTIVE AGES, IN THOSE 9499 06:49:50,565 --> 06:49:53,001 SPECIFIC COUNTRIES, IT ENDS UP 9500 06:49:53,068 --> 06:49:55,304 BEING 96-FOLD INCREASED ODDS FOR 9501 06:49:55,370 --> 06:49:56,071 TRANSFEMININE PEOPLE, REALLY 9502 06:49:56,138 --> 06:50:00,108 HIGH BURDEN. 9503 06:50:00,175 --> 06:50:01,877 NEXT SLIDE PLEASE. 9504 06:50:01,944 --> 06:50:04,713 SOME PROCESSES WHAT'S DRIVING 9505 06:50:04,780 --> 06:50:10,752 THE EPIGENETIC FOR TRANSWOMEN 9506 06:50:10,819 --> 06:50:12,921 AND TRANSFEMININE PEOPLE, THIS 9507 06:50:12,988 --> 06:50:17,526 IS SITUATING BIOLOGICAL RISK FOR 9508 06:50:17,592 --> 06:50:19,928 INFECTION SO INCLUDING THROUGH 9509 06:50:19,995 --> 06:50:21,229 SEXUAL PRACTICES, DRUG NEEDLES, 9510 06:50:21,296 --> 06:50:23,865 HIGH RISK OF CO-INFECTION, 9511 06:50:23,932 --> 06:50:25,167 MENTAL HEALTH, INTERPERSONAL 9512 06:50:25,233 --> 06:50:26,401 VIOLENCE, SOCIAL NETWORK 9513 06:50:26,468 --> 06:50:26,969 CHARACTERISTICS, COMMUNITY, 9514 06:50:27,035 --> 06:50:36,478 LASTLY BUT NOT LEAST STRUCTURAL 9515 06:50:36,545 --> 06:50:37,012 FACTORS. 9516 06:50:37,079 --> 06:50:38,013 IN LATIN AMERICA SETTING IN 9517 06:50:38,080 --> 06:50:40,983 PARTICULAR THESE ARE DATA FROM 9518 06:50:41,049 --> 06:50:42,918 TRANSGENDER MONITORING PROJECT, 9519 06:50:42,985 --> 06:50:46,321 THE DARKEST AREA SHADED IS IN 9520 06:50:46,388 --> 06:50:47,622 LATIN AMERICA SETTING, 74% IF 9521 06:50:47,689 --> 06:50:50,792 YOU LOOK THE MOST RECENT DATA 9522 06:50:50,859 --> 06:50:54,763 FROM OCTOBER 2022 TO 2023, 74% 9523 06:50:54,830 --> 06:50:58,300 IN LATIN AMERICA CONTEXT. 9524 06:50:58,367 --> 06:51:00,635 WE HAVE UNDERSTOOD IN THE 9525 06:51:00,702 --> 06:51:07,109 CONTEXT OF LARGER EPIDEMIC OF 9526 06:51:07,175 --> 06:51:07,876 VIOLENCE. 9527 06:51:07,943 --> 06:51:10,579 THESE ARE PHOTOS FROM A PROJECT 9528 06:51:10,645 --> 06:51:13,015 IN PERU, WHERE I'M SHOWING WORK, 9529 06:51:13,081 --> 06:51:18,120 YOU CAN SEE THE CONTEXT OF 9530 06:51:18,186 --> 06:51:19,688 STIGMA, A FAMILY ON THE RIGHT, 9531 06:51:19,755 --> 06:51:21,356 TRANSWOMEN ON THE LEFT, BROADER 9532 06:51:21,423 --> 06:51:21,990 CONTEXT PEOPLE ARE WALKING 9533 06:51:22,057 --> 06:51:26,161 AROUND LIVING IN THE WORLD, THAT 9534 06:51:26,228 --> 06:51:28,797 IS A MAJOR SHAPER AND 9535 06:51:28,864 --> 06:51:29,197 CONTRIBUTOR. 9536 06:51:29,264 --> 06:51:32,034 THERE IS DIFFERENT THINKING OF 9537 06:51:32,100 --> 06:51:33,368 VIOLENCE, ECONOMIC VIOLENCE THAT 9538 06:51:33,435 --> 06:51:34,903 IS HAPPENING AT STRUCTURAL LEVEL 9539 06:51:34,970 --> 06:51:37,539 IN PART DUE TO TRANSPHOBIA, IN 9540 06:51:37,606 --> 06:51:45,180 PART RACISM, AND SO FORTH. 9541 06:51:45,247 --> 06:51:47,682 SEX WORK IS MAIN SOURCE OF 9542 06:51:47,749 --> 06:51:49,584 OCCUPATION FOR MANY TRANSWOMEN, 9543 06:51:49,651 --> 06:51:51,086 AND WE GET EXPOSURES IN THAT 9544 06:51:51,153 --> 06:51:55,991 SETTING TO MANY THINGS SUCH AS 9545 06:51:56,058 --> 06:51:56,825 STRUCTURAL VIOLATIONS FROM 9546 06:51:56,892 --> 06:52:00,262 POLICE AND SO FORTH. 9547 06:52:00,328 --> 06:52:02,564 WE HAVE LEGAL VIOLENCE, LACK OF 9548 06:52:02,631 --> 06:52:04,099 RECOGNITION AROUND GENDER THAT'S 9549 06:52:04,166 --> 06:52:05,967 HAPPENING, ABILITY TO CHANGE 9550 06:52:06,034 --> 06:52:08,170 GENDER MARKERS, LEGAL NAME 9551 06:52:08,236 --> 06:52:10,472 CHANGE, THOSE THINGS. 9552 06:52:10,539 --> 06:52:11,907 SO THERE'S HETEROGENEITY ACROSS 9553 06:52:11,973 --> 06:52:14,142 LATIN AMERICAN AREA IN TERMS OF 9554 06:52:14,209 --> 06:52:16,078 COUNTRIES MORE PERMISSIVE, FOR 9555 06:52:16,144 --> 06:52:18,280 EXAMPLE ARGENTINA, OTHER PLACES 9556 06:52:18,346 --> 06:52:21,416 LIKE PERU ARE NOT. 9557 06:52:21,483 --> 06:52:23,852 WHEN I TALK ABOUT LATIN AMERICA 9558 06:52:23,919 --> 06:52:26,254 THERE MANY COUNTRIES IN LATIN 9559 06:52:26,321 --> 06:52:27,355 AMERICA, TODAY I'M FOCUSING 9560 06:52:27,422 --> 06:52:29,224 PRIMARILY ON WORK I'VE DONE IN 9561 06:52:29,291 --> 06:52:29,524 PERU. 9562 06:52:29,591 --> 06:52:30,192 NEXT SLIDE. 9563 06:52:30,258 --> 06:52:34,029 SO IT'S ALSO IMPORTANT TO THINK 9564 06:52:34,096 --> 06:52:36,031 ABOUT DEVELOPMENTAL CONTEXT, SO 9565 06:52:36,098 --> 06:52:37,866 SOCIAL ECOLOGICAT MODEL, THIS IS 9566 06:52:37,933 --> 06:52:40,035 HAPPENING OVER TIME, NOT STATIC. 9567 06:52:40,102 --> 06:52:42,137 IF WE THINK ABOUT PARTICULARLY 9568 06:52:42,204 --> 06:52:46,475 PEOPLE GROWING UP, IN CHILDHOOD, 9569 06:52:46,541 --> 06:52:48,443 ADOLESCENCE, YOUNG ADULTHOOD, WE 9570 06:52:48,510 --> 06:52:50,745 REALLY START TO UNPACK THE WAYS 9571 06:52:50,812 --> 06:52:52,280 OF THESE ECOLOGIES OPERATE IS 9572 06:52:52,347 --> 06:52:53,081 DIFFERENT. 9573 06:52:53,148 --> 06:52:54,916 THERE MAY BE SCHOOL CONTEXTS AT 9574 06:52:54,983 --> 06:52:57,119 ONE AGE, MAY BE MORE EMPLOYMENT 9575 06:52:57,185 --> 06:52:58,553 CONTEXT AT ANOTHER MORE RELEVANT 9576 06:52:58,620 --> 06:53:00,388 AND SO FORTH. 9577 06:53:00,455 --> 06:53:04,993 WITH PARTNERSHIPS, PEOPLE ARE 9578 06:53:05,060 --> 06:53:06,428 FIRST EXPLORING SEXUALITY THAT'S 9579 06:53:06,495 --> 06:53:12,134 DIFFERENT THAN LATER IN LIFE 9580 06:53:12,200 --> 06:53:13,969 WITH OTHER SEXUAL EXPERIENCES. 9581 06:53:14,035 --> 06:53:18,006 A STUDY FUNDED BY NIMH, R21 9582 06:53:18,073 --> 06:53:22,043 LOOKING AT CONTEXT OF HIV 9583 06:53:22,110 --> 06:53:22,711 VULNERABILITIES FOR YOUNG 9584 06:53:22,777 --> 06:53:24,713 TRANSWOMEN IN THE CONTEXT OF 9585 06:53:24,779 --> 06:53:26,314 PERU PARTICULARLY IN LIMA. 9586 06:53:26,381 --> 06:53:29,618 WE DID SOME QUALITATIVE 9587 06:53:29,684 --> 06:53:31,586 INTERVIEWS, IDENTIFIED THEMES IN 9588 06:53:31,653 --> 06:53:34,756 FORMATIVE WORK AND A PIECE 9589 06:53:34,823 --> 06:53:35,957 AROUND DEVELOPMENTAL 9590 06:53:36,024 --> 06:53:36,391 CONSIDERATIONS. 9591 06:53:36,458 --> 06:53:40,595 THAT THERE WERE FAMILY REJECTION 9592 06:53:40,662 --> 06:53:43,298 WAS PATTERNING ALONGSIDE 9593 06:53:43,365 --> 06:53:45,267 MIGRATION, MIGRATING FROM OTHER 9594 06:53:45,333 --> 06:53:50,405 AREAS OUTSIDE OF LIMA INTO THIS 9595 06:53:50,472 --> 06:53:53,041 VICINITY, INTRANATIONAL, FROM 9596 06:53:53,108 --> 06:54:02,918 THE JUNGLE TO LIMA FOR BETTER 9597 06:54:02,984 --> 06:54:04,085 OPPORTUNITY, VENEZUELA AND 9598 06:54:04,152 --> 06:54:06,021 DIASPORA, EVOLUTION COMING TO 9599 06:54:06,087 --> 06:54:06,888 DEVELOPMENTALLY ONE'S GENDER IS 9600 06:54:06,955 --> 06:54:10,325 PART OF THIS IN THE CONTEXT OF 9601 06:54:10,392 --> 06:54:11,459 PEER BULLYING AND SO FORTH IN 9602 06:54:11,526 --> 06:54:13,962 RELATION TO THAT. 9603 06:54:14,029 --> 06:54:15,397 WE THINK ABOUT HIV VULNERABILITY 9604 06:54:15,463 --> 06:54:17,933 AND PREVENTION AND TREATMENT 9605 06:54:17,999 --> 06:54:22,604 WE'RE WORKING IN THIS FRAMEWORK. 9606 06:54:22,671 --> 06:54:29,878 WE FOLLOWED THIS WITH A SURVEY, 9607 06:54:29,945 --> 06:54:30,712 SEROEPIDEMIOLOGIC SURVEY TO 9608 06:54:30,779 --> 06:54:31,012 UNDERSTAND. 9609 06:54:31,079 --> 06:54:32,747 THIS WAS FIELDED FROM FEBRUARY 9610 06:54:32,814 --> 06:54:36,518 TO JUNE IN 2022. 9611 06:54:36,585 --> 06:54:39,120 WE RECRUITED YOUNG TRANS-WOMEN 9612 06:54:39,187 --> 06:54:46,027 16-24 RESIDING IN LIMA, WORKED 9613 06:54:46,094 --> 06:54:47,562 WITH COMMUNITY ORGANIZATION 9614 06:54:47,629 --> 06:54:48,530 FEMINAS, A WONDERFUL GROUP, 9615 06:54:48,597 --> 06:54:50,832 WORKING WITH THEM MANY YEARS, 9616 06:54:50,899 --> 06:54:54,035 DOING INCREDIBLED A ADVOCACY 9617 06:54:54,102 --> 06:54:54,402 WORK. 9618 06:54:54,469 --> 06:54:55,870 WE PARTNERED WITH THEM. 9619 06:54:55,937 --> 06:54:58,740 THEY HAVE BEEN WANTING TO DO 9620 06:54:58,807 --> 06:54:59,941 MORE WORK WITH YOUTH AND THAT 9621 06:55:00,008 --> 06:55:03,211 WAS A PART OF THIS AS WELL, 9622 06:55:03,278 --> 06:55:03,878 INCREASING EVERYBODY'S CAPACITY 9623 06:55:03,945 --> 06:55:05,413 TO WORK WITH THIS POPULATION AND 9624 06:55:05,480 --> 06:55:07,382 REACH THIS POPULATION. 9625 06:55:07,449 --> 06:55:10,885 IT WAS A NON-PROBABILITY SAMPLE, 9626 06:55:10,952 --> 06:55:13,722 211 INDIVIDUALS WITH BEHAVIORAL 9627 06:55:13,788 --> 06:55:16,224 SURVEY, HIV TESTING, OVERALL STI 9628 06:55:16,291 --> 06:55:19,628 TESTING, 78% PROVIDED BLOOD 9629 06:55:19,694 --> 06:55:20,428 SPECIMEN. 9630 06:55:20,495 --> 06:55:22,998 PEOPLE WERE COMPENSATED WITH 9631 06:55:23,064 --> 06:55:23,798 INCENTIVE, CONDOMS, IRB 9632 06:55:23,865 --> 06:55:24,833 APPROVED, DONE IN COLLABORATION 9633 06:55:24,899 --> 06:55:32,974 WITH THE UNIVERSITY OF PERU, AND 9634 06:55:33,041 --> 06:55:36,378 UNIVERSITY OF TORONTO. 9635 06:55:36,444 --> 06:55:37,779 NEXT SLIDE PLEASE. 9636 06:55:37,846 --> 06:55:40,515 SO LARGELY IN TERMS OF THE 9637 06:55:40,582 --> 06:55:42,384 SAMPLE WE DID UNFORTUNATELY FIND 9638 06:55:42,450 --> 06:55:44,786 HIGH PREVENTIBLE LENS OF THE 9639 06:55:44,853 --> 06:55:46,454 BURDENS I'VE PREVIOUSLY 9640 06:55:46,521 --> 06:55:49,424 ARTICULATED THAT WE SEE, THE 9641 06:55:49,491 --> 06:55:53,762 SAMPLE ARE MEDIAN AGE OF 23, 9642 06:55:53,828 --> 06:55:57,966 LARGELY NON-WHITE. 9643 06:55:58,033 --> 06:56:08,576 INDIGENOUS PERUVIAN AND MESTIZA, 9644 06:56:16,651 --> 06:56:19,254 ECONOMIC PRE-CARITY, 51%. 9645 06:56:19,321 --> 06:56:23,758 17% CONDOMLESS STRESS FOR MONEY, 9646 06:56:23,825 --> 06:56:28,563 50% REPORTED MIGRATING, HIGH 9647 06:56:28,630 --> 06:56:29,164 HOMELESSNESS, CHILDHOOD 9648 06:56:29,230 --> 06:56:30,865 EXPERIENCES LIKE ASKING PEOPLE 9649 06:56:30,932 --> 06:56:32,867 ABOUT THEIR CHILDHOOD BULLYING 9650 06:56:32,934 --> 06:56:34,703 EXPERIENCES WERE COMMON. 9651 06:56:34,769 --> 06:56:37,572 ACEs ARE ADVERSE CHILDHOOD 9652 06:56:37,639 --> 06:56:38,540 EXPERIENCES, VALIDATED SCALE, 9653 06:56:38,606 --> 06:56:41,276 ALSO UNFORTUNATELY COMMON IN 9654 06:56:41,343 --> 06:56:43,878 FAMILY REJECTION REPORTED BY 9655 06:56:43,945 --> 06:56:48,383 ABOUT 1 IN 5. 9656 06:56:48,450 --> 06:56:50,018 ADOLESCENT VIOLENCE WAS HIGH, 9657 06:56:50,085 --> 06:56:50,251 60%. 9658 06:56:50,318 --> 06:56:54,422 WE FIELDED A SCALE SPECIFIC TO 9659 06:56:54,489 --> 06:56:55,790 TRANSGENDER INTIMATE PARTNER 9660 06:56:55,857 --> 06:56:57,359 VIOLENCE ASKING PEOPLE ABOUT 9661 06:56:57,425 --> 06:56:58,660 COERCION AND CONTROL AROUND 9662 06:56:58,727 --> 06:57:01,296 THINGS RELATED TO GENDER LIKE, 9663 06:57:01,363 --> 06:57:02,297 FOR EXAMPLE, NOT LETTING THEM 9664 06:57:02,364 --> 06:57:03,898 DRESS OR PRESENT IN A WAY THEY 9665 06:57:03,965 --> 06:57:07,435 WOULD WANT TO AND SO FORTH, 9666 06:57:07,502 --> 06:57:08,970 REPORTED BY 25%. 9667 06:57:09,037 --> 06:57:13,007 MENTAL HEALTH UNFORTUNATE RATES 9668 06:57:13,074 --> 06:57:15,243 HIGH, 24% SUICIDE, AND PSYCH 9669 06:57:15,310 --> 06:57:21,483 DISTRESS, PTSD AND AUDIT. 9670 06:57:21,549 --> 06:57:24,419 20% ACCESSED HORMONES, VERY FEW 9671 06:57:24,486 --> 06:57:25,186 RECEIVING SUPERVISION FOR 9672 06:57:25,253 --> 06:57:28,790 HORMONES, AND HEALTH CARE 9673 06:57:28,857 --> 06:57:31,326 DISCRIMINATION PRACTICES, 17% 9674 06:57:31,393 --> 06:57:33,595 REPORTED FILLERS. 9675 06:57:33,661 --> 06:57:36,664 SO, THE SEROPREVALENCE WAS 41%. 9676 06:57:36,731 --> 06:57:39,401 79, THIS IS A SAMPLE THAT'S 23 9677 06:57:39,467 --> 06:57:41,703 YEARS OLD RANGING FROM 16-24. 9678 06:57:41,770 --> 06:57:46,207 79% WERE NEW HIV DIAGNOSES. 9679 06:57:46,274 --> 06:57:51,045 CO-INFECTION RATES WERE HIGH, 9680 06:57:51,112 --> 06:57:52,680 OVERALL GREATER THAN 64% ARE 9681 06:57:52,747 --> 06:57:55,850 MORE THAN ONE STI, HIGHLY 9682 06:57:55,917 --> 06:57:57,285 ASSOCIATED WITH HIV, SO 9683 06:57:57,352 --> 06:57:57,819 CO-INFECTION. 9684 06:57:57,886 --> 06:57:59,854 WE ALSO LOOKED AMONG THOSE NOT 9685 06:57:59,921 --> 06:58:03,191 LIVING WITH HIV AT THE PrEP 9686 06:58:03,258 --> 06:58:03,892 CASCADE, PRE-EXPOSURE 9687 06:58:03,958 --> 06:58:05,193 PROPHYLAXIS TO PREVENT HIV. 9688 06:58:05,260 --> 06:58:07,028 HERE IS THE CASCADE. 9689 06:58:07,095 --> 06:58:08,163 YOU CAN SEE THE PERCENTAGES AT 9690 06:58:08,229 --> 06:58:12,167 THE TOP OF THE BARS ARE OF THE 9691 06:58:12,233 --> 06:58:14,235 FULL SAMPLE, 140, YELLOW ARROWS 9692 06:58:14,302 --> 06:58:16,404 ARE THE PERCENTAGE OF THE BAR 9693 06:58:16,471 --> 06:58:18,072 PRIOR, PRIOR STEP. 9694 06:58:18,139 --> 06:58:20,909 YOU CAN SEE ABOUT 60% HAD BEEN 9695 06:58:20,975 --> 06:58:22,877 TESTED FOR HIV, 44% PrEP 9696 06:58:22,944 --> 06:58:23,311 INDICATED. 9697 06:58:23,378 --> 06:58:25,280 NEXT SLIDE. 9698 06:58:25,346 --> 06:58:30,652 INDICATIONS WERE MOST COMMONLY 9699 06:58:30,718 --> 06:58:31,519 SEXUALLY, CONDOMLESS SEX. 9700 06:58:31,586 --> 06:58:33,855 34% NEVER HEARD OF PrEP. 9701 06:58:33,922 --> 06:58:36,724 SEX WORK AND HOMELESSNESS BOTH 9702 06:58:36,791 --> 06:58:37,992 ASSOCIATED WITH PrEP 9703 06:58:38,059 --> 06:58:38,293 INDICATIONS. 9704 06:58:38,359 --> 06:58:40,395 AND IN TERMS OF HAVING HEARD OF 9705 06:58:40,462 --> 06:58:42,030 PrEP, 34% HEARD OF PrEP. 9706 06:58:42,096 --> 06:58:45,200 THE UPTAKE WAS VERY LOW, 9% 9707 06:58:45,266 --> 06:58:45,433 EVER. 9708 06:58:45,500 --> 06:58:47,168 ALMOST ALL THOSE FOLKS HAD 9709 06:58:47,235 --> 06:58:49,270 GOTTEN IT FROM A RESEARCH STUDY. 9710 06:58:49,337 --> 06:58:50,605 THE REASONS FOR NON-PrEP USE 9711 06:58:50,672 --> 06:58:52,207 WERE NOT KNOWING WHERE TO 9712 06:58:52,273 --> 06:58:53,775 ACCESS, A LOT OF CONCERNS ABOUT 9713 06:58:53,842 --> 06:58:56,811 SIDE EFFECTS AS WELL AS 9714 06:58:56,878 --> 06:58:57,812 INTERFERING WITH GENDER 9715 06:58:57,879 --> 06:59:00,415 AFFIRMING HORMONES AS WELL AS 9716 06:59:00,482 --> 06:59:01,983 COST. 9717 06:59:02,050 --> 06:59:12,360 NEXT SLIDE PLEASE. 9718 06:59:13,294 --> 06:59:14,429 THEY REPORTED HIGH WILLINGNESS. 9719 06:59:14,496 --> 06:59:16,064 SO WHEN WE THINK ABOUT 9720 06:59:16,130 --> 06:59:17,165 POPULATION, WHAT WE'VE BEEN 9721 06:59:17,232 --> 06:59:19,133 LEARNING IS NEED FOR COMBINATION 9722 06:59:19,200 --> 06:59:20,101 PREVENTION APPROACHES THAT 9723 06:59:20,168 --> 06:59:22,470 ADDRESS THIS MULTIPLE LEVELS OF 9724 06:59:22,537 --> 06:59:23,838 INFLUENCE, INCLUDING ON THE 9725 06:59:23,905 --> 06:59:28,977 RIGHT THINGS AROUND GENDER 9726 06:59:29,043 --> 06:59:29,410 AFFIRMATION, SOCIAL, 9727 06:59:29,477 --> 06:59:30,512 PSYCHOLOGICAL, MEDICAL, THERE 9728 06:59:30,578 --> 06:59:32,480 ARE TREND SPECIFIC DETERMINANTS 9729 06:59:32,547 --> 06:59:35,083 SHAPING THE LIVES OF 9730 06:59:35,149 --> 06:59:35,750 TRANSFEMININE PEOPLE INCLUDING 9731 06:59:35,817 --> 06:59:36,985 TRANSGENDER YOUNG PEOPLE SO 9732 06:59:37,051 --> 06:59:38,586 THAT'S AN IMPORTANT PIECE. 9733 06:59:38,653 --> 06:59:39,287 NEXT SLIDE. 9734 06:59:39,354 --> 06:59:41,556 EXAMPLE IS WORK THAT IS FUNDED 9735 06:59:41,623 --> 06:59:44,759 BY NIH WHICH IS HIV PREVENTION 9736 06:59:44,826 --> 06:59:47,795 TRIALS NETWORK, THIS IS AN 9737 06:59:47,862 --> 06:59:49,430 INTERVENTION TESTING APPROACH 9738 06:59:49,497 --> 06:59:51,165 THAT CO-LOCATES GENDER AFFIRMING 9739 06:59:51,232 --> 06:59:56,504 CARE WITH PrEP SO THIS IS AN 9740 06:59:56,571 --> 06:59:57,639 IMPORTANT ASPECTED OF 9741 06:59:57,705 --> 06:59:58,306 INTEGRATING TRANSSPECIFIC SOCIAL 9742 06:59:58,373 --> 07:00:01,376 DETERMINANTS, IF YOU WELL, BEING 9743 07:00:01,442 --> 07:00:05,013 FIELDED IN FIVE SITES INCLUDING 9744 07:00:05,079 --> 07:00:07,148 RIO DE JANEIRO, BRAZIL. 9745 07:00:07,215 --> 07:00:09,250 THERE'S ALSO -- I TALKED ABOUT 9746 07:00:09,317 --> 07:00:10,885 THE VULNERABILITY AND NEGATIVE 9747 07:00:10,952 --> 07:00:13,721 PIECES, THERE'S ALSO A NEED TO 9748 07:00:13,788 --> 07:00:14,722 UNDERSTAND THE RESILIENCIES. 9749 07:00:14,789 --> 07:00:16,157 WE KNOW MUCH LESS ABOUT THIS, 9750 07:00:16,224 --> 07:00:17,425 SUCH AN IMPORTANT AREA. 9751 07:00:17,492 --> 07:00:23,331 I THINK PEOPLE ARE LIVING LIVES 9752 07:00:23,398 --> 07:00:24,332 EVERY DAY, RESISTING OPPRESSION 9753 07:00:24,399 --> 07:00:25,800 AND THERE ARE SO MANY WONDERFUL 9754 07:00:25,867 --> 07:00:27,602 THINGS TO BUILD ON. 9755 07:00:27,669 --> 07:00:32,974 SO AT EACH LEVEL OF INFLUENCE 9756 07:00:33,041 --> 07:00:41,082 INCLUDING NETWORKS AND TRANS 9757 07:00:41,149 --> 07:00:43,751 KINSHIP STRUCTURES, PARTICULARLY 9758 07:00:43,818 --> 07:00:44,419 MOTHERS WERE PROFOUND. 9759 07:00:44,485 --> 07:00:45,687 FOR EXAMPLE THERE ARE 9760 07:00:45,753 --> 07:00:51,059 ORGANIZATIONS, THIS IS A QUOTE 9761 07:00:51,125 --> 07:00:52,794 FROM A PARTICIPANT ABOUT 9762 07:00:52,860 --> 07:00:53,127 FEMINAS. 9763 07:00:53,194 --> 07:00:54,662 I CAME TO THE COMMUNITY 9764 07:00:54,729 --> 07:00:58,066 ORGANIZATION, I LIKED IT, I GO, 9765 07:00:58,132 --> 07:01:00,902 THEY GIVE ME CONDOMS, I THOUGHT 9766 07:01:00,969 --> 07:01:03,204 HIV TRANSMITTED THROUGH SALIVA 9767 07:01:03,271 --> 07:01:05,873 BECAUSE OF A KISS, THIS HELPED 9768 07:01:05,940 --> 07:01:06,841 ME GET INFORMATION, THIS SENSE 9769 07:01:06,908 --> 07:01:11,646 OF BEING SEEN IN THIS CONTEXT. 9770 07:01:11,713 --> 07:01:14,716 FORWARD, CALL TO ACTION, ADDRESS 9771 07:01:14,782 --> 07:01:17,352 THE MULTI-LEVEL DRIVERS OF HIV 9772 07:01:17,418 --> 07:01:18,886 EPIDEMIC AND IDENTIFY THOSE 9773 07:01:18,953 --> 07:01:20,288 MULTI-LEVEL RESILIENCIES THAT 9774 07:01:20,355 --> 07:01:22,824 CAN BE LEVERAGED FOR FUTURE 9775 07:01:22,890 --> 07:01:23,157 INTERVENTIONS. 9776 07:01:23,224 --> 07:01:25,326 WE SEE LIKE A LARGE GAP BETWEEN 9777 07:01:25,393 --> 07:01:28,529 HIV PREVENTION INDICATION AND 9778 07:01:28,596 --> 07:01:28,830 UPTAKE. 9779 07:01:28,896 --> 07:01:30,465 WE ALSO SEE THAT FOR FOLKS 9780 07:01:30,531 --> 07:01:33,868 LIVING WITH HIV IN TERMS OF NOT 9781 07:01:33,935 --> 07:01:35,536 BEING VIRALLY SUPPRESSED, HAVING 9782 07:01:35,603 --> 07:01:36,304 ACCESS TO CARE. 9783 07:01:36,371 --> 07:01:38,473 SO THERE'S A HIGH NEED FOR 9784 07:01:38,539 --> 07:01:39,574 COMBINATION APPROACHES. 9785 07:01:39,641 --> 07:01:42,543 MANY OF WHICH INCORPORATE PEERS. 9786 07:01:42,610 --> 07:01:48,616 SOME PHOTOS HERE ARE FROM LAYLA 9787 07:01:48,683 --> 07:01:49,617 AND TEAM AT FEMINAS. 9788 07:01:49,684 --> 07:01:51,986 THERE'S A HUGE NEED FOR 9789 07:01:52,053 --> 07:01:53,054 STATUS-NEUTRAL INTERVENTIONS. 9790 07:01:53,121 --> 07:01:55,123 THE HIGH PREVALENCE THAT WE 9791 07:01:55,189 --> 07:01:58,326 FOUND OF HIV OVER 40% IN THE 9792 07:01:58,393 --> 07:02:00,495 SAMPLE SPEAKS TO THE SOCIAL 9793 07:02:00,561 --> 07:02:02,363 NETWORKS ARE NOT DELINEATED BY 9794 07:02:02,430 --> 07:02:04,999 HIV OR HIV PREVENTION, RIGHT? 9795 07:02:05,066 --> 07:02:06,000 IT'S LIKE EVERYBODY IS IN 9796 07:02:06,067 --> 07:02:08,069 COMMUNITY WITH EACH OTHER. 9797 07:02:08,136 --> 07:02:09,804 STATUS NEUTRAL APPROACHES ARE AN 9798 07:02:09,871 --> 07:02:12,006 IMPORTANT DIRECTION FOR US TO 9799 07:02:12,073 --> 07:02:14,609 MOVE IN. 9800 07:02:14,676 --> 07:02:15,510 CONTINUING TO TAILOR 9801 07:02:15,576 --> 07:02:16,377 INTERVENTIONS WITH TRANS 9802 07:02:16,444 --> 07:02:17,045 COMMUNITIES, WORKING WITH 9803 07:02:17,111 --> 07:02:18,446 COMMUNITIES TO DO THE WORK, NOT 9804 07:02:18,513 --> 07:02:22,283 JUST THE RESEARCH BUT ALSO 9805 07:02:22,350 --> 07:02:23,251 IMPLEMENTATION STRATEGIES. 9806 07:02:23,317 --> 07:02:24,485 PEOPLE SAY TRANS COMMUNITIES ARE 9807 07:02:24,552 --> 07:02:25,586 DIFFICULT TO RECRUIT. 9808 07:02:25,653 --> 07:02:26,888 THAT HAS NOT BEEN MY EXPERIENCE. 9809 07:02:26,954 --> 07:02:30,058 IT WAS NOT OUR EXPERIENCE IN 9810 07:02:30,124 --> 07:02:31,259 THIS STUDY. 9811 07:02:31,325 --> 07:02:33,461 WE AS TRANS PEOPLE ARE HERE AND 9812 07:02:33,528 --> 07:02:34,762 ARE WILLING TO PARTICIPATE AND 9813 07:02:34,829 --> 07:02:36,864 CONTINUE TO DO SO IN PARTNERSHIP 9814 07:02:36,931 --> 07:02:37,932 WITH COMMUNITIES, REALLY THE 9815 07:02:37,999 --> 07:02:41,436 BEST PRACTICE. 9816 07:02:41,502 --> 07:02:44,839 AND LASTLY, ALL THE FACTORS ARE 9817 07:02:44,906 --> 07:02:45,907 DRIVEN BY THE STRUCTURAL 9818 07:02:45,973 --> 07:02:46,240 INEQUALITIES. 9819 07:02:46,307 --> 07:02:48,976 AND IN ORDER FOR US TO MAKE A 9820 07:02:49,043 --> 07:02:50,878 DENT IN THE EPIDEMIC FOR HIV WE 9821 07:02:50,945 --> 07:02:55,249 HAVE TO ADDRESS THOSE. 9822 07:02:55,316 --> 07:02:56,084 PARTICULARLY FOR TRANSFEMININE 9823 07:02:56,150 --> 07:02:57,852 PEOPLE VIOLENCE IN THE CONTEXT 9824 07:02:57,919 --> 07:03:01,589 OF LATIN AMERICA, WHETHER 9825 07:03:01,656 --> 07:03:02,190 PARTNER VIOLENCE, STRUCTURAL, 9826 07:03:02,256 --> 07:03:03,324 LEGAL AND SO FORTH. 9827 07:03:03,391 --> 07:03:06,728 I WANT TO THANK THE TEAM WHO 9828 07:03:06,794 --> 07:03:14,068 WORKED ON THIS PROJECT, ALFONSO, 9829 07:03:14,135 --> 07:03:16,437 MAYA, LAYLA, THE FEMINAS TEAM 9830 07:03:16,504 --> 07:03:18,673 GOT MATCHING OUTFITS AS PART OF 9831 07:03:18,740 --> 07:03:19,207 THE FIELD WORK. 9832 07:03:19,273 --> 07:03:22,710 THEY HAVE A CUTE OUTFIT, 9833 07:03:22,777 --> 07:03:23,478 DELIVERING CLINICAL SERVICES, 9834 07:03:23,544 --> 07:03:25,680 DOING THE TESTING, AND THE OTHER 9835 07:03:25,747 --> 07:03:28,082 FOLKS, ESPECIALLY THE YOUNG 9836 07:03:28,149 --> 07:03:28,850 TRANS WOMEN WHO PARTICIPATED IN 9837 07:03:28,916 --> 07:03:29,283 THE PROJECT. 9838 07:03:29,350 --> 07:03:30,718 SORRY I WENT OVER A COUPLE 9839 07:03:30,785 --> 07:03:35,456 MINUTES. 9840 07:03:35,523 --> 07:03:37,492 THANK YOU VERY MUCH. 9841 07:03:37,558 --> 07:03:40,561 >> THANK YOU SO MUCH FOR THAT 9842 07:03:40,628 --> 07:03:40,895 PRESENTATION. 9843 07:03:40,962 --> 07:03:45,066 AND NOW WE WILL MOVE TO MALLERY 9844 07:03:45,133 --> 07:03:48,035 ROBINSON. 9845 07:03:48,102 --> 07:03:49,403 YOU HAVE THE FLOOR. 9846 07:03:49,470 --> 07:03:50,304 >> THANK YOU. 9847 07:03:50,371 --> 07:03:54,475 GREAT JOB. 9848 07:03:54,542 --> 07:03:55,777 HIGH AGAIN, SUPER HAPPY TO BE 9849 07:03:55,843 --> 07:03:56,778 HERE WITH YOU. 9850 07:03:56,844 --> 07:04:00,047 I'M TAKING A MOMENT TO SHARE MY 9851 07:04:00,114 --> 07:04:01,916 TRANSGENDER EMPATHY TRAININGS. 9852 07:04:01,983 --> 07:04:07,255 I COME AS A TRANSGENDER ADVOCATE 9853 07:04:07,321 --> 07:04:07,922 FROM CALIFORNIA. 9854 07:04:07,989 --> 07:04:10,024 SOME DATA COMES FROM THERE. 9855 07:04:10,091 --> 07:04:11,626 NEXT SLIDE. 9856 07:04:11,692 --> 07:04:14,495 WHY DID I CREATE TRANSGENDER 9857 07:04:14,562 --> 07:04:14,729 EMPATHY? 9858 07:04:14,796 --> 07:04:17,999 I'VE HEARD A LOT OF 9859 07:04:18,065 --> 07:04:20,301 CONVERSATIONS. 9860 07:04:20,368 --> 07:04:24,238 HAVE YOU SOMEONE WITH THE LIVED 9861 07:04:24,305 --> 07:04:25,139 EXPERIENCE. 9862 07:04:25,206 --> 07:04:27,241 I KNOW WHAT THE COMMUNITY FACES, 9863 07:04:27,308 --> 07:04:30,144 ON A DAILY BASIS. 9864 07:04:30,211 --> 07:04:39,453 MY GOAL IS TO SHARE OUR 9865 07:04:39,520 --> 07:04:41,556 TGI/TGNC. 9866 07:04:41,622 --> 07:04:44,926 RECEIVE EQUITY AND JUSTICE BY 9867 07:04:44,992 --> 07:04:47,895 INCREASING EMPATHETIC APPROACHES 9868 07:04:47,962 --> 07:04:49,330 ARE ALLIES, ACCOMPLICES, 9869 07:04:49,397 --> 07:04:49,764 COMMUNITY PARTNERS. 9870 07:04:49,831 --> 07:04:53,134 I WANTED TO ADD MY QUOTE AROUND 9871 07:04:53,201 --> 07:04:54,235 EMPATHY. 9872 07:04:54,302 --> 07:04:56,103 EMPATHY IS THE CAPACITY TO 9873 07:04:56,170 --> 07:04:57,605 UNDERSTAND OR FEEL WHAT ANOTHER 9874 07:04:57,672 --> 07:04:59,273 PERSON IS EXPERIENCING FROM 9875 07:04:59,340 --> 07:05:01,108 WITHIN THEIR FRAME OF REFERENCE, 9876 07:05:01,175 --> 07:05:02,109 AND AGAIN EMPATHY IS THE 9877 07:05:02,176 --> 07:05:03,544 CAPACITY TO UNDERSTAND OR FEEL 9878 07:05:03,611 --> 07:05:04,946 WHAT ANOTHER PERSON IS 9879 07:05:05,012 --> 07:05:06,047 EXPERIENCING FROM WITHIN THEIR 9880 07:05:06,113 --> 07:05:08,015 FRAME OF REFERENCE. 9881 07:05:08,082 --> 07:05:10,484 THAT'S THE CAPACITY TO PLACE 9882 07:05:10,551 --> 07:05:12,520 ONESELF IN ANOTHER POSITION. 9883 07:05:12,587 --> 07:05:14,922 NEXT SLIDE PLEASE. 9884 07:05:14,989 --> 07:05:16,123 SO WE'RE GOING TWO STATISTICS 9885 07:05:16,190 --> 07:05:17,325 AND STORIES. 9886 07:05:17,391 --> 07:05:21,362 RAISE YOUR HAND IF YOU OR 9887 07:05:21,429 --> 07:05:22,997 SOMEONE CLOSE TO YOU HAD BEEN 9888 07:05:23,064 --> 07:05:27,735 SEXUALLY ABUSED AS A CHILD. 9889 07:05:27,802 --> 07:05:32,306 THANK YOU. 9890 07:05:32,373 --> 07:05:33,341 THANK YOU, SARI. 9891 07:05:33,407 --> 07:05:34,408 THANK YOU. 9892 07:05:34,475 --> 07:05:34,842 VULNERABILITY. 9893 07:05:34,909 --> 07:05:35,409 NEXT SLIDE. 9894 07:05:35,476 --> 07:05:40,414 MELISSA, I SEE YOU. 9895 07:05:40,481 --> 07:05:40,848 THANK YOU. 9896 07:05:40,915 --> 07:05:42,817 AONE OUT OF FOUR GIRLS, ONE OUT 9897 07:05:42,884 --> 07:05:49,390 OF SIX GIRLS EXPERIENCES SEXUAL 9898 07:05:49,457 --> 07:05:51,359 ABUSE BY 18. 9899 07:05:51,425 --> 07:05:56,163 THESE RATES ARE EVEN HIGHER FOR 9900 07:05:56,230 --> 07:05:57,465 GENDER NON-CONFORMING. 9901 07:05:57,531 --> 07:05:58,466 ASSIGNED MALE AT BIRTH, I'LL 9902 07:05:58,532 --> 07:06:01,302 MAKE SURE YOU GET ACCESS TO THE 9903 07:06:01,369 --> 07:06:04,272 TERMS, WE DIDN'T GO THROUGH THAT 9904 07:06:04,338 --> 07:06:07,008 TODAY, I HAVE NORMALLY A 2-HOUR 9905 07:06:07,074 --> 07:06:09,210 PRESENTATION, THIS IS THE 9906 07:06:09,277 --> 07:06:10,511 ENGAGEMENT PIECE, THIS IS WHAT 9907 07:06:10,578 --> 07:06:11,712 WE'RE DOING RIGHT NOW. 9908 07:06:11,779 --> 07:06:13,247 PLEASE KNOW I'LL MAKE SURE YOU 9909 07:06:13,314 --> 07:06:15,549 GET THOSE KEY TERMS TO REFER TO 9910 07:06:15,616 --> 07:06:20,254 WHAT I'M REFERRING TO NOW. 9911 07:06:20,321 --> 07:06:23,324 ESPECIALLY VULNERABLE, SIX TIMES 9912 07:06:23,391 --> 07:06:32,667 LIKELIER TO BE SEXUALLY ABUSED. 9913 07:06:32,733 --> 07:06:36,671 MANY TRANS CHILDREN CHILDHOOD 9914 07:06:36,737 --> 07:06:37,905 TRAUMA, ESPECIALLY CHILD SEXUAL 9915 07:06:37,972 --> 07:06:39,874 ABUSE SURVIVORS. 9916 07:06:39,941 --> 07:06:40,975 NEXT SLIDE PLEASE. 9917 07:06:41,042 --> 07:06:42,276 RAISE YOUR HAND IF YOU OR 9918 07:06:42,343 --> 07:06:44,178 SOMEONE CLOSE TO YOU WAS BULLIED 9919 07:06:44,245 --> 07:06:48,649 IN ELEMENTARY OR HIGH SCHOOL. 9920 07:06:48,716 --> 07:06:54,255 AGAIN, THANK YOU FOR YOUR 9921 07:06:54,322 --> 07:06:54,789 VULNERABILITY. 9922 07:06:54,855 --> 07:06:57,091 SOME QUESTIONS CAN BE DAUNTING 9923 07:06:57,158 --> 07:07:01,896 BUT IT TIES INTO EMPATHY. 9924 07:07:01,963 --> 07:07:04,065 NEXT SLIDE. 9925 07:07:04,131 --> 07:07:08,569 ACCORDING TO GAY LESBIAN 9926 07:07:08,636 --> 07:07:11,939 STRAIGHT NETWORK, 75% OF 9927 07:07:12,006 --> 07:07:13,140 TRANSYOUTH FEEL UNSAFE AT 9928 07:07:13,207 --> 07:07:13,374 SCHOOLS. 9929 07:07:13,441 --> 07:07:16,544 THOSE THAT STAY IN SCHOOL HAVE 9930 07:07:16,610 --> 07:07:19,180 SIGNIFICANTLY LOWER GRADE POINT 9931 07:07:19,246 --> 07:07:20,381 AVERAGES, MOST LIKELY TO MISS 9932 07:07:20,448 --> 07:07:22,883 SCHOOL OUT OF CONCERN FOR 9933 07:07:22,950 --> 07:07:23,117 SAFETY. 9934 07:07:23,184 --> 07:07:27,922 FOR EXAMPLE MY GROUP THAT'S HERE 9935 07:07:27,989 --> 07:07:30,224 TODAY, MAYBE THEY ARE ANGRY, 9936 07:07:30,291 --> 07:07:32,226 MAYBE THEY SEE RED, OH, THEY 9937 07:07:32,293 --> 07:07:35,062 HAVE A CHIP ON THEIR SHOULDER, 9938 07:07:35,129 --> 07:07:36,497 THESE ARE SOME STORIES AS TO WHY 9939 07:07:36,564 --> 07:07:39,667 THEY ARE COMING IN UPSET, 9940 07:07:39,734 --> 07:07:40,768 ALREADY FACING BEING SURVIVORS 9941 07:07:40,835 --> 07:07:42,236 OF SEXUAL ASSAULT AND SEXUAL 9942 07:07:42,303 --> 07:07:44,705 ABUSE AS A CHILD. 9943 07:07:44,772 --> 07:07:47,875 THEY ALSO HAVE TO GO TO SCHOOL, 9944 07:07:47,942 --> 07:07:49,510 LEAVE HOME FROM ABUSE, OR 9945 07:07:49,577 --> 07:07:51,278 WHEREVER, AND GO TO A SCHOOL 9946 07:07:51,345 --> 07:07:52,913 WHERE THEY ARE SUPPOSED TO FEEL 9947 07:07:52,980 --> 07:07:55,316 SAFE AND UNFORTUNATELY FACE 9948 07:07:55,383 --> 07:07:55,583 BULLYING. 9949 07:07:55,649 --> 07:07:58,285 WHEN WE HAVE TRANS MEMBERS WHO 9950 07:07:58,352 --> 07:08:00,354 COME IN UPSET, IT'S EASY TO 9951 07:08:00,421 --> 07:08:03,657 WRITE THEM OFF AS PROBLEMATIC OR 9952 07:08:03,724 --> 07:08:06,727 ANGRY PERSON BUT PLEASE KEEP IN 9953 07:08:06,794 --> 07:08:07,728 MIND THOSE ACTIVITIES GIVE YOU 9954 07:08:07,795 --> 07:08:09,230 AN IDEA OF WHAT WE'RE COMING 9955 07:08:09,296 --> 07:08:10,998 INTO AND DEALING WITH ON A 9956 07:08:11,065 --> 07:08:13,167 DAY-TO-DAY BASIS. 9957 07:08:13,234 --> 07:08:13,934 NEXT SLIDE. 9958 07:08:14,001 --> 07:08:15,369 PLEASE RAISE YOUR HAND IF YOU OR 9959 07:08:15,436 --> 07:08:17,872 SOMEONE CLOSE TO YOU WAS EVER 9960 07:08:17,938 --> 07:08:19,740 REJECTED BY FAMILY MEMBERS 9961 07:08:19,807 --> 07:08:23,677 SIMPLY BECAUSE OF WHO THEY ARE. 9962 07:08:23,744 --> 07:08:24,512 APPRECIATE EVERYONE'S 9963 07:08:24,578 --> 07:08:25,846 VULNERABILITY. 9964 07:08:25,913 --> 07:08:26,414 ABSOLUTELY. 9965 07:08:26,480 --> 07:08:28,282 I SEE YOU, REBECCA. 9966 07:08:28,349 --> 07:08:28,582 ABSOLUTELY. 9967 07:08:28,649 --> 07:08:29,150 THANK YOU. 9968 07:08:29,216 --> 07:08:32,086 THANK YOU. 9969 07:08:32,153 --> 07:08:33,521 NEXT SLIDE. 9970 07:08:33,587 --> 07:08:35,056 ACCORDING TO THE WILLIAMS 9971 07:08:35,122 --> 07:08:38,893 INSTITUTE 40% OF HOMELESS YOUTH 9972 07:08:38,959 --> 07:08:39,560 ARE LGBTQ. 9973 07:08:39,627 --> 07:08:42,930 68% OF THESE YOUTH INDICATE 9974 07:08:42,997 --> 07:08:45,266 FAMILY REJECTION WAS A MAJOR 9975 07:08:45,332 --> 07:08:46,434 CONTRIBUTING FACTOR TO 9976 07:08:46,500 --> 07:08:47,201 HOMELESSNESS. 9977 07:08:47,268 --> 07:08:48,769 GIVEN YOU HAVE COMMUNITY 9978 07:08:48,836 --> 07:08:51,138 MEMBERS, CLIENTS, PATIENTS 9979 07:08:51,205 --> 07:08:52,773 COMING IN, UNHOUSED, BEING 9980 07:08:52,840 --> 07:08:54,408 BULLIED AT SCHOOL, ON TOP OF 9981 07:08:54,475 --> 07:08:56,177 THAT SURVIVORS OF SEXUAL ABUSE, 9982 07:08:56,243 --> 07:08:58,379 SO AGAIN YOU HAVE A LOT OF 9983 07:08:58,446 --> 07:08:59,013 PEOPLE ESPECIALLY TRANS 9984 07:08:59,080 --> 07:09:01,248 COMMUNITY COMING IN RED HOT AND 9985 07:09:01,315 --> 07:09:04,385 ANGRY BECAUSE OF SOME OF THESE 9986 07:09:04,452 --> 07:09:05,686 FACTORS. 9987 07:09:05,753 --> 07:09:06,787 NEXT SLIDE PLEASE. 9988 07:09:06,854 --> 07:09:16,430 RAISE YOUR HAND ON THIS ONE. 9989 07:09:16,497 --> 07:09:19,934 I SEE A FEW HANDS. 9990 07:09:20,000 --> 07:09:21,902 THANK YOU. 9991 07:09:21,969 --> 07:09:23,737 NEXT SLIDE PLEASE. 9992 07:09:23,804 --> 07:09:25,406 ACCORDING TO █THE WILLIAMS 9993 07:09:25,473 --> 07:09:28,309 INSTITUTE 29% OF OUR TRANSADULTS 9994 07:09:28,375 --> 07:09:32,079 IN THE UNITED STATES STILL LIVE 9995 07:09:32,146 --> 07:09:32,847 IN POVERTY. 9996 07:09:32,913 --> 07:09:35,783 THANK YOU. 9997 07:09:35,850 --> 07:09:36,150 NEXT SLIDE. 9998 07:09:36,217 --> 07:09:38,986 PLEASE RAISE YOUR HAND IF YOU OR 9999 07:09:39,053 --> 07:09:40,187 SOMEONE CLOSE HAS EVER FEARED 10000 07:09:40,254 --> 07:09:45,593 FOR THEIR LIFE DUE TO HATE 10001 07:09:45,659 --> 07:09:46,727 VIOLENCE? 10002 07:09:46,794 --> 07:09:49,630 I SEE A FEW MORE HANDS. 10003 07:09:49,697 --> 07:09:50,264 THANK YOU. 10004 07:09:50,331 --> 07:09:53,901 THANK YOU FOLLOW YOUR 10005 07:09:53,968 --> 07:09:54,301 VULNERABILITY. 10006 07:09:54,368 --> 07:09:55,503 NEXT SLIDE PLEASE. 10007 07:09:55,569 --> 07:09:56,904 THANK YOU, ELIZABETH. 10008 07:09:56,971 --> 07:10:00,107 I SEE YOU. 10009 07:10:00,174 --> 07:10:01,742 ACCORDING TO NATIONAL COALITION, 10010 07:10:01,809 --> 07:10:09,416 72% OF HATE VIOLENCE VICTIMS IN 10011 07:10:09,483 --> 07:10:12,586 2013 WERE TRANSGENDER WOMEN, 67% 10012 07:10:12,653 --> 07:10:13,587 WOMEN OF COLOR. 10013 07:10:13,654 --> 07:10:16,824 THE NUMBER FROM 2013 STEMS FROM 10014 07:10:16,891 --> 07:10:18,058 HUMAN RIGHTS CAMPAIGN 10015 07:10:18,125 --> 07:10:19,927 ORGANIZATION, STARTED DATA 10016 07:10:19,994 --> 07:10:23,631 COLLECTING BACK IN 2013, BECAUSE 10017 07:10:23,697 --> 07:10:31,071 OF THE RATE OF TRANS FOLKS BEING 10018 07:10:31,138 --> 07:10:34,575 MURDERED ESPECIALLY THOSE OF 10019 07:10:34,642 --> 07:10:35,009 COLOR. 10020 07:10:35,075 --> 07:10:38,245 I'VE BEEN OUT SINCE 2006, IN 10021 07:10:38,312 --> 07:10:41,215 MONTGOMERY, ALABAMA, I COULD 10022 07:10:41,282 --> 07:10:46,253 HAVE FALLEN INTO THIS STATISTIC. 10023 07:10:46,320 --> 07:10:51,725 PEOPLE CAME TO ME, BEING 10024 07:10:51,792 --> 07:10:54,361 MISREPRESENTED, RESULTED IN ME 10025 07:10:54,428 --> 07:11:00,701 CREATING A HATEFUL HOMICIDE, MY 10026 07:11:00,768 --> 07:11:02,336 TRANSGENDER PODCAST, TRUE CRIME 10027 07:11:02,403 --> 07:11:04,638 PODCAST FOCUSING ON MURDER OF 10028 07:11:04,705 --> 07:11:05,372 OUR TRANS COMMUNITY MEMBERS IN 10029 07:11:05,439 --> 07:11:06,941 THE UNITED STATES AND ABROAD. 10030 07:11:07,007 --> 07:11:09,643 NOTE YOU CAN SEE WHERE WE'RE 10031 07:11:09,710 --> 07:11:12,646 AVAILABLE AT SPOTIFY, APPLE, I 10032 07:11:12,713 --> 07:11:15,783 HEART RADIO, AUDIBLE, 10033 07:11:15,849 --> 07:11:18,185 YouTube. 10034 07:11:18,252 --> 07:11:21,622 THIS IS REPORTING ACCURATELY FOR 10035 07:11:21,689 --> 07:11:22,590 OUR COMMUNITY MEMBERS, 10036 07:11:22,656 --> 07:11:27,528 ESPECIALLY THOSE WITH TRANS 10037 07:11:27,595 --> 07:11:28,128 EXPERIENCE, OFTENTIMES 10038 07:11:28,195 --> 07:11:30,698 MISGENDERED, BLAMED FOR A CRIME. 10039 07:11:30,764 --> 07:11:40,641 ONE ARTICLE THAT CAME OUT, NEX 10040 07:11:40,708 --> 07:11:41,842 BENEDICT, THE 16-YEAR-OLD 10041 07:11:41,909 --> 07:11:43,277 NON-BINARY MURDERED IN OKLAHOMA 10042 07:11:43,344 --> 07:11:44,345 DUE TO BULLYING AND VIOLENCE, 10043 07:11:44,411 --> 07:11:46,780 THIS IS WHY WE DO THE WORK. 10044 07:11:46,847 --> 07:11:49,316 PLEASE SHARE AND SUPPORT THE 10045 07:11:49,383 --> 07:11:50,317 PODCAST, MY FRIENDS. 10046 07:11:50,384 --> 07:11:52,386 PLEASE RAISE YOUR HAND IF YOU 10047 07:11:52,453 --> 07:11:54,154 HAVE PERSONALLY EXPERIENCED 10048 07:11:54,221 --> 07:11:57,424 BEING UNHOUSED. 10049 07:11:57,491 --> 07:12:02,463 I SEE A FEW HANDS. 10050 07:12:02,529 --> 07:12:08,369 THANK YOU. 10051 07:12:08,435 --> 07:12:09,036 NEXT SLIDE. 10052 07:12:09,103 --> 07:12:10,904 ONE IN FIVE MEMBERS OF THE TRANS 10053 07:12:10,971 --> 07:12:13,741 COMMUNITY ESPECIALLY IN 10054 07:12:13,807 --> 07:12:15,376 CALIFORNIA WHERE I'M LOCATED 10055 07:12:15,442 --> 07:12:17,344 REPORT BEING UNHOUSED AT SOME 10056 07:12:17,411 --> 07:12:19,213 POINT SINCE FIRST IDENTIFYING AT 10057 07:12:19,280 --> 07:12:20,414 TRANS. 10058 07:12:20,481 --> 07:12:22,049 THERE'S A NATIONAL TRANS SURVEY 10059 07:12:22,116 --> 07:12:24,785 EVERY SEVEN YEARS, 2015 AND 2022 10060 07:12:24,852 --> 07:12:27,388 WAS THE MOST RECENT, BUT 10061 07:12:27,454 --> 07:12:30,891 ACCORDING TO THE 2015 SURVEY 10062 07:12:30,958 --> 07:12:33,460 BLACK TRANSGENDER PEOPLE FACEED 10063 07:12:33,527 --> 07:12:36,230 MOST SERIOUS UNHOUSING EFFECTS. 10064 07:12:36,297 --> 07:12:37,665 42% ARE EXPERIENCED BEING 10065 07:12:37,731 --> 07:12:39,667 UNHOUSED AT SOME POINT IN THEIR 10066 07:12:39,733 --> 07:12:39,967 LIVE. 10067 07:12:40,034 --> 07:12:43,937 I'M ONE OF THOSE PEOPLE. 10068 07:12:44,004 --> 07:12:47,007 NEXT SLIDE PLEASE. 10069 07:12:47,074 --> 07:12:50,110 RAISE YOUR HAND IF YOU 10070 07:12:50,177 --> 07:12:51,712 EXPERIENCED ANTI-BLACK RACISM? 10071 07:12:51,779 --> 07:12:54,014 I SEE A FEW HANDS. 10072 07:12:54,081 --> 07:12:54,748 THANK YOU. 10073 07:12:54,815 --> 07:12:55,249 THANK YOU. 10074 07:12:55,316 --> 07:12:58,819 THANK YOU. 10075 07:12:58,886 --> 07:13:01,121 NEXT SLIDE PLEASE. 10076 07:13:01,188 --> 07:13:03,424 ACCORDING TO "L.A. TIMES," BLACK 10077 07:13:03,490 --> 07:13:08,462 PEOPLE COMPRISE 8% OF POPULATION 10078 07:13:08,529 --> 07:13:16,236 IN LA COUNTY, 34%. OF THE 10079 07:13:16,303 --> 07:13:17,237 HOMELESS POPULATION. 10080 07:13:17,304 --> 07:13:18,439 RAISE YOUR HAND IF YOU OR 10081 07:13:18,505 --> 07:13:20,107 SOMEONE CLOSE TO YOU BECAME 10082 07:13:20,174 --> 07:13:21,008 UNEMPLOYED DUE TO THE COVID-19 10083 07:13:21,075 --> 07:13:25,479 PANDEMIC. 10084 07:13:25,546 --> 07:13:27,247 THANK YOU. 10085 07:13:27,314 --> 07:13:28,315 NEXT SLIDE. 10086 07:13:28,382 --> 07:13:32,386 ACCORDING TO U.S. TODAY 19% OF 10087 07:13:32,453 --> 07:13:34,121 TRANS PEOPLE AND 26% OF 10088 07:13:34,188 --> 07:13:36,323 TRANSPEOPLE OF COLOR BECAME 10089 07:13:36,390 --> 07:13:40,828 UNEMPLOYED BECAUSE OF COVID-19 10090 07:13:40,894 --> 07:13:44,031 COVID-19 COMPARED TO 12% OF THE 10091 07:13:44,098 --> 07:13:45,632 GENERAL U.S. POPULATION. 10092 07:13:45,699 --> 07:13:47,267 DURING COVID-19, IT'S NOT OUR 10093 07:13:47,334 --> 07:13:49,770 SURVIVOR SEX WORKERS, IT'S NOT 10094 07:13:49,837 --> 07:13:52,740 COMMUNITY WORKERS WHO ARE IN 10095 07:13:52,806 --> 07:13:54,041 ORGANIZATIONS SUCH AS NON-PROFIT 10096 07:13:54,108 --> 07:13:55,476 ORGANIZATIONS, IT WAS OUR RIDE 10097 07:13:55,542 --> 07:13:57,444 SHARE COMMUNITY MEMBERS WHO DID 10098 07:13:57,511 --> 07:13:59,613 LYFT AND UBER AND ALL OF THOSE 10099 07:13:59,680 --> 07:14:03,450 DELIVERY SERVICES BECAUSE OF THE 10100 07:14:03,517 --> 07:14:04,985 PANDEMIC, ISOLATING AND 10101 07:14:05,052 --> 07:14:05,819 QUARANTINING AND SOCIALLY 10102 07:14:05,886 --> 07:14:07,054 DISTANCING, WE HAD A LOT OF 10103 07:14:07,121 --> 07:14:07,821 COMMUNITY MEMBERS OUT OF JOBS 10104 07:14:07,888 --> 07:14:09,356 FOR A WHILE AND THIS IS WHERE WE 10105 07:14:09,423 --> 07:14:11,558 SAW SOME OF THAT DATA COME IN. 10106 07:14:11,625 --> 07:14:13,527 I WANTED TO GIVE YOU A LOOK. 10107 07:14:13,594 --> 07:14:15,362 I'VE HAD THIS IN OTHER 10108 07:14:15,429 --> 07:14:15,796 TRAININGS. 10109 07:14:15,863 --> 07:14:17,731 WELL, YOU KNOW, WHAT HAPPENED? 10110 07:14:17,798 --> 07:14:19,299 NO, NO, A LOT OF US KNOW WHEN 10111 07:14:19,366 --> 07:14:21,268 THE PANDEMIC HAPPENED THERE WAS 10112 07:14:21,335 --> 07:14:26,006 A LOT OF TELEHEALTH PIVOTING, WE 10113 07:14:26,073 --> 07:14:27,741 PIVOTED TO TELEHEALTH AND KEPT 10114 07:14:27,808 --> 07:14:29,710 IT MOVING, FOR SURVIVORS OF SEX 10115 07:14:29,777 --> 07:14:31,044 WORK, SEX WORK NEVER STOPS, 10116 07:14:31,111 --> 07:14:33,113 DURING THE PANDEMIC IT WAS A 10117 07:14:33,180 --> 07:14:35,849 HIGH COPING MECHANISM. 10118 07:14:35,916 --> 07:14:37,384 IT WAS THOSE WHO WERE ABLE TO 10119 07:14:37,451 --> 07:14:40,220 HAVE A VEHICLE AND HAVE MODES OF 10120 07:14:40,287 --> 07:14:41,755 TRANSPORTATION TO PROVIDE THOSE 10121 07:14:41,822 --> 07:14:42,856 ESSENTIAL SERVICES LIKE 10122 07:14:42,923 --> 07:14:44,258 DELIVERIES THAT WERE GREATLY 10123 07:14:44,324 --> 07:14:45,125 IMPACTED. 10124 07:14:45,192 --> 07:14:50,330 I WANT TO PROVIDE CLARIFICATION 10125 07:14:50,397 --> 07:14:51,165 THERE AS WELL. 10126 07:14:51,231 --> 07:14:59,807 I WANT TO ASK QUICKLY, HOPEFULLY 10127 07:14:59,873 --> 07:15:01,809 MR. THAT -- MARTHA CAN JOIN US, 10128 07:15:01,875 --> 07:15:03,210 DID ANY OF THESE STATISTICS 10129 07:15:03,277 --> 07:15:04,545 SURPRISE YOU? 10130 07:15:04,611 --> 07:15:05,846 CONSIDER THE FACTS YOU'VE HEARD 10131 07:15:05,913 --> 07:15:07,815 HAS YOUR ORGANIZATION, YOUR 10132 07:15:07,881 --> 07:15:10,784 MEDICAL PRACTICE, CREATED AN 10133 07:15:10,851 --> 07:15:11,885 AFFIRMING AND EMPATHETIC CULTURE 10134 07:15:11,952 --> 07:15:13,954 SAFE AND WORKING FOR THE TRANS 10135 07:15:14,021 --> 07:15:16,390 COMMUNITY AND INTERSECTION 10136 07:15:16,457 --> 07:15:17,124 COMMUNITY MEMBERS. 10137 07:15:17,191 --> 07:15:20,093 THERE'S 24 STATES THAT HAVE 10138 07:15:20,160 --> 07:15:21,061 ANTI-TRANS LEGISLATION, I'LL END 10139 07:15:21,128 --> 07:15:23,931 WITH IT FOR MYSELF WHO CAME OUT 10140 07:15:23,997 --> 07:15:26,667 AS A TRANS YOUTH IN 2006, THE 10141 07:15:26,733 --> 07:15:29,369 GEORGE W. BUSH ERA IN 10142 07:15:29,436 --> 07:15:30,504 MONTGOMERY, ALABAMA, THE 10143 07:15:30,571 --> 07:15:32,339 EXPECTATION WAS AFGHANISTAN AND 10144 07:15:32,406 --> 07:15:42,649 IRAQ WAR, I'LL TELL YOU I 10145 07:15:42,716 --> 07:15:46,587 ENCOURAGE YOU TO BECOME MORE 'EM 10146 07:15:46,653 --> 07:15:49,256 EMPATHETIC AND WELCOMING. 10147 07:15:49,323 --> 07:15:52,092 IF YOU HAVE TRANS PATIENTS AND 10148 07:15:52,159 --> 07:15:54,194 CLIENTS IF THEY SEEM ANGRY, 10149 07:15:54,261 --> 07:15:56,063 FRUSTRATED, I HOPE THESE GIVES 10150 07:15:56,129 --> 07:15:57,030 YOU MON CONTEXT WHAT WE GO 10151 07:15:57,097 --> 07:15:58,232 THROUGH ON A DAILY BASIS. 10152 07:15:58,298 --> 07:16:04,338 THANK YOU SO MUCH FOR OUR TIME. 10153 07:16:04,404 --> 07:16:06,340 PLEASE FEEL FREE RESPOND IN THE 10154 07:16:06,406 --> 07:16:06,807 CHAT. 10155 07:16:06,874 --> 07:16:12,446 >> THANK YOU, MALLORY, FOR YOUR 10156 07:16:12,513 --> 07:16:13,547 PARENTHESES VACCINATION. 10157 07:16:13,614 --> 07:16:18,151 I WAS KEEPING MY FINGERS CROSSED 10158 07:16:18,218 --> 07:16:22,289 HOPING TO GET MARTHA'S 10159 07:16:22,356 --> 07:16:22,723 CONNECTION WORKING, 10160 07:16:22,789 --> 07:16:23,657 UNFORTUNATELY SHE WON'T BE ABLE 10161 07:16:23,724 --> 07:16:25,926 TO JOIN US TODAY. 10162 07:16:25,993 --> 07:16:26,894 WE APOLOGIZE THERE. 10163 07:16:26,960 --> 07:16:29,963 WHAT WE'LL DO NOW IS MOVE TO THE 10164 07:16:30,030 --> 07:16:32,499 Q&A PORTION AND AS A FINAL 10165 07:16:32,566 --> 07:16:35,636 REMINDER FOR ME YOU CAN SUBMIT 10166 07:16:35,702 --> 07:16:36,570 QUESTIONS VIA THE "LIVE 10167 07:16:36,637 --> 07:16:39,606 FEEDBACK" FORM ON THE WEB PAGE, 10168 07:16:39,673 --> 07:16:40,574 OR VIA E-MAIL. 10169 07:16:40,641 --> 07:16:48,115 I'LL TURN IT OVER TO MELISSA. 10170 07:16:48,181 --> 07:16:49,750 >> GREAT PRESENTATIONS. 10171 07:16:49,816 --> 07:16:56,123 WE'VE GOTTEN REALLY POSITIVE 10172 07:16:56,189 --> 07:16:57,190 FEEDBACK FROM DIFFERENT VIEWERS, 10173 07:16:57,257 --> 07:16:59,393 YOU CAN SEE IT IN THE CHAT. 10174 07:16:59,459 --> 07:17:01,261 GREAT SERIES OF PRESENTATIONS 10175 07:17:01,328 --> 07:17:03,530 AND DISCUSSIONS, LOOKING FORWARD 10176 07:17:03,597 --> 07:17:05,532 TO MORE, GREAT PRESENTATION FROM 10177 07:17:05,599 --> 07:17:08,101 ALL THE SPEAKERS. 10178 07:17:08,168 --> 07:17:12,639 WE DO HAVE A FEW QUESTIONS FROM 10179 07:17:12,706 --> 07:17:13,407 THE AUDIENCE. 10180 07:17:13,473 --> 07:17:18,445 I'M GOING TO POST THEM IN THE 10181 07:17:18,512 --> 07:17:19,012 CHAT. 10182 07:17:19,079 --> 07:17:21,982 YOU CAN READ THEM AS WELL. 10183 07:17:22,049 --> 07:17:23,717 WHAT ARE THE POTHOLES WE NEED TO 10184 07:17:23,784 --> 07:17:25,986 AVOID TO ADDRESS THE GAP IN 10185 07:17:26,053 --> 07:17:28,655 WOMEN'S HELD RESEARCH AND 10186 07:17:28,722 --> 07:17:34,528 SPECIFICALLY HIV AND WOMEN? 10187 07:17:34,595 --> 07:17:38,265 >> I CAN START US OFF ON THAT 10188 07:17:38,332 --> 07:17:39,166 ONE. 10189 07:17:39,232 --> 07:17:41,335 FROM A TRANS LENS I'LL QUICKLY 10190 07:17:41,401 --> 07:17:42,869 ADD THAT AGAIN SO MANY TIMES FOR 10191 07:17:42,936 --> 07:17:43,937 MYSELF I HAVE THE LIVED 10192 07:17:44,004 --> 07:17:47,007 EXPERIENCE OF BEING TRANS AND 10193 07:17:47,074 --> 07:17:49,409 ALSO LIVING WITH HIV, SOMEONE 10194 07:17:49,476 --> 07:17:51,044 WHO LIVES UNDETECTABLE FOR THE 10195 07:17:51,111 --> 07:17:55,515 PAST 13 YEARS, I WILL TELL YOU 10196 07:17:55,582 --> 07:17:56,416 COMING FROM ALABAMA, IT'S 10197 07:17:56,483 --> 07:17:57,618 INTERESTING WHEN I TELL FOLKS 10198 07:17:57,684 --> 07:17:59,586 THIS, HAD I NOT GOTTEN DIAGNOSED 10199 07:17:59,653 --> 07:18:01,455 WITH HIV, I WOULD NOT HAVE HAD 10200 07:18:01,521 --> 07:18:03,724 ACCESS TO MY HORMONE REPLACEMENT 10201 07:18:03,790 --> 07:18:06,159 THERAPY BECAUSE OF THE LAWS THAT 10202 07:18:06,226 --> 07:18:07,661 IMPLEMENT AND IMPACT OUR TRANS 10203 07:18:07,728 --> 07:18:10,530 COMMUNITY SO MUCH, ESPECIALLY 10204 07:18:10,597 --> 07:18:11,832 OUR TRANSWOMEN. 10205 07:18:11,898 --> 07:18:14,801 THERE'S A LOT MORE GENDER 10206 07:18:14,868 --> 07:18:16,970 JOURNEYS FOR OUR FEMININE FOLKS 10207 07:18:17,037 --> 07:18:18,372 TO EVEN PRESENT AS FEMININE IN 10208 07:18:18,438 --> 07:18:21,775 SPACES, LIVING WITH HIV CAN BE 10209 07:18:21,842 --> 07:18:22,142 OVERWHELMING. 10210 07:18:22,209 --> 07:18:25,712 I HAD A STUDENT, I USED TO TEACH 10211 07:18:25,779 --> 07:18:26,813 MIDDLE SCHOOL, SECONDARILY HIGH 10212 07:18:26,880 --> 07:18:28,548 SCHOOL, I HAD A STUDENT TRANS, 10213 07:18:28,615 --> 07:18:30,651 ALSO LIVING WITH HIV, ONE OF THE 10214 07:18:30,717 --> 07:18:31,752 THINGS THEY SHARED WAS PROBLEMS 10215 07:18:31,818 --> 07:18:33,920 OF BEING ABLE TO HAVE ACCESS TO 10216 07:18:33,987 --> 07:18:38,191 RESTROOMS AND BEING ABLE TO 10217 07:18:38,258 --> 07:18:39,726 SELF-ADMINISTERS HRT AND ART, 10218 07:18:39,793 --> 07:18:41,395 THINGS THAT IMPACT US ON A 10219 07:18:41,461 --> 07:18:44,965 FEMININE LEVEL AND AS A HUMAN 10220 07:18:45,032 --> 07:18:47,801 LEVEL. 10221 07:18:47,868 --> 07:18:51,304 >> I FEEL LIKE I TOTALLY AGREE. 10222 07:18:51,371 --> 07:18:55,042 A LOT OF PIECES AROUND AVOIDING 10223 07:18:55,108 --> 07:18:55,776 RESTIGMATIZING, YOU KNOW, 10224 07:18:55,842 --> 07:18:59,746 AVOIDING THAT IN THE CONTEXT OF 10225 07:18:59,813 --> 07:19:01,481 CARE, CONTEXT OF HIV IS ANOTHER 10226 07:19:01,548 --> 07:19:03,684 HEALTH CONDITION LIKE ANY OTHER 10227 07:19:03,750 --> 07:19:04,985 CONDITION. 10228 07:19:05,052 --> 07:19:06,553 SO TAKING THAT, THERE'S A LOT 10229 07:19:06,620 --> 07:19:10,724 OF -- IN THE CONTEXT OF LATIN 10230 07:19:10,791 --> 07:19:11,825 AMERICA, THERE'S STIGMA AROUND 10231 07:19:11,892 --> 07:19:14,194 HIV, SO MUCH OF IT. 10232 07:19:14,261 --> 07:19:16,830 SOMETIMES I TALKED ABOUT 10233 07:19:16,897 --> 07:19:17,931 PREVENTION AND TREATMENT 10234 07:19:17,998 --> 07:19:19,833 APPROACHES, THE RESULT, WE NEED 10235 07:19:19,900 --> 07:19:21,868 TO BRING THOSE TOGETHER. 10236 07:19:21,935 --> 07:19:26,773 NOT HAVE THINGS BE ZERO STATUS 10237 07:19:26,840 --> 07:19:28,108 SEPARATE BECAUSE THAT CREATES 10238 07:19:28,175 --> 07:19:29,309 ADDITIONAL STIGMA. 10239 07:19:29,376 --> 07:19:31,244 THE OTHER THING IS IN TERMS OF 10240 07:19:31,311 --> 07:19:32,713 LIKE THE SCIENCE, I THINK WE 10241 07:19:32,779 --> 07:19:36,850 NEED TO PUT THE GENDER BACK IN 10242 07:19:36,917 --> 07:19:37,484 TRANSGENDER. 10243 07:19:37,551 --> 07:19:39,486 THAT'S WHERE FOR ME WOMEN IN 10244 07:19:39,553 --> 07:19:42,789 HIV, THERE ARE GENDERED PATHWAYS 10245 07:19:42,856 --> 07:19:44,458 TO THIS, ADDRESSING THE EPIDEMIC 10246 07:19:44,524 --> 07:19:48,695 THAT WE NEED TO TAKE. 10247 07:19:48,762 --> 07:19:50,464 THERE ARE SEXED PATHWAYS TOO, 10248 07:19:50,530 --> 07:19:52,966 BUT THERE ARE GENDERED PIECES 10249 07:19:53,033 --> 07:19:54,067 AROUND SOCIAL AND CULTURAL 10250 07:19:54,134 --> 07:19:58,438 THINGS PUTTING PEOPLE NOT ONLY 10251 07:19:58,505 --> 07:19:59,573 LIKE MADE VULNERABLE COMMUNITIES 10252 07:19:59,639 --> 07:20:02,709 VULNERABLE BUT ACCESS TO CARE, 10253 07:20:02,776 --> 07:20:07,414 ACCESS TO TREATMENT, MINE -- 10254 07:20:07,481 --> 07:20:08,882 THOSE ARE MY INITIAL THOUGHTS. 10255 07:20:08,949 --> 07:20:11,218 >> DO YOU WANT TO JUMP IN OR WE 10256 07:20:11,284 --> 07:20:13,653 HAVE ANOTHER ONE IN THE CHAT. 10257 07:20:13,720 --> 07:20:15,555 >> NO, I'M AGREEING WITH THE 10258 07:20:15,622 --> 07:20:17,257 REST OF THE PANELISTS. 10259 07:20:17,324 --> 07:20:20,327 WE DON'T WANT TO STIGMATIZE. 10260 07:20:20,393 --> 07:20:20,994 ANSWERED VERY WELL. 10261 07:20:21,061 --> 07:20:21,628 >> THANK YOU. 10262 07:20:21,695 --> 07:20:25,265 THE NEXT QUESTION IS HOW CAN WE 10263 07:20:25,332 --> 07:20:27,567 SUPPORT TRANS PEOPLE WITH 10264 07:20:27,634 --> 07:20:28,435 HOSTILE ENVIRONMENTS INCLUDING 10265 07:20:28,502 --> 07:20:29,903 ANTI-TRANS LEGISLATION AND HIGH 10266 07:20:29,970 --> 07:20:36,877 RATES OF STIGMA? 10267 07:20:36,943 --> 07:20:38,979 >> I CAN START US OFF ON THIS 10268 07:20:39,045 --> 07:20:39,846 ONE TOO. 10269 07:20:39,913 --> 07:20:43,016 I WOULD JUST SAY FOR SOMEONE 10270 07:20:43,083 --> 07:20:45,519 WITH LIVED EXPERIENCE, THE 10271 07:20:45,585 --> 07:20:46,853 BIGGEST SUPPORT, IN CALIFORNIA, 10272 07:20:46,920 --> 07:20:49,823 WHEREVER YOU'RE LOCATED AS TRANS 10273 07:20:49,890 --> 07:20:53,527 PEOPLE, EVERYWHERE, EVEN AS DR. 10274 07:20:53,593 --> 07:20:54,528 SARI MENTIONED IN LATIN AMERICA 10275 07:20:54,594 --> 07:20:55,529 AND EVERYBODY WHERE , THE 10276 07:20:55,595 --> 07:20:58,231 BIGGEST SUPPORT IS HAVE AN 10277 07:20:58,298 --> 07:21:00,200 EMPATHETIC EAR, BE WILLING TO 10278 07:21:00,267 --> 07:21:01,868 UNDERSTAND THESE ARE HUMAN 10279 07:21:01,935 --> 07:21:05,472 RIGHTS FROM HEALTH CARE TO 10280 07:21:05,539 --> 07:21:08,008 HOMELESSNESS, TO FOOD RESOURCES, 10281 07:21:08,074 --> 07:21:08,375 TRANSPORTATION. 10282 07:21:08,441 --> 07:21:10,076 EVEN JUST ACCESS TO DATING 10283 07:21:10,143 --> 07:21:12,579 WEBSITES IS REALLY A BIG THING. 10284 07:21:12,646 --> 07:21:16,917 I HAD A BEAUTIFUL BIG 10285 07:21:16,983 --> 07:21:17,751 TRANSWOMAN, A LAWYER, THERE'S SO 10286 07:21:17,818 --> 07:21:19,820 MUCH THINGS CAN YOU DO, SHARE 10287 07:21:19,886 --> 07:21:20,821 OUR STORIES. 10288 07:21:20,887 --> 07:21:22,756 BE WILLING TO SAY OUR NAMES. 10289 07:21:22,823 --> 07:21:26,393 IF YOU SEE SOMEONE WHO IS OF THE 10290 07:21:26,459 --> 07:21:29,229 TRANS EXPERIENCE OR NON-BINARY 10291 07:21:29,296 --> 07:21:30,330 EXPERIENCE, FACING HARASSMENT, 10292 07:21:30,397 --> 07:21:35,235 AGAIN WE HAVE ALLIES, THOSE WHO 10293 07:21:35,302 --> 07:21:38,038 SAY OUR NAMES, UPLIFT US, 10294 07:21:38,104 --> 07:21:39,506 ACCOMPLICES WILL GET IN FRONT OF 10295 07:21:39,573 --> 07:21:41,675 US, I'LL TAKE THAT LICK FOR YOU. 10296 07:21:41,741 --> 07:21:43,210 DON'T YOU HIT HER, DON'T YOU HIT 10297 07:21:43,276 --> 07:21:45,512 HIM, I'LL TAKE THAT LICK. 10298 07:21:45,579 --> 07:21:48,481 WE NEED THAT LEVEL OF GROUNDS, 10299 07:21:48,548 --> 07:21:50,250 FEET PLANTED, LIKE YOU'RE READY, 10300 07:21:50,317 --> 07:21:52,485 YOU'RE IN THIS AS MUCH AS WE 10301 07:21:52,552 --> 07:21:56,356 WOULD FOR YOU ALL. 10302 07:21:56,423 --> 07:21:57,891 TRANS PEOPLE THE STARTED 10303 07:21:57,958 --> 07:21:58,225 STONEWALL. 10304 07:21:58,291 --> 07:22:03,897 IF YOU KNOW ANYTHING ABOUT THE 10305 07:22:03,964 --> 07:22:05,966 1973 MARCH , THE BEAUTIFUL 10306 07:22:06,032 --> 07:22:07,434 TRANSLATINA WOMAN, THEY TREATED 10307 07:22:07,500 --> 07:22:09,703 HER POORLY, WE STILL GET TREATED 10308 07:22:09,769 --> 07:22:11,471 THAT WAY 50 YEARS LATER. 10309 07:22:11,538 --> 07:22:13,340 SAY OUR NAMES, HEAR OUR STORIES, 10310 07:22:13,406 --> 07:22:14,407 VALUE OUR VOICES, THAT'S THE 10311 07:22:14,474 --> 07:22:15,609 BEST WAY YOU CAN SUPPORT. 10312 07:22:15,675 --> 07:22:18,144 THANK YOU. 10313 07:22:18,211 --> 07:22:21,748 >> I MEAN, I THINK I'M AGREEING, 10314 07:22:21,815 --> 07:22:22,415 JOUST NODDING. 10315 07:22:22,482 --> 07:22:24,618 MALLERY, I COULD NOD TO YOU. 10316 07:22:24,684 --> 07:22:25,819 THERE'S THIS PIECE AROUND 10317 07:22:25,886 --> 07:22:27,387 LETTING PEOPLE KNOW YOU SEE 10318 07:22:27,454 --> 07:22:28,321 THERE'S SOMETHING GOING ON. 10319 07:22:28,388 --> 07:22:30,223 AND I THINK EVEN IN HEALTH CARE 10320 07:22:30,290 --> 07:22:31,424 CONTEXT, A LOT OF PEOPLE, 10321 07:22:31,491 --> 07:22:38,098 THERE'S A LOT OF -- LETTING 10322 07:22:38,164 --> 07:22:40,066 PEOPLE KNOW THAT IT MAKES SENSE 10323 07:22:40,133 --> 07:22:41,801 TO BE DISTRESSED ABOUT THIS 10324 07:22:41,868 --> 07:22:43,570 RIGHT NOW. 10325 07:22:43,637 --> 07:22:45,205 AND ALSO THERE IS SUPPORT. 10326 07:22:45,272 --> 07:22:49,342 I THINK THAT'S THE MAJOR THING, 10327 07:22:49,409 --> 07:22:53,380 WE WERE DOING FOCUS GROUPS, 10328 07:22:53,446 --> 07:22:55,482 NIH-FUNDED STUDY, SUICIDE 10329 07:22:55,548 --> 07:22:56,349 PREVENTION TRIAL, INTERVIEWS AND 10330 07:22:56,416 --> 07:22:57,317 FOCUS GROUPS. 10331 07:22:57,384 --> 07:22:58,919 PEOPLE ARE SCARED WITH YOUTH AND 10332 07:22:58,985 --> 07:22:59,886 THEIR CAREGIVERS. 10333 07:22:59,953 --> 07:23:03,890 THEY ARE VERY SCARED. 10334 07:23:03,957 --> 07:23:05,525 AND BUT SORT OF IDEA AROUND 10335 07:23:05,592 --> 07:23:12,799 LIFTING UP AND AND ENHANCING, 10336 07:23:12,866 --> 07:23:13,900 BRINGING THOSE BACK TO THE 10337 07:23:13,967 --> 07:23:16,102 SURFACE LIKE WE'RE TALKING 10338 07:23:16,169 --> 07:23:19,205 ABOUT, TRYING TO HAVE -- LEAD 10339 07:23:19,272 --> 07:23:23,310 WITH THAT. 10340 07:23:23,376 --> 07:23:26,413 >> OVERALL WE JUST NEED TO BE 10341 07:23:26,479 --> 07:23:26,846 BETTER HUMANS. 10342 07:23:26,913 --> 07:23:29,849 WE JUST NEED TO BE BETTER 10343 07:23:29,916 --> 07:23:32,652 HUMANS. 10344 07:23:32,719 --> 07:23:34,020 >> WE HAVE ANOTHER QUESTION, 10345 07:23:34,087 --> 07:23:35,388 THERE HAVE BEEN A LOT OF EFFORTS 10346 07:23:35,455 --> 07:23:37,891 TO BRING DOWN THE UNACCEPTABLE 10347 07:23:37,958 --> 07:23:40,327 RATES OF MATERNAL MORTALITY SO 10348 07:23:40,393 --> 07:23:42,729 WHAT NEW STRATEGY CAN WE TRY? 10349 07:23:42,796 --> 07:23:48,001 ANYTHING IN THE WORDS 10350 07:23:48,068 --> 07:23:55,942 PARTICULARLY PROMISING? 10351 07:23:56,009 --> 07:23:57,877 >> MY APOLOGIES. 10352 07:23:57,944 --> 07:23:58,912 I WAS HAVING TECHNICAL 10353 07:23:58,979 --> 07:23:59,245 DIFFICULTIES. 10354 07:23:59,312 --> 07:24:02,615 I COULDN'T HEAR THE QUESTION 10355 07:24:02,682 --> 07:24:02,949 PROPERLY. 10356 07:24:03,016 --> 07:24:03,616 >> I'LL REPEAT IT. 10357 07:24:03,683 --> 07:24:06,653 THERE HAVE BEEN A LOT OF EFFORTS 10358 07:24:06,720 --> 07:24:09,255 TO BRING DOWN UNACCEPTABLE RATES 10359 07:24:09,322 --> 07:24:10,657 OF MATERNAL MORTALITY, SO WHAT 10360 07:24:10,724 --> 07:24:12,192 NEW STRATEGIES CAN WE TRY, 10361 07:24:12,258 --> 07:24:15,128 ANYTHING IN THE WORKS 10362 07:24:15,195 --> 07:24:15,996 PARTICULARLY PROMISING? 10363 07:24:16,062 --> 07:24:17,797 >> YOU KNOW, IT HAS TO BE 10364 07:24:17,864 --> 07:24:18,198 COLLABORATIVE. 10365 07:24:18,264 --> 07:24:19,299 WE HAVE A LOT OF ENTITIES 10366 07:24:19,366 --> 07:24:22,736 WORKING IN SILOS DOING THINGS 10367 07:24:22,802 --> 07:24:23,036 SEPARATELY. 10368 07:24:23,103 --> 07:24:23,803 IT'S NOT WORKING. 10369 07:24:23,870 --> 07:24:24,771 HASN'T BEEN WORKING. 10370 07:24:24,838 --> 07:24:27,207 PEOPLE ARE DOING THE SAME 10371 07:24:27,273 --> 07:24:28,174 THINGS. 10372 07:24:28,241 --> 07:24:29,042 AND STILL NOT ACCOMPLISHING, YOU 10373 07:24:29,109 --> 07:24:30,143 KNOW, THE GOALS. 10374 07:24:30,210 --> 07:24:33,446 WE NEED TO ACTUALLY WORK 10375 07:24:33,513 --> 07:24:33,713 TOGETHER. 10376 07:24:33,780 --> 07:24:36,950 AND ACTUALLY FUND THOSE 10377 07:24:37,017 --> 07:24:38,918 ORGANIZATIONS THAT ARE ACTUALLY 10378 07:24:38,985 --> 07:24:39,452 GRASS ROOTS ORGANIZATIONS 10379 07:24:39,519 --> 07:24:40,854 WORKING SIDE BY SIDE WITH 10380 07:24:40,920 --> 07:24:42,689 INDIVIDUALS THAT ARE IN THE 10381 07:24:42,756 --> 07:24:44,524 ACTUAL COMMUNITY. 10382 07:24:44,591 --> 07:24:47,660 A LOT OF INSTITUTIONS JUST DON'T 10383 07:24:47,727 --> 07:24:48,762 HAVE THE GREAT RELATIONSHIP WITH 10384 07:24:48,828 --> 07:24:51,031 THE COMMUNITY LIKE THEY SHOULD. 10385 07:24:51,097 --> 07:24:53,033 THEY KNOW OF THE NUMBERS BUT DO 10386 07:24:53,099 --> 07:24:54,134 THEY HAVE A RELATIONSHIP? 10387 07:24:54,200 --> 07:24:56,536 ARE THEY GOING INTO THE 10388 07:24:56,603 --> 07:24:58,171 NEIGHBORHOODS AND ASKING THE 10389 07:24:58,238 --> 07:24:59,372 COMMUNITY WHAT THEY NEED, WHAT 10390 07:24:59,439 --> 07:25:00,573 THEIR DESIRES ARE, WHAT THEIR 10391 07:25:00,640 --> 07:25:03,209 EXPERIENCE AT THOSE HOSPITALS OR 10392 07:25:03,276 --> 07:25:04,310 INSTITUTIONS OR HEALTH CARE 10393 07:25:04,377 --> 07:25:06,613 CENTERS SO THEY CAN CORRECT THAT 10394 07:25:06,679 --> 07:25:09,215 AND USE THOSE PLACES IN THEIR 10395 07:25:09,282 --> 07:25:09,549 NEIGHBORHOODS. 10396 07:25:09,616 --> 07:25:11,518 SO THEY GOT TO DO MORE FOOT 10397 07:25:11,584 --> 07:25:11,718 WORK. 10398 07:25:11,785 --> 07:25:13,086 COME OUT OF THE OFFICE. 10399 07:25:13,153 --> 07:25:18,191 THEY GOT TO GO OUTSIDE. 10400 07:25:20,193 --> 07:25:21,327 >> THANK YOU. 10401 07:25:21,394 --> 07:25:23,963 ANYTHING TO ADD TO THAT? 10402 07:25:24,030 --> 07:25:27,901 >> YEAH, I WOULD ADD AS WELL, 10403 07:25:27,967 --> 07:25:29,436 BEING WILLING, ONE OF THE THINGS 10404 07:25:29,502 --> 07:25:31,738 I'LL SAY, PUBLIC ACTION, RIGHT? 10405 07:25:31,805 --> 07:25:34,140 I KIND OF SEE IN ONE OF THE 10406 07:25:34,207 --> 07:25:34,941 BOXES TELEVISION OPS. 10407 07:25:35,008 --> 07:25:35,942 GO TO THE MEDIA. 10408 07:25:36,009 --> 07:25:38,278 THEY WANT TO HEAR. 10409 07:25:38,344 --> 07:25:42,215 ESPECIALLY RIGHT NOW, YOU ALMOST 10410 07:25:42,282 --> 07:25:43,083 HATE TO SENSATIONALIZE, VOICESES 10411 07:25:43,149 --> 07:25:46,052 OF BLACK WOMEN HAVE BEEN 10412 07:25:46,119 --> 07:25:47,587 ELEVATED BECAUSE WE'VE BEEN 10413 07:25:47,654 --> 07:25:48,321 SILENCED, IN SILOS. 10414 07:25:48,388 --> 07:25:49,656 PEOPLE WANT TO HEAR WHAT'S GOING 10415 07:25:49,722 --> 07:25:51,124 ON, OUR STORIES. 10416 07:25:51,191 --> 07:25:53,893 I ENCOURAGE ANYONE IN A SPACE 10417 07:25:53,960 --> 07:25:56,162 WHERE YOU'RE BEING DISCRIMINATED 10418 07:25:56,229 --> 07:25:57,664 AGAINST, SIGN AN NDA, MAYBE YOU 10419 07:25:57,730 --> 07:26:03,369 SAW A BLACK WOMAN BE 10420 07:26:03,436 --> 07:26:04,771 DISCRIMINATED AGAINST, WHITE 10421 07:26:04,838 --> 07:26:05,972 GIRL DIDN'T GET TREATED THAT 10422 07:26:06,039 --> 07:26:10,043 WAY, WE HAVE TO OVERLOOK NDAs, 10423 07:26:10,110 --> 07:26:12,011 WE HAVE TO TAKE IT TO THE MEDIA. 10424 07:26:12,078 --> 07:26:13,546 IT'S HOW WE GET THOSE STORIES 10425 07:26:13,613 --> 07:26:16,483 OUT AND I'M TELLING YOU WHEN YOU 10426 07:26:16,549 --> 07:26:17,383 CIRCULATE, YOU'LL NEVER BELIEVE 10427 07:26:17,450 --> 07:26:19,018 HOW MANY PEOPLE RAISE THEIR HAND 10428 07:26:19,085 --> 07:26:20,487 LIKE YOU ALL DID. 10429 07:26:20,553 --> 07:26:21,421 NO, THAT APPLIES TO ME TOO. 10430 07:26:21,488 --> 07:26:22,989 THIS HAPPENED TO YOU TOO? 10431 07:26:23,056 --> 07:26:26,726 I THOUGHT I WAS THE ONLY ONE. 10432 07:26:26,793 --> 07:26:28,128 IT BUILDS CAMARADERIE AND 10433 07:26:28,194 --> 07:26:30,096 SISTERHOOD, CAN YOU EVEN FILE A 10434 07:26:30,163 --> 07:26:32,599 CLASS ACTION SUIT, TAKE IT TO A 10435 07:26:32,665 --> 07:26:33,500 LEGALITY LEVEL. 10436 07:26:33,566 --> 07:26:34,901 FURTHER THAN HAVING THOSE 10437 07:26:34,968 --> 07:26:35,768 CONVERSATIONS INTERNALLY BUT 10438 07:26:35,835 --> 07:26:38,238 MAKING SURE PEOPLE ARE AWARE. 10439 07:26:38,304 --> 07:26:41,941 THANK YOU. 10440 07:26:42,008 --> 07:26:45,712 >> WE HAVE ONE LAST QUESTION. 10441 07:26:45,778 --> 07:26:48,948 SARI, DO YOU WANT TO ADD 10442 07:26:49,015 --> 07:26:49,215 ANYTHING? 10443 07:26:49,282 --> 07:26:53,219 >> I'M HERE. 10444 07:26:53,286 --> 07:26:55,488 THANK YOU. 10445 07:26:55,555 --> 07:26:59,893 >> WHERE CAN RESEARCH MAKE 10446 07:26:59,959 --> 07:27:02,829 PROGRESS IN ADDRESSING GAPS IN 10447 07:27:02,896 --> 07:27:04,063 TRANSGENDER AND GENDER DIVERSE 10448 07:27:04,130 --> 07:27:10,003 PEOPLE? 10449 07:27:10,069 --> 07:27:11,271 >> I CAN JUMP IN. 10450 07:27:11,337 --> 07:27:12,472 FUNDERS HAVE AN IMPORTANT ROLE 10451 07:27:12,539 --> 07:27:14,140 TO PLAY. 10452 07:27:14,207 --> 07:27:16,109 SO MUCH INTERNAL ADVOCACY THAT 10453 07:27:16,176 --> 07:27:17,944 HAPPENS FOR FUNDING ENTITIES 10454 07:27:18,011 --> 07:27:18,278 TOO. 10455 07:27:18,344 --> 07:27:21,581 I KNOW THAT'S AN IMPORTANT PART 10456 07:27:21,648 --> 07:27:25,652 OF WHAT FUNDING OPPORTUNITIES 10457 07:27:25,718 --> 07:27:28,488 GET WRITTEN AND DISSEMINATED. 10458 07:27:28,555 --> 07:27:31,624 INTERN ADVOCACY, SEEING THE NEED 10459 07:27:31,691 --> 07:27:35,395 TO ADDRESS HIV WITHIN 10460 07:27:35,461 --> 07:27:36,796 COMMUNITIES IS EXCELLENT. 10461 07:27:36,863 --> 07:27:40,366 THERE'S A NEED TO KIND OF 10462 07:27:40,433 --> 07:27:43,169 LEVERAGE ACROSS SECONDER 10463 07:27:43,236 --> 07:27:43,636 PARTNERSHIPS. 10464 07:27:43,703 --> 07:27:45,038 PUBLIC HEALTH, A LOT OF WHAT 10465 07:27:45,104 --> 07:27:47,040 WE'RE TALKING ABOUT TODAY IS 10466 07:27:47,106 --> 07:27:47,640 POVERTY, EDUCATION, SOCIAL 10467 07:27:47,707 --> 07:27:51,077 DETERMINANTS OF HEALTH, LEGAL 10468 07:27:51,144 --> 07:27:51,411 ISSUES. 10469 07:27:51,477 --> 07:27:53,213 SO THIS REQUIRES CREATIVE 10470 07:27:53,279 --> 07:27:54,814 SOLUTIONS THAT ARE OUTSIDE OF 10471 07:27:54,881 --> 07:27:57,884 MEDICINE AND THAT BRING IN 10472 07:27:57,951 --> 07:27:59,519 MULTI-SECONDERS -- 10473 07:27:59,586 --> 07:28:01,821 MULTI-SECTORS, THAT WILL BE 10474 07:28:01,888 --> 07:28:04,424 HELPFUL AND NECESSARY TO 10475 07:28:04,490 --> 07:28:05,191 AADDRESS KNOWLEDGE GAPS AND MAKE 10476 07:28:05,258 --> 07:28:10,230 A DENT IN THE EPIDEMIC FOR TRANS 10477 07:28:10,296 --> 07:28:10,663 POPULATIONS. 10478 07:28:10,730 --> 07:28:12,865 THIRDLY THE IDEA HOW CAN WE 10479 07:28:12,932 --> 07:28:14,701 SHORTEN TIME BETWEEN SCIENTIFIC 10480 07:28:14,767 --> 07:28:16,236 KNOWLEDGE AND IMPLEMENTATION OF 10481 07:28:16,302 --> 07:28:16,703 THE STRATEGY. 10482 07:28:16,769 --> 07:28:18,871 BY THE TIME WE DO TRIALS AND 10483 07:28:18,938 --> 07:28:20,640 FIND THE KNOWLEDGE AND WE'RE -- 10484 07:28:20,707 --> 07:28:23,376 IT TAKES A LONG TIME BETWEEN 10485 07:28:23,443 --> 07:28:26,846 WHEN WE GET THE KNOWLEDGE AND 10486 07:28:26,913 --> 07:28:27,580 THEN INTERVENTION. 10487 07:28:27,647 --> 07:28:29,382 SO SOMETHING THAT WOULD LESSEN 10488 07:28:29,449 --> 07:28:32,318 THAT OR ALLOW FOR MORE RAPID 10489 07:28:32,385 --> 07:28:35,188 RESPONSE EFFORTS OF THE 10490 07:28:35,255 --> 07:28:36,522 KNOWLEDGE, FILLING KNOWLEDGE 10491 07:28:36,589 --> 07:28:43,596 GAPS BUT HAVING IMMEDIATE 10492 07:28:43,663 --> 07:28:44,564 RESPONSES SHORTENED IS 10493 07:28:44,631 --> 07:28:46,766 IMPORTANT, AND CALLS THAT 10494 07:28:46,833 --> 07:28:51,537 INTEGRATE RAPID RESPONSE EFFORTS 10495 07:28:51,604 --> 07:28:54,607 WITH THE KNOWLEDGE CREATION. 10496 07:28:56,042 --> 07:28:57,844 >> I DON'T KNOW IF YOU WANT TO 10497 07:28:57,910 --> 07:29:03,549 ADD SOMETHING. 10498 07:29:03,616 --> 07:29:05,084 THANK YOU. 10499 07:29:05,151 --> 07:29:06,853 THIS CONCLUDES TODAY'S SESSION 10500 07:29:06,919 --> 07:29:08,888 ON HEALTH DISPARITIES INEQUITY. 10501 07:29:08,955 --> 07:29:12,592 THANK YOU ALL FOR YOUR 10502 07:29:12,659 --> 07:29:13,393 PARTICIPATION, YOUR 10503 07:29:13,459 --> 07:29:14,460 PRESENTATIONS WERE INSIGHTFUL, 10504 07:29:14,527 --> 07:29:16,963 AND WE LOOK FORWARD TO BEING 10505 07:29:17,030 --> 07:29:19,299 ABLE TO COLLABORATE AND MOVE 10506 07:29:19,365 --> 07:29:23,436 FORWARD IN FILLING THOSE GAPS. 10507 07:29:23,503 --> 07:29:28,741 AND I'M PLEASED TO INTRODUCE 10508 07:29:28,808 --> 07:29:32,779 CORETTÉ BYRD, PROVIDING CLOSING 10509 07:29:32,845 --> 07:29:33,079 REMARKS. 10510 07:29:33,146 --> 07:29:33,946 >> THANK YOU, MELISSA. 10511 07:29:34,013 --> 07:29:37,884 I WANT TO SAY THANK YOU SO MUCH 10512 07:29:37,950 --> 07:29:41,387 FOR SUCH AN ENGAGING AND 10513 07:29:41,454 --> 07:29:42,889 INFORMATIVE SESSION. 10514 07:29:42,955 --> 07:29:44,824 AND I FEEL EXTREMELY FULL OVER 10515 07:29:44,891 --> 07:29:46,526 THE PAST TWO DAYS. 10516 07:29:46,592 --> 07:29:47,627 IT'S BEEN EXTREMELY 10517 07:29:47,694 --> 07:29:48,161 ENLIGHTENING. 10518 07:29:48,227 --> 07:29:51,331 I WANT TO SAY ON BEHALF OF NIH, 10519 07:29:51,397 --> 07:29:52,432 OFFICE OF AIDS RESEARCH, I WANT 10520 07:29:52,498 --> 07:29:56,502 TO THANK YOU FOR ATTENDING AND 10521 07:29:56,569 --> 07:29:58,104 PARTICIPATING IN THIS WORKSHOP. 10522 07:29:58,171 --> 07:30:00,873 OVER THE PAST COUPLE DAYS WE'VE 10523 07:30:00,940 --> 07:30:02,809 HEARD ABOUT INNOVATIVE RESEARCH 10524 07:30:02,875 --> 07:30:05,044 TO ADDRESS THE INTERSECTION OF 10525 07:30:05,111 --> 07:30:07,313 HIV AND WOMEN'S HEALTH. 10526 07:30:07,380 --> 07:30:07,947 MEANINGFUL ENGAGEMENT OF 10527 07:30:08,014 --> 07:30:11,284 AFFECTED COMMUNITIES IS A KEY 10528 07:30:11,351 --> 07:30:12,885 PRINCIPLE OF EQUITY-INFORMED 10529 07:30:12,952 --> 07:30:13,319 RESEARCH. 10530 07:30:13,386 --> 07:30:15,621 WE INVITE CONTINUED ENGAGEMENT 10531 07:30:15,688 --> 07:30:16,389 AND ONGOING DISCUSSION. 10532 07:30:16,456 --> 07:30:20,760 THIS EVENT WILL BE ARCHIVED VIA 10533 07:30:20,827 --> 07:30:22,628 THE NIH VIDEOCAST, WE INVITE YOU 10534 07:30:22,695 --> 07:30:24,597 TO SHARE THE RECORDINGS WIDELY. 10535 07:30:24,664 --> 07:30:27,433 WE WANT YOU TO LEARN MORE ABOUT 10536 07:30:27,500 --> 07:30:28,534 OUR SIGNATURE PROGRAM, AND REACH 10537 07:30:28,601 --> 07:30:31,471 OUT TO US USING THE QR CODE 10538 07:30:31,537 --> 07:30:36,209 SHOWN HERE ON THE SLIDE. 10539 07:30:36,275 --> 07:30:36,843 NEXT SLIDE. 10540 07:30:36,909 --> 07:30:40,046 I WANT TO EXPRESS GRATITUDE TO 10541 07:30:40,113 --> 07:30:43,216 THE WORKSHOP PLANNING COMMITTEE, 10542 07:30:43,282 --> 07:30:47,019 LED BY MYSELF AND DR. BARR, WITH 10543 07:30:47,086 --> 07:30:49,622 SUPPORT OF THE MEMBERSHIP HERE, 10544 07:30:49,689 --> 07:30:53,860 WE'RE GRATEFUL TO THE EXTERNAL 10545 07:30:53,926 --> 07:31:02,935 PLANNING COMMITTEE MEMBERS. 10546 07:31:03,002 --> 07:31:05,638 THANK YOU ALL FOR CONTRIBUTING 10547 07:31:05,705 --> 07:31:07,440 YOUR TIME AND EXPERTISE TO THE 10548 07:31:07,507 --> 07:31:11,344 SUCCESS OF THIS EVENT. 10549 07:31:11,411 --> 07:31:13,279 WITH THAT, THANK YOU AGAIN. 10550 07:31:13,346 --> 07:31:14,747 TODAY'S WORKSHOP IS OFFICIALLY 10551 07:31:14,814 --> 07:31:15,014 ADJOURNED. 10552 07:31:15,081 [END OF PROGRAM]