>> WELCOME BACK.
THANK YOU FOR JOINING US FOR
DAY 2 OF THE NIH VIDEOCAST
ON HIV AND WOMEN SCIENTIFIC
WORKSHOP CENTERING THE
HEALTH OF WOMEN IN HIV
RESEARCH.
I AM PROGRAM OFFICER AT NIAD
AND COAUTHORING THE SESSION
WITH Dr. TATIANA AND
OTHERS.
I WILL PROVIDE INTRODUCTION
FOR ALL THE SPEAKERS OF THE
SESSION AND TATIANA WILL
MODERATE THE DISCUSSION.
THIS IS PART OF THE HIV AND
WOMEN SIGNATURE PROGRAM WITH
THE INTENTION OF PREVENTING
THE NEXT EPIDEMIC.
WE WILL INCLUDE TODAY HOW TO
IDENTIFY HIV RESEARCH.
AS A REMINDER, YOU CAN
PRESENT QUESTIONS USING THE
LIVE FEEDBACK FORM AND VOICE
THEM IF YOU ARE ABLE.
YOU CAN ALSO SUBMIT
QUESTIONS TO WOMENANDHIV AD
OD.NIH.GOV.
Dr. SHARON HILLIER IS A
RESEARCHER DISCOVERING THE
ORGANISM IN THE GENITAL
TRACT INCLUDING HIV.
Dr. HILLIER HEADED THE
NETWORK FROM 2006 TO 2022,
THE ORGANIZER OF THE CHILD'S
NETWORK AND PART OF THE UAB
FUNDED INITIATIVE TO PRESENT
NEW HIV PREVENTION PRODUCTS.
Dr. BRIANNA FURCH IS A
SCIENTIST WHO FOCUSES ON
WOMEN'S HEALTH, HIV
PREVENTION AND INFECTIOUS
DISEASE.
AT THE FRED HUTCHINSON
CANCER CENTER, Dr. FURCH
PLAYS A KEY ROLE FOR
OVERSIGHT AND DEVELOPMENT
AND IMPLEMENTATION OF SARS
COV2, HIV AND ASSOCIATED
TRIALS.
Dr. RASHEETA CHANDLER IS A
PROFESSOR AT UNIVERSITY OF
CALIFORNIA AND SCHOOL OF
MEDICINE SAN FRANCISCO.
AS A PRACTITIONER AT THE
CENTER OF BLACK WOMEN'S
HEALTH IN GEORGIA.
Dr. CHANDLER LOOKS AT
DISPARITIES IN CARE
INCLUDING REPRODUCTIVE CARE
INCLUDING CIS WOMEN.
Dr. SINEAL DELANY-MORETIWE
IS PROTOCOL CHAIR OF THE
LANDMARK TRIALS AND
INJECTABLE PREEXPOSURE PRO
LACKED 'TIS WHICH LED TO --
[INDISCERNIBLE]
IN SEVERAL COUNTRIES.
JACQUELYNE ALESI HAS WORKED
FOR THE WOMEN'S PREVENTION
CAMPAIGN, GLOBAL COMMUNITY
LEADERSHIP SINCE
NOVEMBER 2021.
IN THIS ROLE, SHE MOBILIZES
THE GLOBAL COMMUNITY VOICE,
A GLOBAL COLLABORATION FOR
PEOPLE LIVING WITH HIV TO
INCLUDE U EQUALS YOU IN THE
COVID RESPONSE.
SINCE JACQUELYNE WILL NOT BE
ABLE TO JOIN THE
PRESENTATION, DANIELLE
CAMPBELL WILL BE ATTENDING
THE DISCUSSION.
DANIELLE IS A FOURTH-YEAR
RESEARCH MANAGER FOR
IMPLEMENTATION SCIENCE IN
BIOBEHAVIORAL RESEARCH INTO
HIV TREATMENT PREVENTION AND
CURE RESEARCH.
SHE IS A MEMBER OF THE
FACULTY AT CHARLES R
UNIVERSITY OF MEDICINE AND
SCHOOL OF MEDICINE,
PHYSICIANS OF PREVENTIVE AND
SOCIAL MEDICINE.
NEXT SLIDE, PLEASE.
THE FIRST PRESENTATION IS
FROM SHARON HILLIER.
PLEASE GO AHEAD, Dr.
HILLIER.
>> THANKS SO MUCH AND IT IS
A THRILL TO BE HERE TO GET
TO SHARE SOME OF MY
EXCITEMENT FOR ADVANCES IN
MULTIPURPOSE PREVENTION.
NEXT SLIDE.
SIMPLY PUT, I DON'T REALLY
LIKE THE TERM MPT VERY MUCH
BECAUSE I DON'T THINK MOST
WOMEN THOUGHT FIRST THING IN
THE MORNING I WOULD LIKE TO
PUT MPT IN MY VAGINA.
WHAT THEY ARE IS PRODUCTS
FOR DUAL PREVENTION AND
REALLY GEARED TO PROTECT
AGAINST MORE THAN ONE THING
AT A TIME.
WOMEN GET PREGNANT, STIS AND
HIV ALL IN THE SAME WAY SO
THE IDEA IS QUITE SIMPLY YOU
COULD PREVENT HIV, SEXUALLY
TRANSMITTED INFECTION AND
PREGNANCY ALL FROM THE SAME
EXACT PRODUCT.
FROM A PERSPECTIVE OF WHAT
THEY WANT, WE HAVE HEARD
FROM MANY WOMEN THAT THEY
HAVE A PURPOSE FOR
MULTIPREVENTION PRODUCTS.
58PERCENT
8-- 85 PERCENT SAY THEY
WOULD LIKE A PRODUCT THAT
DOES MORE THAN ONE THING BUT
THERE IS NO PRODUCT
CURRENTLY AVAILABLE ASIDE
FROM A FEMALE CONDOM.
THEY FACE BARRIERS TO
SUCCESS INCLUDING LACK OF
INVESTMENT BY FUNDERS, A
COMPLEX REGULATORY APPROVAL
PATH AND PROGRAM SILOS THAT
EXIST IN FAMILY PLANNING
VERSUS HIV/STI PROGRAMS.
NEXT SLIDE.
SO I WILL GO THROUGH A FEW
OF THOSE PRODUCTS AND ONE OF
THE PRODUCTS THAT DO GO
ALONG IS HERE ON THE
RIGHTHAND SIDE TO SHOW HOW
THIS WOULD BE PACKAGED.
WHAT WE HAVE HEARD FROM MANY
WOMEN IS THAT ORAL PREP
ESSENTIALLY IS WHAT
SIGMATIZED TO MAKE THOSE
TABLETS LOOK EXACTLY LIKE
TREATMENT SO THERE CAN BE
STIGMA ASSOCIATED WITH USING
PREVENTION WHEN ONE IS NOT
LIVING WITH HIV.
SO THE IDEA OF THE DUAL
PREVENTION PILL IS THAT YOU
WOULD COFORM LATE ALONG WITH
THE ORAL CONTRACEPTIVE PILL
AS ONE TABLET AND PACKAGED
IN THE SNAP PACKAGE MANY OF
US ARE FAMILIAR WITH ORAL
CONTRACEPTIVES.
THIS IS A STUDY THAT WILL BE
PRESENTED BY THE HIV TRIAL
PREVENTION NETWORK WITH THE
LAUNCH IN 2024.
AND IF THIS STUDY IS
SUPPORTED, THAT IT REALLY
DOES INCREASE ADHERENCE OR
PREP AND WOMEN LIKE IT, I
THINK IT IS A PATHWAY FOR
HOW THIS COFORMULATION OF
CONTRACEPTIVES AND PREP
PRODUCTS COULD OCCUR.
NEXT SLIDE.
THE NEXT PRODUCT I WANT TO
TELL YOU ABOUT IS A 90-DAY
VAGINAL RING FOR
CONTRACEPTION AND HIV.
THIS WAS DEVELOPED BY THE
INTERNATIONAL PARTNERSHIP
FOR MICROBICIDES AND NOW
HOUSED BY THE POPULATION
COUNCIL.
THIS IS SIMILAR TO THE VAL
RING THAT WENT THROUGH
CLINICAL TRIALS EXCEPT IT IS
LOADED WITH DANNUAL PIVIRENE
SO IT LASTS FOR 90 DAYS AS
WELL AS LEAVING
LEVONORGESTREL FOR
CONTRACEPTION.
THE PRODUCT WAS FOUND TO BE
REALLY WELL TOLERATED WITH
NO CONCERNS AND TWO DAYS
AFTER YOU TAKE THE PRODUCT
OUT OF THE ADVANTAGE FINE IN
A -- SORRY, GO BACK ONE,
PLEASE.
TWO DAYS AFTER IT IS TAKEN
OUT OF THE VAGINA YOU WOULD
SEE THIS DECREASE IN THE
DRUG SO IT DOESN'T HAVE A
DRUG TAIL.
THE PRODUCT WAS FORMULATED
TO MAKE IT EASIER AND THE
RING A LITTLE BIT LESS RIGID
AND THAT STUDY IS ONGOING
THROUGH THE CONTRACEPTIVE
CLINICAL TRIALS, A NETWORK
FUNDED BY THE INSTITUTE OF
CHILD HEALTH WITH 30 TO 40
PARTICIPANTS ENROLLED TO
DATE.
NEXT SLIDE.
SO THE NEXT PRODUCT I WANT
TO TELL YOU ABOUT IS ANOTHER
DAPIVIRNE VAGINAL RING.
THE IDEA OF THIS IS YOU CAN
DELIVER DRUGS OVER A MONTH
OF TIME BUT WITHOUT THE RING
IN THE VAGINA WHICH MAKES IT
MUCH MORE DISCREET, COULD BE
DEFINITELY LOWER COST TO
MANUFACTURE.
SO THERE IS TWO VERSIONS OF
THIS PILL, ONE THAT CONTAINS
JUST DAPIVIRINE AND ONE THAT
CONTAINS DAPIVIRINE AND
PROGESTERONE.
THIS IS IN PHASE 1 STUDY IN
THE U.S., KENYA, ZIMBABWE
AND SOUTH AFRICA.
NEXT SLIDE.
HOW DOES THIS WORK?
NEXT SLIDE.
THE IDEA IS THE IT IS PLACED
IN THE VAGINA BY THE WOMAN,
PRETTY EASY TO DO.
IT IS WETTED BY VAGINAL
FLUID AND AS IT SLOWLY
DISSOLVES, IT SPREADS
THROUGHOUT THE VAGINA AND IN
THAT WAY, BLOCKS HIV AND
PREGNANCY.
AFTER 30 DAYS, THE FILM IS
COMPLETELY GONE AND WOULD BE
REPLACED BY ANOTHER FILM.
SO THIS IS A REALLY EXCITING
COMPLETELY NOVEL WAY OF
DELIVERING A MPT AND WE'RE
EXCITED TO SEE HOW THIS
PROGRESSES IN THE MONTHS
AHEAD.
NEXT SLIDE.
THE NEXT PROBLEM I WANT TO
QUICKLY TELL YOU ABOUT IS
SOMETHING CALLED THE ONE
RING, A DUAL PURPOSE RING TO
PREVENT HIV AND PREGNANCY
AND THIS IS BEING DEVELOPED
IN CALIFORNIA.
THIS IS A RING THAT HAS, AS
YOU CAN SEE THERE AT THE
TOP, TWO LITTLE PODS.
ONE CON PAINS THE ANTI-HIV
AGENT AND THE OTHER CONTAINS
THE CONTRACEPTIVE.
WHAT IS REALLY NOVEL ABOUT
THIS RING IS THAT IT IS A
NONHORMONAL, NONE A RV-BASED
CONTRACEPTIVE AND HIV RING.
SO WHAT IS IT?
THE ANTIVIRAL IS A ANTIVIRAL
PEPTIDE WHICH IS UNIQUE AND
HAS ACTIVITY AGAINST HERPES
AND HPV AND THE
CONTRACEPTIVE AGENT IS
SOMETHING CALLED A SAC
INHIBITOR WHICH BASICALLY
INHIBITS SPERM MOTILITY.
THE PRECLINICAL PLACEBEEN O
RINGS, THIS CARRIER DEVICE,
ARE NOW BEING EVALUATED IN
CLINICAL TRIALS FOR
ACCEPTABILITY AND FOR
SELECTION OF THE STIFFNESS
OF THE VAGINAL RINGS IN AN
ONGOING CLINICAL TRIAL IN
THE U.S. AND AFRICA.
AND WE'RE EXCITED TO SEE THE
ACTIVE VERSION OF THESE
RINGS MOVING INTO CLINICAL
TRIALS NEXT YEAR.
NEXT SLIDE.
SO ONE THAT I THINK WILL BE
FAMILIAR TO MANY OF YOU IS
HOW DO YOU MAKE AN
INJECTABLE TAB THAT SINEAD
IS GOING TO TALK ABOUT IN A
LITTLE BIT, MAYBE A LITTLE
BIT BETTER.
AND THIS IS A PRODUCT CALLED
CAB HYDROGEL INJECTABLE
DEPOT WHICH IS BEING
DEVELOPED IN VIRGINIA AND WE
HOPE WILL BE STUDIED IN A
CLINICAL TRIAL WITH THE
ADOLESCENT TRIALS NETWORK.
SO IT IS NOT EXACTLY LIKE
THE CAB LA THAT HAS BEEN
LICENSED BUT IT IS A NOVEL
PRODUCT THAT CREATES A DEPOT
UNDER THE SKIN BUT WILL
PROVIDE SIX MONTHS OF
PROTECTION FROM HIV ALONG
WITH PROGESTERONE.
WHY?
THE CURRENT CAB LA IS NOT
CURRENTLY FORMULATED SO I
THINK WHAT WE WILL HAVE IS A
3-MONTH PRODUCT WITH SMALLER
MILS, THREE MONTHS OF
INJECTION PROVIDED
SUBCUTANEOUSLY SO LESS
INJECTION PAIN, REDUCED
INJECTION SITE REACTION,
LOWER COST AND REDUCIBLE D
HEALTH SYSTEM BURDEN.
THIS IS IN PRECLINICAL
DEVELOPMENT BUT THERE ARE
PLANS UNDERWAY TO EVALUATE
THIS CLINICALLY IN THE
PHYSICAL 1 STUDY WITH THE
NICHD.
SO WHEN WE THINK ABOUT THE
RINGS OF PRODUCT WE HAVE
CURRENTLY IN DEVELOPMENT, IT
LOOKS PRETTY GOOD BUT IT
NEEDS TO BE A LOT BETTER.
AND MY HEADLINE ON THIS ONE
IS THAT THE FUNDING FOR MPT
IS MODEST AND ACTUALLY
GETTING SOMEWHAT SMALLER.
WE SEE HERE IN THE MIDDLE IN
THE BLUE TABLE A LIST OF THE
WONDERFUL PROJECTS THAT ARE
IN DEVELOPMENT AT NICHD
WHICH HAS REALLY BEEN THE
LEADER IN THIS SPACE AS MPTS
OR POTENTIAL MPTS AND THESE
ARE ALL, AS YOU CAN SEE ON
THE FAR RIGHTHAND COLUMN IN
VERY PRECLINICAL STAGES.
LEAD DISCOVERY, STILL TRYING
TO FIGURE OUT WHAT IS THE
BEST PRODUCT, STILL
SCREENING FOR PRODUCTS AND
THERE IS ONLY ONE REALLY AT
THE TOP THERE, THE PHASE 1
STUDY OF A PRODUCT THAT IS
BEING DEVELOPED BY DEBBIE
ANDERSON AND KEVIN WHALEY
WHICH IS A VAGINAL DEVICE
THAT CONTAINS A ANTI-SPERM
AND ANTIBODY.
SO THIS IS A WONDERFUL
PORTFOLIO OF PRODUCTS BUT
ALL VERY, VERY EARLY.
IN THE BOXES ON THE BOTTOM
WHICH I HIGHLIGHTED IN RED,
TWO THINGS YOU NEED TO KNOW.
ONE, THE BILL AND MELINDA
GATES FOUNDATION, ALTHOUGH
SPIRITUALLY SUPPORTIVE OF
THE DEVELOPMENT, HAS NOTED
MPT IS NOT ON STRATEGY OR AS
WE LIKE TO CALL A PARALLEL
STRATEGY MEANING THEY ARE
NOT MAKING A SIGNIFICANT
INVESTMENT IN THIS AREA.
NIAID WHICH HAS HAD THE NEXT
GENERATION MULTIPURPOSE
TECHNOLOGIES ANNOUNCEMENT
FOR SEVERAL YEARS HAS NOTED
THEIR ANNOUNCEMENT WILL
EXPIRE IN DECEMBER OF THIS
YEAR AND THERE WILL LIKELY
BE A GAP.
SO WE SEE TWO OF THE LARGER
FUNDERS, NIAID AND THE BILL
AND MELINDA GATES FOUNDATION
REALLY NOT IN THIS SPACE YET
THE WORK THAT HAS BEEN DONE
BY NIAID IS CRITICAL, HIGHLY
LAUDABLE BUT VERY EARLY.
NEXT SLIDE.
SO WHEN WE THINK ABOUT WHERE
WE HAVE, THE PRODUCTS WE
HAVE RIGHT NOW INCLUDE THE
PREVENTIVE PILL WHICH WOULD
BE EVALUATED BY MPT4 AND
WILL TEACH US WHETHER ORAL
PREP DRUGS AND ORAL
CONTRACEPTIVE DRUGS
INCREASES UPTAKE, ADHERENCE
AND PERSISTENCE WITH PREP.
IN THE CLINICAL DEVELOPMENT,
WE HAVE THE TAV/EVG INSERT
FOR PREP, A MPT-HIV
CONTRACEPTIVE RING AND A
NONHORMONAL NONARV RING AND
A MONTHLY FILM.
THEN IN A PRECLINICAL
DEVELOPMENT, WE HAVE THE CAB
PELLET IMPLANTS WITH OUR
WITHOUT CONTRACEPTIVES WHICH
I DIDN'T TALK ABOUT TODAY, A
CAB DEPOT SUBQ INJECTABLE
WITH OR WITHOUT
CONTRACEPTIVE WHICH WILL BE
GOING INTO TRIALS SOON AND
THEN A NOVEL VAGINAL FILM
AND RINGS BEING SUPPORTED BY
NICHD.
NEXT SLIDE.
SO WHERE DOES THIS LEAVE US?
IN A WOMAN WHO HAS WORKED IN
HIV PREVENTION FOR 30 YEARS
OR MORE, WHAT WE SEE IS THE
DESIRE EXPRESSED BY WOMEN IN
THE COMMUNITY FOR MPT AND
WHAT WE SEE IS THE
INVESTMENT HAS BEEN
RELATIVELY MODEST.
SO FOR ME, OUR CALL TO
ACTION IS FOR GREATER
FINANCIAL SUPPORT FOR
DUAL-PREVENTION PRODUCTS.
YOU KNOW, I LIKE TO SAY WE
HAVE EVERYTHING WE NEED TO
MAKE A MPT EXCEPT THE WILL
AND THE MONEY SO WE REALLY
NEED GREATER INVESTMENT
BECAUSE THESE PRODUCTS ARE
COMPLICATED.
AND THAT LEADS US TO MY NEXT
POINT.
WE CURRENTLY HAVE NO
REGULATORY PATH LAID OUT FOR
MULTIPURPOSE TECHNOLOGIES.
RIGHT NOW THE WAY IT WORKS
WITH ANY REGULAR --
REGULATOR IN THE WORLD WHO
SAYS THIS IS THE PRODUCT AND
WHAT YOU NEED TO DO BUT THIS
IS DIFFERENT BECAUSE THEY
WILL REQUIRE CLINICAL TRIAL
DESIGN.
IF YOU THINK ABOUT THE ONE
PRODUCT THAT I MENTIONED
WITH A STAPH INHIBITOR AND
HIV PREVENTION AND
ANTIMICROBIAL, IT BECOMES
IMPOSSIBLE TO MOVE SO WE
NEED A REGULATORY PATHWAY
FOR THESE PRODUCTS.
AND FINALLY HIV PREVENTION
AND FAMILY PLANNING LIVE IN
DIFFERENT SILOS FROM R&D TO
SCALE-UP AND WE NEED BETTER
INTEGRATED SYSTEMS TO MAKE
THIS POSSIBLE.
I THINK MPT COULD EXPAND
USE, COULD MEET THE UNMET
NEEDS OF YOUNG WOMEN AND ONE
OF THE THINGS I ALWAYS HEAR
ARE THINGS THAT I CALL THE
ENEMY OF THE GOOD.
THAT IS PEOPLE SAYING WELL,
IF SOMEONE HAS A REALLY
EFFECTIVE CONTRACEPTIVE, WE
DON'T WANT THEM TO USE A MPT
BECAUSE THEN THEY MIGHT FALL
PREGNANT.
OR WE HAVE A PERFECTLY GOOD
HIV PREVENTION PRODUCT AND
SOMEONE SHOULD ALWAYS USE
THAT, SO CAB LA IS ALMOST
PERFECT, RIGHT?
SO WE DON'T WANT TO OFFER
THEM SOMETHING THAT MAY BE
LESS EFFECTIVE.
I HAVE A DIFFERENT VIEW.
WHAT WE WANT TO DO IS CREATE
MANY OPTIONS THAT ALLOWS
WOMEN TO PICK SOMETHING THAT
IS RIGHT FOR THEM.
NEXT SLIDE.
I WOULD LIKE TO ACKNOWLEDGE
ALL THE PEOPLE AND GROUPS
WHO SUPPORTED PROVIDING
INFORMATION FOR THE
PRESENTATION AND OF COURSE
OUR FUNDERS.
THANK YOU SO MUCH.
>> THANK YOU SO MUCH,
SHARON, AS A REMINDER TO THE
AUDIENCE, PLEASE SUBMIT YOUR
QUESTIONS IN THE CHAT OR
FEEDBACK.
Dr. HILLIER IS AVAILABLE
TO ANSWER ANY QUESTIONS.
>> GOOD MORNING, I AM
BRIANA FURCH, I AM HERE
REPRESENTING THE HIV VACCINE
TRIALS NETWORK IN SEATTLE,
WASHINGTON.
THANK YOU FOR INVITING ME TO
BE A PART OF THE -- PART OF
THE NIH HIV PREVENTION
WORKSHOP.
A VACCINE SUBSTANCE CREATES
AN IMMUNE RESPONSE IN A
PERSON'S BODY SO IF YOU
ENCOUNTER A SIMILAR
SUBSTANCE, AN INVADER IN THE
FUTURE, YOUR BODY WILL
RECOGNIZE IT AND KNOW HOW TO
FIGHT IT WITHOUT CAUSING THE
DISEASE ITSELF.
RESEARCHERS USE EPIDEMIOLOGY
TO DESCRIBE WHO HAS HIV IN
YOUR COMMUNITY AND DETERMINE
RISK FACTORS ASSOCIATED WITH
ACQUIRING HIV TO INITIATE
CLINICAL TRIALS.
WE WANT VACCINES TO TARGET
VARIABLE AREAS OF THE HIV
VIRUS AND SHOULD PROTECT
AGAINST HIV-1 INFECTION BY
SEX AND INJECTABLE DRUGS.
THEY SHOULD BE AVAILABLE TO
TAKE NO SIDE TEXTS AND
AFFORDABLE BY ALL PEOPLE FOR
SAFE EFFECTIVE VACCINE FOR
HIV GLOBALLY.
THE OVERALL RESEARCH
INVOLVES WORK IN ALL PHASES
OF THE DESIGN, DEVELOPMENT
AND EVALUATION OF HIV
VACCINATION.
WHILE THE RESOURCES OF THE
NETWORK ARE ALMOST ENTIRELY
DEVOTED TO CLINICAL TRIAL
EVALUATION FROM TEST TO
HUMAN AND CONCEPT TO
LICENSURE EFFICACY TRIALS,
THE NETWORK AND
INVESTIGATORS ARE ALSO
INVOLVED IN PRECLINICAL
ASPECTS OF VACCINE SIGNS AND
DEVELOPMENT.
SO WHAT IS A VACCINE?
A VACCINE BASICALLY TEACHES
YOUR BODY TO RECOGNIZE THE
DISEASE.
IT THEN WILL POST AN ALARM
AND INSTRUCT YOUR CELLS TO
GO TO WORK WITH THE IDEA
THAT IT WILL BE KILLED OR
CONTROLLED.
SO VACCINES CAN BE
PREVENTIVE IN HUMANS.
PREVENTIVE VACCINES FOR THE
HIV-NEGATIVE POPULATIONS ARE
BEING DEVELOPED BY HVTN TO
CONTROL THE SPREAD OF HIV BY
PREVENTING INFECTION AND
DECREASING THE LIKELIHOOD OF
TRANSMISSION.
IF INFECTION DOES OCCUR, A
VACCINE CAN HELP PREVENT HIV
PROGRESSION TO AIDS SO
RESEARCHERS ARE ALSO
EVALUATING THERAPEUTIC
VACCINES TO TREAT PEOPLE
ALREADY INFECTED WITH HIV OR
AIDS.
SO WHAT ARE THESE SYSTEMS WE
TALK ABOUT?
[INAUDIBLE] THE INNATE
IMMUNITY RESULTS IN
PREVENTING OR ELIMINATING
INFECTION THROUGH THE
PRODUCTION OF NATURAL BODY
CHEMICALS OR THROUGH THE
ACTION OF CELLS.
SO THIS IS THE ONE THAT WHEN
YOU HAVE NEVER BEEN EXPOSED
TO ANYTHING BEFORE AND YOUR
BODY ENCOUNTERS IT, IT
STARTS RECRUITING CELLS TO
FIGHT IT.
THE OTHER IMMUNE CELLS
THROUGH PRODUCTION THROUGH
PRODUCTION OF THE SPECIFIC
ANTIBODIES BY B CELLS OR
THROUGH ACTIONS OF CD8
LYMPHOCYTES FOLLOWING
EXPOSURE TO THE PATHOGEN OR
PARTS OF THE PATHOGEN.
THE HELPER CELLS STRENGTHEN
THESE RESPONSES AND VACCINE
GIVE IT A PIECE OF THAT TO
TELL THE BODY WHAT TO LOOK
FOR TO PREVENT INFECTION.
SO THE SYSTEM IS VERY BROAD,
WILL PROGRAM THE IMMUNE
SYSTEM TO START PRODUCING
CLONES TO ATTACK AND THEN
MAKE SPECIFIC ANTIBODIES TO
DO THAT, SPECIFIC T CELLS TO
COUNTER THAT TRIANGLE SHAPE.
THIS IS HELPED ALONG BY T
CELLS THAT STRENGTHEN THE
RESPONSE AND WITH THE
ULTIMATE GOAL IS FOR
VACCINES TO STIMULATE AN
ADAPTIVE IMMUNE RESPONSE, TO
BE THE IMMUNE SOLDIERS AND
HELP PROTECT THE HOST FROM
INFECTION OR TO BLOCK THE
OCCURRENCE OF THE DISEASE.
SO WHY DO WE NEED AN HIV
SPECIFIC VACCINE?
WELL, ANTI-RETRO VIRAL
TREATMENT IS ONE OF THE VIBE
ABILITIES.
95PERCENT OF PEOPLE WITH HIV
LIVE IN DEVELOPING WORLD
COUNTRIES.
THE TREATMENT IS NOT A CURE
AND HAS MANY SIDE EFFECTS.
WE ALSO KNOW THE VIRUS IS
BEING RESISTANCE TO CERTAIN
DRUGS AND WE KNOW PREVENTION
AND EDUCATION HAVE SLOWED
THE EPIDEMIC BUT NOT STOP
MASSIVE SPREAD SO WE NEED
SOMETHING TO HELP COVER AND
REACH AS MANY PEOPLE AS WE
CAN.
SO WHY AN HIV VACCINE?
WELL, AS YOU CAN SEE FROM
THE DIFFERENT COLORS ON THE
MAP HERE, THEY REPRESENT THE
DIFFERENT STRINGS OF THE
VIRUS.
IT IS LIKE A FAMILY.
YOU KNOW YOU ARE ALL RELATED
BUT YOU ARE NOT QUITE THE
SAME.
YOU ARE NOT CLONES OF EACH
OTHER SO EVERYTHING WILL BE
JUST A LITTLE BIT DIFFERENT
AND ALMOST THE SAME.
THE HIV CAN ESCAPE THE
IMMUNE SYSTEM THROUGH VIRAL
MUTATION.
IT CAN HIDE IN LATENT
RESERVOIRS LIKE ADIPOSE
TISSUE OR MUSCLES, WE'RE
FINDING OUT.
IT TARGETS CELLS IN THE
IMMUNE SYSTEM.
IT HAS A HIGH SEQUENCE OF
DIVERSITY AND HIV ALSO MASKS
NEUTRALIZING EPITOPES WHICH
ARE THE PLACES ON THE VIRUS
THAT TARGET OUR TD 4 CELLS
AND CONNECT AND BIND AND
START THE PROCESS OF THE
DISEASE.
SO IT CAN MASK THESE AND
THAT MAKES THINGS MORE
DIFFICULT.
THIS SLIDE DEMONSTRATES THE
STRUCTURE OF THE VIRUS WHERE
RESEARCHERS CAN TARGET
DIFFERENT AREAS FOR A BETTER
VACCINE WITH THE GOAL IT OF
CREATING MULTICLONAL STRINGS
THROUGHOUT GEOGRAPHIC AREAS,
CREATING SEVERAL VACCINES
TARGETING REGIONS THAT ARE
SPECIFIC ON THE VIRUS ACROSS
CLAVES, TO CREATE A VACCINE,
A LITTLE OF THIS, LITTLE OF
THAT TO KEEP NEUTRALIZING
BODIES FROM PEOPLE LIVING
WITH HIV AND FIRST ENGINEER
THEM TO MAKE COMBINATION
VACCINES THAT CAN BE THE
SAME BODIES. ANTIBODIES.
AND THIS WORK USING DNA
PEPTIDE, RECOMBINANT
PROTEIN, PARTICLES, VIRAL
VECTORS AND ULTIMATELY
CHYMERA.
THERE ARE ADDITIONAL THINGS
TO BOOST THE VIRUS AND THIS
WILL AFFECT THE DOSE, HOW
MUCH WE WILL NEED TO USE,
HOW WILL IT ADMINISTER, WILL
IT BE SHOT, INTRAVENOUS,
WILL IT BE DONE
SIMULTANEOUSLY, IT WILL
AFFECT THE TIMING, HOW MANY
INJECTIONS WE NEED, HOW FAR
BETWEEN THEM AND THE METHOD,
WILL WE USE JUST THE SYRINGE
OR OTHER METHODS AND ALL OF
THESE THINGS WE TAKE INTO
CONSIDERATION WHEN WE THINK
ABOUT VACCINES.
IN ORDER TO DETERMINE
WHETHER A VACCINE WORKS, IT
WILL NEED TO BE TESTED.
KNOWING THE RISK FOR
ACQUIRING HIV ENABLES US TO
BE ABLE TO RUN A TRIAL FOR
HIV.
BEING ABLE TO DESCRIBE WHO
HAS HIV IN YOUR COMMUNITY
WILL LEAD US TO DETERMINE
RISK FACTORS ASSOCIATED WITH
ACQUIRING HIV.
THESE ARE ALL PERSISTENT AND
EX VENT AND WE USE MODELS TO
DETERMINE THESE RISK
FACTORS.
WITH THIS INFORMATION, WE
CAN THEN DESIGN AND RECRUIT
APPROPRIATE HIV VACCINE
TRIALS.
SO HOW DO WE TEST A
POTENTIAL VACCINE CANDIDATE?
WELL, THERE ARE PHASES FOR
CLINICAL TRIALS.
PHASE 1 REQUIRES A SMALL
GROUP OF HEALTHY
PARTICIPANTS WITHOUT HIV TO
TEST SAFETY, DOSE AND
SCHEDULE.
IN PHASE 2, HUNDREDS OF
PARTICIPANTS WITHOUT HIV TO
TEST SAFETY AND IMMUNE
RESPONSE.
AND PHASE 3 WHICH IS
THOUSANDS OF PARTICIPANTS
FROM POPULATIONS OF INTEREST
TO TEST SAFETY AND
EFFECTIVENESS.
AND AS YOU CAN SEE, EACH
PHASE TAKES A DIFFERENT
AMOUNT OF TIME SO BY THE
TIME WE ARE FINISHED THE
PHASE 3, WE'RE AT THE YEAR 4
MARK.
AND WE KEEP TRACK THROUGH
EACH OF THE PHASES BECAUSE
IT IS THE MOST IMPORTANT
THING WHEN DOING ANY KIND OF
VACCINE OR CLINICAL TRIAL,
WE ALWAYS MAKE WE USE
INFORMED CONSENT ON RISKS
AND IMPLEMENTATION.
IT IS REQUIRED FOR ALL
VOLUNTEERS.
WE MAKE SURE THEY UNDERSTAND
AND CONSENT.
SO WHEN WE FIND IT, JUST
WHAT MIGHT A PREVENTIVE HIV
VACCINE DO?
THERE ARE SEVERAL WAYS WE
BELIEVE A HIV VACCINE MIGHT
WORK.
FIRST WAY IT MIGHT WORK IS
BY TRIGGERING A STRONG
ANTIBODY RESPONSE.
THAT WOULD BE THE GOAL TO
COMPLETELY PREVENT
INFECTION.
BUT A VACCINE THAT CAN
TRIGGER A REALLY STRONG T
CELL RESPONSE MAY BE ABLE TO
COMBAT INFECTION AND CLEAR
IT FROM THE BODY TO FIGHT
THE DISEASE.
JUST LIKE WE'RE ABLE TO
FIGHT BACK FROM THE COLD OR
FLU.
THIS WOULD BE THE SILVER
MEDAL.
AND THEN THE THIRD IDEA,
PERHAPS WE COULDN'T
COMPLETELY FIGHT OFF THAT
INFECTION BUT ONLY PARTIALLY
CONTROL IT?
THIS COULD RESULT IN SLOWING
IT DOWN, GIVING US THE TIME
IT WOULD TAKE TO GO FROM
INITIAL HIV TO DEVELOPING
CLINICAL PIECE.
THIS WOULD STRETCH OUT BY
HELPING CONTROL THE VIRAL
LOAD AND THIS IS THE GOLD
MEDAL BECAUSE WE KNOW THEY
WOULD BE LESS ABLE TO
TRANSMIT INFECTION TO OTHERS
AND LESS LIKELY TO DEVELOP
THE DISEASE THEMSELVES.
THEY COULD ALSO CREATE HERD
IMMUNITY WITH THE IDEA THAT
EVEN THOUGH SOME PEOPLE ONLY
GET THE VACCINE MAKING THEM
LESS ABLE TO TRANSMIT THE
VIRUS TO OTHERS, THEN THERE
IS FEWER CONNECTIONS WITH A
GREATER RESULT.
WITH FEWER PEOPLE
TRANSMITTING, THE WIDER
PUBLIC COULD STILL BENEFIT.
SO THAT IS MY CALL TO
ACTION.
IF YOU SEE A CLINICAL TRIAL
FOR A HIV VACCINE, READ UP
ON IT.
TALK TO THE RECRUITERS, TALK
TO THE NURSES, THE
PHYSICIANS, AND SEE IF THIS
IS A GOOD TRIAL FOR YOU.
READ THE INFORMED CONSENT
AND IF YOU AGREE, SIGN UP.
WE WOULD LOVE TO HAVE YOU.
WE NEED HEALTHY
PARTICIPANTS, HEALTHY
VOLUNTEERS ALL AROUND THE
WORLD TO HELP US FIGURE OUT
WHICH VACCINES ARE GOING TO
BE THE BEST VACCINES TO USE
SO PEOPLE CAN DECREASE VIRAL
LOSE, DECREASE TRANSMISSION
EVERYWHERE AND HOPEFULLY IN
THIS HIV EPIDEMIC.
SO I WOULD LIKE TO THANK MY
COLLEAGUES AT FRED HUTCH.
LIKE TO THANK MY COLLEAGUES
AT THE HIV TRIAD, THANK MY
COLLEAGUES AT THE NIH FOR
INVITING ME AND PLEASE LET
ME KNOW IF YOU HAVE ANY
QUESTIONS.
THANK YOU.
>> THANK YOU SO MUCH, Dr.
FURCH.
SOME OF YOU MAY NOT KNOW
THAT SHE IS A NEW MOM AND
YOU COULD HEAR HER BABY
CRYING IN THE BACKGROUND.
SO AS A REMINDER, PLEASE PUT
YOUR QUESTIONS IN THE
FEEDBACK.
GO AHEAD, Dr. CHANDLER.
>> I AM OVERVOID WITH THE
PRESENTATION PRIOR TO MINE,
VERY EXCITED ABOUT THE NEW
DEVELOPMENT WITH MPT AND
ALSO THE INTRODUCTION AND
FUNDING SPECIFIC FOR THAT
VACCINATION.
IT'S VERY EXCITING SO THANK
YOU TO MY PREVIOUS
COLLEAGUES WHO PRESENTED
THEIR INFORMATION.
I AM GOING TO TAKE IT BACK
TO THE BASICS WITH PREP IN
USA AND I WANT TO
SYMBOLICALLY REPRESENT AS
YOU SAW ON ALL OUR SLIDES
AND REMEMBERING NATIONAL
WOMEN AND GIRLS ON HIV
AWARENESS DAY THAT WAS ON
MARCH 10TH.
NEXT SLIDE, PLEASE.
WE ARE GOING TO BREAK PREP
DOWN HERE JUST A LITTLE BIT
AND TALK ABOUT THE
FORMULATION AND THEN SOME OF
THE ISSUES THAT PERSIST.
WE HAVE ALL THESE GREAT
DISCOVERIES BUT WE HAVE TO
GET IT TO THE POPULATION AND
WE HAVE TO TRY TO ENCOURAGE
YOU AND DO THAT EQUITABLY.
SO I WILL START OUT BY
SAYING PREP IS RECOMMENDED
FOR PEOPLE WHO ARE HIV
NEGATIVE AND AT RISK FOR
GETTING THE VIRUS FROM SEX
OR INJECTION DRUG USE.
AND FOR SEXUAL TRANSMISSION,
THIS INCLUDES PEOPLE WITHOUT
HIV WHO HAVE HAD AGE OR
VAGINAL SEX IN THE PAST 6
MONTHS AND HAVE A SEXUAL
PARTNER WITH HIV, ESPECIALLY
IF THE PARTNER HAS AN
UNKNOWN OR DETECTABLE VIRAL
LOAD, OR HAVE NOT
CONSISTENTLY USED A COULD
NOT COME TO.
OR HAVE BEEN DIAGNOSED WITH
A SEXUALLY TRANSMITTED
DISEASE IN THE PAST SIX
MONTHS.
FOR PEOPLE WHO INJECT DRUGS,
THIS INCLUDES THOSE WHO HAVE
AN INJECTION PARTNER WITH
HIV OR HAVE SHARED WOULD
NEEDLES, SYRINGES OR OTHER
INJECTION EQUIPMENT.
NEXT SLIDE PLEASE.
I WANTED TO TALK A LITTLE
BIT ABOUT PREP FORMULATION.
I WON'T GO INTO THE
SPECIFICS BUT WITH THE
ALLOTTED TIMELINE, JUST SHOW
HOW PREP CAME ALONG.
SO IN 2012, WE HAD TRUVADA,
THE BLUE PILL THAT IS TAKEN
ONCE A DAY.
THEN WE HAD DESCOVY AND I
WANT TO -- YOU KNOW THAT
DISCOVERY WAS IN -- WELL,
MADE AVAILABLE IN 2019 BUT I
WANT YOU TO KNOW IT IS NOT
IN USE FOR FEMALES OR THOSE
AT BIRTH TO PREVENT HIV
BECAUSE THIS HAS NOT BEEN
STUDIED.
IN 2020, GENERIC PREP WAS
MADE AVAILABLE AND IN 2021,
APPRETUDE OR CABOTEGRAVIR
WAS MADE AVAILABLE IN LONG
ACTING FORM AND INJECTABLE
FORM.
NEXT SLIDE, PLEASE.
WHAT I REALLY WANT TO GET
INTO IS THE PREP CAB AND
THAT IS WHAT I ALLUDED TO
EARLIER, IS THAT WE HAVE
THESE GREAT OPTIONS FOR
INDIVIDUALS BUT WE NEED TO
HOPEFULLY ENSURE THAT WE CAN
GET THEM TO INDIVIDUALS
EQUITABLY AND YOU WILL NOTE
IN SOME OF THE SLIDES THAT I
HAVE WHERE THOSE DISPARITIES
OCCUR.
SO LOOKING AT CDC MODELING
AND INSURANCE CLAIM DATA, IT
ESTIMATES 1.2 MILLION PEOPLE
ARE LIKELY TO BENEFIT FROM
PREP IN THE U.S. BUT THAT
ONLY 30 PERCENT OF THOSE
INDIVIDUALS WHO COULD
BENEFIT FROM PREP WERE
PRESCRIBED IT.
AND SO WE NEED TO IMPROVE
THAT AND UNFORTUNATELY THIS
IS RACIALLY SIGNIFICANT AND
RELATED TO RACE.
SO I WILL DEMONSTRATE THAT
AS WELL.
AND SO IN ALL RACES,
41 PERCENT OF MEN WHO WERE
ELIGIBLE WERE DESCRIBED AS
WHITE AND THEN 14.5 PERCENT
OF WOMEN ELIGIBLE WERE
PRESCRIBED SO WE HAVE SOME
IMPROVEMENT WE NEED TO DO
THERE.
NEXT SLIDE, PLEASE.
AND AS YOU WILL NOTICE, AS
SHOWN HERE WHERE YOU SEE
THAT RACIAL BREAKDOWN SO IN
2021, LESS THAN 1/4 OF
PLAQUE, HISPANIC OR LATINO
PEOPLE WHO WERE ELIGIBLE FOR
PREP WERE PRESCRIBED IT
COMPARED TO 3/4 OF WHITE
PEOPLE SO THIS IS A VISUAL
TO ILLUSTRATE THAT.
NEXT SLIDE, PLEASE.
AND IN OUR EFFORT OF ENDING
THE HIV EPIDEMIC IN THE
UNITED STATES, HERE ARE SOME
OF THE GOALS.
SO THE GOAL IS FOR
75 PERCENT REDUCTION IN NEW
HIV DIAGNOSES IN FIVE YEARS
AND A 90 PERCENT REDUCTION
IN TEN YEARS.
SO THESE GOALS ARE SLATED
FOR 2030 SO WE'RE DILIGENTLY
TRYING TO GET TO THAT.
AGENCIES ACROSS THE U.S.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES DEVELOP A
OPERATIONAL PLAN TO PURSUE
THAT GOAL ACCOMPANIED BY A
REQUEST FOR ADDITIONAL
ANGLED FUNDING TO DO SO.
THIS PLAN LEVERAGES CRITICAL
ADVANCES IN HIV PREVENTION,
DIAGNOSIS, TREATMENT AND
OUTBREAK BY LEVERAGING THE
INFRASTRUCTURE IN OFFICES.
INFECTIONS ARE HIGHLY
CONCENTRATED AMONG MEN,
MINORITIES, ESPECIALLY
AFRICAN-AMERICANS,
HISPANICS, LATINOS, AMERICAN
INDIANS AND ALASKA NATIVES
AND THOSE WHO LIVE IN THE
SOUTHERN UNITED STATES.
SO THOSE ARE THE AREAS OF
CONCENTRATION.
NEXT SLIDE, PLEASE.
YOU WILL SEE ON THE NEXT
SLIDE I HAVE ILLUSTRATED OR
SHOWN A MAP WHERE THERE IS
HIV EPIDEMIC IN THE UNITED
STATES.
IT IS CONCENTRATED.
THE INITIATIVE INITIALLY
FOCUSES EFFORTS IN 48
COUNTIES, WASHINGTON D.C.
AND SAN JUAN AND PUERTO RICO
WHERE MORE THAN 50 PERCENT
OF HIV DIAGNOSES OCCUR AND
AN ADDITIONAL 7 STATES WITH
A SUBSTANTIAL NUMBER OF HIV
DIAGNOSIS IN RURAL AREAS
BRINGING THE TOTAL NUMBER OF
PRIORITIZED TO A
JURISDICTION TO 57.
NEXT SLIDE, PLEASE.
SO ENDING THE HIV EPIDEMIC
IN THE UNITED STATES, I TRY
TO THINK OF A SOLUTION MAP
TO THINK OF SOME OF THE
OBSTACLES WE NEED TO
OVERCOME TO IMMEDIATE OUR
HIV GOALS.
THE FIRST ONE IS DYING ALL
PEOPLE WITH HIV AS EARLY AS
POSSIBLE, TREATMENT OF
PEOPLE WITH HIV RAPIDLY AND
EFFECTIVELY TO REACH
SUSTAINED VIRAL SUPPRESSION,
PREVENT NEW HIV
TRANSMISSIONS BY USING
PROVEN INTERVENTIONS
INCLUDING PREP AND SSPS AND
RESPOND QUICKLY TO POTENTIAL
PIV OUTBREAKS TO GET NEEDED
PREVENTION AND TREATMENT
SERVICES TO PEOPLE WHO NEED
THEM.
NEXT SLIDE, PLEASE.
ALSO I AM WANTING TO
HIGHLIGHT THE INFECTIONABLE
ISSUES TO PREP BECAUSE WE
WANT TO ADDRESS SOME OF
THESE SOCIAL ISSUES THAT
WILL HINDER INDIVIDUALS FROM
HAVING PREP.
SO ON THE INDIVIDUAL LEVEL,
THERE ARE LINKS LIKE MENTAL
HEALTH, POVERTY, UNSTABLE
HOUSING, SUBSTANTIAL USE,
CRIMINAL JUSTICE
INVOLVEMENT, SELF STIGMA,
AWARENESS OF RISK AND PREP
ADHERENCE.
AS FAR AS THE NETWORK IN
LEVEL 2, IT INCLUDES THINGS
SUCH AS MIV PREVALENCE IN
THE NETWORK, YOUNG AGE OF
NETWORK MEMBERS AND
COMMUNITY OF STIGMA IS
IDENTIFIED.
I THINK THAT WAS MENTIONED
BEFORE, POVERTY, RACISM,
TRANSPORTATION COULD BE AN
ISSUE BETWEEN PATIENTS AND
HEALTHCARE PROVIDERS AS
WELL.
AS FAR AS POLICY, MEDICAID
EXPANSION.
A LOT OF SOUTHERN STATES
UNFORTUNATELY DID NOT EXPAND
AND THEREFORE NOT COVERING
SOME OF THE COSTS ASSOCIATED
WITH PRESCRIPTIONS.
ILLICIT DRUG LAWS AND
POLICIES AS FAR AS THE
EPIDEMIC AND PREP
AVAILABILITY AND THEN LEVEL
5, PREVALENCE AND POPULATION
LEVEL OF VIREMIA.
NEXT SLIDE PLEASE.
SO SOME OF THE PREP
CHAMPIONS, SOLUTION TO
PROMOTE PREP UPTAKE AND
PERSISTENCE, SOME OF THE
CURRENT CHALLENGES, LACK OF
PERSONAL RESPONSIBLE FOR
PREP MANAGEMENT,
INCONSISTENT PREP SUPPORT
AND BUY-IN FROM CLINIC
LEADERSHIP.
AND SO SOME OF THE SOLUTIONS
WAS TO CREATE A PREP
CHAMPION AND I THINK THIS
KIND OF COMES FROM THE
NAVIGATOR -- SOME OF THE
NAVIGATOR PARADIGM WHERE YOU
TRAIN PROVIDERS AND PREP
COORDINATORS TO MEET WITH
PATIENTS AND MEET THEIR
NEEDS.
USE EVIDENCE TO STRENGTHEN
COMMUNICATION AND INCREASE
LEADERSHIP SUPPORT AND
MAXIMIZE PREP COORDINATOR
ROLE TO SUPPORT AND FOLLOW
UP TO IDENTIFY AND REDUCE
BARRIERS.
NEXT SLIDE, PLEASE.
OTHER THINGS TO HELP WITH,
EDUCATING PATIENTS AND
HEALTHCARE PROVIDERS ABOUT
CREATING CHANGE TO WELFARE
AND ENCOURAGING REVENUES,
COMMUNITY BASED EDUCATION TO
RAISE AWARENESS, COMBAT
IMPLICIT AND UNCONSCIOUS
BIAS, INSTILL TRUST IN
HEALTHCARE SYSTEM.
MORE BLACK HCPS AS TRUSTED
COMMUNITY SOURCES OF NO,
ALSO HISPANIC AND THOSE
CONDUCTING THE RESEARCH,
ADDRESS UNFOUNDED BELIEFS
ABOUT RISK COMPENSATION THAT
FEED RELUCTANCE TO RECEIVE
PREP.
POSITIVE MESSAGING TO
PATIENTS VIA SOCIAL NETWORKS
AND SOCIAL MEDIA TO IMPROVE
KNOWLEDGE AND ATTITUDES AND
REDUCE STIGMA.
SUPPORT PREVENTION MESSAGES
FOR HIV AND STIS THROUGH
MONITORING AND TESTING AND
DISCUSS ALL AVAILABLE PREP
OPTIONS TO GIVE PATIENTS
WHAT CAN AND WHAT MIGHT WORK
FOR THEM.
NEXT SLIDE, PLEASE.
I WOULD ALSO LIKE TO
ACKNOWLEDGE NIH SPECIAL MY
TEAM AND THANK YOU FOR THE
OPPORTUNITY TO PRESENT.
>> THANK YOU SO MUCH, Dr.
CHANDLER.
AS A REMINDER TO THE
AUDIENCE, PLEASE SUBMIT
QUESTIONS OR COMMENTS IN THE
LIVE FEEDBACK OPTION AT THE
BOTTOM OF THE VIDEOCAST.
WE WILL NOW HEAR FROM Dr.
DELANY-MORETIWE.
>> THANKS VERY MUCH, I WOULD
LIKE TO THANK THE WORKSHOP
ORGANIZERS FOR INVITING ME
TO SPEAK WITH ALL OF YOU FOR
THE HIV PREVENTION IN WOMEN.
NEXT SLIDE.
AND I WOULD ALSO LIKE TO
ACKNOWLEDGE THE MANY, MANY
PEOPLE WHO HAVE BEEN
INVOLVED IN THE CABOTEGRAVIR
PROGRAM INCLUDING FUNDERS,
HTPS, NIH AND ALL THOSE
INVOLVED IN AFRICA AND THE
AMERICAS.
NEXT SLIDE.
SO WOMEN STILL EXPERIENCE
MANY BARRIERS TO DAILY PILL
TAKING INCLUDING STIGMA,
JUDGMENT AND IN SOME CASES,
THE THREAT OF INTIMATE
PARTNER VIOLENCE.
SO THERE HAS BEEN A STRONG
INSTANCE ON WHETHER WE COULD
OVERCOME SOME OF THE
BARRIERS TO DAILY PILL
TAKING AND THE RECENT
COMPILED EVIDENCE REALLY
CONCLUDE THE POPULATIONS
THAT WORKERS AND EVEN
TRANSWOMEN PREFER THE
INJECTABLE AND THE MANY
REASONS THEY WANT THE PREP
AGENT IS THEY SEE IT COULD
BE CONVENIENT, CIRCUMSTANCE
COUPLE VENTS DAILY PILL
TAKING, COULD BE DISCREET
AND AVOID STIGMA AND IN SOME
CASES, IT RELIES ON SOME
PEOPLE'S EXPERIENCE WITH
CONTRACEPTION.
SO THIS IS ALLOWING IT TO BE
DEVELOPED AS ONE OF THE
FIRST INJECTABLE AGENTS.
NEXT SLIDE, PLEASE.
SO CAB WAS EVALUATED IN TWO
LARGE TRIALS IN CIS AND
TRANSWOMEN WHO HAVE SEX WITH
MEN, AND HIV PATIENTS.
AND IT WAS FOUND THAT CAB LA
WAS SUPERIOR TO ORAL PILLS
IN PREVENTING INFECTION IN
THE CAB GROUP IN HTP03 AND
HTP04 AND THESE SHOW THE
ADVANTAGE OVER THE DAILY
PILL TAKING.
WHAT IS IMPORTANT TO NOTE IS
THAT THESE RESULTS WERE
SUSTAINED OVER ONE YEAR AND
THAT THESE EFFECTS WERE ALSO
CONSISTENT ACROSS AGE
GROUPS, RACE, GENDER
IDENTITY AND REGION.
AND BECAUSE OF THESE
RESULTS, THE FDA AND EMA AND
MANY OTHER REGULATORY
AUTHORITIES WHERE THE CALLS
HAVE TAKEN PLACE INCLUDE THE
INJECTABLE CAB FOR PREP AND
TWO YEARS AGO, WHO INCLUDED
IT IN ITS PREP GUIDELINES.
NEXT SLIDE, PLEASE.
SO WHAT WE HAVE LEARNED FROM
THESE CABS AND ALMOST 8000
PEOPLE IS THAT LONG ACTING
INJECTABLE CAB IS GENERALLY
SAFE AND WELL TOLERATED AND
THIS INCLUDES EVEN IN HAD A
LESS SENSE UNDER THE AGE OF
18.
THE MOST COMMON SIDE EFFECT
THAT WAS OBSERVED IN THE
TRIALS THAT WAS DIFFERENT
BETWEEN THE TWO GROUPS IS
PEOPLE WHO RECEIVED CAB WERE
MORE LIKELY TO EXPERIENCE
INJECTION SITE REACTIONS.
THESE INJECTION SITES
REACTIONS WERE GENERALLY
MILD AND RESOLVED AFTER THE
FIRST INJECTION AND YOU CAN
SEE IN THE FIRST PANEL THAT
MOST PEOPLE EXPERIENCED AN
INITIAL INJECTION SITE
REACTION BUT VERY PEOPLE
EXPERIENCED SUBSEQUENT
INJECTION SIDE REACTION.
MOST OF THESE WERE
ASSOCIATED WITH PAIN AND
TENDERNESS AND IN WOMEN IN
PARTICULAR, WE DIDN'T SEE
ANY DISCONTINUATION
FOLLOWING THE INJECTION SITE
REACTION WHICH WAS SOMEWHAT
DIFFERENT THAN THE MEN'S
TRIAL AND EVEN IN ADOLESCENT
WOMEN, THERE WERE NO
DISCONTINUATION FROM ADVERSE
EVENTS.
THOSE TAKING THE INJECTION
FOR ANTIVIRAL THERAPY, WE
LOOKED AT CHANGES IN WEIGHT
IN THE TRIALS, AND ALTHOUGH
WE SAW AN INITIAL DIFFERENCE
OF ABOUT 1KG WHICH IS ABOUT
TWO POUNDS, BOTH GROUPS
GAINED WEIGHT AND THERE WAS
NO SUBSTANTIAL DIFFERENCE
BETWEEN THE TWO GROUPS
SHOWING VERY LITTLE
INFLUENCE ON CAB FROM WEIGHT
GAIN AND THERE ARE OTHER
ITEMS WE'RE REALLY EXPLORING
WITH CAB THROUGH ITS EFFECT
ON WEIGHT GAIN AND
HYPERTENSION.
SOME OF THESE RESULTS WERE
SUBMITTED FROM MEN IN LA KOI
AND THE ONE ON WOMEN IS
FORTHCOMING.
NEXT SLIDE.
SO ONE OF THE THINGS THAT WE
NEED TO REMEMBER IS THAT IN
THE TRIALS WE HAVE OBSERVED
VERY FEW HIV INFECTIONS
OVERALL AND PARTICULARLY IN
WOMEN.
AND THIS HAS MADE IT
DIFFICULT TO CONTROL IT IN
WOMEN.
SO THE INFECTIONS WERE
CUMULATIVE AND IN ONE CASE,
A WOMAN WHO ACQUIRED HIV
INFECTION WHILE TAKING DAILY
ORAL PILLS HIGHLIGHTING THE
LIMITATION FOR PEOPLE WHO
WANT A INJECTION AND WE HAVE
SEEN ONE CASE WHILE
RECEIVING INJECTIONS,
RECEIVED MULTIPLE INJECTION
DELAYS.
SO IT MAY BE BECAUSE OF THE
DOSING INTERVAL PLUS THE
FACT WE TEND TO SEE THE
CONCENTRATIONS IN THE FEMALE
COMPARTMENT COMPARED TO THE
RECTAL COMPARTMENT, THESE
MAY EXPLAIN WHY WE HAVE SEEN
SO FEW INFECTIONS IN WOMEN
WITH THE CAB INJECTION TO
DATE.
WHAT WE HAVE LEARNED IS THAT
LONG LASTING ANTIVIRALS LIKE
CAB ARE EXTREMELY POWERFUL
AND VERY GOOD AT REPLACING
VIRAL REPLICATION.
SO WHEN SOMEONE ACQUIRES HIV
INFECTION, THERE IS A
SUPPRESSED RESPONSE WHICH
MEANS THE INJECTABLES WORK
VERY WELL.
IN MEN AND WOMEN, THESE LAY
ITS LED TO EMERGENCE OF
RESISTANCE TO INS TI THERAPY
BUT WE HAVE NOT SEEN SIMILAR
RESISTANCE IN CIS WOMEN.
FORTUNATELY THOSE WHO DID
ACHIEVE SUPPRESSION RECEIVED
PI ON REGISTRATION.
BUT THESE REALLY HIGHLIGHT
THE RECOMMENDATION FOR THIS
IN WOMEN BUT IS NOT FEASIBLE
IN SOME COUNTRIES AND WE
LEARN MORE ABOUT THE VALUE
OF HIV TESTING THROUGH
HTPN03 AND 04.
NEXT SLIDE.
I JUST WANTED TO HIGHLIGHT
THAT ALTHOUGH PEOPLE WORRY
ABOUT THE INABILITY TO
DIAGNOSE HIV, IN FACT THE
BIGGER PROBLEM WE HAVE SEEN
AND ONE THAN CLINICIANS WILL
FACE IS WHEN YOU HAVE A HIV
POSITIVE TEST FOR SOMEONE
WHO HAS RECEIVED CAB AND YOU
NEED TO DECIDE WHETHER TO
INITIATE ANTIVIRAL RETRO
THERAPY.
AND THE ANALYSIS FROM 03 AND
04 PROVIDE US WITH
REASSURANCE THAT IF YOU HAVE
TWO HIGHLY EFFECTIVE CASES,
YOU COULD ADMIT THE PERSON
ON ANTIRETRO VIRAL THERAPY.
ONE OF THE THINGS WE SEE IS
A LOWER PREDICTOR VALUE FOR
PEOPLE WHO ARE ON CAP AND I
THINK THIS REFLECTS THE
POSITIVE PREDICTIVE VALUE
BEING VERY LOW.
BUT THE TAKEHOME MESSAGE FOR
YOU IS TO RECOGNIZE THE
EFFECTS WE SEE ON LONG
ACTING AGENTS ON HIV TESTS
IS NOT REFLECTIVE TO CAB AND
WILL LIKELY AFFECT THE OTHER
PATTERN WE SEE IN FUTURE
LONG AGENTS AND WE NEED TO
REFLECT ON OUR CURRENT
APPROACHES TO HIV AND
WHETHER WE NEED TO ADAPT
THEM IN THE CONTEXT OF LONG
ACTING PREP.
NEXT SLIDE, PLEASE.
SO ONE OF THE THINGS THAT --
WELL, AN ONGOING QUESTION
PARTICULARLY FOR WOMEN IS
WHETHER WE COULD EXPAND THE
DOSING INTERVAL FOR CAB TO
12 WEEKS TO LINE UP WITH
CONTRACEPTION AGENTS.
AND WE EXPLORED THIS
QUESTION IN HTPN84 BECAUSE
WE HAD FEW TO THE COVID LEX,
EXPANDED THEM TO 12 WEEKS.
WHAT WE OBSERVED IS THAT
THERE'S PROBABLY SOME DOSE
FORGIVENESS WHEN PEOPLE MISS
A SINGLING JECTION BUT WE
DID HAVE ONE HIV INFECTION
IN SOMEBODY WHO HAD MULTIPLE
INJECTION DELAYS AND THIS IS
REALLY THE CONCERN WITH
EXTENDING THE DOSE INTERVAL.
THE MODELING HAS SUGGESTED
IT IS PROBABLY NOT POSSIBLE
TO ACHIEVE THE DRUG
CONCENTRATIONS WITH
QUARTERLY DOSING TO PROTECT
AGAINST HIV INFECTIONION SO
CURRENTLY EXTENDING THE DOSE
INTERVAL IS NOT RECOMMENDED
FOR WOMEN, CIS OR OTHER
POPULATIONS.
THOSE WHO MAKE CAB HAVE NOW
DETERMINED A LONG ACTING
FORMULATION THAT MAY ALLOW
FOR EXTENDIBLE DOSING IN THE
FUTURE.
NEXT SLIDE.
SO THE KEY FOR PARTICULARLY
TRANSWOMEN IS THAT THE
POTENTIAL FOR CAB
SURROUNDING HORMONE THERAPY
AND IN THE TPTN83 TRIAL,
THEY USED WOMEN USING
HORMONE THERAPY AND THOSE
NOT USING HORMONE THERAPY
AND THE CAB CONCENTRATIONS
WERE COMPARABLE BETWEEN THE
TWO GROUPS SUGGESTING THE
VARIOUS EFFECTS ON CAB ON
GENDER AFFIRMING HORMONES.
WE LACK DATA CURRENTLY ON
INTERACTIONS BETWEEN CAB AND
TESTOSTERONE THAT MAY BE
USED BY TRANSMEN.
AND GIVEN THE INTEREST IN
COMBINING CAB AND
CONTRACEPTION EITHER WITHIN
THE SAME SCHEDULE OR
FORMULATION AS Dr. HILLIER
ALLUDED TO EARLIER, THERE
ARE SEVERAL PRODUCTS IN VERY
EARLY DEVELOPMENT THAT MIGHT
OFFER THE POTENTIAL TO
COMBINE CAB WITH A
CONTRACEPTIVE AGENT.
AND TO DATE WE HAVE NOT SEEN
ANY SIGNIFICANT DRUG
INTERSECTIONS BETWEEN CAB
AND CONTRACEPTION.
NEXT SLIDE.
SO IN THE INITIAL SLIDE I
SHOWED YOU THE SUGGESTION
THAT INJECTABLE AGENTS WOULD
BE HIGHLY SUCCESSFUL IN
POPULATIONS BUT THIS WAS
REALLY A THEORY BECAUSE MANY
PEOPLE HAD NOT EXPERIENCE
WITH INJECTABLE PREP.
SO IT IS NICE TO SEE THAT IT
HAS ACCEPTABILITY AND WE SAW
IN ADULTS A STRONG
PREFERENCE FOR INJECTION
OVER PILLS PARTICULARLY
DURING THE PERIOD WHERE
PEOPLE WERE USING BOTH AND
WHEN PEOPLE WERE OFFERED THE
CHOICE TO EITHER TAKE CAB OR
ORAL PREP, ABOUT EIGHT OUT
OF TEN OF THEM CHOSE THE
INJECTABLE CAB FOR PREP.
AND WE ALSO SAW HIGH NUMBERS
OF UNDER 18S WHO OPTED TO
CONTINUE CAB INJECTIONS FROM
THE ADOLESCENT STUDY.
THE MAIN REASON PEOPLE GIVE
FOR CHOOSING CAB IS NOT
SURPRISING.
IT IS CONVENIENT, DISCREET
AND EASIER TO ADHERE TO BUT
WHAT HAS ALSO BEEN
INTERESTING TO SEE IS THAT
PEOPLE CHOOSING CAB APPEAR
TO BE AT HIGHER RISK FOR HIV
AND RECOGNIZE THAT RISK SO
PEOPLE WITH CAB ARE LESS
LIKELY TO LIVE WITH THEIR
PARTNERS, PORN PERHAPS OUT
OF RECENT PORT NEVER
VIOLENCE OR PAID FOR SEX.
THERE IS A POPULATION
DESPITE THE HTPN84 THAT
STILL OPTED FOR PILLS AND
THIS REMINDS US ALL THAT
PEOPLE NEED A CHOICE FOR
AGENTS THAT THEY CAN
INTEGRATE INTO THEIR LIVES.
NEXT SLIDE.
SO ONE OF THE ANSWERED
QUESTIONS IS REALLY ABOUT
THE SAFETY AND MOST OF THE
INFORMATION WE HAVE COMES
FROM PRECLICK CALL STUDIES.
SO WE HAVE NOT SEEN TOXICITY
CONCERNS PARTICULARLY AT
THOSE USED FOR HUMAN DOSES.
WE HAVE LEARNED FROM
PRECLINICAL STUDIES THAT
THERE IS TRANSFER BUT IT IS
VERY LOW AND SIMILARLY FOR
LACTATION.
THERE PROBABLY IS SOME
TRANSFER OF CAB IN BREAST
MILK BUT AGAIN THE
CONCENTRATIONS ARE LIKELY TO
BE VERY LOW.
WHAT WE HAVE LEARNED FROM
THE TRIALS IS THAT EVEN IN
PEOPLE WHO STOP TAKING
INJECTIONS ONCE THEY HAVE A
POSITIVE PREGNANCY TEST IS
THAT THEY WILL STILL
CONTINUE TO HAVE CAB
CONCENTRATIONS THROUGHOUT
PREGNANCY AND THAT IS WHAT
THE GRAPH IS TRYING TO SHOW
AND YOU THESE CONCENTRATIONS
ARE VERY SIMILAR IN PREGNANT
AND NONPREGNANT WOMEN SO
THAT MAY BE SOME REASSURANCE
THAT WE MAY NOT HAVE TO
ADJUST THE DOSE IN WOMEN WHO
ARE PREGNANT.
NEXT SLIDE.
ONE OF THE KEY QUESTIONS
THAT WE ARE BUSY ADDRESSING
IN THE OPEN LABEL EXTENSION
OF HTPM084 IS REALLY TO
PROVIDE SUPPORTIVE DATA
AROUND THE SAFETY OF CAB
WHEN PEOPLE CHOOSE TO TAKE
INJECTIONS DURING PREGNANCY
AND WHETHER OR NOT WE NEED
TO ADJUST THE DOSE IN
PREGNANCY GIVEN THE CHANGES
IN DRUG METABOLISM THAT
OCCUR DURING WOMEN IN
PREGNANCY AND ALSO WE WANT
TO BE ABLE TO TELL BOTHERS
ARE BREASTFEEDING IF THEY
ARE USING CAB 1 WHAT THE
RISK WOULD BE FOR THEIR
INFANTS SO THESE TRIALS ARE
ONGOING AS WE SPEAK AND HOPE
TO PROVIDE THESE RESULTS IN
2024.
HAVING SAID THAT, BASED ON
THE DATA ALREADY BEING
SUBMITTED TO REGULATIVE
AUTHORITY, WHAT WE HAVE SEEN
IS CURRENT APPROVALS ARE
PERMISSIVE FOR PREGNANCY AND
THIS IS BECAUSE OF THE
REALIZATION THAT PEOPLE ARE
BEING EXPOSED TO CAB EVEN IF
YOU STOP INJECTION.
NEXT SLIDE.
>> WE'RE AT TIME.
>> SO JUST TO SAY A COUPLE
OF NEXT STEPS WILL BE KEY TO
GETTING PREP TO PEOPLE WHO
NEED IT AND THERE ARE A
NUMBER OF IMPLEMENTATION
STUDIES THAT WILL RAISE A
NUMB OF THESE QUESTIONS
INCLUDING MODELS OF DELIVERY
AND WHAT PEOPLE IN THE REAL
WORLD WILL CHOOSE AS WELL AS
HOW TO BEST SUPPORT CHOICE.
NEXT SLIDE.
AND HERE REALLY IS A SUMMARY
OF WHAT I HAVE ARTICULATED,
THAT CAB IS GENERALLY SAFE
AND WELL TOLERATED AND
EFFECTIVE FOR HIV
IMPLEMENTATION AND REALLY
THAT THE INTERVENTION
PRODUCTS ARE CRITICAL TO
SUPPORT STRATEGIES FOR WOMEN
AND THOSE WHO NEED IT.
>> THANK YOU SO MUCH.
>> WE HAVE ONE MORE
PRESENTATION.
>> THANK YOU SO MUCH AND AS
A REMINDER TO THE AUDIENCE,
PLEASE SUBMIT QUESTIONS AND
COMMENTS VIA THE FEEDBACK
BUTTON AT THE BOTTOM OF THE
NEWSCAST.
AND SO NOW WE HAVE OUR NEXT
PRESENTATION.
>> WE'RE NOT HEARING IT,
MELISSA.
>> HI, EVERYONE, MY NAME IS
SUJATA --
[ POOR AUDIO ]
[INAUDIBLE]
[INDISCERNIBLE]
>> THANK YOU EVERYBODY FOR
YOUR EXCELLENT
PRESENTATIONS.
WE DO HAVE VERY GOOD
QUESTIONS AND I INVITE ALL
OF THE SPEAKERS TO TURN ON
YOUR CAMERAS AGAIN AND AS A
REMINDER, IF YOU HAVE
QUESTIONS OR COMMENTS,
PLEASE ENTER THEM ON THE
LIVE FEEDBACK ON THE BOTTOM
OF THE SCREEN.
SO WHAT IS ACCEPTABLE FOR
PROVIDERS AND ALSO WOMEN SO
THIS QUESTION IS TO Dr.
HILLIER.
IT WAS INTERESTING TO HEAR
ABOUT THE DESIGN OF
NONHORMONAL AND NONHIV USE,
SO COULD YOU PROVIDE
INFORMATION ON CONNECTIVITY
AND WHETHER NONHORMONAL
PLAYS SOME ROLE WITH THIS
BEING MORE ACCEPTABLE TO
WOMEN.
>> THANKS FOR THE QUESTION
AND IT IS AN IMPORTANT ONE
AND BASICALLY I WANT TO
REMIND EVERYONE THAT IN THE,
FOR EXAMPLE THE STUDY OF
YOUNG WOMEN 16 TO 21 YEARS
OF AGE WHERE YOUNG WOMEN
WERE OFFERED THE VAGINAL
RINK AND ORAL PREP AND USED
BOTH FOR SIX MONTHS, AFTER
ONE YEAR, TWO-THIRDS OF
YOUNG WOMEN CHOSE THE RING.
SO WE ALREADY HAVE DATA THAT
VAGINAL RINGS ARE QUITE
ACCEPTABLE TO YOUNG WOMEN IN
AFRICA AND WE ALSO FOUND
HIGH ACCEPTABILITY IN THE
U.S.
SO ONE RING THAT I TALKED
ABOUT WHICH IS THE
NONHORMONAL, NONHIV RING HAS
JUST BEEN ACCEPTED IN A
TRIAL, 80 IN AFRICA AND 20
IN THE U.S. AND WE WILL
UNDERSTAND BETTER HOW THEY
FEEL ABOUT THIS PARTICULAR
RING BUT MANY WOMEN HAVE
TOLD US IN STAKEHOLDER
ENGAGEMENTS THAT THEY ARE
WHY INTERESTED IN A
NONHORMONAL OPTION SO WE
WILL FIND OUT.
>> THANK YOU, WE LOOK
FORWARD TO SEEING THE
STATUS.
NEXT QUESTION IS TO Dr.
DELANY-MORETIWE.
WHAT INJECTABLE IS INCLUDED
IN THE PORTFOLIO OF HIV
VACCINES?
>> THANK YOU FOR THE
QUESTION.
I DIDN'T REALLY GO THROUGH
MANY OF THEM.
PERSONS LIVING WITH HIV WHO
HAVE ALREADY MADE
ANTIBODIES, WE WILL USE SOME
OF THAT ANTIBODIES AND I
DON'T KNOW WHAT THEY DO WITH
IT AT THE LAB BUT CLEAN IT
UP AND VACUUM AND GIVE THAT
AS A PROFUSION TO
PARTICIPANTS.
THAT IS ONE WAY.
ANOTHER WAY IS TO ISOLATE
THE PARTICLES WHICH ARE
ATTACHED TO THE VACCINE
WHILE IN THE BODY SO THAT
WILL HELP TRIGGER A MORE
ROBUST T CELL RESPONSE AND
WE HAVE VACUUM IN THE
PIPELINE THAT INCORPORATES
DIFFERENT PLATFORMS SO WE
USE CERTAIN ADJUVANTS THAT
WILL HELP BOOST THE VACCINE
AND MAKE IT WORK BETTER AND
CONSIDERING PLATFORMS LIKE
MRNA OR PT S M.D., DIFFERENT
VIRUSES THAT WILL WORK AND
BE INCLUDED WITH THE
VACCINATION THAT WILL HELP
THE BODY RECOGNIZE AND
TRIGGER A RESPONSE AND MAKE
T-CELLS MUCH FASTER.
AND WE ALSO HAVE TRIAL SITES
ALL OVER THE WORLD, IN THE
AMERICA, ASIA AND AFRICA, TO
BE SPECIFIC, AND WE INCLUDE
VARIOUS POPULATIONS SO THESE
ARE EXPOSED AND USE HEALTHY
ADULTS.
WE WORK WITH VOLUNTEERS THAT
ARE TRANSAND ALSO WORK WITH
VOLUNTEERS THAT ARE ALREADY
ON CAB.
SO MANY, MANY TRIALS IN THE
PIPELINE WITH MANY
COLLABORATIONS AND JUST
SEEING WHAT WORKS AND HOPE
TO DEVELOP MORE PILES IN THE
FUTURE WITH OUR PARTNERS.
THANK YOU.
>> THANK YOU SO MUCH.
WE HAVE ANOTHER VERY
INTERESTING QUESTION.
IT IS FOR Dr. CHANDLER.
CAN YOU PLEASE SPEAK TO THE
FACTORS AS THERE IS A BIG
GAP BETWEEN BLACK AND WHITE
GROUPS AND LOOSE THE BIG GAP
BETWEEN DESCRIPTION OF GAP
FOR WOMEN AND MEN SO PLEASE
COMMENT AND --
[INDISCERNIBLE]
-- BUT PLEASE ANSWER THE
QUESTION.
>> THANK YOU, I WILL BE VERY
QUICK.
I WOULD BE REMISS TO SAY
THERE ARE SOME STRUCTURAL
ISSUES THAT OCCUR, WHETHER
THAT IS RACISM, SOME OF WILL
THE ISMS THAT EXIST SO
UNFORTUNATELY WITH
STRUCTURAL ISSUES THAT ARISE
WITH REGARD TO PROVIDERS,
FOR INSTANCE, I WORK A LOT
WITH BLACK WOMEN IN CERTAIN
CARE SETTINGS AND IN MY
RESEARCH AND A LOT OF THE
ISSUES THAT HAVE COME UP
AROUND NOT BEING
PRESCRIBBLED PREP IN
PARTICULAR IS THAT THEY
DON'T EVEN GET OFFERED PREP
AND IF THEY INQUIRE, LIKE IF
THEY MAKE A CONSCIOUS EFFORT
TO INQUIRE, THEY ARE TOLD,
WELL, YOU DON'T SEEM TO NEED
IT, YOU ARE MARRIED, OR
THERE IS A ALLOTTED OF
HESITANCY AND MAYBE BECAUSE
OF THEM NOT NECESSARILY
BEING COMFORTABLE WITH PREP
AND KNOWING ENOUGH ABOUT IT,
TO FEEL LIKE THEY CAN
PRESCRIBE IT.
SO THOSE ARE SOME OF THE
VARIANTS THAT HAVE COME UP
WITH SOME OF THE MEN AND
WOMEN I HAVE WORKED WITH AND
AS FAR AS HIV IN WOMEN,
WOMEN IN PARTICULARLY --
BLACK WOMEN, WE HAVE ALWAYS
BEEN KIND OF SECONDARY SO
MOST OF THE TIME, THE
EFFORTS ARE ADDRESSING IT IN
MEN.
BUT WE RECENTLY HAD A
MEETING WITH TRANSGENDER
BLACK WOMEN AND THEY TEND TO
FEEL SIMILARLY SO WE HAVE
SOME VARIETY IN THAT BUT
MANY OF THEM TO INCLUDE
WOMEN ARE THOUGHT OF AS
SECONDARY, LIKE OH WE FORGOT
WOMEN, LET'S PULL THEM IN.
AND LIKE WHY ARE WOMEN AN
AFTERTHOUGHT?
WE SHOULD BE IN THE
CONVERSATION AT THE
BEGINNING AS WELL SO NOW
WE'RE TRYING TO PLAY CATCHUP
IN A LOT OF THE WORK WE ARE
TO GO.
>> THANK YOU SO MUCH, WE ARE
ALMOST OUT OF TIME AND IF
YOU HAVE MORE QUESTIONS,
FEEL FREE TO REACH OUT AFTER
THE SESSION.
WE WISH TO THANK ALL
PRESENTERS AND ALL
PARTICIPANTS ON THE
VIDEOCAST.
THANK YOU FOR PARTICIPATING.
THIS CONCLUDES SECTION 7.
AND NOW TURN IT OVER TO
Dr. SUJATA VIJH WHO WILL
CONDUCT SESSION 8.
>> THANK YOU, TATIANA, GOOD
MORNING, EVERYBODY.
-- SEEMA DESAI.
I WILL BE COMODERATING THIS
SESSION WITH KATHLEEN
BORGMANN.
THE SCIENTIFIC COMMUNITY HAS
ACHIEVED REMARKABLE
MILESTONES EFFORTS TO REDUCE
HIV INCLUDING THE ANTIVIRAL
THERAPIES.
THE DIVERSE POPULATION OF
HIV RESEARCH IS A FUNCTIONAL
COMPONENT OF REACHING THE
HIV EPIDEMIC.
WE ARE LOOKING FORWARD TO
TODAY'S SESSION WHICH WILL
BE HIGHLIGHTING EXCITING AND
GOOD ANSWERS [ INDISCERNIBLE
] AND FOR CONSIDERATIONS IN
THE GLOBAL SOUTH.
THE LONG-TERM EFFECTS AND
COMMUNITY PERSPECTIVE ON
PARTIAL ABILITIES TO ENHANCE
HIV TREATMENT.
AS A REMINDER, YOU CAN
SUBMIT QUESTIONS USING LIVE
FEEDBACK FORM AND WE WILL
ANSWER THEM AS WE GO.
NEXT SLIDE.
INFORMATION ON THE RETRO
VIRUS CAN BE FOUND ON THE
BACK PAGE.
Dr. CHLOE ORKIN, PROFESSOR
IN LONDON AND HAS BEEN --
[INDISCERNIBLE]
Dr. ORKIN SERVES AS
COLLABORATOR --
[INDISCERNIBLE]
CONTRIBUTED TO LICENSING FOR
MORE THAN 20 THERAPIES EVER
DEVISES ENCLOUDING HIV.
AND OUR SECOND SPEAKER,
Dr. ROSIE MNGIBISA,
DEVELOPMENT OF INFECTIOUS
DISEASES AND RESULTING
CONDITIONS.
Dr. IGHO WILL BE OUR THIRD
SPEAKER, A VERY
DISTINGUISHED PROFESSOR OF
MEDICINE AT EMERY SCHOOL OF
MEDICINE AND DIRECTOR OF
SOCIAL AND HEALTH EDUCATION
SCIENTIST AS EMERY
UNIVERSITY SCHOOL OF PUBLIC
HEALTH.
AS A CLINICIAN SCIENTIST,
Dr. OFOTOKUN'S CAREER HAS
BEEN ON --
[INDISCERNIBLE]
AND FOCUSED ON THAT AGE
RELATED MORBIDITY IN PEOPLE
WITH HIV.
AND Dr. STEVEN DEEKS WILL
BE SPEAKING ON HIV MEDICINE.
Dr. DEEKS IS PROFESSOR AT
UNIVERSITY OF CALIFORNIA-SAN
FRANCISCO.
HE HAS PUBLISHED OVER 700
FIELD REVIEWED ARTICLES ON
THESE AND UNRELIED TOPICS.
AS A NATIVE OF PHILADELPHIA,
PENNSYLVANIA BUT RESIDES IN
NORTH CAROLINA.
HE HAS A BACHELOR DEGREE IN
SOCIAL WORK, MASTER IN
PUBLIC HEALTH AND HAS
COMPLETED DOCTOR DOCTORATE
COURSES THAT FOCUS ON
ADVOCACY AND LEADERSHIP.
HE DOES THIS WORK FOR
UNIVERSITY OF NORTH
CAROLINA-CHAPEL HILL AND
RESEARCH AT THE OFFICE OF
COMMUNITY ENGAGEMENT.
NEXT SLIDE.
THE FIRST PRESENTATION IS
FROM Dr. CHLOE ORKIN.
GO AHEAD, DOCTOR, THE STAGE
IS YOURS.
>> THANK YOU, NEXT SLIDE
PLEASE.
SO WHAT WOULD YOU SAY IF
TREATMENT FOR HIV GOT A LOT
SIMPLER.
[ POOR AUDIO ]
AND WHAT THE DOCTOR WAS
SAYING REGARDING
CABOTEGRAVIR AND ANOTHER
DRUG FOR PEOPLE WHOSE VIRUS
IS SUPPRESSED AND WHERE
CERTAIN OTHER MEDICAL
CRITERIA APPLY.
TWO-MONTHLY INJECTABLE
THERAPY IS AVAILABLE IN MANY
COUNTRIES.
IT WORKS VERY WELL AND
PEOPLE WHO CHOOSE TO GO INTO
THE TRIALS PREFERRED IT TO
ORAL THERAPY.
NOT ENOUGH WOMEN HAVE BEEN
ENROLLED IN THE TRIALS
TESTING AND FEWER WOMEN THAN
MEN ARE RECEIVING IT IN
CLINICS AND TRIALS ENSURING
EQUITABLE ENROLLMENT HAVE
BEEN SUCCESSFUL IN THE U.K.
AND VERY MUCH NEEDED.
NEXT SLIDE, PLEASE.
SO WITH THE TWO-MONTH
INJECTABLE THERAPY, WHERE WE
ARE NOW IS IN THE EARLY DAYS
THE SUCCESS WAS DEFINED AS
PROLONGING LIFE.
ART WAS AVAILABLE IN
MULTIPLE PILLS AND THEN A
DAILY ORAL TABLET AVAILABLE
IN A SINGLE PILL, THREE DRUG
COMPOUND GIVING US PREP
WHICH IS A SITUATION WHERE
TWO DRUGS CAN KEEP THE
DISEASE AT BAY.
AND THEN WE HAVE THE CAB AND
RPV TREATMENT WHERE THERE IS
MORE EMPHASIS ON
UNDERSTANDING PATIENT
OUTCOMES AND ENGAGEMENT
INTEGRAL TO SUCCESS.
NEXT SLIDE PLEASE.
SO WHAT WE HAVE NOW IS A
PROJECTION TREATMENT,
QUIVERING EVERY TWO MONTHS
AND IT MEANS PEOPLE CAN GO
FROM 365 TREATMENT DAYS A
YEAR TO JUST SIX.
AND THIS THERAPY IS LICENSED
IN TREATMENT GUIDELINES AND
WHAT IT MEANS IS IT CAN BE
GIVEN DEVICE MONTHLY AND IN
SOME COUNTRIES, BE GIVEN
MONTHLY.
SO WHERE I WAS IN EUROPE, IT
WAS DEVICE MONTHLY.
AND THE INJECTIONS --
[INDISCERNIBLE]
NEXT SLIDE PLEASE.
SO WHY AM I FOCUSING ON
THIS?
AND WHY IS THIS NEEDED?
WHAT THE DATA ARE SHOWING IS
THAT THIS CAN ADDRESS SOME
OF THE CHALLENGES PEOPLE
EXPERIENCE ON ALL THERAPY.
NOW THERE ARE TWO RECENT
STUDIES, ONE IS CALLED THE
SOLAR STUDY AND THE OTHER
CALLED THE CARLOS STUDIES
AND THESE WERE DONE
EXCLUSIVELY WITH YOUNG WHITE
MEN AROUND THE AGE OF 30.
YET AT BASELINE, WHAT THEY
REPORTED IS THAT LARGE
PROPORTION OF THE PEOPLE
WERE WORRIED ABOUT BEING
UNINTENTIONALLY DISCOVERED,
BORDER FOR GETTING TO TAKE
THEIR TREATMENT AND ALSO
FEELING THAT LIVING WITH HIV
WAS SOMETHING TO BE REMINDED
OF BY THEIR TABLETS.
AND I THINK THIS IS ACTUALLY
IN SOME WAYS FRIGHTENING
BECAUSE WE KNOW THE
COMMUNITIES THAT ARE
EXCHANGING ILLNESS AND IT IS
NOT THE YOUNG HEALTHY
COMMUNITIES.
BUT WHAT WE ARE SEEING IS
THE FEELINGS ARE THERE EVEN
IN THIS COMMUNITY.
NEXT SLIDE, PLEASE.
SO WHAT WE'VE SEEN IS THAT
ACROSS MANY STUDIES THAT
HAVE BEEN DONE, THESE ARE
SEVEN STUDIES -- ACTUALLY
SIX STUDIES WE'RE TALKING
ABOUT.
WHAT YOU CAN SEE IS PEOPLE
WERE ASKED IN THE STUDY DO
YOU PREFER ORAL THERAPY OR
INJECTABLE AND ALMOST
90 PERCENT IN THE SOLAR
STUDY SAID THEY WANTED ORAL
AND EVEN THOUGH THE RESEARCH
HAS GONE ON TO INJECT HAS,
THEY WERE STILL HAPPY WITH
THEIR CHOICE.
THEY ARE NOT GOING TO OFFER
INJECT HAS UNLESS THEY WANT
IT AND WHAT THIS SHOWED WAS
THAT BOTH THERAPIES WERE
PREVENTIVE.
SO WHEN PEOPLE WERE ASKED
DID THEY WANT INJECTABLE
THERAPIES AND THEY SAID YES,
WE ASKED THEM WHY AND YOU
CAN SEE HERE THAT THE ANSWER
ARE REALLY ABOUT STIGMA,
INADVERTENT DISCLOSURE AND
THINKING ABOUT THE STATUS.
SO THIS IS THE BENEFIT IN
THE SENSE OF WHAT WAS
IMPROVED IN ADDITION TO
CONVENIENCE SO THERE IS
SOMETHING HELPFUL IN THIS
REGARD.
NEXT SLIDE PLEASE.
AND WHAT HAS BEEN SHOWN HOW
MUCH SATISFACTION WITH YOUR
TREATMENT INCREASES, IF YOU
LOOK AT THE SLIDE HERE, WHAT
YOU SEE IS THE GREEN
CATEGORY AND WHEN IT GOES
UP, IT WILL INCREASE AND THE
BLUE IS COMPARED WITH THE
INJECTABLE TO DAILY PILL AND
YOU CAN STILL SEE THE
IMPROVEMENT IN PEOPLE BUT IF
YOU GO TO THE RIGHTHAND SIDE
AND WITH PEOPLE WHO STARTED
OFF WITH AT LEAST THREE
CHALLENGES, WHAT YOU CAN SEE
IS THE AMOUNT OF BENEFIT IN
THE GREEN, HOW HIGH IT IS
ABOVE THE LINE, IT IS
SIGNIFICANTLY HIGHER.
SO WHEN PEOPLE HAVE
CHALLENGES, THEY FIND THE
INJECTABLE REALLY REALLY
HELPFUL.
NEXT SLIDE, PLEASE.
SO HOW WE HAVE DONE IN THE
BIG PHASE 3 STUDY, THE
ACCEPTANCE WAS OVERWHELMING
IN MALES AND OVERWHELMING IN
WHITES AND UNDER 50 YEARS SO
THEY ARE WOMEN AND
ADOLESCENTS NOT DOING WELL
WITH LONG-TERM USE.
AND SO THE WOMEN WHO ARE
PARTICIPATING DO NOT
REPRESENT ALL WOMEN BUT JUST
THOSE WITH THE RISK FAX TORT
OR BPOC AND UNDER 50 YEARS
OF AGE.
ALL THE PEOPLE LIVING WITH
HIV REALLY FEEL THEY ARE
EXPERIENCING AGEISM SO THIS
IS NOT GOOD EITHER.
NEXT SLIDE, PLEASE.
SO THERE HAS BEEN THIS
ANALYSIS THROUGH THE STUDY
TO SEE IF THEY CAN DETECT
DIFFERENCES THROUGH RISK
FACTORS AND SO FAR THERE ARE
NO SEX DIFFERENCES IN
OUTCOMES AT WEEK 48.
SO YES, NEXT SLIDE.
SO I THINK IT IS IMPORTANT
WE THINK ABOUT -- WE ARE
THINKING ABOUT CERTAIN
ASPECTS OF INCLUSION,
THINKING AROUND WITH THE
WORLD HEALTH ORGANIZATION
TRYING TO ENSURE WE HAVE
SAFER PEOPLE THAT ARE
PREGNANT, PEOPLE THAT ARE
BREASTFEEDING BUT WE ALSO
NEED TO THINK ABOUT STUDIES
AND TRIALS THAT ARE JUST
COMMON STUDIES.
SO WE NEED TO THINK ABOUT
WHO IS ACTUALLY GETTING
THESE STUDIES.
SO ACROSS 16 REAL WORLD
STUDIES THAT HAVE BEEN DONE,
1 INCLUDED FEMALE
PARTICIPANTS AND THIS IS
ACROSS THE REAL WORLD
STUDIES.
IN OTHER WORDS, CLINICIANS
ARE MANUFACTURING SPECIAL
MAKING CAB AND REPORTING ON
IT AS WELL.
THIS IS EXPLICITLY
ANTIRACISM, ANTISEXIST AND
ANTIAGING STUDY DESIGN AND
WE WORK TO MAKE SURE THEY
WOULD AGREE TO RECRUIT, TO
TARGET WITH ME AND THIS IS
JUST PARTICIPATION FROM HIV
WOMEN AND STUDIES --
[INDISCERNIBLE]
AND WE MANAGED THIS IN A
MULTIPHASE LONGITUDINAL
STUDY DESIGN.
AND TO ACHIEVE OUR GOALS,
NEXT SLIDE, WE DEVISED THE
ILANA STUDY THAT MET
INCLUSIVITY TARGETS.
SO I THINK IT IS IMPORTANT
WE DON'T JUST DESIGN SPECIAL
STUDIES TO WOMEN.
AND THIS WAS VERY MASSIVE
AND INCLUSIVE TO WOMEN AND
ALSO RACIALLY MINORITIES BUT
I THINK WOULD HE NEED TO
THINK ABOUT TREATMENT
STUDIES AND MAKING SURE
WOMEN ARE INCLUDED IN THE
STUDIES WE ARE DOING IN
GENERAL AND IT CAN BE DONE.
SO NEXT SLIDE, PLEASE.
AND I AM GOING TO END THERE.
THE STUDY --
[INDISCERNIBLE]
BUT THE STUDY CALLED SHARE
WHICH IS RESEARCH FOR HEALTH
EQUITY AND THE LIST OF THOSE
INVOLVED WITH THIS BECAUSE
WE NEED TO UNDERSTAND THE
DIFFERENCES AND INCLUDE ALL.
>> THANK YOU SO MUCH.
PLEASE POST YOUR QUESTIONS
OR COMMENTS ON THE FEEDBACK
OPTION OF THE LIVE
VIDEOCAST.
>> OUR NEXT SPEAKER IS ROSIE
MNGQIBISA.
>> THANK YOU VERY MUCH.
CAN YOU HEAR ME?
>> YES, I JUST HAVE TO WARN
YOU, I AM HAVING TROUBLE
WITH POWER SO HOPEFULLY IT
WILL HOLD TILL THE END OF MY
PRESENTATION.
SO I WOULD LIKE TO START BY
THANKING ORGANIZERS FOR
INVITING ME TO BE PART OF
THIS VERY IMPORTANT TOPIC
AND I WANT TO REMIND
EVERYONE THAT WOMEN CONTINUE
TO BE A GLOBAL CONSIDERATION
FOR HIV DESPITE ALL THE
PREVENTION AND ACCESS TO
TREATMENT.
THE ACCESS HAS IMPROVED BUT
STILL TREATMENT CHOICES IN
WOMEN WITH HIV IN SOME
COUNTRIES STIGMA EXISTS.
WOMEN IN OTHER COUNTRIES
FACE MANY HEALTH CHALLENGES
AND I WILL MENTION A FEW IN
THIS PRESENTATION.
I WILL ALSO GO THROUGH THE
RESEARCH GAPS FOR WOMEN'S
HEALTH IN SUBIS A
SUB-SAHARAN AFRICA.
IN 2022, THERE WERE 20
MILLION WITH HIV.
53PERCENT OF THE WORLD'S
PEOPLE LIVING WITH HIV WERE
MOSTLY IN AFRICA.
46PERCENT WERE AMONG GIRLS
AND WOMEN HOWEVER IF YOU
LOOK CLOSELY AND LOOK AT
SUBSAHARAN AFRICA, YOU WOULD
NOTE 77 PERCENT OF THE NEW
INFECTIONS ARE AMONG YOUNG
GIRLS AND AFRICAN MEN.
SO LOOKING AT THIS A
DIFFERENT WAY, THERE ARE
4000 PEOPLE ACQUIRING HIV
EVERY WEEK AND 57 PERCENT OF
THEM LIVE IN SUBSAHARA
AFRICA.
NEXT SLIDE, PLEASE.
IF YOU LOOK AT THE
TREATMENT, 86 PERCENT PEOPLE
LIVING WITH HIV, 89 PERCENT
WERE ACCESSING TREATMENT AND
93 PERCENT WERE VIRALLY
SUPPRESSED WHICH IS NOT BAD
BUT STILL BELOW THE GOALS
FOR 2025.
WHEN WE LOOK AT PREGNANT
WOMEN, WE REALIZE 82 PERCENT
OF THEM ARE LIVING WITH HIV
HAD ACCESS TO MEDICINES TO
PREVENT TRANSMISSION OF HIV
TO THE CHILD.
THIS IS A HUGE IMPROVEMENT
ESPECIALLY IN AFRICA BUT
SHOWS ACCESS, EQUITY AND
CHOICE IS STILL A DREAM.
AND ACCESS IS NOT ONLY
SUFFICIENT, IT IS ALSO ABOUT
HAVING THE RIGHT DRUGS AND
SAFE DRUGS TO USE FOR
VARIOUS COMORBIDITIES PUT WE
ALL KNOW THAT AFRICA IS
STILL A BIG EXCEPTION.
IF YOU COMPARE ON THE RIGHT,
THE LOW INCOME COUNTRIES
VERSUS THE HIGH INCOME
COUNTRIES, ONLY THE LOW
INCOME COUNTRIES HAD HIGH
HIV COMPARED TO THE HIGH
INCOME COUNTRIES.
NEXT SLIDE PLEASE.
SO THERE ARE BARRIERS TO
CARE IN WOMEN WITH HIV
THROUGHOUT THE WORLD.
THIS INCLUDES SUBOPTIMAL
ADHERENCE AND THOSE NOT
COPING WITH ALL THEY ARE
SUPPOSED TO BE MANAGING.
THERE ARE STILL BARRIERS TO
CARE, STIGMA AND POVERTY FOR
PEOPLE TO ACCESS CARE.
YOU FIND THEY DON'T HAVE
ENOUGH MONEY FOR FOOD OR TO
GO GET TREATMENT AND
SOCIOECONOMIC FACTORS A BIG
PART OF THIS IN LOW INCOME
COUNTRIES.
YOU ALSO FIND IN SOME
COUNTRIES, PEOPLE CANNOT
ACCESS HELP FREELY, THEY
HAVE TO PLAY OUT OF POCKET
AND REMEMBER THESE ARE
PEOPLE WHO CAN'T AFFORD TO
PAY FOR THIS.
AND BECAUSE THEY MONITOR
PEOPLE WITH HIV, YOU END UP
PEOPLE NOT ABLE TO BE EVEN
SCREENED BECAUSE OF THE OUT
OF POCKET COSTS ASSOCIATED
WITH THAT.
NEXT SLIDE, PLEASE.
SO AS NOTED BY THIS GRAPH ON
THE LEFT, AFRICA WILL
EXPERIENCE THE MOST IN THE
WORLD OVER THE NEXT 50 YEARS
AND THIS IS EVIDENCE OF NOT
BEING ABLE TO PROVIDE FOR
THE POPULATION.
THE POP LADIES AND
GENTLEMENNING WITH HIV IS
NEARING 4000 AND DUE TO THE
PROBLEMS WITH AGING
POPULATION, BURDEN OF NCDS,
INFECTIOUS DISEASE,
MULTIMORBIDITY, TOXICITY AND
CONTRACEPTION.
AS WELL AS THE PANDEMIC.
WE ALSO HAD WOMEN WITH HIV
WITH A HIGHER RISK OF
MULTIMORBIDITY IN SUBSARARAN
SOUTH AFRICA AND WE ALSO HAD
A STUDY IN ZIMBABWE WITH
WOMEN LIVING IN HIV AND
SUBJECT TO COMORBIDITIES.
THERE IS ALSO THE INFECTION
RATE, 63.6 PERCENT
WORLDWIDE.
NEXT SLIDE, PLEASE.
SO THINKING ABOUT THE
QUESTIONS FOR WOMEN'S HEALTH
IN SUBSARARA AFRICA PRO
DOMINANTLY.
SO WITH THE DISEASE, THE
ASIAN POPULATION IN AFRICA,
IT IS IMPORTANT WE FOCUS ON
THE MIDDLE TO LOW INCOME
COUNTRIES TO UNDERSTAND THE
DIFFERENCE OF HIV FOR THOSE
WOMEN.
WE NEED TO LOOK AT OPTIMAL
RATES FOR HUMANS AND WHAT
ARE THE BEST PROVIDERS FOR
THIS POPULATION.
WHAT DRUG THERAPIES WOULD BE
THE MOST CONCERNED ABOUT,
WHERE WE SHOULD STOP
THINKING ABOUT IMPORTANCE OF
INCLUSIVITY, AGING AND
FRAILTY AND IMPACT ON WL
HIV.
AND ALSO MENOPAUSE AND HRT,
WHAT WE KNOW IS BLACK WOMEN
ARE KNOWN TO EXPERIENCE
MULTIMORBIDITIES WITH HIV.
INCREASED DEPRESSION AND
ANXIETY ALSO IMPACT THIS AND
WHAT SYSTEMS DO WE HAVE TO
PUT IN PLACE TO SUPPORT
WOMEN AT CLINICS?
HOW IS IT INTEGRATED, IS IT
FEASIBLE?
WE NEED TO UNDERSTAND
MENOPAUSE IN WOMEN WITH HIV.
WE NEED TO UNDERSTAND THE
ROLES OF HORMONE REPLACEMENT
THERAPY IN PREVENTING WEIGHT
GAIN AND VULNERABILITY IN
WOMEN WITH THE DISEASE.
WE HAVE A WORRYING TREND OF
STIS WHERE WOMEN ARE
DISPROPORTIONATELY AFFECTED
MORE THAN MEN.
AND WE NEED TO KNOW OPTIMAL
TREATMENT STRATEGIES FOR
VULNERABLE WOMEN.
PREGNANT AND POSTPARTUM.
SO WE NEED TO FIND A WAY OF
MAKING SURE WOMEN GET
TREATMENT BECAUSE LONG
TREATMENT WILL IDENTIFY THE
VULNERABLE POPULATION.
WE KNOW THAT THERE IS A
STUDY IN AFRICA THAT WENT
PRETTY WELL DESPITE THE
RARITY BUT WHERE YOU GO TO
GET THE TREATMENT IT IS
STILL BASED ON POPULARITY.
NEXT SLIDE, PLEASE.
SO YOU WILL HAVE EPIDEMIC
IS NOT OVER PARTICULARLY FOR
WOMEN IN LOW TO MIDDLE
INCOME COUNTRIES AND WE NEED
MORE WOMEN IN CLINICAL
TRIALS AS MOST PARTICIPANTS
ARE MALE.
WE NEED MORE RESEARCH NEEDED
FOR PREVENTION, SCREENING
AND MANAGEMENT OF
MULTIMORBIDITY.
WE NEED IMPLEMENTATION OF
RESEARCH FINDINGS TO BE
QUICK AND INCREASE ACCESS TO
LIFE-SAVING INTERVENTIONS
WHICH IS CRITICAL TO AVOID
GROWING DISPARITIES.
WE NEED HEALTH EQUITY TO BE
ONE OF THE MOST URGENT
PRIORITIES.
IT NEEDS TO BE PRAGMATIC
COST EFFECTIVE SOLUTION FOR
LOW AND MIDDLE INCOME
COUNTRIES AND WE NEED TO
LISTEN TO WOMEN WHO HAVE
POORER TOLLABILITY.
SO AS A CONCLUSION, WOULD
NEED TO FOCUS ON
COMORBIDITIES.
WE CANNOT END HIV UNLESS WE
LOOK AFTER OUR WOMEN.
THE FACT WE HAVE STILL
BABIES BORN WITH HIV MEANS
THE END IS NOT NEAR.
NEXT SLIDE.
SO I WOULD JUST LIKE TO
THANK MY COLLEAGUES FOR THE
MATERIAL I AM PRESENTING AND
ALSO THE PRESENTERS IN THE
AFRICAN HIV WOMEN WORKSHOP.
THIS WAS REALLY EYE OPENING.
THEY REALLY DISCUSSED KEY
CHALLENGES AND IDEAS ABOUT
HOW THE EPIDEMIC IN
SUBSARARA SOUTH AFRICA AND
HOW WE CAN MOVE FORWARD TO
BENEFIT WOMEN.
THANK YOU SO MUCH.
>> THANK YOU DOCTOR FOR THAT
PRESENTATION.
AS A REMINDER TO THE
AUDIENCE, PLEASE PUT YOUR
QUESTIONS OR COMMENTS VIA
THE LIVE FEEDBACK OPTIONS AT
THE BOTTOM OF THE VIDEOCAST.
OUR NEXT PRESENTATION IS
FROM Dr. IGHO OFOTOKUN.
PLEASE GO AHEAD.
>> YES, THANK YOU SO MUCH
AND THANKS TO THE ORGANIZERS
FOR INVITING ME TO SHARE
SOME OF MY THOUGHTS ON THIS
VERY IMPORTANT TOPIC.
NEXT SLIDE SO REALLY THE
SUMMARY OF MY WORK IS TO
HIGHLIGHT LONG-TERM EFFECTS
OF HIV THERAPY.
WE ARE SEEING SOME OF THE
EFFECTS OF THOSE LIVING WITH
THE VIRUS FOR A VERY LONG
TIME AND HAVING TO TAKE
MEDICATION FOR THE ENTIRE
DURATION OF THEIR LIFE.
WHAT WE NOW KNOW IS THAT
PEOPLE WHO ARE TESTING WITH
HIV, LIVING ABOUT 16 FEWER
HEALTHY YEARS THAN PERSONS
WITHOUT HIV DUE TO NONAIDS
HEALTH RELATED ISSUES.
WOMEN ARE DISPROPORTIONATELY
AFFECTED BY THESE RELATED
HEALTH ISSUES AND WE NEED TO
UNDERSTAND.
NEXT SLIDE.
ONE THING THAT THE STUDIES
TELL US IS THAT THE VIRUS
AND TREATMENT HAVE LONG-TERM
EFFECTS.
THEY CONTRIBUTE TO NONAIDS
AGING RELATED COMORBIDITIES
AND ALMOST EVERY ORGAN
SYSTEM IN THE BODY IS
AFFECTED.
NO SYSTEM IN THE BODY IS NOT
AFFECTED, WHETHER IT BE THE
BRAIN, KIDNEY, HEART, BONE,
GI TRACTS.
SO EVERY ORGAN IS THREATENED
WITH THIS IMPACT OF LIVING
LONG WITH TREATMENT AS WELL
AS WITH THIS VIRUS THAT IS
LIVE.
SO THIS IS MY TEAM.
WE WERE REALLY INTERESTED IN
EXPLORING THESE QUESTIONS
FOR THEM AND TO LOOK AT WHAT
THE CONTRIBUTION OF THE
VIRUS IS, WHAT THE
CONTRIBUTION OF THE
TREATMENT IS.
WE STARRED OUR WALK FIRST
HERE IN THE U.S., IN ATLANTA
AND CONDUCTED IT FOR 100
DAYS.
THEN WE EXTENDED IT TO
AFRICA WHERE THE BULK OF THE
EPIDEMIC CURRENTLY RESIDES.
AND I WORKED WITH A LARGE
TEAM OF SCIENTISTS SO WE
REALLY WERE INTERESTED IN
WHAT -- HOW DID THIS
TREATMENT AND VIRUS AFFECT
THE BONE AND EXPANDED TO THE
BRAIN AS WELL AS THE HEART.
NEXT SLIDE.
SO ONE OF THE ONES OF THE
THINGS WE WERE ABLE TO
PURSUE, USING ONE OF THE
LARGEST LONGITUDINAL STUDIES
DONE IN THE U.S. AND DONE BY
MY COLLEAGUE WAS TO
HIGHLIGHT WHAT WE ALREADY
KNOW.
IT AFFECTS THE COMORBIDITIES
AND THAT THE BURDEN IS
HIGHER IN WOMEN BUT SOME OF
THE ANALYSIS DONNELL WAS
THIS EFFECT IS OCCURRING AT
A MUCH YOUNGER AGE.
SO YOU WOULD SEE TREATMENT
DEFERRED WOULD CAUSE THINGS
LIKE HYPERTENSION, PSYCH
ILLNESS, DYSLIPIDEMIA, LIVER
DISEASE, BONE DISEASE, LUNG
DISEASE, DIABETES, VVD AND
KIDNEY DISEASE AS WELL AS
CANCER.
AND EARLY IN LIFE WE ARE
SEEING THIS EFFECT MORE IN
WOMEN COMPARED TO THE
GENERAL POPULATION AND EVEN
WHEN YOU LOOK AT WOMEN
COMPARED TO MEN LIVING WITH
HIV, YOU SEE A MARKED
DIFFERENCE, WHICH HAS
PREVALENCE ON WOMEN VERSUS
MEN.
NEXT SLIDE.
SO ONE OF THE THINGS WE WANT
TO TACKLE IN OUR BON STUDY
HERE WAS DECIPHERING HOW
HIV-1 WEAKENS AND CRACKS THE
BONES.
THIS VIRUS, THE IMPACT OF
HIV ON T CELLS ALL TRYING TO
BALANCE AND THAT IS SUCH A
WAY YOU HAVE INCREASED
AMOUNT RIGHT IN YOUR BODY,
THE PART OF BODY THAT IS
INVOLVED WITH BREAKING TOWN
BON AND -- DOWN BONE AND
ALL OF THIS HAS AN IMPACT ON
HIV.
SO THEN THROUGH THIS
PROCESS, THEY GET BETTER
WHICH IS TRUE BUT THESE T
CELLS THAT RECREATED OR
RECONSTITUTED, MANY OF THESE
ESPECIALLY IN AN ADULT ARE
THE RANKL AND TNFA.
SO YOU SEE THE INCREASE OF
TREATMENT AND IMPACT OF HIV
WORKING TOGETHER TO REALLY
CREATE THESE CONDITIONS TO
WEAKEN THE BONES OF PEOPLE
WORKING FOR HIV.
SO NEXT SLIDE.
WE LOOK AT TWO KEY PROTEINS,
THE RANKL AND OPG THAT
REGULATE BONE HEALTH IN THE
BODY.
SO IF YOU HAVE A SYSTEM
WITHOUT A TREATMENT OR VIRUS
WITH ACCESS IN THE BODY, YOU
CAN EXTRAPOLATE THAT IT WILL
AFFECT DIFFERENT SYSTEMS
WITHIN THE BODY.
NEXT SLIDE.
SO VERY QUICKLY FROM THE
DATA, WHEN YOU LOOK AT THE
VOLUME, JUST SIMPLE WOMEN
WHO DO NOT HAVE SYMPTOMS,
THEY JUST SHOW UP FOR
STUDIES AND WE DO THIS TEST
TO MEASURE CALCIUM AND LOOK
AT A NUMBER OF THINGS FOR
HEALTH BUT WHAT WAS MOST
IMPRESSIVE IS THE CORONARY
PLAQUE.
IT WAS 43 PERCENT AS
COMPARED TO 20 PERCENT OF
THE CONTROLS IN BLACK WOMEN
OF COMPARABLE AGE.
AND IMPORTANTLY THE ANALYSIS
OF REPEAT C CTA TWO YEARS
APART SHOWS RAPID PLAQUE
PROGRESSION.
SO WHY ARE WOMEN
PROPORTIONATELY AFFECTED?
SO I SHOW YOU THE
PRELIMINARY DATA FROM ANIMAL
MODERATE TELLS THAT SUGGEST
IMMUNE-RECONSTITUTION AND
ESTROGEN DEFICIENCY ACT IN
SYNERGY TO ENHANCE BONE
LOSS.
AND THESE TWO EFFECTS, THE
IMPACT OF HIV TO EXAGGERATE
THE DEFECT OF BONE LOSS IN
THE BODY.
SO WE SEE THAT THIS IS A
PROBLEM AND THOUGHT WHAT CAN
WE DO TO ADDRESS THIS ISSUE.
SO THIS IS JUST A SMALL
PROOF OF CONCEPT STUDY THAT
WE DID USING BOTH OUR ANIMAL
STUDY AND SMALL PHASE 2
CLINICAL STUDY TO SEE
WHETHER WE CAN BLOCK THE
IMPACT OF THE ANTIVIRAL.
AND HERE WE SAW THAT WITH
ZOLEDRONIC ACID INFUSION
THAT IS USED TO TREAT
OSTEOPOROSIS, IF YOU GIVE IT
AT THE TIME OF THE ANTIRETRO
VIRAL INJECTION, IT
PROTECTED THE BONE FOR OVER
A PERIOD OF TEN YEARS AND
THAT IS AS FAR AS WE COULD
LOOK.
I AM SURE I HAVE FOLLOWED
THESE PEOPLE IN PHASE 2
TRIAL AND WE SAW THIS IN
ANIMAL MODEL STUDIES AS
WELL.
IN SOME OF THESE CONDITIONS,
WE SEE THERE ARE THINGS WE
CAN DO TO PREVENT BONE LOSS.
SO LAST SLIDE.
THIS IS MY LAST SLIDE TO SAY
THAT ANTIRETRO VIRAL THERAPY
INDUCE BONE LOSS, MOSTLY IN
WOMEN AND HIV VIRUS AND
TREATMENT HAVE LONG-TERM
EFFECTS ON MORE WOMEN THAN
MEN, THE UNDERLYING
MECHANISM IN CASE OF BONE IS
RELATED TO ASSAULT ON
DIFFERENT COMPONENTS OF THE
IMMUNE SYSTEM AND SYNERGY
BETWEEN ESTROGEN DEFICIENCY
AND HIV TREATMENT EFFECTS
MAY COACT TO CAUSE INCREASED
BURDEN AMONG WOMEN AND THIS
TYPES OF INFORMATION ARE
NEEDED TO HELP US FASHION
PREVENTIVE MEASURES FOR
WOMEN.
AND LAST SLIDE, I
ACKNOWLEDGE ALL OF THOSE WHO
CONTRIBUTE FUNDING AND THOSE
INVOLVED IN RESEARCH.
>> AS A REMINDER, PLEASE
POST YOUR QUESTIONS OR
COMMENTS ON THE FEEDBACK
BUTTON OF THE LIVE
VIDEOCAST.
WE NOW WILL GO TO Dr.
STEVEN DEEKS, THE MICROPHONE
IS YOURS.
>> THANK YOU, CAN I GET THE
NEXT SLIDE, PLEASE?
SO I AM ACTUALLY A BIT
INVOLVED IN THE HIV CURE
EFFORTS, PART OF THE
TREATMENT PARADIGM, FOR 10
OR 15 YEARS NOW AND IT IS
LIKE STRIKING PARTICULARLY
IN THE LAST TWO YEARS HOW
THE COMMUNITY IS BEGINNING
TO REALIZE THE IMPACT OF
BIOLOGIC SECTION ON
THERAPEUTIC VACCINATION ARE
LIMITED.
FEMALES MOUNT A STRONGER
IMMUNE RESPONSE TO
INFECTIONS INCLUDING HIV.
WE KNOW FROM OBSERVATIONAL
STUDIES AND ALSO FROM PEOPLE
OTHER THAN ANIMAL MODELS
THIS TO BE TRUE.
THEY ALSO MOUNT A STRONGER
IMMUNE RESPONSE TO VACCINES.
ON THE FLIP SIDE, AND THIS
IS GOING TO BE THE THEME
THROUGHOUT, THE CONSEQUENCE
OF THESE STRONGER IMMUNE
RESPONSES, WOMEN HAVE HIGHER
RISK OF INFLAMMATORY
DISORDERS, MORE ADVERSE
EVENTS TO VACCINES AND SO
FORTH.
SO I WILL GO THROUGH THAT
REAL QUICK.
DON'T HAVE TIME TO TALK
ABOUT IT BUT MAYBE IN THE
NEXT SESSION WE WILL HEAR
ABOUT THIS.
BUT THIS IS QUITE TRAUMATIC
FACTS EMERGING THAT THE HIV
LANDSCAPE DURING LONG-TERM
ANTIRETRO VIRAL THERAPY
DIFFERENCE BASED ON WHETHER
THEY ARE MEN OR WOMEN.
SO NEXT SLIDE.
SO WE KNOW THAT MORE HIV
CURE STUDIES OCCUR FOR MEN
VERSUS WOMEN AND IN ABSENCE
OF EVIDENCE, SHOULD WE BE
CONCERNED THAT THE EMERGING
CURE DEPEND AGENDA WILL
DIFFER BASED ON SEX OR
GENDER?
NEXT SLIDE.
SO WE KNOW THE FEMALE
EXHIBITS STRONGER INNATE AND
ADAPTIVE IMMUNE RESPONSES
THAN MALES AND THIS IS DUE
TO MULTIPLE FACTORS, THE X
LINKED INFLAMMATORY GENE,
TLR7 AND Y LINKED REGULATORY
GENES WITH HORMONAL EFFECTS.
IT IS COMPLICATED TO STUDY
THIS, IT IS UNDER STUDIES
WHICH WON'T BE SURPRISING.
BUT IT IS QUITE A DRAMATIC
EFFECT.
NEXT SLIDE.
AND GOING BACK 20 YEARS,
WOMEN HAVE A LOWER THRESHOLD
TO DISEASE AND MORE LIKELY
THAN MEN TO ACHIEVE
UNDETECTABLE VIRAEMIA IN
ABSENCE OF ART.
THERE ARE TWO NATURAL CURES
TO DATE IN WOMEN AND THE
REBOUND FOR INTACT GENOMES
IN GENIC REASONS, LOWER IN
WOMEN THAN MEN.
NEXT SLIDE.
BUT AGAIN ON THE FLIP SIDE,
GENERALLY WHEN WE LOOK AT
LEVELS OF T CELL ACTIVATION,
INFLAMMATION WHICH WE THINK
LONG-TERM ARE HARMFUL, THESE
TEND TO BE HIGHER.
NEXT SLIDE.
AND IN THE GENERAL
POPULATION, THIS HAS BEEN
KNOWN FOR A WHILE BUT NOT
BEEN WELL STUDIED, MANY OF
THE REALLY SIGNIFICANT
AUTOIMMUNE DISEASES,
INFLAMMATORY DISEASES, ROOM
AUTOMATIC AND LUPUS ARE
LINKED TO THIS LONGER IMMUNE
RESPONSE AND ADAPTIVE
ABILITY OF WOMEN.
NEXT SLIDE.
SO VACCINES, ON THE FLIP
SIDE, WHAT DO WE EXPECT TO
SEE IN TERMS OF VACCINES AND
ARE THERE VACCINES, ANY
IMMUNOTHERAPY, SHOULD WE
EXPECT SEX DIFFERENCES.
SO NEXT SLIDE.
LOOKING AT BODY OUTCOMES,
ALMOST UNIFORMLY YOU GET
STRONGER ANTIBODY PRODUCTION
AS A CONSEQUENCE OF VACCINES
IN WOMEN THAN MEN.
T CELL RESPONSES WHICH ARE
ANOTHER IMPORTANT PART OF
THE IMMUNE RESPONSE
APPARENTLY HAVE NOT BEEN
WELL STUDIES AND WHEN THEY
HAVE, THE DATA WAS POORLY
STUDIED AND INCONSISTENT.
NEXT SLIDE.
BUT ALSO ON THE FLIP SIDE AS
SEEN HERE, LOT EFFICACY IS
BETTER, IT IS LESS
RECOMMENDED AND WE SAW THAT
WITH COVID IN PARTICULAR.
RAISING THE ISSUE WHETHER WE
SHOULD GO FORWARD AND THE
AMOUNT OF VACCINE DOSE
SHOULD BE SMALLER OR SEX
SPECIFIC.
AND NEXT SLIDE.
IMPORTANTLY IN THE LAST DATA
SLIDE NOTICE NOT JUST AN
ISSUE WITH VACCINES.
IMMUNOTHERAPIES IN GENERAL
IN THE DATA ARE NOT A
HUNDRED PERCENT CONSISTENT
BUT ANY TIME YOU MANIPULATE
THE IMMUNE RESPONSE AND TRY
TO MAKE SOMETHING MORE
INFLAMMATORY, YOU GET MORE
ADVERSE EFFECTS OR TOXICITY
SO IT IS A COMPLICATED
THING.
NEXT SLIDE.
SO CONCLUSION, AGAIN, IN THE
ANIMAL MODELS AND IN PEOPLE,
COMPARED TO MALES, FEMALES
MOUNT A STRONGER IMMUNE
RESPONSE TO VACCINES AND IN
INFECTIONS WITH A STRONG
IMMUNE RESPONSE, IT IS
HELPFUL TO DO TWO STUDIES.
COMPARED TO MALES, FEMALES
HAVE MORE ADVERSE REVENTS
POST VACCINATION BUT AS A
MECHANISM LIKELY RELATED TO
STRONGER INFLAMMATORY
RESPONSE SO THEN THEY GET
LIKE LONG COVID IN TERMS OF
THAT VACCINE.
SO THIS DOUBLE EDGED SWORD
THAT HAS REALLY BEEN DRIVEN
BY HORMONE AND HEALTH
DIFFERENCES HAVE MADE THE
COMMUNITY VERY AWARE THAT WE
NEED TO DOUBLE DOWN ON OUR
EFFORTS TO HAVE MORE
STUDIES, PERHAPS SEPARATE
STUDIES AND NOT ONLY WRITE
IT DOWN BUT TO LOOK AT CURES
AS THEY TALK AND IT MIGHT BE
EASIER TO CURE IT IN WOMEN
THAN IN MEN AND THAT WOULD
MOVE THE CARE TO WHERE MOST
PEOPLE COULD NOT BE
REINFECTED.
>> THANK YOU FOR YOUR
PRESENTATION.
AS A REMINDER TO THE
AUDIENCE, PLEASE PROVIDE
YOUR QUESTION OR FEEDBACK IN
THE FEEDBACK BUTTON ON THE
VIDEOCAST.
OUR FINAL SPEAKER TODAY, YOU
GO AHEAD, THE PROGRAM IS
YOURS.
>> THANK YOU.
GOOD MORNING EVERYONE, MY
NAME IS ALICA DIGGS, AIM
DAUGHTER, SISTER MOTHER AND
A GRANDMOTHER AND UNITARIAN
AND AFRICAN-AMERICAN WOMAN
LIVING WITH HIV.
I WAS DIAGNOSED IN 2001 AND
AFTER LEARNING THAT MY
HUSBAND AT THE TIME KEPT THE
TRUTH ABOUT HIS DIAGNOSIS
FROM ME, I COULD HAVE BEEN
RESENTFUL OR LET MY LIFE
SLIP AWAY BUT INSTEAD I MADE
THE DECISION TO LIVE NOT
JUST FOR ME BUT MAINLY FOR
MY CHILDREN.
SO EVEN AFTER GOING THROUGH
THE FEELINGS OF BEING
DISAPPOINTED WITH MYSELF,
ANGRY, FEELING EMBARRASSED
AND ISOLATED, I FELT THE
NEED TO TELL MY STORY AND
DURING THAT TIME OF MY
DIAGNOSIS, I WASN'T HEARING
STORIES ABOUT BLACK WOMEN
ACQUIRING HIV FROM THEIR
PARTNERS SO STARTING TO TELL
MY STORY GAVE ME HOPE TO
PREVENT OTHER WOMEN FROM
GOING THROUGH WHAT I WAS
GOING THROUGH AT THE TIME.
AND EVEN IN THE EARLY 2000'S
THERE WAS STILL A LOT OF
LEARNING GOING ON ABOUT HIV.
IT WASN'T SO EASY TO GET
IMMEDIATELY INTO CARE LIKE
IT IS NOW.
DURING THE TIME OF MY
DIAGNOSIS, I WAS TOLD MY
VIRAL LOAD WAS VERY LOW AND
WASN'T GIVEN A DIRECT NUMBER
BUT MY DOCTOR AT THE TIME
INFORMED ME SINCE IT WAS
OVER 500, I DID NOT HAVE TO
START MEDICATION.
SO FOR THE FIRST TEN YEARS
OF MY DIAGNOSIS, I WAS
ACTUALLY TOLD I WAS
CONSIDERED A NONPROGRESSIVE
BECAUSE MY IMMUNE SYSTEM WAS
STRONG ENOUGH TO KEEP
FIGHTING HIV OR KEEP IT
SUPPRESSED.
SO I WANTED TO SAY IN 2008 I
STARTED PARTICIPATING IN
RESEARCH STUDIES AND ONLY
BECAUSE I DEALT WITH A LOT
OF MISTRUST.
OVER TIME AS I STARTED TO
UNDERSTAND RESEARCH AND
BUILD THE RELATIONSHIPS WITH
THOSE I WAS WORKING WITH, I
DELVED A LITTLE FURTHER TO
PARTICIPATING IN TRIALS AND
MOSTLY BECAUSE THERE WAS NO
ONE INVITING ME TO THESE
TRIALS.
I WILL STILL CHECKING MY
VIRAL LOAD TO MAKE SURE I
WAS STABLE BUT BY THE 11TH
YEAR OF MY DIAGNOSIS I WAS
NO LONGER CONSIDERED A
NONPROGRESSIVE.
I NOTICED MY NUMBERS WERE IN
THE INCORRECT DIRECTION FOR
ME AND THAT MADE ME NERVOUS
SO I STARTED LOOKING INTO
MEDICATION.
OVER THE YEARS, 80s,
90s, SO MANY PEOPLE WERE
GETTING AIDS AND DIED AND
HAD COMPLICATIONS FROM
MEDICATION, I WAS TERRIFIED,
NOT OF THE DISEASE BUT THE
MEDICATION.
BUT AFTER DISCUSSIONS WITH
AND SUPPORT OF MY DOCTOR, I
STARTED MEDICATION, I
STARTED TREATMENT.
AND LIKE I SAID, I WAS
TERRIFIED BECAUSE I KNEW
ONCE I TOOK THAT FIRST PILL,
I WOULD HAVE TO DO IT FOR
THE REST OF MY LIFE AND I
WASN'T SURE WHAT REACTIONS I
WOULD EXPERIENCE TO THESE
MEDICATIONS, ESPECIALLY THE
LONG-TERM EFFECTS OF THEM.
SO OVER THE PAST 12 YEARS, I
HAVE CHANGED MEDICATIONS
ABOUT FOUR TIMES.
I WAS ONCE ON TRICLO, THEN
TRIAMED AND VERY ACTIVE INTO
THE INJECT HAS AND THREE
MONTHS INTO TAKING CAB, IT
FAILED ME.
I WAS SO DEVASTATED BECAUSE
I BECAME DETECTABLE AND
GAINED RESISTANCE TO A
NONREVERSE TRANSCRIPTASE
INHIB TO YOUR AND SEVERAL
OTHER INHIBITORS.
BUT MY DOCTOR WAS SO AMAZING
AND ACTED FAST TO GET ME ON
TREATMENT TO GET BACK TO A
UNDETECTABLE STATUS.
SO NOW I AM ON A NEW
MEDICATION AND UNDETECTABLE
AGAIN.
THIS IS THE FIRST TIME OF
SHARING MY MEDICATIONS TO
THE PUBLIC BUT DO SO BECAUSE
I HAVE HAD GREAT DOCTORS WHO
REALLY LISTENED TO ME AND WE
WORKED TOGETHER AS A TEAM TO
KEEP ME HEALTHY.
BUT TO BE HONEST WITH YOU
ALL, IT IS NOT EASY TO GET
AFFORDABLE CARE.
THERE IS STILL STIGMA WHICH
PLAYS A HUGE PART TO
TREATMENT AND EQUITY.
AND I KNOW SO MANY WOMEN WHO
SAY HEALTHCARE PROVIDERS
DON'T LISTEN TO THEM WHEN
THEY ARE SHARING THEIR
HEALTH ISSUES AND HOW THEY
FEEL.
AND WE KNOW HISTORICALLY
TRAUMA HAS BEEN IMPOSED ON
BLACK AND BROWN BODIES AND
IT IS A LONG ACTING SCAR
THAT REALLY NEEDS TO BE
ACKNOWLEDGED AND ADDS TO THE
MISTRUST.
SO SINCE THERE HAS BEEN -- I
AM SORRY, THERE HAS TO BE
TRUST BETWEEN HEALTHCARE
PROVIDERS AND PATIENTS TO
START TO LISTEN TO WOMEN.
THIS HAS TO BE SAID MULTIPLE
TIMES DURING THIS WORKSHOP
AND IT HAS BEEN SAID
MULTIPLE TIMES IN THIS
WORKSHOP THAT YOU HAVE TO
LISTEN TO WOMEN AND ALTHOUGH
MANY OF US MAY NOT BE
PHYSICIANS, WE DO KNOW OUR
BODIES, HOW WE FEEL AND WHAT
WE'RE GOING THROUGH.
WOMEN TRULY DESIRE TO WORK
WITH OUR HEALTHCARE
PROVIDERS AND OUR HEALTHCARE
TEAM AND TEAM MEMBERS TO
MAKE SURE WE CONTINUE TO
DELIVER LARGE ON HIV.
AND WE KNOW HISTORICALLY
WOMEN TEND TO BE DIAGNOSED
LATER IN THEIR DISEASE THAN
MEN AND FEWER WOMEN THAN MEN
ARE GETTING HIV TREATMENT.
SOMETIMES WOMEN DELAY
GETTING MEDICAL TREATMENT
AND CARE AND CHOOSE NOT TO
EVEN DISCLOSE THEIR HIV
STATUS.
THIS IS ALL FEW TO NUMEROUS
REASONS, STIGMA BEING NUMBER
ONE, BUT ALSO IN THE U.S.,
WOMEN WITHOUT HEALTH CARE
INSURANCE, ARE UNABLE TO GET
ADEQUATE CARE FOR
MEDICATIONS.
EVEN THOUGH WE HAVE THE AIDS
PROGRAM AVAILABLE TO ASSIST
WITH MEDICATIONS FOR PEOPLE
WITHOUT INSURANCE.
TRANSPORTATION IS ANOTHER
BARRIER.
UNSTABLE HOUSING.
AND WE TALKED ABOUT THIS IN
THE SESSIONS YESTERDAY,
INTIMATE PARTNER VIOLENCE.
WOMEN ARE IN FEAR AT HOME.
THEY HAVE SEVERAL
RESPONSIBILITIES SUCH AS
TRYING TO GET CHILDCARE OR
CARE FOR SICK FAMILY
MEMBERS.
WE ALWAYS TAKE CARE OF
OTHERS BEFORE WE TAKE CARE
OF OURSELVES.
THERE MAY BE PROBLEMS WITH
ADDICTION, STRESS,
DEPRESSION.
THERE IS A LACK OF MENTAL
CARE FOR SO MANY PEOPLE.
MENTAL HEALTHCARE IS A
CONVERSATION THAT IS NOT
REALLY HAD IN A LOT OF
COMMUNITIES BUT WE NEED
ACCESS TO MENTAL HEALTHCARE.
LACK OF FINANCIAL RESOURCES.
I REMEMBER WHEN I HAD
LOWER-PAYING JOBS, MY
CONCERN WAS ALWAYS MAKING
SURE I HAD FOOD ON THE
TABLE, MAKING SURE MY
TRANSPORTATION WAS ADEQUATE
TO GET ME TO WORK, GET MY
CHILDREN TO SCHOOL SO HIV
WAS DEFINITELY NOT A MAJOR
CONCERN FOR ME, MOO SO THE
THINGS THAT WERE GOING ON IN
MY HOUSEHOLD AND AS I
MENTIONED BEFORE, MISTRUST
OF THE HEALTHCARE PROVIDERS
AND MEDICAL SYSTEM, THAT IS
A MAJOR BARRIER.
ANOTHER CONCERN IS
NONINCLUSIVE MARKETING.
IT IS LEADING TO LACK OF
AWARENESS OF WHO WILL
BENEFIT FOR TREATMENT.
FEWER TREATMENT OPTIONS FOR
WOMEN THAN MEN ARE AVAILABLE
AND MEDICAL PROFESSIONALS
CAN BE WARY IN PRESCRIBING
TREATMENT SUCH AS PREP.
WE DO KNOW ANTIRETRO VIRAL
THERAPY CAN HELP WOMEN LIVE
LONGER AND HEALTHIER LIVES
IS WHEN PEOPLE HAVE ACCESS
TO ART AND HAVE A CONSISTENT
UNDETECTABLE VIRAL MODE, THE
VIRUS CANNOT BE TRANSMITTED
THROUGH SEX.
THIS WAS DISCUSSED BY Dr.
DEVEENA CONNOR WHERE HE IS
DAY.
THERE NEEDS TO BE NEW MODELS
OF CARE THAT PROVIDE
COMPREHENSIVE HEALTHCARE FOR
OLDER ADULTS THAT INSTIGATE
HIV CARE, HEALTH MANAGEMENT,
GERIATRIC CARE.
NOW THAT I AM 50 AND OLDER,
THOSE THINGS I AM CONCERNED
ABOUT NOW WHEN HONESTLY I
DIDN'T KNOW I WOULD EVEN
MAKE IT TO THAT.
BUT ALL OF THE WORK THAT HAS
BEEN DONE WITH ADVANCEMENT
IN RESEARCH AND MEDICATIONS,
IS VERY IMPORTANT TO THAT
AND WE DO ACKNOWLEDGE AND
APPRECIATE THAT.
BUT EVEN WITH THAT, WE ASK
PROVIDER THINK OF THE WHOLE
PERSON AND HOW EVERYTHING IN
OUR LIFE IMPACTS US, NOT
JUST HIV.
WE ARE DIVERSE, FROM
DIFFERENT BACKGROUNDS BUT WE
ARE TREATED ALL THE SAME.
AND USE FIRST PERSON
LANGUAGE.
I CANNOT EXPRESS THAT
ENOUGH.
THIS IS WHY I STARTED MY
INTRODUCTION OFF WITH WHO I
AM AND NOT A DIAGNOSIS.
PEOPLE LIVING WITH HIV ARE
NOT INFECTIONS BUT WE
CONTINUE TO HEAR
STIGMATIZING LANGUAGE FROM
HEALTHCARE PROVIDERS THAT
ADDIBLE ADDS TO THE STIGMA
WE ALREADY HAVE.
WE UNDERSTAND THERE ARE
MEDICAL TERMS OR JARGON USED
IN WORK SETTINGS BUT AS SAID
YESTERDAY BY Dr. MCDONALD,
AS WOMEN, PEOPLE WHO LIVE
WITH HIV, WE SUGGEST USING
FIRST PERSON LANGUAGE.
TREAT US AS HUMAN BEINGS, AS
PEOPLE FIRST, NOT A
INFECTION OR DISEASE.
THERE IS A GREAT ARTICLE ON
THE WEBSITE OF WHY HIV
MATTERS, AND MANY OTHER
ORGANIZATIONS THAT HAVE
GUIDES AVAILABLE OR THEIR
WEBSITES FOR PERSONS
AFFECTED TO ACCESS.
AND I WILL CLOSE WITH THIS.
IT WAS MENTIONED YESTERDAY
OW PROVIDERS HAVE TO CARE
ENOUGH TO DO THIS WORK FOR
ALL OF US HOLISTICALLY,
OTHERWISE WE WILL NOT BE
ABLE TO ACCESS ADEQUATE
CARE.
WE NEED TO TREAT WOMEN WITH
HUMANITY AND COMPASSION.
WE CANNOT END THE HIV
EPIDEMIC WITHOUT TREATING
WOMEN.
SO IN THE WORDS OF DIALO,
MEET PEOPLE WHERE THEY NEED
TO BE MET.
THANKS FOR THE OPPORTUNITY
TO SHARE AND I LOOK FORWARD
TO ANY QUESTIONS.
>> THANK YOU, MS. DIGGS.
AND FOR ALL OF US, WE WOULD
LIKE TO RESPOND TO THE
QUESTIONS, IF YOU WANT TO
SUBMIT YOUR COMMENT OR
QUESTION, DO SO VIA THE LIVE
FEEDBACK BUTTON AT THE
BOTTOM OF THE PAGE AND THEN
WE INVITE ALL OF OUR
PRESENTERS TO TURN ON YOUR
CAMERA SO WE CAN HAVE A
CONVERSATION.
THANK YOU ALL.
WE DO HAVE A LIST OF
QUESTIONS HERE FOR US TO
START ASKING.
OUR FIRST QUESTION IS FOR
Dr. MNGIBISA.
WHERE CAN WOMEN GO FOR
OPPORTUNITIES TO PARTICIPATE
IN THERAPEUTIC RESEARCH?
YOU MIGHT STILL BE MUTED.
>> HE MIGHT BE STRUGGLE LING
WITH HIS CONNECTION IF YOU
WANT TO MOVE TO THE NEXT
ONE.
>> YES, DOCTOR ORKIN IS NOT
WITH US AT THE MOMENT SO WE
WILL MOVE ON TO A QUESTION
FOR Dr. OFOTOKUN.
ARE THE THERAPY
RECOMMENDATIONS FOR WOE
MORBIDITY LIKE BONE LOSS OR
HEART DISEASE DIFFERENT FOR
WOMEN WITH HIV THAN THOSE
WITHOUT?
>> NOT NECESSARILY
DIFFERENT.
I THINK WHAT THE DATA SEEM
TO BE SUGGESTING IS THAT WE
NEED TO BE MORE VIGILANT IN
SCREENING WOMEN LIVING WITH
HIV FOR SOME OF THESE
COHORDE COMORBIDITIES AND
IF WE USE THE CURRENT DRIVEN
GUIDELINE FOR SCREENING, A
LOT OF WOMEN, ALREADY
DIAGNOSED EARLIER THAN MEN,
SO IF YOU ARE IN A CLINIC
TAKING CARE OF A WOMAN
LIVING WITH HIV, YOU WANT TO
START THIS CONVERSATION
EARLY SO BEGIN IT TALK ABOUT
YOUR HEART, TALK ABOUT YOUR
BONE, THE GI SCREENING
BECAUSE SOME OF THIS
CONDITION, WE ARE SEEING
THEM MUCH BETTER IN THE
SECOND OR THIRD DECK CADE OF
LIFE, NOT THE FOURTH OR
FIFTH OR SIXTH DECADE OF
LIFE.
WE DON'T HAVE AN ORDER OF
THESE CONDITIONS BUT THERE
IS THE PRIEST STUDY THAT
SUGGESTS PUTTING EVERYBODY
ON STATINS WITH HIV, IT DOES
REDUCE CARDIOVASCULAR EVENTS
AND INFLAMMATION.
SO THE TREATMENT IS THE SAME
BUT WE NEED TO BE MORE
VIGILANT AT THIS POINT.
>> THANK YOU.
I HAD A QUESTION FOR Dr.
DEEKS.
FEMALES HAVE A STRONGER
REACTION TO INFECTION,
STRONGER RESPONSE TO
VACCINES AND A LOWER VIRAL
LOAD SET POINT.
IS THE SAME TRUE FOR
TRANSWOMEN AND HOW MUCH OF
THIS IS BECAUSE OF THE X
CHROMOSOME VERSUS THE
HORMONE?
>> YOU WOULD THINK
STUDYING -- I DON'T THINK
THAT HAS BEEN -- WELL, WE
DON'T KNOW THE ANSWER IN
TERMS OF TRANSWOMEN AND WHAT
WOULD HAPPEN AS THEY
TRANSITION.
IT WOULD BE AN IDEA TO STUDY
SOME OF THESE ESPECIALLY
WITH COOR MULTICONDITIONS.
BUT WITH THE TRANSITION, IS
MAKES IT MORE DIFFICULT TO
DO THE DEEPER DIVE AS FAR AS
BLOOD SO THE ANSWER IS IT IS
NOT KNOWN.
THE RELATED QUESTION TO GET
AT THINGS AS THEY CHANGE IS
MENOPAUSE AND THERE THE DATA
SUGGESTS THAT AS WOMEN GO
THROUGH MENOPAUSE AND
ESTROGEN LEVELS CHANGE, IT
DOES HAVE A IMPACT AND TENDS
TO INCREASE IN MOST IF NOT
ALL WOMEN.
>> THANK YOU.
I HAVE A FOLLOW UP FOR Dr.
OFOTOKUN.
THE CHALLENGES YOU SAY COME
WITH A LOT OF CHALLENGE DEAL
WITH PHYSICAL ABILITY AND
HEALTH ISSUES.
HOW CAN PAIN BE MANAGED
BECAUSE IT SOAPS LIKE IT IS
OVERSTATED AND THEREFORE
PEOPLE DON'T GET ADEQUATE
PAIN MANAGEMENT AFFECTING
QUALITY OF LIFE.
>> I THINK THAT IS A GREAT
QUESTION AND I THINK WHAT WE
ARE ADVOCATING IS THE WAY
YOU MANAGE MEN MAY BE
DIFFERENT FROM THE WAY YOU
MANAGE WOMEN.
THE PRESSURE FOR CERTAIN
THERAPIES OR SCREENING FOR
IMPACT OF SYMPTOMS, WHERE
THERE IS PAIN, DEPRESSION,
ANXIETY, THE THRESHOLD FOR
SCREENING FOR THEM SHOULD BE
HIGHER WHEN YOU ARE DEALING
WITH WOMEN AND THE PRESSURE
FOR ANY INTERVENTION SHOULD
BE LOWER WHEN YOU DEAL WITH
WOMEN BECAUSE NOT ONLY ARE
THEIR CONDITION MORE COMMON,
WHEN THEY APPEAR AS THE
QUESTION SUGGESTS, THEY TEND
TO BE MORE SEVERE.
SO IF YOU ARE USED TO
DEALING WITH MEN, IF YOU
APPLY THE SAME PRESSURE TO
WOMEN, YOU WOULD SUBJECT
MANY WOMEN TO UNDUE
SUFFERING BEFORE
INTERVENTION.
SO THIS IS SOMETHING THAT --
THIS IS THE MESSAGE WE NEED
TO CONTINUE TO HIGHLIGHT TO
PEOPLE WHO TAKE CARE OF
PEOPLE LIVING WITH HIV,
PARTICULARLY WOMEN WHO ARE
LIVING WITH HIV.
>> I ACTUALLY HAVE ANOTHER
FOLLOW UP QUESTION FOR YOU.
ISN'T THE EARLIER
SIGNIFICANT THERE WILL FOR
CARDIOVASCULAR HEALTH IN THE
STUDIES THAT YOU HAVE A
FEATURE OF PREGNANCY, EVENTS
THAT WOULD NOT BE OBSERVED
IN MALES AT THE SAME YOUNG
AGE?
>> I THINK THAT IS A GREAT
QUESTION AND ASK HAVE TO DO
WITH EXTRA CELLS.
WE WE DO ANALYSIS IN SOME OF
OUR DATA WE TAKE IN
PREGNANCY, WE SEE INCREASET
BODIES OF THESE CONDITIONS
IN WOMEN.
SO WHEN WE SENSE PEOPLE HAVE
BEEN PREGNANT.
WE DO HAVE ANOTHER COHORT
THAT IS CALLED THE STACK
COHORT AND FUNDED BY NIACHD
WHERE WE INCLUDE YOUNG WOMEN
OF REPRODUCTIVE PHASE AND
TRYING TO LOOK AT -- ONE OF
THE GOALS OF THAT PARTICULAR
COHORT IS TO STUDY IMPACT OF
PREGNANCY ON SOME OF THESE
COMORBIDITIES BUT IN THE
COMBINED COHORT STUDIES, ALL
OF THESE BODIES OF DISEASE,
EVEN IN THE ABSENCE WHEN YOU
CONTROL FOR PREGNANCY,
OCCUR.
>> THANK YOU, I NOW HAVE A
QUESTION FOR ALICIA DIGGS.
WHERE CAN A YOUNG WOMAN
INVOLVED IN ACTIVIST LEARN
MORE?
SOMETIMES THESE SPACES ARE
MALE DOMINATED.
>> THANK YOU FOR THE
QUESTION.
I WILL BRIEFLY SHARE THAT
FOR ME THERE IS AN
ORGANIZATION HERE WHERE I
LIVE IN THE PIEDMONT
TRIANGLE AREA, PIEDMONT
HEALTH SERVICES AND
SICKLE-CELL AGENCY.
THEY ARE AN AGENCY THAT
PROVIDE TREATMENT FOR
SICKLE-CELL AS WELL AS HIV
CARE AND HONESTLY I JUST
WENT THERE TO START TELLING
THIS IS WHO I AM AND I HAVE
A DESIRE TO TALK TO OTHER
PEOPLE.
AND FROM THERE, I GAINED
MENTORS AND WAS GUIDED INTO
THIS WORK BUT I WOULD
DEFINITELY SUGGEST, LIKE I
MENTIONED EARLIER, THE WELL
PROJECT WEBSITE IS AMAZING,
HAS A LOT OF WONDERFUL
INFORMATION.
SISTERHOOD AS WELL AS THE
POSITIVE WOMEN'S NETWORK
USA, THERE IS HE A
ORGANIZATION AVAILABLE FOR
BLACK CIS GENDER WOMEN WHICH
IS CALLED THE ETHIC MOVEMENT
FOR YOUNG WOMEN LIVING WITH
HIV BUT I WOULD SUGGEST
CONNECTING WITH ANY OF YOUR
LOCAL ASO'S OR COMMUNITY
BASED ORGANIZATIONS AND JUST
PROVIDE THEM WITH THE WORK
YOU WANT TO DO.
YOU CAN ALSO CONNECT WITH
SOCIAL MEDIA OR TPHRO*EUB, I
AM HAPPY TO GUIDE A LITTLE
BIT MORE WITH YOU YEAH, I
HOPE THAT ANSWERS THE
QUESTIONS.
>> THANK YOU SO MUCH.
I INVITE THE PANELISTS TO
SHARE ANY OTHER INFORMATION
YOU MIGHT WANT TO GET OUT IN
OUR QUESTION AND ANSWER
SESSION.
IF THERE ARE NO FURTHER
COMMENTS, I WOULD LIKE TO
CONCLUDE SECTION 8 ON HIV
TREATMENT AND I WELCOME YOU
TO COME BACK AT 11:45 A.M.
EASTERN TIME FOR THE NEXT
SESSION ON HIV RESEARCH.
THANK YOU.
SO WELCOME BACK AND THANK
YOU AGAIN FOR JOINING US.
TODAY THE NEXT SESSION IS
HIV CURE-RELATED RESEARCH, I
AM ELIZABETH BARR FROM THE
OFFICE OF RESEARCH ON
WOMEN'S HEALTH AND HERE
TODAY TO KICK OFF TODAY
INFORMATION ON SESSION 9.
SO ONLY 70 PERCENT OF
PARTICIPANTS TO HIV CURE
RELATED RESEARCH WERE FEMALE
AND PARTICIPATION IN THE
TRIAL INCLUDED REQUIREMENTS
TO ATTEND FREQUENT AND LONG
STUDY VISITS, INVASIVE
SAMPLING AND --
[INDISCERNIBLE]
MOST OF THE RESEARCH HAS
BEEN IN THE U.S. BUT AT THE
SAME TIME GLOBALLY, IT IS
IMPERATIVE TO ENROLL WOMEN,
ESPECIALLY ADOLESCENT GIRLS
AND YOUNG WOMEN, WHO ARE
DISPROPORTIONATELY AFFECTED
WITH THE CURE STUDIES.
COMMUNITY VOICES IS ALSO
QUEUE AS FAR AS
IMPLEMENTATION IN RESEARCH
AND SO THIS IS AN IMPORTANT
TOPIC AND WE ARE REAL LOW
PLEASED TODAY TO BE JOINED
BY ADVOCATES WHO WILL
HIGHLIGHT HIV CURE-RELATED
RESEARCH FOR WOMEN.
NEXT SLIDE, PLEASE.
SO THIS IS A WONDERFUL PANEL
OF SPEAKERS.
AND WE HAVE EILEEN SCULLY,
WOMEN'S COLLABORATIVE
SCIENCE GROUP, A MEMBER OF
THE AGENCY FOR WOMEN AND A
MEMBER OF THE U.S.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES PANEL AND
ANTIRETRO VIRAL INFORMATION
FOR ADULTS AND HIV
PATIENTS --
[INDISCERNIBLE]
THEN WE HAVE Dr.
KARINE DUBE, ASSISTANTS
PROFESSOR IN GLOBAL PUBLIC
HEALTH AND STUDIES THE
BEHAVIORAL SCIENCES AND AN
EXPERIENCED RESEARCH PROGRAM
HAMMER WHO INTEGRATES
BIOMEDICAL, SOCIAL SCIENCES,
ETHICS AND PATIENT
ENGAGEMENT AROUND HIV
RELATED RESEARCH IN THE
UNITED STATES AND SOUTH
AFRICA.
WE WILL THEN HAVE PHILLISTER
ADHIAMBO MADLEGA WHO WORKS
AS A SCIENTIST IN THE HIV
PREVENTION AND CLINICAL
RESEARCH TRIALS AND
CURRENTLY A COORDINATOR IN
THE COVID VACCINE PREVENTION
WORK COVID PM30008 STUDY.
SHE IS WORKING AS A HIV CURE
FELLOW --
[INDISCERNIBLE]
THEN WE HAVE RICHARD
JEFFREYS AND HIS CURRENT
ROLE IS IN THE TREATMENT
ACTION GROUP, TAG, VACCINE
SCIENCE AND PROJECTS.
HIV FUNDING IN RESEARCH AND
ADVOCACY AND HIV LISTING OF
RELATED CURE STUDIES ON THE
TAG WEBSITE.
AND THEN WE HAVE Dr. AN
TONIA DORSAY, SECRETARY OF
THE INLAND EMPIRE PLANNING
COUNCIL, STUDIES CLINICAL
RESEARCH, FOUNDER OF
TRANS100 AND --
[INDISCERNIBLE]
THIS IS A FABULOUS PANEL.
AND FOR ALL OF THOSE WISHING
TO INTERACT, JUST REMEMBER
YOU CAN POST ANY QUESTIONS
USING THE LIVE FEEDBACK THAT
YOU CAN SEE ON THE BOTTOM OF
YOUR SCREEN AND CAN ALSO
SUBMIT QUESTIONS AT
WOMENANDHIV@OD.NIH.GOV.
SO WE WILL START WITH THE
FIRST SPEAKER, Dr. SCULLY.
>> OKAY, THANKS FOR HAVING
ME HERE TODAY.
NEXT SLIDE.
JUST A SUMMARY OF WHAT I AM
GOING TO DISCUSS TODAY, THE
HIV PATHOGENESIS HAS MARKED
DIFFERENCES BASED ON SEX AND
THE EVIDENCE OF DIFFERENCES
IN HIV REGS SKY BETWEEN CIS
GENDER MEN AND WOMEN AND
THERE IS EMERGING EVIDENCE
THAT HIV RESERVOIR DYNAMICS
MAY BE INFLUENCED BY SEX
STEROID HORPL HONES AND
REPRODUCTIVE AGING.
NEXT SLIDE.
SO GENDER IS DIFFERENT AND
IS RELATED TO AN INTERNAL
SENSE OF SELF WITH THE CIS
GENDER AND WE HAVE MANY
DIFFERENT EXCEPTIONS IN
DIFFERENT CONTEXTS.
CRITICALLY, BOTH OF THESE
ARE VERY IMPORTANT FOR
HEALTH OUTCOME AND I THINK
ONE OF THE CHALLENGES AND
TRULY EVERY MEDICAL FIELD IN
SCIENCE IS TO BE VERY
PRECISE ABOUT WHAT QUESTIONS
WE'RE ASKING AND WA DATA WE
HAVE AVAILABLE TO SEE CAN
BETTER TAILOR WERE SREPBGSZ
AND TREATMENT BASED ON WHERE
WE HAVE GATHERED
INFORMATION.
HAVE WE GATHERED INFORMATION
RELATED TO SEX OR THOSE
RELATED TO GENDER?
BUT REGARDLESS, WHETHER OR
NOT WE ARE THINKING ABOUT
SEX OR GENDER, WE ARE ALL
HAVING HORMONES AND THEY MAY
NOT BE CONCORDANT WITH THOSE
AT BIRTH.
SO IT IS A VERY COMPLEX
SYSTEM AND THAT CAN BE A
DISINCENTIVE FOR SOME PEOPLE
IN TERMS OF RESEARCH BUT FOR
US IT IS THE MOST
INTERESTING PLACE TO BE
BECAUSE THERE ARE SO MANY
POSSIBILITIES AND
INTERESTING AVENUES TO
PURSUE.
SO NEXT SLIDE.
NEXT I WOULD LIKE TO TALK A
LITTLE BIT ABOUT THE
FRAMEWORK FOR CURATIVE
INTERVENTIONS AND YOU THIS
THEY FIT INTO THAT.
SO WE HAVE LATENCY AND ONE
WAY WE THINK OF TO CURE IS
TO BLOCK TRANSMISSION AND IF
WE BLOCK IT, IT DOESN'T
MATTER.
THIS IS A ROCK AND BLOCK
IMPACT WHERE HIV DOESN'T
PERSIST AND HAVE LITTLE
IMPACT ON THE PERSON
CARRYING IT.
BLOCKING HIV, WHAT IT DOES
IS POTENTIALLY BLOCK THE
RECOGNITION OF THAT CELL.
THERE IS AN INDICATION THE
CELL IS CARRYING HIV AND NO
REASON IT WOULD BE TARGETED
OR REMOVED BUT WHEN WE
ACTIVATE TRANSCRIPTION, WE
CAN IN THEORY IDENTIFY THAT
CELL AND REMOVE IT.
THEN THIS LEADS TO THE NEXT
RESPONSE WHICH IS AN MRNA
RESPONSE, THINKING ABOUT HOW
WE CAN THERAPEUTICALLY
ACTIVATE THE RESPONSE OF HIV
AND THAT IS ANOTHER ACTIVE
PART OF WORK ONGOING.
SO NOW WE WILL TRY TO
ADDRESS HIV THAT MIGHT BE
IMPACTFUL FOR EACH OF THESE
DIFFERENT PARTS OF THE
FRAMEWORK WHERE WE ARE
THINKING CURE.
SO THE NEXT SLIDE, MAYBE ONE
OF THE PRESSURE POINTS WHERE
GENDER MAY COME TO BEAR IS
PARTICULARLY THINKING OF HIV
LATENCY AND WAYS WE MAY
BLOCK IT WITH RNA
EXPRESSION, WOMEN TYPICALLY
HAVE A LOWER VIRAL LOAD AND
THIS DOES NOT PROTECT
AGAINST DISEASE PROGRESSION.
SO EVEN THOUGH A WOMAN'S
VIRAL LOAD IS LOWER, IT WILL
PROGRESS THE SAME AS A MAN
WITH A HIGHER VIRAL LOAD.
WE ALSO KNOW THERE IS LOWER
PLASMA RNA HIV PLUS LYMPH
NODE CELL.
WE ALSO KNOW THE IMMUNE
RESPONSE TO THE VIRUS IS A
LITTLE BIT TURNED ON AND
TEND TO BE MORE ROBUST AND
THEN TYPICALLY THERE IS
HIGHER IFN ALPHA PRODUCTION
PER HIV RNA STIMULATION.
SO THIS WAS TALKED ABOUT IN
THE LAST SESSION BY ALICIA
WHERE WOMEN WITH A LOWER
VIRAL LOAD AT THE BEGINNING
OF THE EPIDEMIC WAS NOT
STUDIED DUE TO THE
DIFFERENCE WITH MEN.
SO WHEN WE LOOK AT THERAPY,
ARE THERE DIFFERENCES IN THE
HIV RESERVOIR AND WHAT CAN
WE EXPECT IS HAPPENING?
WE DID A STUDY THAT INVOLVED
REPRODUCTIVE AGED MEN AND
WOMEN WHO HAD BEEN ON
TREATMENT FOR A DURATION OF
TIME BEFORE THEIR RESERVOIRS
GET STABILIZED AND LOOKED AT
A COUPLE OF FEATURES.
WHAT WE FOUND IS THERE WERE
LOWER LEVELS OF RESIDUAL
PLASMA BY SINGLE COPY ASSAY,
AND LOWER LEVELS OF PLASMA
VIRUS IN FEMALES IN OUR
STUDY AND THEN IN SEPARATE
WORKS WITH A COHORT IN
UGANDA, WE SAW THERE WERE
LOWER LEVELS OF INDUCIBLE
RESERVOIR EXPRESSION BY
QUANTITATIVE VIRAL OUTGROWTH
ASS AY IN WOMEN VERSUS MEN.
SO THAT IS ONE AREA WHERE WE
CAN EXPECT TO SEE
DIFFERENCES IN HOW TIGHTLY
HIV LATENCY IS CONTROLLED.
SO NEXT SLIDE.
THIS WILL ALSO TALK ABOUT
WHAT THE MECHANISMS WILL BE.
SO IF WE SUGGEST THERE ARE
DIFFERENCES IN RNA
EXPRESSION, CAN WE FIGURE
OUT WHY?
SO WE DID SOME STUDIES TO
SHOW THAT 17 BETAESTRODIAL
CIRCULATING IN WOMEN AND IF
WE TRIED TO SIMULATE TURNING
THAT ON IN THE PRESENCE OF
ESTRADIOL, WE BLOCKED THE
EXPRESSION OF RNA.
AND WE ALSO FOUND IF YOU
KNOCK DOWN THE EXPRESSION OF
THE RECEPTOR 1, WE CAN ALSO
ALTER THEIR HIV
TRANSCRIPTION IN CELL MODELS
AND IF YOU CAN ADVANCE AND
THEN ADVANCE AGAIN, AND THEN
WE ALSO SAW THAT THE
EXPRESSION INCREASES IN
MENOPAUSE AND THIS WAS PART
OF THE TALK WE HEARD
YESTERDAY BUT AGAIN SHOWS
THAT ESTRADIOL CAN IMPACT
LOWER THE LIFE CONTROL AND
MAY HAVE AN IMPACT ON HIV
RESERVOIR STABILITY.
SO THE NEXT SLIDE, THINKING
ABOUT HOW WE ARM OR LEVERAGE
OUR IMMUNE RESPONSE, THERE
ARE HIGHER RATES OF CONTROL
IN COHORT STUDIES THAT LOOK
AT FEMALES VERSUS MALES.
YOU CAN ADVANCE.
AND THEN WE ALSO SO HERE
WITH BEING IN SPONTANEOUS
CONTROL IS 1.5 PERCENT
HIGHER IN FEMALES THAN MEN
AND PARTICULARLY HIGHER WITH
AFRICAN-AMERICAN WOMEN.
AND THEN NEXT SLIDE.
AND WITH STUDIES WE DID, WE
LOOKED AT SPECIFIC GENES
THAT WERE ASSOCIATED WITH
VIRAL LOAD SETPOINT AND IN
FEMALES HAVING MALES, WE SAW
CHROMOSOME 19 THAT IMPACTED
THE VIRAL LOAD BUT ONLY IN
MALES AND NOT FEMALES.
SO THIS SHOWS US THERE IS A
DIFFERENCE IN CONTROL AND
THAT CHROMOSOMES MAY IMPACT
THE OVERALL VIRAL LOAD THAT
YOU HAVE IN ADDITION TO
OTHER DATA ABOUT SEX
HORMONES.
AND THEN FINALLY WE DID SEE
A COHORT IN REPRODUCTIVE MEN
THERE WERE A HIGHER LOAD OF
TESTOSTERONE MARKERS IN
MALES THAN IN FEMALES IN
THIS HIV TREATED SITUATION.
SO WHAT ARE THE OTHER NOVELS
IN THE FIELD?
I WILL JUST MENTION HERE,
THE SEX DIFFERENCES IN
TRANSMISSION BETWEEN MALE
AND FEMALE FETUSES, SEX
DIFFERENTIAL RATES OF
SPONTANEOUS VIROLOGIC
CONTROL IN EARLY LIFE AND
ACCUMULATION OF PRO-VIRUSES
IN SPECIFIC EPIGENETIC
REGIONS.
SO NEXT SLIDE.
SO WE HAVE TO ASK HOW THIS
AFFECTS EXPRESSIBILITY OVER
TIME, WE CAN USE THE SEX
DIFFERENCES TO ELUCIDATE
MECHANISMS OF VIRAL
REGULATION AND IMMUNE
CONTROL AND THEN HOW DO WE
CONSIDER ALL PEOPLE, CIS AND
TRANSGENDER, AND WEIGH THE
IMPACT OF BIOLOGICAL SEX IN
THE CONTEXT OF OTHER
FEATURES.
NEXT SLIDE.
SO WE HAVE TO CLEARLY BE
ABLE TO IDENTIFY THE
POPULATIONS THE DATA IS
APPLIED TO AND ALL FINDINGS
CAN BE APPLIED TO ALL
INDIVIDUALS.
NEXT SLIDE.
SO I WOULD LIKE TO THANK THE
PEOPLE WHO WORKED ON THE
STUDIES WITH ME, COMMUNITY
MEMBERS WHO HAVE BEEN MY
ADVOCATES AND HELPED ME
LEARN HOW TO EFFECTIVELY
WORK IN THIS SPACE AND
THANKS FOR THE OPPORTUNITY
TO BE HERE.
>> WONDERFUL, THANK YOU SO
MUCH.
AND AS A REMINDER FOR THE
AUDIENCE, PLEASE SUBMIT YOUR
QUESTIONS OR COMMENTS
THROUGH THE FEEDBACK AND WE
WILL ANSWER THEM ALL AT THE
END.
SO WE ARE GOING TO HAVE NOW
OUR NEXT SPEAKER AND THAT IS
Dr. DUBE.
>> THANKS SO MUCH TO THE OR
NICER FOR THIS ABILITY TO
PRESENT TODAY ON BEHAVIORAL
AND SOCIAL SCIENCES AND HIV
CURE-RELATED RESEARCH.
STAY OFF CAMERA BECAUSE MY
INTERNET IS UNSTABLE.
SO HERE IS WHAT I WOULD LIKE
TO TALK ABOUT IN THIS
SESSION.
WE NEED MORE RESEARCH AND
CLINICAL TRIAL DESIGNS FOR
WOMEN.
WE NEED TO CALL FOR
JUSTICE-INFORMED HIV CURE
RELATED TRIALS FOR
ANALYTICAL TREATMENT
INTERRUPTIONS OR ATI WHICH
WE WILL HEAR A LOT IN THIS
SESSION.
WE ALSO NEED TO CALL FOR
INTEGRATED COMPONENTS IN THE
TRIALS AND ALL THE REASONS
WE OUTLINE PARTICULARLY FOR
TRIAL OF ATI.
NEXT SLIDE.
THIS SLIDE SHOWS A
THEORETICAL FOUNDATION OF
FRAMEWORK AND BASIS FOR
RESEARCH WITH Dr. CINDY
GROSSMAN, WE OUTLINED THE
AGENDA FOR RESEARCH THAT
INTEGRATE SOCIAL BEHAVIORAL
RESEARCH FUNCTIONAL
FRAMEWORK TO HIV CURE
RESEARCH.
WE ALSO IDENTIFIED THE
FUNCTIONAL FRAMEWORK OF THE
RESEARCH AND OUTLINED THE
PRIDES TO ALIGN WITH BASIC,
BSSR, ELEMENTARYAL AND
INTEGRATED BSSR TO
STRENGTHEN HOW MANY PEOPLE
GET CLINICAL TRIALS.
AND NEXT SLIDE.
THERE HAVE BEEN A NUMBER OF
SURVEYS WITH WOMEN WHO
PARTICIPATE IN AND TAKE
RISKS FROM HIV CURE RESEARCH
AND WE FOUND SPECIFIC
DIFFERENCES BY SEX AND
GENDER.
WHEN WE LOOKED AT HOW PEOPLE
WITH HIV PERCEIVED RISK OR
TREATMENT, THE IMPACT ON
BONE OR MUSCLES, HAVING
CHILDREN AND ATI WAS
SIGNIFICANT FOR WOMEN.
WOMEN WERE IN GENERAL MORE
AVERSE TO PAIN.
WE ALSO FOUND WOMEN WERE
MORE CONCERNED ABOUT
BECOMING DETECTABLE FOR
HIV ATI.
WHEN ASKED ABOUT
PREFERENCES, THE LONG ACTING
TREATMENT AND HIV REMISSION.
WHEN WE GET INTO THE
DATABASE BY BENDER, MEN ARE
MORE LIKELY TO ENTER INTO
TREATMENT.
[ OFF AUDIO ]
-- ABLE TO INTEGRATE AND THE
TRIALS AND FOUND IMPORTANT
DIFFERENCES -- CAN YOU HEAR
ME?
>> NOW WE CAN, YES.
>> OKAY SO IN THE FIRST
TRIAL IMPLEMENTED ENTIRELY
WITH WOMEN IN THE U.S. WITH
Dr. LIEBERT,
CONSIDERATIONS FOR
INCROWSING RACIAL, ETHNIC
GENDER AND SEXUAL DIVERSITY
IN HIV CURE RELATED RESEARCH
WITH ANALYTICAL TREATMENT
INTERRUPTIONS OR ATI.
SO NEXT SLIDE.
NEXT SLIDE.
THIS WAS A STUDY INCREASING
THE MEANINGFUL --
[ AUDIO CUTTING OUT ]
[ NEXT SLIDE PLEASE AND
ABLE TO IDENTIFY FACTORS OF
WOMEN WITH THEIR HOLISTIC
NEEDS.
THIS IS A STUDY BY Dr.
POTEAT ON TRANSGENDER WOMEN
ACROSS THE UNITED STATES.
NEXT SLIDE.
SO THIS IS A STUDY
IMPLEMENTED IN COLLABORATION
WITH FEMALE RISING THROUGH
EDUCATION SUPPORT AND HEALTH
IN SOUTH AFRICA, THE STUDY
OF YOUNG WOMEN AGE 18-24 AND
FOUR TIMES GREATER THAN MEN
AND PARTICIPATED IN THE
STUDY --
[ AUDIO CUTTING OUT ]
>> I THINK WE'RE LOSING YOUR
AUDIO AGAIN.
>> -- PARTICULARLY ATI
TRIALS -- I AM SO SORRY, CAN
YOU HEAR ME NOW?
>> YES AND MELISSA, YOU MAY
WANT TO GO BACK TWO
SLIDES -- ONE SLIDE, THAT
ONE, YEAH.
>> AGAIN EXTREMELY SORRY FOR
MY AUDIO ISSUES.
WE HAVE EXTREMELY LIMITED
DATA ON MENTAL HEALTH ASPECT
IN CAN A CAN STUDY THROUGH
RISE WHERE WOMEN TRIALS TEND
TO BE INVOLVED IN STUDIES
AND HOPING TO CHANGE THIS
ISSUE BY 2024.
NEXT SLIDE.
SO WE ARE CURRENTLY
PARTNERING WITH Dr --
[ NO AUDIO ]
>> WE'RE MISSING YOU AGAIN.
AND NOW WE LOST YOU
COMPLETELY.
MAYBE WE SHOULD MOVE ON TO
THE NEXT PRESENTATION AND
YOU CAN CALL BACK IN?
>> YEAH, LET'S DO THAT.
>> OKAY, SO THINGS HAPPEN.
SO WE WILL MOVE ON TO Dr.
CALER'S PRESENTATION.
NEXT SLIDE.
>> THANK YOU SO MUCH FOR
INVITING ME, I AM PHILISTER
MADIEGA.
AND I WOULD LIKE TO SAY THAT
TODAY THAT WOMEN WITH HIV IS
A PRIORITY AREA.
[INDISCERNIBLE]
I WOULD LIKE TO ALSO ENTER
THE NEED FOR COMMUNITY
IMPROVEMENT AND MOBILIZATION
OF FUNDAMENTALS TO ENSURE
THAT THIS QRE UPTICK IN
AFRICA AMONG THE MOVEMENT
AND TO ENSURE THAT WE HAVE
OPTIMAL PARTICIPATION FOR
AGREEMENT WHO BETTER TO
TREAT WITH HIV.
WE MUST ENSURE THAT
COMMUNITY ENGAGEMENT USING
THE CDC GUIDELINES, WE MUST
INCLUDE THAT WHEN WE TEST
THE WOMEN AND WE ARE
TRANSPARENTLY ENGAGING THEM
AND ALSO TRANSPARENCY WHEN
IT COMES TO THE LEVEL OF
RESEARCH WE ARE GOING TO
CONDUCT ON WOMEN IN AFRICA.
AND MOSTLY LOOK AT THE
COMMUNITY ENGAGEMENT PLANS
THAT WE HAVE, WE HAVE TO
ENSURE THAT WE ALSO --
[INDISCERNIBLE]
-- AMONG DIFFERENT AND
DIVERSE COMMUNITIES THAT ARE
REPRESENTED, MUST INCLUDE
REPRESENTATION IN THE
COMMUNITY ADVISORY BOARD OF
WOMEN FROM DIFFERENT
POPULATIONS.
WE HAVE FEMALES IN THE
COMMUNITY, YOUNG WOMEN ALSO,
WE HAVE TO ENSURE THAT THEY
ARE THERE AND PARTICIPATING.
WE HAVE PUBLISHED AN
ADVISORY GROUP TO ENABLE
YOUNG WOMEN TO VOICE THEIR
ISSUE TO BE ADDRESSED AND BE
TAKEN UP ALSO.
WE ALSO ENSURE THAT WE LOOK
AT PARTICIPATION IN THE
COMMUNITY ENGAGEMENT SO THE
ADVOCACY WILL HELP US IN
ENSURING THAT GUIDELINES AND
DECISIONS AND --
[INDISCERNIBLE]
WE HAVE TO ENSURE THAT WORK
IN THE COMMUNITY IS DONE
TOSURE THAT WOMEN ARE
INCLUDED IN RESEARCH.
THROUGH COMMUNITY
ENGAGEMENT, WE WILL BE ABLE
TO BUILD COHORTS AND
MOMENTUM AMONG THESE WOMEN
AND ALSO BUILD COLLABORATION
TO ENSURE WE ARE BEING
INCLUSIVE AND DISPARAGE NOT
BEING INCLUSIVE AND WOMEN
HAVE THE PERMISSION TO
PARTICIPATE IN THE PROCESS.
WE MUST ALSO ENSURE THAT
THERE IS STRUCTURAL
COMPATIBILITY WHEREBY WITH
THE RESPONSES THEY REQUIRE
FOR THEM TO MAKE A INFORMED
DECISION AND -- [
INDISCERNIBLE ] WHEREBY THE
IDEA LEADS TO THE PRINCIPLES
THAT WE ARE HANDING UP.
AND THIS COULD BE DONE BY
LIVED EXPERIENCES AND WHAT
THEY FEEL.
THEY NEED TO BE CONSIDERED
IN THE PRINCIPLES AND ALSO
BE A CLEAR ACCESSIBILITY,
LIKE POSSESSION OF
MATERIALS, GROUPS OF WOMEN,
SOMETIMES YOUNG WOMEN TO
ENSURE THAT THE KIND OF
COMMUNITY EDUCATION IS
REALLY TO THEM AND CAN MAKE
A INFORMED CHOICE.
FOR COMMUNITY ENGAGEMENT
REALLY PLAYS AN INTEGRAL
ROLE FOR INSURING THE
COMMUNITY HEALTH SUCH AS
STERILIZATION AND ISSUES OF
CONTRACEPTION, THIS COULD BE
ADDRESSED RIGHT IN THEIR OWN
PLACE BEFORE THEY DECIDE TO
PARTICIPATE.
ALSO RELATED WOULD BE
PRINCIPLES OF STIGMA AND
ISOLATION TO BE ADDRESSED AT
A PARTICULAR POINT TO ENSURE
WOMEN REALLY BENEFIT FROM
THESE SPES PHYSICIAN TEASE
INSTEAD OF WOMEN NOT BEING
ABLE TO ENJOY THE FRUITS OF
RESEARCH BUT BEING STOUBGTD
INTIMATE SEXUAL VIOLENCE OR
WAITING FOR THE MALE
COUNTERPART AND FOR INSTANCE
IF A SITUATION WITH A STI,
HOW YOU TACKLE THESE WITH
OUR PARTNERS SO WE NEED TO
BEGIN TO REQUIRE OUR
PARTNERS TO GO FOR CONDOM.
AND ALSO WE WOULD LIKE TO
INFUSE THE LEVEL OF STIGMA
WHERE IF THE WOMAN IS
STRESSED, IF THERE ARE OTHER
MEN IN THE ROOM, SHE IS
ALREADY STRESSED AND WHEREBY
EVEN USING A RING, A MAN CAN
GO --
[INDISCERNIBLE]
SO OTHER THINGS, YOU KNOW TO
REDUCE INFORMATION, WE CAN
USE COMMUNITY ENGAGEMENT TO
ADDRESS THESE CHALLENGES OF
LANGUAGE THAT LEADS TO
INFORMATION AND FOR
APARTMENTS PARTICIPANTS IN
THE PROCESS AND THAT COULD
INCLUDE JUST WOMEN BEING MET
IN A LANGUAGE THEY CAN
UNDERSTAND AND ACKNOWLEDGE
THAT WOMEN ARE DIFFERENT
MEMBERS.
SO THE ADDITIONAL LEVEL OF
STIGMA AND PROCESSES LEADING
TO DIFFERENCES IN WOMEN WITH
THAT.
AND COMMUNITY ENGAGEMENT
SHOULD BE THE FIRST DESIGN
OF THE PROTOCOL AND
INTEGRATION OF RESOURCE AND
PROVIDE SOLUTION IN TERMS
OF --
[INDISCERNIBLE]
>> THANK YOU SO MUCH,
PHILISTER.
AS A REMINDER, WE WILL HAVE
QUESTIONS AT THE END SO FOR
THE AUDIENCE, PLEASE PUT
YOUR QUESTIONS IN THE
FEEDBACK TAB.
SO NOW WE HAVE KAREN BACK
AND SO I THOUGHT WE WERE TO
FINISH HER TALK.
AM I RIGHT IN THAT?
>> YES, SO MELISSA SHOULD BE
PULLING UP HER SLIDES FROM
EARLIER.
>> VERY GOOD.
KIN, WHENEVER -- KAREN,
WHENEVER YOU ARE READY.
>> IS SHE MUTED?
>> YEAH, I AM TRYING TO
UNMUTE HER.
BACK THERE YOU ALL HEAR ME?
YES, UNMUTE YOUR LAPTOP.
>> OH, KAREN, WHAT YOU NEED
TO DO IS PUT LIKE IF YOU
HAVE THE HEAD SET OPTION
WHEN YOU ARE ON THE LAPTOP,
I LEARNED THAT AS WELL.
IF YOU MUTE YOURSELF, IT IS
GOING TO -- WE CANNOT HEAR
YOU.
SO SHE HAS TO GO TO THE
MICROPHONE, THERE IS A
HEADSET OPTION.
BACK.
>> >>>: YOU ALL HEAR ME?
>> YES.
>> JUST AN INTERNET ISSUE, I
DEEPLY APOLOGIZE.
OKAY, SO I WILL ACTUALLY
EMPHASIZE SEVERAL POINTS
MADE BY PHILISTER INVOLVING
FEMALE RISING THROUGH
EDUCATION SUPPORT AND ARE
HEALTH COHORTS IN DURBAN AND
SOUTH AFRICA.
SO WE BELIEVE --
>> UH-OH, WE LOST YOU,
KAREN.
>> SLIDE?
>> NO, NO, SORRY, LET'S GO
ON.
>> NEXT SLIDE.
NEXT SLIDE.
THIS SLIDE SHOWS OUR STUDY
DESIGN CURRENTLY WITH THE
FEMALE COHORT, WE ARE DOING
EIGHT STUDIES IN THE
PREVENTION TREATMENT FOR
CURE AND ACKNOWLEDGE THE
PARTNER PROTECTION PACKAGE
FOR HIV CURE RELATED
INDIVIDUALS AND THIS SHOWS
THE NEED FOR GREATER
ASSESSMENT AS KEY PARTNERS,
AND THEN THE LAST SLIDE WE
ARE CALLING FOR JUSTICE
REFORM.
SO AGAIN, SINCERE POLICY
APOLOGIES FOR ALL THESE
TECHNICAL DIFFICULTIES.
>> WELL, THANK YOU.
SO QUESTIONS AT THE END AND
WE WILL MOVE ON TO THE NEXT
SPEAKER.
GO AHEAD WHEN YOU ARE READY.
>> I WAS ON MUTE.
THANKS SO MUCH TO THE
ORGANIZERS FOR THE INVITE TO
PARTICIPATE IN THIS AMAZING
WORKSHOP.
I AM VERY GREATFUL GRATEFUL
TO BE HERE.
NEXT SLIDE.
I CAN GO PRETTY QUICKLY, THE
SLIDES ARE JUST A QUICK
SUMMARY OF WHAT I WILL TALK
ABOUT THE CURE RELATED
RESEARCH AND CIS AND
TRANSGENDER WOMEN ARE
UNDER-REPRESENTED AND I
THINK THIS IS SORT OF
STATING THE OBVIOUS A LITTLE
BIT BUT DISCLOSURE OF
PARTICIPANT DEMOGRAPHIC
INFORMATION IS REALLY
ESSENTIAL FOR TRACKING WHAT
IS HAPPENING.
ALTHOUGH I AM NOT GOING TO
TALK MUCH ABOUT THIS LAST
POINT BUT PERHAPS ONE THING
TO CONSIDER WHEN THERE IS A
LOT OF SMALL, YOU KNOW --
STUDIES TEND TO BE SMALLER
AT THE MOMENT, PARTICULARLY
THE INTERVENTIONAL TRIALS
AND OPPORTUNITIES TO
AGGREGATE DATA AND SHARE
DATA TO TRY TO GET MORE
ROBUST ANALYSIS OF SUBSETS
OF PARTICIPANTS.
BUT I KNOW THIS CAN BE QUITE
TECHNICALLY AND LOGISTICALLY
CHALLENGING BUT MIGHT BE
SOMETHING TO CONSIDER.
NEXT SLIDE.
AND SO THERE HAS BEEN PAST
RESEARCH DONE SORT OF
LITERATURE REVIEWS FOR THE
PARTICIPATION OF WOMEN IN
HIV-CURE RELATED STUDIES.
JOHNSON AND HEITZEG
PUBLISHED THESE STUDIES
SHOWING ONLY 21 PERCENT OF
THE PARTICIPANTS IN THE
CLINICAL TRIALS WERE WOMEN.
NEXT SLIDE.
SO WHAT WE ARE TRYING TO DO
IS TRY TO TRACK THE
RESEARCH-CURE HAPPENING
USING CHILD REGISTER STRESS
AVAILABLE TO THE PUBLIC,
PARTICULARLY THE U.S.
CLINICAL TRIALS.GOV.
SO WE UPDATE THIS MONTHLY,
IT IS ONLINE AND A LOT OF
INFORMATION TO HANDLE SO IT
IS NOT ALWAYS PRESENTED IN
THE MOST IDEAL WAY BUT ALL
THERE.
THERE IS SO MUCH, WE TRY TO
ADD LINKS TO STUDIES AS WE
FIND OUT ABOUT THEM AS WELL
SO THE TRIALS ARE INCLUDED
IN THE LISTINGS BUT WE
PROPOSE TO PUBLISH WITH THE
UNPRESENTED RESULTS.
NEXT SLIDE.
AND WHAT THIS HAS ALLOWED US
TO DO IS EXTRACT WHEN IT IS
PRESENTED THE INFORMATION ON
THE DEMOGRAPHICS OF THE
STUDY PARTICIPANTS AS THESE
RESULTS FROM THE STUDIES
BECOME AVAILABLE.
SO IN 2022, WE CREATED THIS
BIG XL FILE OF ALL THE STUDY
RESULTS WE HAVE ADDED SINCE
THE BEGINNING OF 2018 TO
MAKE THAT ACCESSIBLE TO
PEOPLE FOLLOWING THE TOPIC.
NEXT SLIDE.
SO THIS IS A SUMMARY OF
WHERE WE ARE WITH THAT WORK
AND THE RECENT UPDATE.
I WON'T GO THROUGH ALL THE
NUMBERS AS YOU CAN SEE THEM
THERE BUT THEY SAY IT IS 142
TRIALS, BUT IT IS 132 IN
ADULT AND 9 WITH PEDIATRIC
AND CHILDREN BUT YOU CAN SEE
IT IS VERY FEW TRANSGENDER
MEN AND WOMEN AND STILL SOME
ISSUES AS YOU CAN SEE THERE
AROUND DEMO GRAPHIC
INFORMATION NOT BEING
RECORDED FOR SEX OR RACE
ETHNICITY.
NEXT SLIDE.
AND THEN I ALSO BROKE THIS
OUT TO GET A BIT MORE DETAIL
ON INTERVENTIONAL AND
OBSERVATIONAL STUDIES SO
INTERVENTIONAL IS
ADMINISTERED TO PEOPLE WHERE
OBSERVATIONAL IS JUST
PRESENTED TO THE STUDY AND
AS YOU CAN SEE INFORMATIONAL
IS MORE STARK WITH
11 PERCENT VERSUS 88 PERCENT
WITH REDUCTIONS IN
TRANSGENDER AND NONBINARY
PEOPLE.
THE FOOTNOTES REFLECT SOME
OF THE ISSUES REFLECTING NO
DATA AND THE WORK THAT JP
SPOKE ABOUT YESTERDAY WHERE
IF PEOPLE DON'T USE THE
TWO-STEP RECORDING OF BIRTH
AND CURRENT GENDER, IT CAN
LEAD THESE KIND OF GAPS
WHERE THE FENDERS --
GENDERS CAN'T BE BROKEN OUT.
NEXT SLIDE.
AND THIS IS THE SAME
BREAKDOWN ON OBSERVATIONAL
STUDIES WITH THE 22 WE
TRACKED TO DATE AND THE
REPRESENTATION IS LIKE
DIFFERENT HERE WITH A
DECREASE IN CIS GENDER WOMEN
AT 20 PERCENT AND THEN NEXT
SLIDE.
THIS IS PEDIATRIC,
ADOLESCENT AND MORE OF THESE
STUDIES ARE HAPPENING
MULTINATIONALLY AS OPPOSED
TO THE AFRICAN STUDY, A
TRIAL STUDY AND THERE IS
ANOTHER TRIAL WITH HIV
INFECTION IN YOUNG PEOPLE
AGE 16-24 WHICH IS INCLUDED
HERE AS WELL.
NEXT SLIDE.
AND THEN THE LOCATION OF THE
STUDY GIVING A SENSE OF HOW
IT IS STILL SKEWED TO THE
U.S. AND NOT SO MUCH IN THE
GEOGRAPHIC LOCATIONS WHERE
THERE IS MORE HIV IN BLACK
WOMEN.
SO I THINK YOU CAN SEE THE
WE DO YO GRAPHIC --
GEOGRAPHIC INFORMATION IS
STILL SKEWED, CIS GENDER
TRANSGENDER WOMEN ARE OFTEN
UNDER-REPRESENTED IN
RESEARCH PARTICULARLY
INTERVENTIONAL TRIALS,
GEOGRAPHIC DISTRIBUTION OF
STUDY SITES REMAIN LIMITED
AND SKEWED TO THE U.S., AND
NEXT SLIDE.
THE IMPORTANCE OF THIS WORK
FOR AIDS RESEARCH AND ALSO
THE BILL AND MELINDA GATES
FOUNDATION AND ELIZABETH
BARR AND I WANT TO THANK
RESEARCHERS AND TRIAL
SPONSORS WHO TAKE THE TIME
TO REGISTER THEIR CLINICAL
STUDIES AND ARE DILIGENT
ABOUT REPORTING PARTICIPANT
DEMOGRAPHICS BECAUSE THEY
ARE IMPORTANT.
THANK YOU SO MUCH.
>> THANK YOU.
AND WE ARE GOING TO MOVE TO
OUR LAST TALK WITH TONI.
>> HI EVERYONE, I DON'T HAVE
A SLIDE SHOW BUT I WANTED TO
BE LAST SO THE FIRST THING I
WILL REMIND YOU, THERE IS A
COMMON LINE HERE IN THIS
SESSION AND I THINK SOME OF
THE OTHER SESSIONS AND I
THINK WE CAN SUM IT UP AS
HELL -- HEALTH IS OTHER
PEOPLE.
THAT POINTS TO THE FACT WE
DON'T HAVE DATA AND THE DATA
WE HAVE IS NOT GOOD ENOUGH.
IT IS BAD DATA BECAUSE IT
DOESN'T PROVIDE US WITH THE
DEPTH OF INFORMATION, THE
FULL STRENGTH OF
UNDERSTANDING THAT WE NEED
BUT ALSO IT IS KIND OF A
CHALLENGE BECAUSE WE OFTEN
DON'T KNOW THE QUESTIONS WE
NEED TO ASK.
CURRENTLY I AM WORKING FOR A
COMPANY CALLED BIOS CLINICAL
RESEARCH AND WHAT IS
INTERESTING TO ME IS I WAS
LOOKING AT KARIM'S
PRESENTATION AND THERE WAS
ONE OF MY COWORKERS ON IT
AND I THOUGHT THAT WAS COOL
AS I HAVE HAD SITUATIONS
WITH KARIM IN OTHER AREAS.
AND THE THING IS THIS IS
STILL A SMALL COMMUNITY NO
MATTER HOW MUCH WE TRY TO
FORGET THAT.
THIS CONFERENCE IS AN IDEA
HOW SMALL IT IS, THERE ARE
SO MANY CONNECTIONS BETWEEN
US AND THOSE ARE ALL
INTERSECTIONS.
I AM A TRANSWOMAN WHO IS OF
MIXED RACE WHO HOLDS ON TO
ALL OF HER INDIVIDUAL
CATEGORIES AND LINES.
I AM BISEXUAL, A WIDOW,
GRANDMOTHER, A MOTHER, I AM
ALL OF THESE DIFFERENT
THINGS AND THE KEY TO IT IS
HOW DO YOU SLUICE ME UP
SLICE ME UP WHEN YOU ARE
DOING RESEARCH?
HOW DO WE LOOK INTO THAT?
WE ALREADY KNOW THE LOW
HANGING FRUIT IS GONE.
THIS IS NOT ABOUT THE EASY
RESEARCH, THIS IS ABOUT THE
DIFFICULT RESEARCH AND ABOUT
FINDING A CURE WHICH HAS
ALLUDED US FOR DECADES.
AND WE'RE FINDING OUT IN
SOME OF THIS MORE EVOLVED
RESEARCH SOME OF THE REASONS
THIS HAS BEEN ELUSIVE TO US
AND THAT IS THE
PRESUPPOSITIONS AND INHERENT
BIASES WITH OUR OWN SYSTEMS
ARE LIMITING US.
THIS CONFERENCE IS TRYING TO
BREAK DOWN SOME OF THOSE, TO
USE THE DATA TO SHOW THAT.
THE CATCH IS THAT, A COMMON
REFRAIN FROM MANY OF THE
PRESENTATIONS I HAVE HEARD
THE LAST FEW DAYS, WE DON'T
HAVE GOOD DEMOGRAPHICS SO I
WILL DRIVE HOME HOW TRUE
THAT IS.
EVERY SLIDE I HAVE SEEN THAT
HAS US IN IT ARE TRANSWOMEN,
TRANSMEN AND NONBINARY.
THERE ARE THOUSANDS OF
BINARY ENTITIES.
IN THE AREA THAT I WORK,
THERE ARE ONLY SEVEN THAT
ARE COMMON.
IN AN AREA IN A DIFFERENT
PART OF THE UNITED STATES,
THERE MIGHT BE ONLY FOUR.
IN AN AREA IN BRAZIL, THERE
MIGHT BE 12.
IT ALL DEPENDS, BUT IF WE
CONTINUE TO ONLY USE THESE
THREE CATEGORIES, WHAT WE'RE
GOING TO END UP WITH IS THE
SAME CHALLENGE FOR JUST THAT
SMALL PORTION OF NONBINARY
INDIVIDUALS THAT WE DEAL
WITH WHEN WE TALK ABOUT THE
TRANSAND CIS GENDER
ENVIRONMENT IT IS.
THAT WON'T WORK AND WHAT WE
WANT TO REPORT.
WHEN ASKED TO SUBMIT OUR
FINDINGS, WE'RE ASKED TO
SUBMIT THEM IN A FORMAT
WHERE THE CATEGORIES ARE
OFTEN MORE NARROW THAN THE
STUFF WE USE IN COLLECTING
THE DATA.
THAT IS WHY WE NEED TO MAKE
SURE WHAT WE REPORT IS FULLY
DEM O NSTRATIVE TO THE
INFORMATION WE HAVE
COLLECTED.
WHAT IS INTERESTING IS WE
DON'T MENTION THINGS LIKE
ZERO AND WHEN WE ARE DOING A
LARGER STUDY, YOU CAN
INCLUDE ZERO IF THERE IS
ZERO IN THERE FOR ALL THE
DIFFERENT DEMOGRAPHIC
STRUCTURES WE USE, WE KNOW
WE'RE REPORTING ABOUT A
PARTICULAR THING.
AND THAT MATTERS BECAUSE
THAT WAY WE CAN SEE WHERE
OUR GAPS ARE AND A LOT OF
WHAT WE'RE DEALING WITH IS
TRYING TO IDENTIFY THE AREAS
WE WEREN'T SUCCESSFUL IN
BECAUSE IN A LOT OF CASES
THE POPULATIONS WE'RE
ATTEMPTING TO ADDRESS,
WOMEN, TRANSINDIVIDUALS,
PERSONS OF COLOR, VARIANCES
IN SEX DEVELOPMENT, ALL OF
THESE DIFFERENT ELEMENTS,
ONE OF THE THINGS WE NEED TO
UNDERSTAND IS HOW DO YOU
SURVEIL A POPULATION THAT IS
IN HIDING?
IN THE SOUTHERN UNITED
STATES RIGHT NOW, THERE'S A
TREMENDOUS AMOUNT OF FEAR
AND TERROR THAT IS ABOVE AND
BEYOND WHAT WE WOULD
NORMALLY SEE BECAUSE OF A
GENERALIZED HOSTILITY THAT
IS BEING ENGAGED.
THIS IS NOT THE ONLY COUNTRY
DEALING WITH THAT.
ONE OF THE ELEMENTS THAT IS
IMPORTANT TO THAT IS IF YOU
CAN'T REACH THEM, YOU CAN'T
TALK TO THEM AND IF YOU
CAN'T TALK TO THEM YOU CAN'T
MAKE IT ABOUT THEM AND IF
YOU CAN'T MAKE IT ABOUT
THEM, YOU WILL NEVER GET
THEM INVOLVED AND THE CORE
ELEMENT OFTEN USED TO SPEAK
TO THIS IS NOTHING ABOUT US
WITHOUT US.
THE PROBLEM IS YOU CAN'T GET
TO THEM TO START GETTING
SOMETHING ABOUT THEM UNLESS
YOU KNOW WHO AND WHERE THEY
ARE.
ONE OF THE POINTS RAISED UP
EARLIER IS YOU HAVE TO
INCORPORATE SOCIAL AND
BEHAVIORAL SYSTEMS AND
UNDERSTANDING OF THE SCIENCE
AROUND THOSE ELEMENTS.
SHE WAS POINTING OUT HOW
IMPORTANT IT WAS FOR ATIS.
I WILL TELL YOU IT IS
IMPORTANT FOR STUDY DESIGN
AND TO BE ABLE TO REACH
PEOPLE.
YOU CAN'T REACH PEOPLE
UNLESS YOU REACH THEM WHERE
THEY LIVE AND UNDERSTAND
THEIR DEMOGRAPHICS AND THAT
MEANS YOU WILL NEVER BE ABLE
TO IDENTIFY THOSE.
IN CASES YOU WILL NEVER BE
ABLE TO IDENTIFY THE
ENVIRONMENTS WHERE THEY
EXIST.
ONE OF THE REASONS WHY
RESEARCH HAS BEEN SO
SUCCESSFUL IN GAINING OUR
TEAM IS WOMEN.
NOT ENTIRELY WOMEN, I DON'T
WANT ANYONE TO FEEL LIKE HE
IS BEING LEFT OUT BUT THAT
IS ONE OF OUR BENEFITS,
TRADITIONALLY WE ARE WOMEN
OF COLOR AND THAT MEANS WE
ARE ABLE TO IDENTIFY THINGS
FROM OUR OWN PERSONAL
EXPERIENCE WHEN LOOKING AT A
PERSONAL STUDY THAT ALLOW US
TO CONVERT AND CHANGE STUDY
METRICS INTO THE REALITY OF
LIFE BECAUSE THERE IS A
DIVISION THERE, TWO THOSE
TWO THINGS.
THAT MEANS ALSO THAT IF YOU
ARE GOING TO REACH SOMEBODY,
YOU HAVE TO REACH THEM IN A
MANNER THAT BENEFITS THEM.
OFTENTIMES WE ARE TALKING TO
COMMUNITIES WHERE THERE IS
ARE A DEEP LEVEL OF MEDICAL
MISTRUST SUCH AS OH, WELL,
WOMEN GET HYSTERICAL AND
THAT IS THE CAUSE OF YOUR
PROBLEM.
OR TRANSWOMEN IN THE PROCESS
OF CHANGING, HOW CAN WE
STUDY THEM BEFORE AND DURING
AND AFTER THE CHANGE WHEN
THEY ARE ON HORMONES BECAUSE
THAT IS A STUDY WE DON'T
HAVE ENOUGH DATA ON THE
DIFFERENCES OF.
AND WE ALL KNOW THERE IS A
DIFFERENCE IN A TRANSWOMAN,
BETWEEN A CIS MAN AND CIS
WOMAN TO A TRANSWOMAN BEFORE
ANY CHANGES HAVE BEEN TAKEN
ON BY THAT WOMAN.
WE DON'T KNOW IF THERE IS A
DIFFERENCE TWO THOSE FOUR
GROUPINGS IN NONBINARY
PEOPLE.
WE DON'T HAVE ENOUGH DATA
AND WILL NOT BE ABLE TO PICK
THE RIGHT QUESTIONS TO ASK.
NOW, IF YOU ARE TRYING TO
REACH COMMUNITY AND TRYING
TO BREAK INTO A COMMUNITY,
THE THING THAT IS MOST
IMPORTANT TO UNDERSTAND IS
THAT YOU ARE GOING TO HAVE
RISKS WHEN IT COMES TO
DEALING WITH THAT COMMUNITY
IF IN ANY WAY, SHAPE OR FORM
THE LARGER, THE CULTURAL
ETHOS THAT SURROUNDS THAT
COMMUNITY IS PUSHING THEM
DOWN.
THAT MEANS YOU HAVE TO TAKE
RISKS NO MATTER WHAT ELSE
MAY GO ON AND UNFORTUNATELY
THAT IS A HUGE CHALLENGE
NONE OF US WANT TO DO
BECAUSE WE DON'T HAVE TIME
TO DEAL WITH SOCIAL POLITICS
AND BEHAVIORAL CHALLENGES.
WE'RE TRYING TO GET SOME
FACTS AND SOME DATA BUT WE
CAN'T GET THOSE DATA UNLESS
WE TAKE THOSE RISKS.
THAT MEANS WE HAVE TO MAKE
SURE OUR SYSTEMS ARE MORE
HARDENED WHEN WE TALK ABOUT
DATA COLLECTION AND STORAGE.
THAT MEANS WE HAVE TO BE
ABLE TO COLLECT A GREATER
LEVEL OF DATA THAT IS
IMPORTANT TO THEM, NOT TO US
BUT TO THEM.
IT MEANS THAT IN THE CASE OF
SOMEBODY SUCH AS A
TRANSCOMMUNITY, THERE IS A
DEARTH OF PEOPLE WHO ARE
WILLING AND ABLE AND THEN
HAVE THE KNOWLEDGE NECESSARY
TO PROVIDE THE PARTICULAR
FORMS OF CARE WHICH IS MORE
THAN WE'RE GOING TO GIVE YOU
ESTROGEN OR TESTOSTERONE.
THERE IS A HUGE DEARTH OF
ABILITY TO PROVIDE
DIAGNOSTIC MATERIAL, CORE
STANDARDS FOR MEDICAL
STRUCTURE BECAUSE WE DON'T
UNDERSTAND THE BASE MEDICINE
OF THIS PARTICULAR
POPULATION YET TRYING TO
CURE THE DISEASE IT REQUIRES
US TO.
SO IF YOU AROUND PROVIDING
THOSE SERVICES, IF YOU
AREN'T FINDING THE
CONNECTIONS WITHIN YOUR
LOCAL COMMUNITY TO BE ABLE
TO GIVE THEM A CHANCE TO
MOVE FORWARD IN THEIR
INDIVIDUAL GOALS, IF YOU ARE
NOT MAKING THIS RESEARCH
SOMETHING THAT BENEFITS
THEM, YOU ARE NOT GOING TO
SUCCEED.
AND I JUST GOT MY FLASH SO I
AM GOING TO GO AHEAD AND
STOP HERE AND SAY --
[LAUGHTER]
-- EVERYBODY THANK YOU FOR
YOUR TIME AND ENERGY AND FOR
INVITING ME AND THE REST OF
THE PANELISTS.
I AM HONORED TO BE HERE AND
INVITED.
THANK YOU VERY MUCH.
>> THANK YOU SO MUCH, TONI,
THANKS FOR THAT.
>> THANK YOU LIZ AND TO ALL
THE PANELISTS.
WE HAVE SOME TIME FOR
DISCUSSION SO I WILL INVITE
EILEEN AND PHILISTER AND
RICHARD, IF YOU CAN COME
BACK ON CAMERA, WE PUT A
COUPLE OF QUESTIONS IN THE
CHAT SO YOU CAN SEE THEM AND
I WILL ASK THEM TO YOU
OUTLOUD.
SO FIRST, WE RECEIVED A
QUESTION ARE THERE PLANS TO
DO POLYPHENOME IN WOMEN OR
T-1 IN WOMEN OVER MALES, CAN
YOU SPEAK TO THAT?
>> YES, THAT IS A GOOD
QUESTION AND IN OUR STUDY WE
ACTUALLY TRIED TO DO THAT.
IT IS THE LARGEST GENOME
STUDY OF PEOPLE LIVING WITH
HIV SPECIFICALLY LOOKING AT
FEATURES TO CONTROL SET
POINT VIRAL LOADS.
ALTHOUGH I MENTIONED WOMEN
ARE MORE LIKELY TO BE
CONTROLLED AND 17 PERCENT OF
CONTROLLERS CONCLUDED AS WAS
SO ELOQUENTLY DISCUSSED IN
OUR LAST TALK, WE DO NOT
KNOW AND FROM THE ANALYSIS
WE JUST DID OF THIS TYPE, WE
DON'T HAVE THE ADEQUATE DATA
THAT WERE SPECIFIC TO MALES
AND FEMALES WITH CONTROL.
>> THANKS SO MUCH, EILEEN.
KARINE, I WILL ASK YOU A
QUESTION AND WE CAN SEE YOU
SO HOPEFULLY YOUR INTERNET
WILL HOLD STEADY.
CAN YOU TALK TO ONGOING WORK
TO PREPARE PARTICIPATION IN
ATI IN LONG-TERM STUDIES,
INCLUDING INCLUSION OF DATA
THAT MAY NOT BE VERIFIED AND
REGULAR POLICY AND OTHER
STRUCTURAL ISSUES?
>> THANK YOU AGAIN AND
APOLOGIES FOR MY TECHNICAL
ISSUES TODAY.
SO THERE ARE A FEW STUDIES
GOING ON TODAY AS PART OF
ATI TRIALS AND PROJECTS.
A LOT OF THIS WORK REMAINS
UNFUNDED AND VOLUNTEER
EFFORTS.
FOR EXAMPLE, THE DETECTION
GROUP WAS --
[INDISCERNIBLE]
SO WE NEED A LOT MORE
EVIDENCE AROUND
EXCLUSION/INCLUSION CRITERIA
AND HOW TO SUPPORT PEOPLE TO
PARTICIPATE IN TRIALS
INCLUDING SUPPORT TEAMS.
THERE WILL BE A NEW TI
CONSENSUS MEETING IN MAY
WHERE WE WILL BE EXPLORING
THESE ISSUES AS WELL BUT WE
NEED A LOT MORE RESEARCH TO
INFORM THESE TOPICS.
THANK YOU.
>> THANK YOU AND A QUESTION
FOR YOU, RICHARD.
SO YOUR REGISTRY SAYS 2014.
HAVE YOU SEEN ANY CHANGES OR
PROGRESS IN REPORTING
BESIDES THE GROWTH IN THE
NUMBER OF STUDIES TO REPORT?
>> YOU Y O U ARE STILL
MUTED.
>> SORRY, I HAVE BEEN SO
WORRIED ABOUT ACCIDENTAL
LISTENING.
SO THERE HAS BEEN SOME
IMPROVEMENT IN CONSISTENCY
OF THE STUDY OF DEMOGRAPHICS
BUT IT HAS BEEN KIND OF
SLOW.
I THINK THERE IS STILL ROOM
FOR IMPROVEMENT.
SOME OF THE ISSUES TONI WAS
MENTIONING I THINK AFFECTS
HOW CATEGORIES ARE REPORTED
FOR EXAMPLE, CLINICAL TRIALS
DOES HAVE AN OPTION FOR
PEOPLE TO POST THE RESULTS
THERE BUT SOMETIMES IT JUST
SEEMS LIKE THE DEMOGRAPHIC
CATEGORIES AREN'T REALLY
APPROPRIATE SO I THINK THERE
IS STILL ROOM FOR
IMPROVEMENT THERE.
THE GENERAL TREND JUST THAT
WE HAVE NOTICED RECENTLY, IT
DOES SEEM FOR UPPER AGE
LIMITS FOR THE CURE-RELATED
STUDIES BUT BEYOND THAT, I
THINK THE BARRIERS TO
PARTICIPATION STILL EXIST
SIMILAR TO TREATMENT STUDIES
AROUND THINGS LIKE
CONTRACEPTIVES REQUIREMENTS
AND THOSE KIND OF THINGS.
>> THANKS, RICHARD.
AND PHILISTER, CAN YOU SHARE
MORE ABOUT THE IMMEDIATE
THINGS YOU ARE WORKING ON
RIGHT NOW THAT CAN BE
ADDRESSED TODAY AND HAVE YOU
SEEN ANY PROGRESS IN AND
THAT IS ALSO IN THE CHAT.
>> OKAY, THANK YOU SO MUCH
FOR THAT QUESTION.
SO CURRENTLY I AM
COLLABORATING WITH THE IRD
AND WE ARE WORKING ON
TEENAGER FOR VEHICLE FOR
TRANSMISSION AND ABLE TO
ENGAGE WITH A COMMUNITY OF
RESEARCHERS, COMMUNITY
STAKEHOLDERS, COMMUNITY
ADVISORY BOARD ON THE
INITIATIVE WE HAVE DEVELOPED
AND HAVE LEARNED A LOT FROM
IT BECAUSE THE OPTIONS WE
COVER, MOST PEOPLE DO NOT
REALLY UNDERSTAND WHAT IT
MEANS.
AND FROM OUR LEARNINGS, EVEN
IN TRADITION, THEY SHOULD
CHANGE THEIR TERMINOLOGY
SUBSAHARAN AND USE THEIR
INDIGENOUS NAMES.
THE WOMEN TO WANT
PARTICIPATE TO BE ABLE TO
MAKE INFORMED DECISIONS ON
WHETHER TO PARTICIPATE OR
NOT.
AND ALSO WE ARE LOOKING AT
THE PRECEDING MODELS WHICH
GIVE US INPUT ON THE TYPE OF
MEDIA WE NEED WHERE WOMEN
GET INFORMATION AND
INFORMATION PEOPLE USE TO
PROGRESS TO VIDEO AND SOME
JUST HAVING ONE OR MORE
CONDITIONS IDEAL FOR THEM TO
GET THEIR INFORMATION ABOUT
THIS STUDY.
AND SOME OF THIS SEEMS WHAT
IS SUGGESTED, THEY WANT TO
BE PART OF THE COUNTERPARTS
AT THE BEGINNING SO THEY CAN
COOPERATE IN THE INITIAL
PART TO REALLY BE SEEN AS A
PART OF THE RESEARCH
PROCESS.
>> THANKS SO MUCH,
PHILISTER.
RICHARD, I MIGHT PASS THIS
ONE TO YOU AS OUR DATA
EXPERT.
WHERE WOULD A WOMAN GO TO TO
FIND OUT IF THIS IS TAKING
ANTIRETRO VIRAL DRUGS ARE
WOMEN?
>> YOU KNOW, I THINK THERE
ARE POSSIBLY COMMUNITY
PARTNERS LINKED TO THE ACCG
BUT NOT COMPLETELY SURE,
SORRY.
NOT SURE IF ANYONE ELSE MAY
KNOW.
SORRY I CAN'T ANSWER.
>> EILEEN?
>> I CAN JUST SAY FOR ANY
INDIVIDUAL MEDICATION YOU
ARE TAKING, IF YOU GO TO THE
PACKAGE INSERT WHICH IS
GOOGLE-ABLE, IT WILL GIVE
YOU THE ORIGINAL REFERENCE
TO THE DRUGS.
SO IN SOME CASES IF THE DRUG
HAS BEEN AROUND FOR A LONG
TIME, THERE MAY BE FOLLOW UP
STUDIES AND USE IN BROADER
POPULATIONS BUT IN TERMS OF
WHAT LED THE FDA TO SAY IT
IS OKAY TO TAKE THIS, IT
WILL BE INSERTED IN THE FDA
PACKAGE INSERT AND THAT IS A
CASE WHERE THE ACTUAL
INFORMATION COULD BE FOUND.
>> SOUND LIKE A MUCH NEEDED
RESOURCE.
SO OUR LAST QUESTION IN JUST
THE TWO MINUTES WE HAVE
REMAINING IS FOR YOU TONY
AND DO -- TONI, DO YOU SEE
COMMUNITIES OF TRANSWOMEN
THERE IS A STIGMA OR
TRANSWOMEN ARE DISTRUSTFUL?
>> THAT IS AN OUTSTANDING
QUESTION AND GETS TO ONE OF
THE HEARTS OF TRYING TO FIND
THE WAY IN TO A COMMUNITY.
THE KEY ELEMENT THERE IS
WHILE STIGMA IS AN IMPORTANT
ISSUE, IT IS NOT NECESSARILY
ALWAYS OR ONLY
STIGMA-RELATING TO HIV.
MORE IMPORTANTLY, IT IS THE
PERCEPTION WHICH IS OFTEN
VERY ACCURATE THAT THE
MEDICAL SYSTEM ITSELF HAS
TALKED TO TRANSAND GENDER
INDIVIDUALS, FOR EXAMPLE IF
YOU EVER FILLED OUT A FORM
AND YOU ARE A TRANSWOMAN WHO
HAS A BIRTH CERTIFICATE THAT
SAYS YOU WERE BORN FEMALE,
IT SAYS WHAT IS YOUR SEX AND
GENDER IT DOESN'T GIVE YOU
THE CHANCE TO SAY TRANSAND
WOMAN, IT GIVES YOU MALE OR
FEMALE AND IF YOU CLICK
FEMALE, OKAY THAT IS YOUR
REALITY, YOUR FUNCTIONAL
STRUCTURE, THE PROBLEM IS
THAT DOESN'T DO ANYTHING
MEDICALLY FOR US AS
RESEARCHERS AND WE DEPEND ON
THAT PARTICULAR ELEMENT
THERE BUT WHAT IF, FOR
EXAMPLE, YOU ARE IN AN AREA
WHERE YOU WERE BORN IN
CALIFORNIA, HAVE AN X ON
YOUR GENDERMILE -PER-HOURER,
WHERE DO YOU FALL IN BECAUSE
HOW MANY SYSTEMS ALLOW YOU
TO PICK SOMETHING THAT IS
NOT FAIL OR FEMALE?
THAT IS THE REALITY.
AND IN SOME CASES THERE IS A
LEGAL REASON WHY A
TRANSWOMAN MAY NOT BE ABLE
TO CHECK IN WHICH A LOT OF
PEOPLE DON'T UNDERSTAND.
SO THERE IS A MEDICAL
MISTRUST AND THE HISTORY
BEHIND THE MEDICAL MISTRUST
THAT SERIOUSLY IMPACTS AND
LIMITS US, PARTICULARLY IN
THE AREA OF HIV WHERE, IF
YOU GO OUT AND ASK MOST
TRANSWOMEN, THEY WILL SAY
THE CDC CALLS US ALL MEN SO
WHY SHOULD WE HELP THEM.
>> I WANT TO ASK EILEEN,
COULD YOU MAYBE COMMENT ON
THE RESERVOIR STUDY YOU ARE
INVOLVED IN?
BECAUSE IT JUST SEEMS LIKE
THE LEVELS OF TRAUMA
INVOLVED ARE OR HICK.
HORRIFIC.
AND THERE ARE LIKE 22CIS AND
TRANSGENDER WOMEN IN THAT
ONE.
>> YES, THAT WAS TRYING TO
LOOK AT WHETHER WE COULD
IDENTIFY THE SEX ON THE
RESERVOIR DYNAMIC.
IT RAISES ONE OF THE
CHALLENGES THAT I THINK TONI
IS HIGHLIGHTING AND ALSO WE
NEED TO TAKE GREAT CARE WITH
OUR STUDIES THAT WHEN YOU
ENTER A COMMUNITY WHERE THE
EXPERIENCE IS BROAD AND
INVOLVES MULTIPLE BIOLOGICAL
AND ENVIRONMENTAL FACTORS,
YOU CAN'T JUST LOOK AT THE
BIOLOGICAL FACTOR YOU MAY BE
INTERESTED IN OR EXPOSURE
BUT THINK ABOUT THE TRAUMA
WITHIN THE COMMUNITY THAT
IMPACTS OTHER THINGS.
SO WE HAVE INCLUDED A COHORT
IN BRAZIL THAT INCLUDES
TRANSFEMININE INDIVIDUALS
WHO ARE BOTH ON OR OFF
GENDER AFFIRMING HORMONE
THERAPY TO TRY TO SEPARATE
OUT SOME OF THESE QUESTIONS
ON ESTRODIOL OR NOT AND I
THINK WE'RE OUT OF TIME SO I
WILL LEAVE IT THERE.
>> SO I THINK SOME OF THESE
ARE BRIEF UNITED.
>> I WILL ALSO SAY THE ACCG
IS CURRENTLY ENROLLING
INDIVIDUALS ON ESTRODIOL TO
MEET AT THAT DISSATISFACTION
AND THE WORK TO LOOK AT ONE
INDIVIDUAL OVER TIME AND TO
LOOK AT A SEPARATE MENOPAUSE
STUDY THAT CENTERED AROUND
HORMONE THERAPY.
AND I CITE THOSE STUDIES SO
THOSE ARE WHERE WE CAN HONE
IN ON THE VARIABLES AND WORK
WHERE YOU CAN CONSULT WITH
THE COMMUNITY AND HONE IN
WHERE THE DATA IS NEEDED, IT
IS A MUCH MORE COMPREHENSION
SAN FRANCISCO UNDERSTANDING
OF WHAT THE --
COMPREHENSIVE UNDERSTANDING
OF WHAT THE QUESTIONS ARE
YOU ARE ASKING.
>> TONI, ANOTHER ONE FOR
YOU.
SINCE ROMPING CATEGORIES CAN
BE VERY RESTRICTIVE AND
MINIMAL, FOR EXAMPLE, HAVING
ONLY THREE OPTIONS, MALE,
FEMALE OR NONE, HOW DO YOU
RECOMMEND LETTING PEOPLE
KNOW WHO YOU HAVE ENROLLED
IN TERMS EVER GENDER,
DIVERSITY AND VARIATIONS IN
SEX CHARACTERISTICS.
>> I WILL SKIP OVER THE PART
OF YOUR RESEARCH TOOLS THAT
MAY NOT ALLOW YOU TO COLLECT
THAT DATA BUT BEYOND THAT,
YOU COLLECT THAT DATA
YOURSELF AND IF NECESSARY,
DO A SPREADSHEET.
AND THEN NOT ONLY WILL YOU
BE STANDARD REPORTING, BUT
WHEN YOU SUPPLY YOUR DATA TO
THE PARTICULAR ORGANIZATION,
WHATEVER, YOU INCLUDE THE
ACTUAL DATA YOU HAVE
ALONGSIDE THE DATA BEING
REQUIRED FOR REPORTING.
AND IT IS ALSO A GOOD IDEA
TO INCLUDE YOUR CONVERSION
BECAUSE THERE'S STILL A SET
OF CONVERSIONS YOU CAN DO.
I MEAN IT IS ULTIMATELY
PROGRAMMATICALLY DONE IF YOU
CATEGORIZE THEM IN A CERTAIN
WAY.
YOU HAVE YOUR BREAKDOWNS,
THIS IS WHAT WE WERE, THIS
IS WHAT YOU COLLECT AND
THERE IS YOUR DATA.
AND A LOT OF PEOPLE DON'T
DIG INTO IT.
YOUR ACTUAL WHITE PAPER WILL
STILL CONTAIN THE DATA AND
THAT WILL TELL THE FUNDERS
THROUGH THAT PROCESS
PARTICULARLY THROUGH
REPETITION THAT THEY ARE
MISSING SOMETHING AND
ESPECIALLY WHERE THEIR DATA
DOESN'T SHOW AN ABSENCE OR
GAP OR A PROBLEM AND THEIRS
DOES.
THEN THEY WILL START
NARROWING DOWN ON THAT AND
CHANGE THEIR PRACTICES.
>> THANK YOU, ANOTHER ONE
FOR YOU Dr. SCULLY.
IF WOMEN HAVE LOWER VIRAL
SET POINTS AND LIKELY TO
CONTROL THE DISEASE THAN MEN
WHAT IS THE EXPECT OUTCOME
WITH REGARD TO THE DISEASE?
>> GREAT QUESTION.
THIS IS THE YIN AND YAN OF
THE BALANCE OF SUCCESSFUL
RESPONSE AND IF YOU AREN'T
SUCCESSFUL AT CONTROLLING
IT, THERE IS A PAYLOAD ON
THE RESPONSE.
THE THEORY IS THAT BECAUSE
WOMEN HAVE A LOWERED
RESPONSE, THERE MAY BE
CHRONIC DEPRESSION WHEN THE
STIMULUS LEADS TO
INFLAMMATORY RESPONSES LIKE
CARDIOVASCULAR OR BONE
DISEASE BUT THAT IS LARGELY
THEORY.
>> THANK YOU AND I AM JUST
CHECKING IF I HAVE MISSED
ANY QUESTIONS IN THE CHAT.
I DO NOT SEE ANY ADDITIONAL
QUESTIONS.
SO LIZ CORRECT ME IF I AM
MISSING ONE.
>> I THINK YOU COVERED THEM
ALL.
>> OKAY, THEN WE WILL THANK
YOU ALL SO MUCH, THIS WAS
REALLY JUST A TREAT AND
HIGHLY INFORMATIVE.
WE WILL TAKE A SLIGHTLY
EXTENDED BREAK AND SEE YOU
AT 1:40 P.M. EASTERN TIME
FOR OUR NEXT SESSION ON --
[INDISCERNIBLE] THANK YOU.
>> WELCOME BACK.
THANK YOU FOR JOINING US FOR
THIS SESSION ADDRESSING
COMORBIDITY AND MULTI-MORBIDITY
IN THE CONTEXT OF HIV.
I'M DR. ANGELA LEE-WINN, WITH
THE NATIONAL INSTITUTE OF DRUG
ABUSE, NIDA, THRILLED TO BE
JOINED BY DR. MARIELLE GROSS,
MODERATING THIS SESSION.
MULTI-MORBIDITY IS A
CO-OCCURRENCE OF TWO OR MORE
CHRONIC CONDITIONS, IT IS COMMON
ACROSS THE LIFESPAN, ALTHOUGH
CISGENDER RISK FROM GREATER RISK
THAN CISGENDER MEN IN THE
POPULATION.
THIS SEX DIFFERENCE IS
HEIGHTENED AMONG PEOPLE WITH
HIV.
DEVELOPMENT OF INNOVATIVE
HIV-SPECIFIC SEX-TAILORED TOOLS
AND STRATEGIES TO MITIGATE THE
RISK OF DEVELOPMENT AND
PROGRESSION ARE URGENTLY NEEDED.
IN THE ERA OF ART MORBIDITY AND
MORTALITY IS INCREASING DUE TO
CARDIOVASCULAR, KIDNEY,
N EUROCOGNITIVE DISEASES AM
WE'RE THRILLED TO BE JOINED BY
SCIENTISTS AN ACTIVISTS
HIGHLIGHTING KEY ISSUES AMONG
WOMEN WITH HIV.
TODAY'S SPEAKERS ARE SHOWN HERE,
BIOS FOUND IN THE EVENT WEB
PAGE.
NIDA FADUL IN UNIVERSITY OF
NEBRASKA MEDICAL CENTER,
FOCUSING ON HIV DISPARITIES.
JULIE WOMACK IS ASSOCIATE
PROFESSOR AT YALE SCHOOL OF
NURSING, RESEARCH ON HIV AND
AGING, WITH CONCENTRATION ON
CONDITIONS THAT
DISPROPORTIONATELY AFFECT WOMEN.
AMY JUSTICE IS A PROFESSOR AT
YALE UNIVERSITY, CLINICAL
EPIDEMIOLOGIST, INTERNATIONALLY
RECOGNIZED EXPERT IN AGING WITH
HIV INFECTION.
IN 1996, SHE STARTED THE
VETERANS AGING COHORT STUDY,
ONGOING LONGITUDINAL STUDY OF
MORE THAN 180,000 VETERANS WITH
AND WITHOUT HIV.
LEAH RUBIN IS PROFESSOR OF
NEUROLOGY, PSYCHIATRY,
BEHAVIORAL SCIENCES,
EPIDEMIOLOGY, JOHNS HOPKINS
UNIVERSITY, HER WORK IS
DEDICATED TO IMPROVING COGNITIVE
AND MENTAL HEALTH OF A NUMBER OF
VULNERABLE POPULATIONS INCLUDING
PEOPLE WITH HIV, SERIOUS MENTAL
ILLNESS, TRAUMATIC BRAIN INJURY.
MARTHA CAMERON IS EXECUTIVE
DIRECTOR, INTERNATIONAL
COMMUNITY OF WOMEN LIVING WITH
HIV NORTH AMERICA, INVOLVED IN
POLICY, ADVOCACY, RESEARCH
FORUMS.
KATHLEEN SIKKEMA, COLUMBIA
MAILMAN SCHOOL OF PUBLIC HEALTH,
CONDUCTED COMMUNITY-BASED
INTERVENTION RESEARCH FOCUSED ON
HIV PREVENTION AND MENTAL HEALTH
TREATMENT IN THE UNITED STATES
AND LOW- AND MIDDLE-INCOME
COUNTRIES.
YOU CAN SEND QUESTIONS, WE'LL
ANSWER AS WE'RE ABLE.
YOU CAN E-MAIL QUESTIONS.
THE FIRST PRESENTATION IS FROM
DR. FADUL.
>> THANK YOU FOR HAVING ME.
IT'S MY PLEASURE TO BE HERE
TODAY TO SPEAK TO YOU DID
COVID-19 AND HIV, INTERSECTION
OF THE TWO EPIDEMICS AND
PANDEMICS.
IF WE CAN MOVE TO THE NEXT SLIDE
PLEASE.
WOMEN AND MINORITIZED
POPULATIONS WHO HAVE HIV HAVE
BEEN HIGHLY IMPACTED BY
COVID-19.
WE DIDN'T NEED TO SUSTAIN THE
LESSONS FROM THE COVID-19
PANDEMIC AND SEE HOW WE CAN USE
THESE LESSONS TO ENHANCE HIV
CARE AND BE PREPARED FOR WHEN
THE NEXT PANDEMIC WILL HAPPEN.
WE ALL KNOW I THINK WE NEED TO
GET READY FOR THE NEXT
PANDEMIC, WHEN, NOT IF.
ALL THE IF.
ALL THE LESSONS HAVE BEEN PUT ON
THE SHELF.
WE DON'T EXCEED THE SAME CARE
DISPARITIES IN COVID-19, I THINK
MOST OF THE PEOPLE HERE IN THIS
AUDIENCE KNOW THAT WHEN IT COMES
TO PEOPLE WITH HIV, THERE WERE
MAJOR DISPARITIES IN INCIDENCE
OF COVID-19, IN TREATMENT OF
COVID-19, AND OUTCOMES OF
COVID-19.
AND THIS IMPACTED SPECIFICALLY
PEOPLE WITH HIV FROM RACIAL AND
ETHNIC MINORITIES AS WELL AS
THOSE IMPACTED BY OTHER SOCIAL
DETERMINANTS OF HEALTH.
I'M SHARING AN EXAMPLE OF THAT,
THIS IS NOT COMPREHENSIVE BUT
JUST AN EXAMPLE BY THE N3C COVID
LAB A ACTIVE THAT --
COLLABORATIVE TO SEES OUT WHO IS
AT RISK OF GETTING COVID-19 OF
PEOPLE WITH HIV AND BEING
IMPACTED BY COVID-19.
THEY LOOKED AT THE COHORT AND
FOUND .7% OF THE N3C COHORT WERE
IDENTIFIED AS PEOPLE WITH HIV,
WE'LL TALK ABOUT THAT
IDENTIFICATION A LITTLE LATER.
OUT OF THOSE, 13% TESTED
POSITIVE FOR COVID.
THERE WAS A GOOD PERCENTAGE OF
THOSE PEOPLE IN THE COHORT WHO
TESTED POSITIVE FOR COVID-19.
PEOPLE WITH BOTH COVID AND HIV,
PEOPLE WHO TESTED POSITIVE FOR
COVID WERE MORE LIKELY TO BE
OLDER, MORE LIKELY TO BE MALE,
MORE LIKELY TO BE BLACK.
COMPARED TO THOSE WHO WERE HIV
NEGATIVE.
THIS SPEAKS TO INTERSECTIONALITY
OF SOCIAL DETERMINANTS OF HEALTH
AND STIGMA THAT IMPACTS THIS
POPULATION.
WHEN THEY LOOKED AT WHO IS
LIKELY OUT OF THE HIV COHORT,
LIKELY TO BE IMPACTED BY
COVID-19, AGAIN RACIAL/ETHNIC
MINORITY GROUPS, ESPECIALLY
BLACK, LATINX, INTERESTINGLY
ASIANS WERE ALSO MORE LIKELY TO
HAVE COVID-19, AND THIS IS AFTER
ADJUSTING FOR AGE, SEX,
COMORBIDITY SCORE.
THE LESSON TO BE TAKEN HOME, IF
WE LOOK AT PEOPLE NOT LIVING
WITH PEOPLE AND PEOPLE LIVING
WITH HIV, OR WE LOOK AT PEOPLE
WITHIN THE SAME HIV COHORT,
RACIAL/ETHNIC MINORITY AND
SOCIAL DETERMINANTS OF HEALTH
SEEM TO RISE AS MAIN RISK
FACTORS FOR PEOPLE CONTRACTING
COVID-19.
MORE STUDIES EXAMINE THAT IN
DEPTH CURRENTLY UNDER REVIEW
LOOKING AT INDIVIDUAL SOCIAL
DETERMINANTS OF HEALTH, ONE IS
LED BY JESSICA, ONE LED BY
THERESA, ALSO THOSE WILL COME UP
SOON.
NEXT SLIDE PLEASE.
A LITTLE BIT ABOUT THE N3C
COHORT, A REALLY GOOD COHORT TO
GO BACK TO WHEN WE TRY TO
UNDERSTAND MORE ABOUT COVID-19
AND HOW IT IMPACTS PATIENTS WITH
HIV.
DATA IS USING COMPUTATIONAL
PHENOTYPING TO IDENTIFY, AS WELL
AS PRE-EXPOSURE PROPHYLAXIS.
AND WE DID A SMALL CLINICIAN
VALIDATION, AND WHEN WE LOOKED
AT COMPUTATIONAL PHENOTYPING
ACTUALLY THIS COHORT IS PRETTY
ACCURATE IN PREDICTING PEOPLE
WHO HAVE HIV WITH GOOD
SENSITIVITY, BASICALLY DONE BY
DIAGNOSIS, MEDICATION, AS WELL
AS VIRAL LOAD TESTING.
NEXT SLIDE PLEASE.
SO THEN EARLY ON IN THE PANDEMIC
WE WANTED TO LOOK AT OUR OWN
CLINIC POPULATION AND IDENTIFY
THOSE STRUCTURAL
VULNERABILITIES, AND WE FOUND
THE SAME EXACT FINDINGS IN OUR
POPULATION.
WE FOUND THAT IF WE COMPARE
PEOPLE WHO HAD COVID-19 AND HIV,
TO OVERALL CLINIC POPULATION,
OVER TWICE THE ONES WITH
COVID-19 WERE HISPANIC, THREE
TIMES WERE UNDOCUMENTED
PATIENTS, AND FOUR TIMES WERE
REFUGEE PATIENTS WHO CONTRACTED
COVID-19 AND THESE ARE
POPULATIONS NOT USUALLY PAID
ATTENTION TO.
THIS IS A SPECIFIC UNIQUE THING
ABOUT NEBRASKA, A MAJOR REFUGEE
STATE IN THE COUNTRY, SO WE SEE
A LOT OF REFUGEE PATIENTS AND WE
HAVE A LARGE UNDOCUMENTED
POPULATION.
THOSE PEOPLE TEND TO BE HIGHLY
IMPACTED BY STRUCTURAL
VULNERABLES BECAUSE WE WORK,
THEIR CONDITIONS ARE NOT
CONDUCIVE TO PREVENTION OF
COVID-19 INFECTION.
THE OTHER FINDING WE FOUND IS
OVER 80% OF THOSE WHO HAD
COVID-19 LIVED BELOW THE 300%
POVERTY LIMIT.
NEXT SLIDE PLEASE.
I FEEL LIKE THIS IS A REALLY
IMPORTANT STUDY TO SHARE IN SUCH
A FORUM WHEN TALKING ABOUT
IMPACT OF COVID-19 ON WOMEN.
THIS STUDY WAS DONE OUT OF
CHICAGO, THE TITLE TELLS THE
WHOLE STORY, EVEN IF I'M
UNDETECTABLE I JUST FEEL LIKE I
WILL DIE.
THIS WAS EQUAL IT THATTIVE STUDY
LOOKING AT PSYCHOSOCIAL AND
SOCIOECONOMIC IMPACT OF WOMEN
LIVING WITH HIV, THE IMPACT WAS
HUGE, RANGING FROM DISRUPTION IN
CARE, MEDICATION ADHERENCE,
SOCIOECONOMIC IMPACT, LOSS OF
CHILD CARE, LOSS OF EMPLOYMENT,
MENTAL HEALTH CONCERNS,
ASSOCIATE ISOLATION.
WOMEN WITH HIV FACE SIGNIFICANT
SOCIAL ISOLATION ISSUES AND THE
PANDEMIC JUST AUGMENTED THAT
SIGNIFICANTLY.
LET'S GO TO THE NEXT SLIDE
PLEASE.
TO THINK MORE ABOUT THE
PERCEIVED RISK OF COVID-19 AND
HOW THAT RELATES TO VACCINATION
WE DID A QUALITATIVE STUDY ON
OUR PATIENTS, EXAMINED PERCEIVED
RISK OF COVID-19.
PERCEIVED RISK WAS MODERATE.
THAT I WAS DONE IN 2021, COVID
HAD BEEN THERE OVER A YEAR.
PEOPLE HAD MORE OF A MODERATE
PERCEIVED RISK OF COVID-19, AND
WE FOUND 85% OF OUR PATIENTS
RECEIVED AT LEAST ONE DOSE OF
COVID-19.
AND ABOUT A THIRD REPORTED
HISTORY OF COVID-19 ABOUT THAT
TIME.
PATIENTS 19-30 HAD A LOWER
PERCEIVED RISK OF COVID-19, ALSO
HAD HIGHER INCIDENCE OF
CONTRACTING COVID-19.
NOW, INTERESTINGLY WE ALSO FOUND
THAT THE FEAR OF COVID OR
PERCEIVED RISK OF COVID WANED
OVER TIME, SO THE MORE PEOPLE
HAD LIVED WITH THE PANDEMIC THEY
HAD THE LOWER RISK, LOWER
PERCEIVED RISK OF CONTRACTING
COVID-19.
WE ASKED PARTICIPANTS ABOUT
THEIR PERCEPTIONS ABOUT THE
COVID-19 VACCINATION, THOSE WHO
DID NOT RECEIVE VACCINATION, DID
NOT RECEIVE A BOOSTER DOSE,
REVEALED THEY ARE LACK OF TRUST
IN THE VACCINE WAS THE MAIN
HESITANCY, INFLUENCED BY MEDIA,
WHAT THEY WERE HEARING FROM
PEERS AND NETWORKS AT THE TIME,
A LOT OF TALK WHETHER VACCINES
WERE STUDY ENOUGH, AND WE FOUND
INTERESTING CODES THAT MATCHED
WITH WHAT THE MEDIA ET.
LET'S GO TO THE NEXT SLIDE
PLEASE.
MOST OF YOU ARE AWARE DURING
COVID-19 WE HAD TO SWITCH VERY
QUICKLY TO TELEHEALTH.
WE USED A MULTI-FACETED
IMPLEMENTATION STRATEGY TO
IMPLEMENT HEALTH IN OUR CLINIC
TO ENSURE THAT FIRST WE STUDIED
THIS, HOW IT'S DONE, SO WE USE
IT IN THE FUTURE IN A SYSTEMATIC
WAY THAT DOES NOT IMPACT OUR
PATIENTS.
YEAR 1, BETWEEN APRIL AND
OCTOBER, 2020, 30% OF VISITS
THROUGH TELEHEALTH, VIRAL
EXPRESSION RATE REMIND HIGH, 97%
OF TELEHEALTH PATIENTS WERE
VIRALLY SUPPRESSED COMPARED TO
91% FOR INPATIENT VISITS, DID
NOT AFFECT RETENTION AND CARE,
THEY WERE SHOWING UP FOR
TELEHEALTH VISITS.
WE OFFERED MODALITY, SOME WANTED
PHONE, SOME WANTED VIDEO VISIT,
WE ACCOMMODATED ALL.
IN YEAR 2 WE FOUND DISPARITIES
THAT IMPACTED TELEHEALTH
UTILIZATION.
PEOPLE WHO USED IT HAD HIGHER
FEDERAL POVERTY LEVEL, MORE
LIKELY TO HAVE UNDETECTABLE
VIRAL LOAD.
WE DID NOT FIND ASSOCIATION WHEN
RACE, GENDER, OR YEAR OF HIV
DIAGNOSIS, WHEN WE LOOKED
FURTHER AT THE DATA WE FOUND
NONE OF OUR PATIENTS WERE
TRANSGENDER USED TELEHEALTH,
THAT SPEAKS TO ISSUES AROUND
CONFIDENTIALITY, STIGMA, WHETHER
THERE'S FEAR OF BREAKING
CONFIDENTIALITY IN THIS
POPULATION.
NEXT SLIDE PLEASE.
SO IN AN ATTEMPT TO ADDRESS SOME
OF THESE DISPARITIES WE NOW HAVE
AN IMPLEMENTATION STUDY GOING ON
THAT'S LOOKING AT IMPLEMENTATION
OF TELEHEALTH, EXACT SAME
POPULATION NOT USED BEFORE SO
PEOPLE WITH CHALLENGES, DETECT
AL VIRAL LOADS, 47 OUT OF 50
ENROLLED, ATTENDING MOST 10 OUT
OF 12 COUNSELING SESSIONS.
ANYTHING FROM EDUCATION OF HIV,
SUSTENANCE, SOCIAL SUPPORT,
HEALTHY LIFESTYLES, ABOUT 520
INTERVENTION EXPOSURES.
NEXT SLIDE PLEASE.
I WANTED TO SPEAK ABOUT ANOTHER
IMPLEMENTATION STUDY THAT TRIED
TO ADDRESS DISPARITIES WE'RE
SEEING IN OUR PATIENT
POPULATIONS.
WHEN YOU LOOK AT PEOPLE USING
INJECTABLE, AT LEAST EVERY MONTH
OR EVERY TWO MONTHS TO RECEIVE
INJECTIONS.
THREE PHASES, CURRENTLY
PRE-IMPLEMENTATION ASSESSING
ACCESSIBILITY AND FEASIBILITY
DELIVERING AT REMOTE SITES
CLOSER TO WHERE THEY LIVE.
WE'RE USING THE FRAMEWORKS IN
TERMS OF IMPLEMENTATION AND
EVALUATION FRAMEWORKS.
DURING THE IMPLEMENTATION PERIOD
WE'LL USE TELEHEALTH, TEXT
MESSAGING, CREATING A LEARNING
COLLABORATIVE IN RURAL SITES,
MORE FAMILIAR WITH TAKING
PATIENTS OF HIV, AND WILL
CONTINUE TO ENSURE
SUSTAINABILITY OF OUR
INTERVENTION.
NEXT SLIDE PLEASE.
KEY MESSAGE TO TAKE HOME,
COVID-19 AMPLIFIED THE
DISPARITIES EXPERIENCED WITH
HIV, BUT ALSO GAVE US A LOT OF
OPPORTUNITIES TO LEARN LESSONS
ABOUT HOW TO ENSURE ACCESS IN
THESE DIFFICULT CIRCUMSTANCES,
AND IMPLEMENTATION SCIENCE CAN
ADDRESS DISPARITIES WHETHER IT
COMES TO COVID-19 OR TREATMENT
ACCESS OR HIV TREATMENT ACCESS
OR WHETHER IT COMES TO
ADDRESSING HEALTH DISPARITIES.
WE HAVE A LOT OF CENTRALIZED
DATA SOURCES, N3C AND OTHER DATA
SOURCES FROM COVID-19 THAT COULD
BE LEVERAGED TO UNDERSTAND
DISPARITIES BETTER AND HOW TO
ADDRESS THEM.
I WANTED TO EMPHASIZE THE ROLE
OF TRAUMA-INFORMED APPROACHES,
ESPECIALLY WOMEN LIVING WITH
HIV.
WE REALLY NEED SOME STRATEGIES
TO ACCELERATE IMPLEMENTATION OF
NEW MODALITIES OF TREATMENT
BEFORE WE ACTUALLY GET THEM TO
FDA APPROVAL BECAUSE WE
EXPERIENCE WITH INJECTABLES
AFTER WE START IMPLEMENTATION IN
THE REAL WORLD WE FACE ALL THE
CHALLENGES, NOW WE TRY TO
ADDRESS SOME CHALLENGES BUT I
REALLY FEEL STRONGLY
IMPLEMENTATION SCIENCE SHOULD
START EARLY ON DURING THE FIRST
STAGES OF STUDY OF THESE
TREATMENTS IN ORDER TO MAKE THEM
EFFECTIVE ONCE THEY GET FDA
APPROVAL.
LASTLY I WANT TO THANK OUR STAFF
AND OUR PARTNERS AND COMMUNITY
PARTNERS FOR ALL THE ROLE THEY
PLAY IN MAKING THIS EFFORT
SUCCESSFUL AND FOREVER GRATEFUL
FOR THE EFFORTS.
THANK YOU SO MUCH AND OVER TO
YOU.
>> THANK YOU SO MUCH, DR. FADUL.
REMINDER TO AUDIENCE, SEND YOUR
QUESTIONS OR COMMENTS VIA THE
"LIVE FEEDBACK" OPTION BELOW THE
VIDEOCAST.
WE'LL NOW HEAR FROM JULIE
WOMACK.
>> GOOD MORNING.
THANK YOU FOR JOINING US FOR
THIS TALK.
I'M GOING TO BE SPEAKING ABOUT
HIV AND GERIATRIC SYNDROME,
FALLS AND FRAGILITY FRACTURES.
THERE ARE FOUR POINTS I'M HOPING
TO MAKE IN THIS TALK.
FIRST IS THAT AS THEY AGE,
PERSONS LIVING WITH HIV ARE AT
GREATER RISK FOR FALLS AND
FRAGILITY FRACTURES THAN THOSE
AGING WITHOUT HIV IN MANY BUT
NOT ALL STUDIES.
SECOND, THE COUNT IS PREDICTOR
OF FALLS AND FRAGILITY
FRACTURES, WE NEED MORE RESEARCH
DETERMINING WHEN TO ADD ANOTHER
MEDICATION.
RISK FACTORS ARE SIMILAR BETWEEN
MEN AND WOMEN BUT RATES OF BOTH
ARE HIGHER IN WOMEN THAN MEN.
AMONG PEOPLE AGING WITH HIV WE
LIKELY UNDERESTIMATE IMPORTANCE
OF SERIOUS FALSE, FRAGILITY
FRACTURES, OTHER GERIATRIC
SYNDROMES, MOST COMMONLY AMONG
THOSE 80 YEARS OF AGE OR OLDER.
MORE OF THE POPULATION LIVING
WITH HIV JOINS THIS CATEGORY,
UNTIL THEN WE WON'T HAVE AN IDEA
OF FULL IMPACT.
I THINK IT'S IMPORTANT TO
RECOGNIZE EVEN AT RELATIVELY
YOUNG AGES, GERIATRIC SYNDROMES
ARE BEGINNING TO BE A PROBLEM
FOR PEOPLE AGING WITH HIV, AS
SHOWN IN A POPULATION WHERE THE
MEAN AGE WAS 52 YEARS AND 85%
WERE MEN, 30% OF THE SAMPLE
POPULATION REPORTEDLY
EXPERIENCING A PAUL IN THE
PAST -- FALL IN THE PAST YEAR,
61% REPEAT, FEMALES ASSOCIATED
WITH INCREASED RISK IN THIS
STUDY.
ACCORDING TO PINETTI, THE
SYNDROMES OCCUR IN MULTIPLE
ORGAN SYSTEMS RENDERING AN OLDER
PERSON VULNERABLE.
FROM THE WORK WE'VE DONE, WE
INCLUDE FALLS, FRAGILITY
FRACTURES, PHYSIOLOGIC FRAILTY,
COGNITIVE IMPAIRMENT, FUNCTIONAL
DISABILITY IN THIS DEFINITION.
OUR FOCUS TODAY IS GOING TO BE
ON TWO GERIATRIC SYNDROMES,
FALLS AND FRAGILITY FRACTURES.
GERIATRIC SYNDROMES ARE A FOCUS
OF CARE, ASSOCIATED WITH
DEPENDENCE, DECREASED QUALITY OF
LIFE, AND DEATH.
RESEARCH SUGGESTS THAT PERSONS
LIVING WITH HIV MAY BE AT
GREATER RISK FOR THESE OUTCOMES
RELATIVE TO THOSE LIVING WITHOUT
HIV, AND WOMEN APPEAR TO BE AT
GREATER RISK FOR GERIATRIC
SYNDROMES THAN MEN.
WE'VE BUILT A PREDICTIVE MODEL
FOR SERIOUS FALLS AMONG PERSONS
AGING WITH HIV.
ON THE LEFT SIDE OF THE SLIDE WE
HAVE BASIC DEMOGRAPHIC
INFORMATION ABOUT OUR SAMPLES,
INCLUDING ONLY INDIVIDUALS
LIVING WITH HIV WHO WERE 50+
YEARS OF AGE, THE MAJORITY WERE
BETWEEN 50 AND 54, AND 90% LESS
THAN 65 YEARS OF AGE.
2% WOMEN, 60% PEOPLE OF COLOR.
ON THE RIGHT PREDICTIVE MODEL,
RISK FACTORS ON THE LEFT, AND
ODDS RATIOS WITH 95% CONFIDENCE
INTERVALS ARE NOTED.
DISCRIMINATION OR AREA UNDER THE
CURVE WAS GOOD AT 0.73.
I SHOULD NOTE INCLUSION OF
ANTIRETROVIRAL THERAPY AS DRUG
CLASSES OR INDIVIDUAL
MEDICATIONS DID NOT IMPROVE
MODELS, WE DID NOT INCLUDE THEM
FOR FINAL MODELS.
MUCH OF THE MODEL IS CONSISTENT
WITH WHAT WE FIND TO BE KEY
PREDICTORS OF FALLS IN THE
GENERAL POPULATION, INCLUDING
HISTORY OF FALL WITHIN THE PAST
YEAR, PHYSICAL HEALTH CONDITIONS
OR MULTI-MORBIDITY, CHRONIC
MEDICATION, SPECIFIC HIGH RISK
MEDICATIONS NOTED HERE.
ANTI-CONVULSANTS,
BENZODIAZEPINES, PRESCRIPTION
OPIOIDS, SSRIs.
FACTORS PROTECTIVE AGAINST FALLS
ARE FOUND IN LITERATURE FROM THE
GENERAL POPULATION, SO BEING A
PERSON OF COLOR, HAVING A BODY
MASS INDEX GREATER THAN OR EQUAL
TO 25.
BUT THERE ARE ALSO IMPORTANT
DIFFERENCES BETWEEN RISK FACTORS
IDENTIFIED AMONG PERSONS LIVING
WITH HIV, AND WHAT HAS BEEN
IDENTIFIED IN THE GENERAL
POPULATION.
AMONG PERSONS LIVING WITH HIV,
PAIN SCORE WAS IMPORTANT.
EVERY ONE POINT INCREASE WAS
ASSOCIATED WITH ADDITIONAL 3%
INCREASED ODDS OF FALL.
HAVING ALCOHOL USE DISORDER
INCREASING LEVELS WERE
ASSOCIATED WITH INCREASED ODDS
OF SERIOUS FALL.
CONTRIBUTION OF PHYSICAL
COMORBIDITY TO FALLS IS WELL
ESTABLISHED IN OLDER ADULTS, BUT
CONTRIBUTION OF MENTAL HEALTH
COMORBIDITIES BEYOND DEPRESSION
HAVE NOT RECEIVED THE SAME LEVEL
OF ATTENTION AND YET BOTH ARE
IMPORTANT PREDICTORS OF FALLS
AMONG PERSONS AGING WITH HIV.
AN INCREASE IN THE MEASURE OF
PHYSIOLOGIC FAIL WAS ASSOCIATED
WITH INCREASED ODDS OF SERIOUS
FALL.
FEMALE SEX WAS NOT SIGNIFICANTLY
ASSOCIATED WITH SERIOUS FALLS.
WHY NOT?
IT MAY BE A QUESTION OF SAMPLE
SIZE.
HOWEVER, EARLIER WORK ALSO FOUND
THAT AMONG INDIVIDUALS LIVING
WITH HIV FEMALE SEX WAS NOT
ASSOCIATED WITH INCREASED RISK
OF A FALL.
SO THIS REQUIRES FURTHER
EXPLORATION.
IN THE CASE OF SERIOUS FALLS
ALREADY SUBSTANTIAL SIMILARITIES
BETWEEN WHAT PREDICTS FALLS IN
THOSE WITH HIV AND GENERAL
POPULATION.
WE CAN BASE A LOT OF PREVENTIVE
EFFORTS ON INFORMATION FROM THE
GENERAL POPULATION BUT THERE ARE
ADDITIONAL CONDITIONS OR
CONCERNS WE NEED TO PAY
ATTENTION TO SUCH AS PAIN,
ALCOHOL USE, MENTAL HEALTH
DIAGNOSES, THAT ARE NOT A FOCUS
OF FALL RISK ASSESSMENT AND
INTERVENTIONS AMONG OLDER ADULTS
IN THE GENERAL POPULATION.
TURNING NOW TO FRAGILITY
FRACTURES, I'M GOING TO WORK
REPRESENTING PRELIMINARY DATA
FROM ONGOING R01, THE PURPOSE OF
THE PROJECT IS A ONE-YEAR
PREDICTIVE MODEL FOR FRAGILITY
FRACTURES IN PEOPLE WITH HIV,
FAIRLY WELL ESTABLISHED EXISTING
FRACTURE RISK PREDICTION MODELS
UNDERPREDICT RISK AMONG PEOPLE
AGING WITH HIV.
WE'RE WORKING TO DEVELOP A MODEL
THAT WORKS BETTER FOR THIS
POPULATION.
A FEW NOTES, WE USED DATA FROM
2011-2020, WE DIVIDED FOLLOW-UP
INTO ONE-YEAR INTERVALS FOR EACH
PARTICIPANT, AS WE WERE
INTERESTED IN PREDICTING RISK OF
FRAGILITY FRACTURE WITHIN A
ONE-YEAR INTERVAL.
WE INCLUDED MEN AND WOMEN
VETERANS WITH HIV 50+ YEARS OF
AGE, 2% OF SAMPLE WAS WOMEN.
WE DEFINED FRAGILITY FRACTURES
AS THOSE FRACTURES MOST COMMONLY
ASSOCIATED WITH OLDER AGE.
SO FOREARM FRACTURE, HIP AND
FEMORAL, VERTEBRAL, UPPER ARM
AND SHOULDER FRACTURES.
THIS IS ONE OF OUR PRELIMINARY
MODELS IN THE LOWER LEFT-HAND
CORNER YOU SEE MODEL
DISCRIMINATION, AREA UNDER THE
CURVE, IT'S VERY GOOD AT 0.77.
YOU CAN SEE VARIABLES LISTED ON
THE LEFT, FOLLOWED BY ODDS
RATIOS, AND LOWER AND UPPER
LIMITS OF THE CONFIDENCE
INTERVALS AND FIGURE OF THESE
RESULTS ON THE RIGHT.
VALUES ARE LOG SCALE TO FIT
EVERYTHING IN ONE IMAGE.
THE VARIABLES INCLUDED IN THE
MODEL ARE AGE, FEMALE SEX, BODY
MASS INDEX, WHICH IS PROTECTIVE,
ALBUMIN , COPD, LIVER DISEASE,
FALL IN THE PAST YEAR WHICH HAS
GREATEST IMPACT, ON
NON-ANTIRETROVIRAL MEDICATION,
FOR EVERY ADDITIONAL MEDICATION
ADDED TO A REGIMEN, RISK OF
FRAGILITY FRACTURE INCREASES BY
5%.
SHOULD ALSO NOTE WE COMPARED
MODEL BY SEX, WORKS EQUALLY WELL
IN WOMEN AND MEN.
IN WOMEN AREA UNDER THE CURVING
0.78, IN MEN 0.77.
KEY REMAINING QUESTION FOR US IS
WHAT IS THE PURPOSE OF THIS
PREDICTIVE MODEL?
WE WANT TO IDENTIFY PEOPLE AT
RISK FOR FRAGILITY FRACTURE.
BUT THEN WHAT?
WHAT DO WE DO ABOUT IT?
A NUMBER OF FRACTURE RISKS
PREDICTION MODELS CAN IDENTIFY
INDIVIDUALS WHO MIGHT BENEFIT
FROM A DEXA SCAN TO EVALUATE
BONE MINERAL DENSITY.
OTHERS USE MODELS TO IDENTIFY
INDIVIDUALS WHO WOULD BENEFIT
FROM INITIATING MEDICATION TO
TREAT OSTEOPOROSIS AND PREVENT
FRAGILITY FRACTURE.
BUT BEFORE WE MOVE DIRECTLY TO
USING THE MODEL TO ADD ANOTHER
MEDICATION, I THINK THERE ARE A
FEW THINGS WE NEED TO THINK
ABOUT.
THE FIRST IS THAT THE MEAN
NUMBER OF NON-ANTIRETROVIRAL
MEDICATIONS IN THIS SAMPLE IS
10.
INDIVIDUALS TOOK TEN CHRONIC
MEDICATIONS IN ADDITION TO
ANTIRETROVIRAL.
AS I MENTIONED EARLIER FOR EVERY
NON-ANTIRETROVIRAL MEDICATION AN
INDIVIDUAL TAKES, THE RISK OF
FRACTURE FOR BOTH INCREASES BY
5%, SOMEONE TAKING 10
MEDICATIONS, THEIR RISK OF
FRAGILITY FRACTURE WITHIN THE
NEXT YEAR INCREASES BY 50%
WITHOUT CONSIDERING ANY OF THE
OTHER RISK FACTORS.
WE NEED TO UNDERSTAND LEVEL OF
FRACTURE RISK, RISK OF FRAGILITY
FRACTURE OUTWEIGHS RISK OF
ADDING ONE MORE CHRONIC
MEDICATION TO A PERSON'S
MEDICATION LIST, THIS IS A KEY
NEXT STEP IN OUR WORK.
SO TO CONCLUDE, I THINK THE KEY
MESSAGES OF THE TALK ARE FIRST
THAT THE FULL IMPACT OF
GERIATRIC SYNDROME AMONG PERSONS
WITH HIV HAS YET TO BE FULLY
APPRECIATED, STILL A VERY YOUNG
POPULATION.
SERIOUS FALSE AND FRAGILITY
FRACTURES ARE MORE COMMON IN
THOSE WITH HIV.
RATES OF SERIOUS FALLS AND
FRAGILITY FRACTURES ARE HIGHER
AMONG WOMEN THAN MEN AGING WITH
HIV, RISK FACTORS FOR THESE
OUTCOMES SEEM TO BE THE SAME IN
MEN AND WOMEN.
I THINK IT'S IMPORTANT TO NOTE
THAT NON-ART CHRONIC MEDICATION
COUNT IS AN IMPORTANT PREDICTOR
FOR BOTH OUTCOMES.
MOVING FORWARD WE NEED A BETTER
UNDERSTANDING OF WHEN BENEFITS
OF ADDITIONAL MEDICATIONS
OUTWEIGH RISKS, WHICH MEANS WE
NEED TO IDENTIFY AND ACKNOWLEDGE
THESE RISKS.
PROVIDERS AND PATIENTS NEED TO
KEEP RECORDS AND DISCUSS
DISCONTINUING OR DECREASING THE
DOSE OF HIGH RISK MEDICATIONS
SUCH AS BENZODIAZEPINES,
PRESCRIPTION OPIOIDS, MUSCLE
RELAXANTS.
WE'D LIKE TO THANK OUR FUNDERS
FOR MAKING THIS RESEARCH
POSSIBLE, WE WOULD LIKE TO THANK
RESEARCH TEAM, PARTICIPANTS, AND
THE COLLABORATORS AT THE
CONSORTIUM.
THANK YOU FOR YOUR TIME.
>> THANK YOU SO MUCH, DR.
WOMACK.
REMINDER TO THE AUDIENCE, SEND
YOUR QUESTIONS OR COMMENTS VIA
THE LIVE FEEDBACK OPTION BELOW
THE VIDEOCAST.
WE'LL NOW HEAR REMARKS FROM LEAH
RUBIN.
PLEASE GO AHEAD, DR. RUBIN.
>> ANGELA, I'VE TRIED TO START
MY VIDEO BUT IT WON'T LET ME,
FOR SOME REASON.
>> LET'S FIGURE THIS OUT.
>> START MY VIDEO.
OKAY.
YOU'RE ALLOWING ME TO START MY
VIDEO NOW.
I'M GOING TO GET STARTED AND
HOPEFULLY I CAN MAKE THIS WORK.
FIRST I WANT TO THANK THE
ORGANIZERS FOR THE OPPORTUNITY
TO SPEAK TODAY.
I WAS SPECIFICALLY ASKED TO
SPEAK ABOUT THE ISSUE OF
POLYPHARMACY ON COGNITION IN
WOMEN WITH HIV.
I'VE BEEN FOCUSING ON PATTERNS
AND PREDICTORS OF COGNITION FOR
A NUMBER OF YEARS, AND
POLYPHARMACY IS JUST ONE FACTOR
THAT WE NEED TO PAY ATTENTION
TO.
THERE'S MANY OTHER FACTORS, AND
THEY OFTEN INTERSECT AND
PREVIOUSLY SPOKEN DID -- ABOUT
SOCIAL DETERMINANTS OF HEALTH,
DIET, METABOLIC, EARLY LIFE
TRAUMA, HONESTLY THIS TALK IS
COMING AT A PERFECT SEGUE
BECAUSE YOU JUST HEARD FROM THE
PREVIOUS DISCUSSION ABOUT
NON-ART CHRONIC MEDICATIONS THAT
ARE IMPORTANT FOR PREDICTORS OF
FALLS AND FRACTURES, AND NOW
IT'S ALSO IMPORTANT WHEN WE
THINK ABOUT COGNITION.
SO NEXT SLIDE PLEASE.
COMMUNITY SUMMARY, SO FIRST AND
FOREMOST THERE ARE VERY FEW
STUDIES THAT EVALUATED THE
CONTRIBUTION OF POLYPHARMACY TO
COGNITIVE FUNCTION SPECIFICALLY
IN WOMEN WITH HIV DOING MORE
STANDARD COGNITIVE ASSESSMENTS.
SECONDLY, OF THE STUDIES THAT
HAVE BEEN CONDUCTED WE'VE FOUND
POLYPHARMACY PARTICULARLY THE
DEGREE OF POLYPHARMACY TO BE
ASSOCIATED WITH POOR COGNITION
IN WOMEN WITH HIV.
THIRD, THE DRUGS WITHIN SELECT
CLASSES OR DRUGS WITH CERTAIN
SIDE EFFECT PROFILES ARE ALSO
ASSOCIATED WITH POOR COGNITION
IN WOMEN WITH HIV.
AND IT'S NOT REALLY A
ONE-SIZE-FITS-ALL HAT.
POLYPHARMACY IS JUST LIKE THIS
GENERAL CONSTRUCT WHICH I'M
GOING TO GET INTO, AND THERE'S A
LOT OF HETEROGENEITY WITHIN
THERE, AND THERE'S DIFFERENT
MEDICATIONS AND DIFFERENT
COMBINATIONS.
AND FINALLY, TRADITIONAL
STATISTICAL METHODS ARE NOT WELL
SUITED FOR ADDRESSING THE
CONTRIBUTION OF DRUG
COMBINATIONS ON COGNITIVE HEALTH
MORE BROADLY, WE HAVE A NUMBER
OF METHODS IN DEVELOPMENT THAT
WILL HOPEFULLY PUSH THIS
FORWARD, MORE WORK IS NEEDED.
NEXT SLIDE PLEASE.
AS AN EPIDEMIOLOGIST AND
COGNITIVE NEURO NEUROSCIENTIST,
PEOPLE WITH HIV CAN EXPECT TO
LIVE CLOSE TO NORMAL LIFE
EXPECTANCY WITH ACCESS AND
ADHERENCE TO ART.
WHEN WE THINK ABOUT POLYPHARMACY
AND EFFECT ON COGNITIVE HEALTH
WE NEED TO TAKE A LIFESPAN
RESPECT TO THE PROBLEM.
AS WE HEARD WITH RESPECT TO ART
PEOPLE ARE LIVING LONGER,
DEVELOPING AGE-RELATED MEDICAL
COMORBIDITIES MORE FREQUENTLY
THAN THE GENERAL POPULATION, AND
OF COURSE IT'S NOT SURPRISING
THEY ARE TAKING MORE MEDICATIONS
THAN PEOPLE WITHOUT HIV.
IT'S JUST OF NOT JUST AN ISSUE
IN OLDER AGE.
PEOPLE WITH HIV, ESPECIALLY
WOMEN, ALSO EXPERIENCE OOCAN
CO-OCCURRING MENTAL HEALTH,
NON-ART MEDICATIONS ARE
PRESCRIBED FOR THESE CONDITIONS,
ALSO THIS CUMULATIVE BURDEN.
NEXT SLIDE.
ALL RIGHT.
POLYPHARMACY, WHAT IS IT?
THE MOST GENERAL DEFINITION OUT
THERE IS TAKING FIVE OR MORE
PRESCRIPTION MEDICATIONS.
AND SO, AGAIN, THAT COULD BE ANY
FIVE MEDICATIONS.
SO, THINKING ABOUT THIS KIND OF
GENERAL TERM, YOU CAN SEE THE
DEFINITION HERE IN THE
DICTIONARY, BUT IF YOU CAN HIT
THE NEXT SLIDE.
IN OUR WORK IN THE WOMEN'S
INTERAGENCY HIV STUDY, WORKING
CLOSELY WITH THE BRONX SITE, WE
FOCUSED ON POLYPHARMACY AND
COGNITION IN WOMEN OLDER THAN 50
YEARS OF AGE AND FOUND THAT IT'S
THE DEGREE OF POLYPHARMACY
RELATING TO COGNITION.
YOU CAN SEE IT'S PRIMARILY
INDIVIDUALS THAT ARE TAKING TEN
OR MORE MEDICATIONS, MORE SEVERE
POLYPHARMACY, VERSUS TAKING 0-3
MEDICATIONS, ASSOCIATED WITH
POORER EXECUTIVE FUNCTION,
PROCESSING SPEED, AS WELL AS
MOTOR FUNCTION IN WOMEN WITH HIV
GENERALLY AND THEN YOU CAN SEE
ON THE RIGHT-HAND SIDE IF YOU
FOCUS IN ON JUST VIRALLY
SUPPRESSED WOMEN WITH HIV, THE
MOTOR FALLS OUT BUT YOU STILL
SEE THE EXECUTIVE FUNCTION AND
PROCESSING SPEED.
THE OTHER THING TO NOTE HERE IS
THAT THE UNSTANDARDIZED DATA SO
EFFICIENTS, WE'RE TALKING ABOUT
T SCORES HERE, AND A T SCORE IS
A MEAN OF 50, STANDARD DEVIATION
OF 10, SO EFFECTS ARE THERE BUT
DEFINITELY SMALL.
AND TO ME THAT'S NOT SURPRISING
GIVEN THE HETEROGENEITY IF WE
THINK ABOUT POLYPHARMACY SO IF
YOU HIT THE NEXT SLIDE.
I THINK THE PROBLEM WITH THE
DEFINITION IN GENERAL IN PUSHING
THIS WORK FORWARD IS THAT
THAT -- THE DEFINITION OF
POLYPHARMACY ISN'T
NECESSARILY -- DOESN'T CARE
ABOUT WHAT THE EXACT MEDICATIONS
ARE.
IF WE START HONING IN, THIS IS
WORK BY KENDRA RADKE, RUTH
BRINGBLAT, AND THEY HAD -- SHE
WAS A PharmD. STUDENT,
INTERESTED IN PULLING OUT THE
NON-ART MEDICATION THAT HAD BEEN
ASSOCIATED WITH ADVERSE CENTRAL
NERVOUS SYSTEM EFFECTS,
COGNITIVE EFFECTS.
WHAT SHE FOUND IS THAT YOU CAN
SEE HERE WITHIN WOMEN WITH HIV,
THEY ARE MORE LIKELY TO BE ON
ANTI-ANXIETY MEDS,
ANTIDEPRESSANTS, ANTIHISTAMINES,
GASTROINTESTINAL MEDS, OPIOIDS
COMPARED TO WOMEN WITHOUT HIV.
MORE LIKELY TO BE ON MEDS WITH
NEGATIVE EFFECTS ON COGNITION,
AND WHEN WE'VE LOOKED AT IN A
SUBSEQUENT STUDY WITH KENDRA AND
COLLEAGUES WE'VE TAKEN KIND OF
THE COMBINATION OF ALL THOSE
MEDS, MEDS THAT HAVE KNOWN
ADVERSE CNS EFFECTS, AND IN
GENERAL THE SIGNAL WASN'T GREAT
WHEN WE LOOKED AT IT WITH
RESPECT TO ITS RELATIONSHIP WITH
COGNITION.
HOWEVER, IF YOU HIT THE NEXT
SLIDE, IF DON'T JUST LOOK AT
GLOBAL DEFINITION OF JUST
MEDICATIONS THAT HAVE NEGATIVE
ADVERSE EFFECTS ON COGNITION,
AND YOU START DIGGING IN A BIT
INTO THE MEDICATION OR DRUGS
THAT HAVE DIFFERENT SIDE EFFECT
PROFILES, SO WE'VE LOOKED AT
MEDICATIONS WITH ANTICHOLINERGIC
PROPERTIES, IN INDIVIDUALS WITH
PSYCHOSIS, YOU CAN SEE MY
COLLEAGUE JEFF BISHOP AND OTHER
FOLKS WITHIN THIS, THE CLINICAL
RATING SCARE HIGHER IS POORER
PERFORMANCE, WHAT YOU CAN SEE
HERE IS THAT WHEN IT COMES TO
TAKING ONE OR MORE MEDICATION,
THAT HAS THIS PROPERTY, WOMEN
PERFORM MORE POORLY.
SO AGAIN ALL OF THE PRIOR WORK
WE WERE DOING, POLYPHARMACY,
THIS MORE GENERAL TERM, WE'VE
LOOKED AT DRUGS WITH ADVERSE CNS
EFFECTS SPECIFICALLY, OR
MEDICATIONS, WE FOUND ONE BY ONE
LOOKING AT ANTIDEPRESSANTS,
ANGIOLYTICS, OPIOIDS, AGAIN
THAT'S A ONE BY ONE PERSPECTIVE.
WE KNOW THAT THERE'S
COMBINATIONS OF DRUGS THAT
INDIVIDUALS ARE ON, AND HOW THEY
CO-OCCUR.
AND SO IN TRYING TO THINK HOW TO
MOVE THIS WORK, THE FIELD
FORWARD IN THIS AREA, WE DO NEED
TO BE THINKING ABOUT ALTERNATIVE
APPROACHES TO EXAMINING THE LINK
BETWEEN POLY -- LIKE DRUG
CLASSES AND COGNITION, IN PEOPLE
WITH HIV.
WE'VE-- YOU CAN SEE ON THE TOP
HERE, IT'S NOT A
ONE-SIZE-FITS-ALL HAT WITH
RESPECT TO COGNITIVE PROFILES,
NOT JUST BEING IMPAIRED OR NOT.
YOU CAN SEE ON THE LEFT-HAND
SIDE THIS IS DATA AS PART OF A
GRANT ON POLYPHARMACY AND
COGNITION, YES, THERE'S A LARGE
PERCENTAGE OF PEOPLE THAT DON'T
SHOW COGNITIVE IMPAIRMENT ON ANY
GIVEN DOMAIN, YOU CAN SEE THERE
ARE DIFFERENT SUBGROUPS THAT
SHOW ISSUES, GLOBAL IMPAIRMENT
IS SECOND GROUP, 46% OF THOSE
INDIVIDUALS ARE FEMALE, AND YOU
CAN SEE GOING ACROSS THAT
THERE'S PROFILES THAT MAY HAVE
WEAK MOTOR SKILLS, LEARNING AND
MEMORY WITH MOTOR IMPAIRMENT.
WHAT WE HAD DONE LOOKING AT
THESE NON-ANTIRETROVIRAL DRUG
CLASSES WAS TO DO MORE OF A DATA
REDUCTION APPROACH, PRINCIPAL
COMPONENTS ANALYSIS TO IDENTIFY
KIND OF NON-ART DRUGS.
ON THE LEFT-HAND SIDE, THE
FACTOR SCORE WAS MORE OF DRUGS
THAT COMBINED TOGETHER, CNS
DRUGS, PSYCHOTHERAPEUTIC DRUGS,
ANTIDEPRESSANTS, ET CETERA, AND
WHAT WE HAD DONE USING MACHINE
LEARNING WAS TO IDENTIFY WHICH
OF THESE COMPONENTS CONTRIBUTE
TO, SAY, THAT GLOBAL IMPAIRMENT
PROFILE VERSUS SHOWS SHOWING NO
IMPAIRMENT.
SO UNDER THAT GLOBAL IMPAIRMENT
WHAT YOU'RE SEEING HERE IS THE
WEIGHTS FROM THE MACHINE
LEARNING ANALYSIS TO SHOW WHICH
OF THOSE COMPONENTS ARE REALLY
DISTINGUISHING, SO YOU SEE THAT
RC-1, THAT BLUE BOX ON THE LEFT,
THOSE ARE DRUGS THAT ARE MORE
LIKELY TO BE USED IN THOSE WITH
GLOBAL IMPAIRMENT VERSUS
UNIMPAIRED.
NEXT SLIDE.
OTHER APPROACHES AGAIN, STARTING
TO ADAPT COMMUNITY DETECTION
ALGORITHMS FOR PEOPLE WITH
SIMILAR COMBINATIONS, USED FOR
ANALYSIS OF COMPLEX NETWORKS,
AND USING THESE METHODS AS
OPPOSED TO TRADITIONAL
CLUSTERING METHODS OVERCOMES
ISSUES WE'VE OBSERVED IN
POLYPHARMACY DATA SUCH AS
SIMILAR DRUGS NOT BEING
CO-PRESCRIBED OR BEING PRESENT
IN DIFFERENT TIME PERIODS.
HOW THEY ARE ENTERING THE MARKET
OR FDA APPROVAL.
AND USING SPECIFIC NETWORK
DESIGNS, THAT CONSISTS OF NODES,
THOSE ARE PEOPLE, AND EDGES THAT
CONNECT THEM IF THEY ARE TAKING
SIMILAR DRUGS, THAT'S ON THE
LEFT-HAND SIDE.
YOU GET THESE CLUSTERS OF
INDIVIDUALS WHO ARE USING
SIMILAR COMBINATIONS OF DRUGS,
AND COMMUNITIES CONSIST OF
PEOPLE, YOU KNOW, THEY MAY NOT
BE PERFECTLY OVERLAPPING BUT
THEY ARE TAKING SIMILAR DRUGS.
AND OVER TIME, WE'RE GOING TO BE
LOOKING AT YOU WHO TO IMPROVE
THESE ADAPTATION OF THESE
METHODS AND LINKING TO
COGNITION.
ON THE LEFT SIDE ONE COMMUNITY
WAS IDENTIFIED WITH A LARGE
NUMBER OF INDIVIDUALS, AND
ANYTHING THAT'S IN BETWEEN THE
DOTTED LINES ARE DRUGS THAT ARE
KIND OF IN THE MIDDLE.
THERE'S REALLY NO DIFFERENCE.
WHAT YOU SEE ON THE TOP ARE
DRUGS THAT ARE OVERREPRESENTED
IN THIS COMMUNITY.
SO THINGS LIKE TRAZODONE MORE
LIKELY TO BE USED IN ANY
COMMUNITY OF INDIVIDUALS VERSUS
DRUGS THAT ARE UNDERREPRESENTED,
LIKE BUPROPION ON THE BOTTOM.
ALSO WORKING THROUGH NSF AN R01
RECENTLY RECEIVED IS LOOKING AT
MORE PRECISION MEDICATION
APPROACHES FOR EFFECTS OF DRUG
COMBINATIONS ON BRAIN HEALTH.
WE'RE NOW MOVING THIS TO NON-ART
MEDICATIONS AND EVENTUALLY
COMBINATIONS.
THE GOAL IS TO TAKE INFORMATION
BASEs ON AN INDIVIDUAL'S MASS,
BODY MASS, ALL THOSE THINGS, TO
BE IDENTIFYING WHAT IS OPTIMAL
SITUATION ON CNS OUTCOMES.
FINAL SLIDE.
KEY MESSAGES IS THAT MORE WORK
IS NEEDED IN THE AREA OF
POLYPHARMACY AND COMPLICATIONS
MORE GENERALLY IN WOMEN.
WE NEED TO SHIFT I THINK FROM
THAT DEFINITION OF POLYPHARMACY
TO MORE SPECIFIC DRUG
COMBINATIONS.
AND TAKING A MORE NUANCED
APPROACH TO UNDERSTAND THAT
HETEROGENEITY, AND, YOU KNOW,
THIS OTHER ISSUE IS THINKING
ABOUT HOW TO DISTINGUISH THE
DRUGS FROM THE UNDERLYING
CONDITIONS AND I THINK THAT'S A
MUCH MORE -- THAT'S A LARGER
ISSUE.
THEN THE LAST SLIDE JUST TO
ACKNOWLEDGE THE BRAIN HEALTH
PROGRAM, THE NIH AND NSF FOR
FUNDING THIS WORK.
THANK YOU.
>> PLEASE SEND QUESTIONS OR
COMMENTS VIA THE LIVE FEEDBACK
OPTION BELOW THE VIDEOCAST.
WE'LL NOW HEAR REMARKS FROM
MARTHA CAMERON.
THE VIRTUAL PODIUM IS YOURS.
>> HI, EVERYONE.
I WANT TO MAKE SURE YOU CAN ALL
HEAR ME.
>> YEP.
YES, WE CAN.
>> OKAY.
THANK YOU FOR THIS OPPORTUNITY,
QUITE EXHILARATING TO HEAR WHAT
SOME OF THE SPEAKERS HAVE SAID
OVER THE PAST TWO DAYS.
I THINK THE OTHER THING I JUST
WANTED TO SORT OF UPDATE OR
CORRECT IS THAT WHILE I STILL
WORK WITH INTERNATIONAL
COMMUNITY OF PEOPLE LIVING WITH
HIV MY DAY JOB IS HERE AT
GEORGETOWN UNIVERSITY WORKING
WITH THE MACS/WIHS AND STAR
STUDIES.
THAT HAS BEEN A REAL GREAT
OPPORTUNITY, IT HAS HELPED ME
EVEN HAVE, YOU KNOW, LIKE A
FRONT-ROW SEAT TO SOME OF THIS
RESEARCH AND SOME OF THE
FINDINGS THAT ARE HAPPENING.
I WAS ALSO GLAD TO SEE SOME OF
MY FELLOW WOMEN LIVING WITH HIV
BEING INCLUDED IN SOME OF THE
PANELS, I'M A PERSON LIVING WITH
HIV OF 20 YEARS.
I'VE ALSO HAD TWO CHILDREN, NOW
12 AND 14, SINCE I'VE BEEN
LIVING WITH HIV SO I HAVE A REAL
KEEN INTEREST IN ANYTHING TO DO
WITH BABIES, BREASTFEEDING, AND
ALSO SOME OF THE INFORMATION
THAT WE HAD HEARD RELATED TO
CURE, ESPECIALLY AS IT IS
HAPPENING OR REMISSION AS IT IS
HAPPENING IN BABIES THAT ARE IN
CURE TRIALS.
I JUST HAVE A LOT OF INTEREST IN
HIV IS OBVIOUSLY PERSONAL AND
PROFESSIONAL INTEREST TO ME.
BUT AS IT RELATES TO THIS PANEL,
THAT WE'RE ON, AND TALKING ABOUT
COMORBIDITIES AND TALKING ABOUT
HOW WE'RE AGING WITH HIV, I
THINK THERE'S A LOT TO DISCUSS
ON BEHALF OF THE COMMUNITY.
AND CERTAINLY SOME OF THE THINGS
THAT I WANTED TO ENCOURAGE ALL
OF THE RESEARCHERS THAT ARE
ESSENTIALLY WORKING ON THIS TO
BE HELPING, YOU KNOW, CONTRIBUTE
TO SOME OF THE POLICY AS IT
RELATED TO HEALTH CARE OF
PEOPLE.
SO, WE KNOW THAT PEOPLE OVER 50
YEARS OLD ARE MAKING UP MORE
THAN HALF OF THE PEOPLE LIVING
WITH HIV IN THE U.S.
AND SO IN A SENSE PEOPLE ARE
AGING WITH HIV.
WE KNOW THAT.
I THINK IN THE NEXT TEN YEARS OR
SO, OVER 50% OF PEOPLE LIVING
WITH LIVING WILL BE ABOVE 6 5.
I THINK DR. WOMACK SAID WE
HAVEN'T REALIZED THE FULL IMPACT
OF THE GERIATRIC SYNDROME ON
PEOPLE LIVING WITH HIV BECAUSE I
HAVE HEARD OTHER RESEARCH
RESULTS, OBVIOUSLY BEING PART OF
THESE STUDIES WE'RE ALREADY
SEEING IMPACTS, ESPECIALLY ON
WOMEN LIVING WITH HIV.
WE'VE KNOWN FOR OVER TEN YEARS
AS WE AGE WITH HIV WE'RE
EXPERIENCING MORE COMORBIDITIES
THAT HAVE BEEN MENTIONED IN
TERMS OF DIABETES AND HEART
DISEASE, WE'RE SEEING IMPACT ON
OUR LIVERS AND KIDNEYS.
ONE OF THE MOST CONCERNING
THINGS I'VE HEARD TOO IS AS
RELATES TO MENTAL HEALTH WHICH
FOR ME DIDN'T TAKE THE RESEARCH
TO TELL ME THAT.
IN THE COMMUNITY WE'RE DOING
TRAUMA INFORMED WORK, ADVOCATING
FOR SERVICES OVER 20 YEARS AGO
KNOWING THAT A LOT OF ISSUES
ASSOCIATED WITH, YOU KNOW, THE
ADVERSE CHILDHOOD EXPERIENCES AS
WELL AS JUST THE TRAUMA OF BEING
DIAGNOSED AND LIVING WITH HIV OR
ISSUES LIKE POVERTY AND
VIOLENCE, DISCUSSED HERE,
PREDISPOSE US TO LIVING WITH --
TO HIV IN THE FIRST PLACE, AND
SO IT SHOULDN'T BE NEW THAT AS
WE'RE LIVING WITH HIV WE'RE
EXPERIENCING HEIGHTENED FORMS OF
VIOLENCE AND MENTAL HEALTH.
THAT'S ONE OF THE STUDIES THAT
I'VE SEEN FROM THE CCF, THE
MACS/WIHS COHORT SHOWS HOW WE
CAN DIE FROM MENTAL HEALTH, THE
TRAJECTORY OF EXPERIENCING
SYMPTOMS OF MENTAL HEALTH,
MENTAL HEALTH COVERS A LOT OF
THINGS, LET REALLY CAN KILL US
JUST AS -- LITERALLY CAN KILL US
AS IF WE'RE NOT ON ART
TREATMENT.
REGARDLESS OF TAKING ART, WE
HAVE THIS, YOU KNOW, MENTAL
HEALTH EPIDEMIC IN OUR
COMMUNITIES.
AND THE SAME THING WITH WHAT WE
HEARD, I DON'T NEED TO REPEAT,
WE KNOW THAT COVID IMPACTED OUR
COMMUNITY A LOT MORE THAN THE
REST OF THE COMMUNITY BECAUSE WE
KNEW THAT THE SAME FACTORS, SAME
POVERTY, PEOPLE LIVING UNDER
POVERTY, TRAUMA, VIOLENCE, ALL
THOSE THINGS WERE ALREADY
EXISTING AMONG US AS PEOPLE
LIVING WITH HIV SO WE KNEW IT
WOULD IMPACT US MORE.
WHAT CONCERNS US FOR THOSE THAT
DO ADVOCACY AND WORK IN HIV IS
HOW THIS INFORMATION THAT IS
KNOWN IN THE RESEARCH IN THIS
PUBLICATION DOES NOT TRANSLATE
TO CHANGING POLICY AND CHANGING
MORE ESPECIALLY HIV SERVICES.
FOR EXAMPLE, THE RYAN WHITE ACT
WHICH SERVES AS YOU ALREADY
HEARD PEOPLE LIVING WITH HIV,
ABOUT HALF OF THE PEOPLE LIVING
WITH HIV, ALL THESE PEOPLE
LIVING UNDER CERTAIN POVERTY
LINES FOR THEM TO BE ELIGIBLE
FOR THOSE SERVICES, YOU KNOW,
DON'T HAVE THEIR CARE, THOSE
SERVICES ONLY TREAT HIV.
IF THEY HAVE TO TREAT THEIR
DIABETES AND HEART DISEASE,
MENTAL HEALTH, ANY OF THESE
OTHERS, THEY HAVE TO BE REFERRED
OUT AND HIV FUNDING DOES NOT
COVER THE GERIATRIC OR
COMORBIDITIES, LET ME SAY,
SERVICES.
AND YOU WOULD THINK IF THE
RESEARCH IS REALLY SHOWING AND
HAS BEEN SHOWING FOR THE PAST
TEN YEARS THAT NOT ONLY ARE WE
MORE PRE-DISPOSED, WE'RE
EXPERIENCING THIS MORE, IT'S
HAPPENING AS WE AGE WITH HIV,
WHY HAVEN'T THEY STARTED
COMBINING GERIATRIC SERVICES,
YOU KNOW, AND SCREENINGS FOR
HEART DISEASE OR ALL THESE OTHER
THINGS, WHY CAN'T THEY BE
COMBINED IN THE HIV CARE AND NOT
HAVE PEOPLE LIVING WITH HIV
HAVING ALREADY TO NAVIGATE
SERVICES TO BE ABLE TO ENCOMPASS
ALL THE OTHER COMORBIDITIES.
THIS IS A REAL ISSUE.
I CAN SPEAK FROM A PERSONAL
EXPERIENCE WHERE I WAS ASKED TO
GET A COLONOSCOPY BEFORE I WAS
50 YEARS OLD BECAUSE IN THE HIV
CARE IT'S RECOMMENDED, I THINK
GENERALLY RECOMMENDED IN THE
REGULAR POPULATION, BUT MY
INSURANCE WOULDN'T COVER IT
BECAUSE I HAVEN'T HIT THE
RECOMMENDED AGE.
THEY HAD TO GET A WAIVER.
MY DOCTOR HAD TO INSIST THAT I
NEEDED TO GET THAT COLONOSCOPY,
AND THAT WAS WHEN, AND IT WAS
THE SAME THING WITH THE SHINGLES
VACCINES.
THEY ASKED ME HOW COME YOU'RE
GETTING SHINGLES VACCINES,
YOU'RE NOT AT THE AGE YOU'RE
SUPPOSED TO BE GETTING SHINGLES
VACCINES.
WELL, BECAUSE I'M HIV POSITIVE,
THIS HAS BEEN RECOMMENDED EVEN
BEFORE I REACHED THOSE AGES THAT
ARE NORMALLY RECOMMENDED FOR YOU
TO START GETTING SHINGLES OR
COLONOSCOPIES OR SOME OTHER
SCREENINGS.
THE RESEARCH IS NOT CATCHING UP
WITH THE CARE THAT WE SHOULD BE
GETTING AS PEOPLE LIVING WITH
HIV.
AND AS PEOPLE AGING WITH HIV.
AND AS PEOPLE EXPERIENCING THESE
CO-MORBIDITIES OF HIV.
ALREADY, BECAUSE OF CERVICAL
CANCER, WHAT WAS -- WHEN I HAD
MY PAP SMEAR AND SO ON, THEY
FOUND SOME STUFF THAT THEY WERE
SAYING, I CAN'T REMEMBER WHAT
THE CELLS ARE, THAT SHOW THIS
COULD TURN INTO CANCER, HAD A
HYSTERECTOMY, ALL THESE THINGS
THAT I THINK WE NEED TO BE MORE
AWARE OF.
THE OTHER THING THAT IS VERY
TOUCHING FOR ME, FOR THOSE
YOUNGER WOMEN THAT WERE BORN
WITH HIV, THAT HAVE LIVED THUS
FAR, WE HAVE LOST LIFE SOMETIME
SURVIVORS TO BREAST CANCER AND
TO I THINK THE OTHER ONE -- I'M
BLACKING OUT ON THE NAME OF A
COMMON CANCER, THESE YOUNG
PEOPLE WE LOST IN OUR COMMUNITY
ARE REALLY LOST TO DISEASES THAT
COULD HAVE BEEN TREATED, MAYBE
POTENTIALLY PREVENTED IF THEY
WERE BEING TREATED AS PEOPLE WHO
ARE MAYBE NOT OLDER WITH HIV BUT
LIFETIME, THEY WERE BORN WITH
HIV, MEANING THE IMPACT OF THE
DISEASE, OF THE MEDICATION, HAS
BEEN WORKING ON THEM LONGER THAN
OTHER PEOPLE.
AND SO, YOU KNOW, NOW I'M ON A
MISSION TO REALLY START SAYING,
WELL, WHEN IS THIS RESEARCH -- I
THINK THE SPEAKER BEFORE ME
TALKED ABOUT FRAILTY AND
FRACTURES, AND I KNOW, AGAIN,
FROM NOW BEING INSIDE THE
RESEARCH THAT THIS INFORMATION
HAS BEEN COLLECTED FOR OVER 30
YEARS FROM PEOPLE THAT ARE AGING
WITH HIV.
WE KNOW THAT WE'RE BECOMING MORE
FRAIL SOONER.
I MEAN, I AM ONLY 50, I HAVE TO
TRANSFORM IN THE MORNING TO GET
MY JOINTS AND BONES GOING.
THAT WOULD BE MY LAST CALL TO
ACTION, ESPECIALLY NOW AS WE
HAVE THE OPPORTUNITY TO SPEAK TO
OTHER RESEARCHERS, I KNOW
SOMETIMES IT TAKES LONG TO
PUBLISH RESULTS AND GET THOSE
RESULTS BUT WE'RE REALLY ASKING
THAT THESE FINDINGS CAN BE ADDED
TO POLICY THAT CAN CHANGE THE
CARE OF PEOPLE LIVING WITH HIV.
THANK YOU SO MUCH.
>> THANK YOU SO MUCH, MARTHA.
PLEASE SEND QUESTIONS OR
COMMENTS VIA LIVE FEEDBACK
OPTION BELOW THE VIDEOCAST.
FINAL SPEAKER TODAY IS KATHLEEN
SIKKEMA.
>> CAN YOU SEE ME?
I MAY BE HAVING A VIDEO PROBLEM.
>> WE CAN SEE YOU.
>> DIDN'T KNOW IF YOU COULD SEE
ME.
I CAN NO LONGER SEE PEOPLE, ONLY
THE SCREEN.
HELLO, EVERYONE.
IT'S A PLEASURE TO BE PART OF
THIS PANEL.
MARTHA, I WANT TO THANK YOU FOR
QUEUING ME UP, AND HOPEFULLY I
CAN TALK MORE ABOUT THE DECADES
OF WORK WE'VE BEEN TRYING TO DO
IN MENTAL HEALTH.
WHAT I'LL TALK ABOUT TODAY, I
WANT TO TRACK MY TIME, IS THE
DEVELOPMENT OF AN INTERVENTION
THAT'S ADDRESSING MENTAL HEALTH
AND TRAUMA, SEXUAL TRAUMA IN
PARTICULAR, AMONG WOMEN LIVING
WITH HIV IN CAPE TOWN, SOUTH
AFRICA, AND HOW THAT'S NOW BEING
TESTED IN A CLINICAL TRIAL, BUT
HOW IT'S ALSO BEEN BASED ON A
NUMBER OF STUDIES OVER TIME.
SO AS I SAID, THIS IS BEING DONE
IN CAPE TOWN.
I OBVIOUSLY HAVE COLLABORATORS
THERE AT THE UNIVERSITY OF CAPE
TOWN.
NEXT SLIDE.
A FEW POINTS I'LL MAKE FOR AN
OVERVIEW FOR CONTEXT, THIS IS
WHERE MARTHA SET ME UP FOR THIS,
THAT WE KNOW THAT MENTAL HEALTH
TRAUMA AND VIOLENCE IMPACT HIV
CARE ENGAGEMENT.
WE'VE OF COURSE KNOW THAT'S A
PSYCHOLOGICAL IMPACT BUT THERE'S
A BIOLOGICAL IMPACT AS WELL.
MY WORK LOOKS AT ADDRESSING
MENTAL HEALTH, AND THE
CONSEQUENCES OF TRAUMA BEING
AVOIDING COPING IN WAYS WE COULD
IMPROVE HIV ADHERENCE AMONG
WOMEN WITH SEXUAL TRAUMA AND IN
THIS PARTICULAR STUDY AS ART IS
INITIATED.
I WILL COME BACK TO WHY WE FOCUS
AT THAT POINT.
MY EXPERIENCE SO FAR ALTHOUGH
WE'RE IN THE MIDDLE OF A
CLINICAL TRIAL IS THAT EFFECTIVE
TREATMENT CAN BE WE CAN LOOK AT
PREVIOUS EVIDENCE-BASED
APPROACHES TO TRAUMA TREATMENT,
AND INCLUDING FOCUSED ON HIV OR
MORE BROADLY, CAN BE CULTURALLY
TAILORED AND USED IN COMMUNITY
SETTINGS BY WHAT WE OFTEN REFER
TO IN GLOBAL MENTAL HEALTH AS
NON-SPECIALISTS.
SO WE'RE TRYING TO DO MENTAL
HEALTH INTERVENTIONS IN SETTINGS
THAT OFTEN HAVE VERY FEW IF ANY
MENTAL HEALTH PROFESSIONALS,
PSYCHOLOGISTS, PSYCHIATRISTS,
SOCIAL WORKERS OR NURSES WITHOUT
PSYCHOLOGICAL TRAINING, SO IT'S
THE FOCUS OF MANY GLOBAL MENTAL
HEALTH EFFORTS TO SEE WHAT HOW
WE CAN MODIFY AND MAKE EFFECTIVE
INTERVENTIONS THAT ARE BASICALLY
IMPLEMENTABLE AND SUSTAINABLE
OVER TIME.
SO, ANOTHER POINT THAT I'LL TRY
TO MAKE WHEN I FOCUS ON THE
TRIAL DESIGN IS THE CHALLENGE,
THE IMPORTANCE AND THE CHALLENGE
OF CONDUCTING INTERVENTION
TRIALS IN COMMUNITY SETTINGS
THAT ADHERE TO HIGHEST ETHICAL
STANDARDS INCLUDING HOW THEY ARE
DESIGNED IN THE FIRST PLACE.
SO THAT WE CAN EVALUATE IF THESE
MENTAL HEALTH TREATMENTS CAN
ACTUALLY IMPROVE PSYCHOLOGICAL
WELLNESS AS WELL AS CLINICAL
OUTCOMES.
NEXT PLEASE.
MARTHA, I'LL SAY YOUR NAME FOR
THE LAST TIME.
IT'S INTERESTING, I SHOW THIS
SLIDE THAT WE KNOW THAT THE
IMPACT OF VIOLENCE, VIOLENCE AND
TRAUMA CAN IMPACT HIV CARE
ENGAGEMENT.
I DIDN'T PUT UP THIS ONE
PARTICULAR SLIDE BUT THERE HAVE
BEEN STUDIES OF ADHERENCE IN THE
PAST THAT TAKE INTO ACCOUNT A
LOT OF THINGS THAT WE THINK
MIGHT BE RELATED TO ADHERENCE,
AND AMONG WOMEN LIVING WITH HIV
ACTUALLY INTERPERSONAL VIOLENCE
IS THE STRONGEST PREDICTOR OF
NON-ADHERENCE.
SO, WE HAVE KNOWN, AND YOU'LL
SEE CITATIONS OVER 20 YEARS OLD,
THAT WE'VE KNOWN THIS
DESCRIPTIVELY FOR SOME TIME THAT
DEPRESSION AND ANXIETY AND
TRAUMATIC STRESS IS RELATED TO
AVOIDANCE AND SHAME AND STIGMA,
AND THAT THEY ARE RELATED TO
POOR RETENTION AND CARE, AND
POOR ADHERENCE.
SO WHAT MY WORK HAS ALWAYS BEEN
ON, HOW TO DEVELOP INTERVENTIONS
THAT ARE HOPEFULLY POSSIBLE TO
IMPLEMENT AND SERVICE, AND
CONDUCTED IN COMMUNITY SETTINGS
TO ENHANCE THAT LIKELIHOOD.
AND NOW MY FOCUS IS ON WHETHER
WE CAN SHOW A PSYCHOLOGICAL
INTERVENTION CAN RESULT IN VIRAL
LOAD SUPPRESSION.
THIS IS A CONCEPTUAL MODEL OF
WHAT'S GUIDING THE CURRENT STUDY
IN CAPE TOWN.
SO, IMPACT PLUS IS THE ENGLISH
NAME OF OUR INTERVENTION, WHICH
STANDS FOR IMPROVING AIDS CARE
AFTER TRAUMA.
AND ESSENTIALLY IT'S THE
QUESTION OF CAN WE THINK OF
MENTAL HEALTH IMPROVEMENT AS A
MEDIATOR, SO THE STUDY I'LL TALK
TO ABOUT IS FOCUSED ON REDUCING
TRAUMATIC STRESS AND REDUCING
AVOIDANT COPING WITH THE
INTENTION OF INCREASING ART
ADHERENCE AND RETENTION AND CARE
WITH PRIMARY OUTCOME OF VIRAL
LOAD SUPPRESSION.
SO ESSENTIALLY, WE HAVE AN
EXPERIMENTAL DESIGN WHICH IS
COMPARING TWO INTERVENTIONS, AND
OUTCOME IS WHAT'S THE PERCENTAGE
OF VIRAL LOAD SUPPRESSION IN ONE
INTERVENTION VERSUS ANOTHER.
SO THAT'S THE FRAMEWORK.
HONESTLY, IN SOME WAYS SADLY TO
SAY SOME VERY -- THERE'S BEEN
VERY LITTLE WORK IN LOOKING AT
CLINICAL TRIALS WITH THE MENTAL
HEALTH APPROACH AND VIRAL LOAD
SUPPRESSION.
RECENTLY A COUPLE YEARS AGO WE
HAVE LOTS OF ASSOCIATIONS, LOTS
OF IMPLICATIONS THAT THAT CAN BE
EFFECTIVE BUT WE RECENTLY THERE
WAS A STUDY, MAYBE A COUPLE
YEARS AGO, PUBLISHED WITH THE
SIMILAR APPROACH BUT FOCUSED ON
DEPRESSION.
I'M HAPPY TO TALK MORE ABOUT HOW
OBVIOUSLY THEY ARE NOT MUTUALLY
EXCLUSIVE, DEPRESSION AND
TRAUMA, WITH THE FOCUS OF VIRAL
LOAD SUPPRESSION AS THE OUTCOME.
NEXT PLEASE.
JUST BRIEFLY, I WOULD SAY I WANT
TO GIVE A SENSE OF HOW I CAME TO
DEVELOP THIS INTERVENTION,
WHAT'S GUIDED MY THINKING.
THIS HONESTLY WAS A CLINICAL
TRIAL I GOT FUNDED I THINK IN
1999 OR 2000, SO ALMOST 25 YEARS
AGO.
AND IT WAS REALLY THE IDEA THAT
WHAT WE ALREADY KNEW ABOUT THE
IMPACTS OF SEXUAL TRAUMA IN
PREVIOUS RESEARCH THAT WAS NOT
HIV SPECIFIC, THE QUESTION WAS
WHETHER WE DID A TRAUMA COPING
ORIENTED INTERVENTION, COULD WE
ACTUALLY -- IT WAS PREVENTION
FOCUSED AT THE TIME.
IT BECAME AN EVIDENCE-BASED
INTERVENTION FOR CDC AND SAMHSA
BECAUSE WE WERE ABLE TO SHOW
THAT FOCUSING ON SEXUAL TRAUMA
AND PARTICULARLY MORE EFFECTIVE
COPING ACTUALLY RESULTED IN LESS
SEXUAL RISK BEHAVIOR, LESS
COCAINE USE, LESS ALCOHOL, AND A
NUMBER OF SEXUAL AND SUBSTANCE
USE OUTCOMES AS WELL AS
PSYCHOLOGICAL ONES NOT SHOWN
HERE, REDUCTIONS OF PTSD
SYMPTOMS, ACTUALLY FULLY
MEDIATED BY AVOIDANT COPING.
THAT'S WHY CONCEPTUALLY I
FOCUSED ON THE PSYCHOLOGICAL END
OF TRAUMATIC STRESS AND AVOIDANT
COPING.
JUST AS A REMINDER, THIS WAS
FUNDED IN 1999, AND WE ACTUALLY
GOT TREATMENT IN I BELIEVE 1996,
AND SO WE MEASURED ADHERENCE BUT
ADHERENCE WAS NOT THE FOCUS OF
THESE STUDIES.
THEY ALSO WERE VERY -- WHAT I
WOULD CALL U.S. FOCUSED IN
NATURE, IT WAS A VERY INTENSIVE
GROUP INTERVENTION OF COPING
COMPARED TO A SOCIAL SUPPORT
INTERVENTION.
SO, EVERYONE GOT AN
INTERVENTION.
THIS WILL BE A THEME OF WHAT MY
POINT I WANT TO MAKE, THAT I DO
FEEL THAT WHEN YOU DO
INTERVENTIONS OF THIS NATURE,
THAT IT'S NOT EVEN PROBABLY NO
LONGER REALLY ACCEPTABLE TO DO
TREATMENT AS USUAL IF TREATMENT
AS USUAL DOES NOT INVOLVE SOME
TYPE OF MENTAL HEALTH
INTERVENTION.
NEXT SLIDE PLEASE.
SO THAT LED US TO FOCUS, I'VE
WORKED IN IN SOUTH AFRICA SINCE
2000, GENDER-BASED VIOLENCE
ISSUES FOR HIV AND WOMEN THERE.
ABOUT TEN YEARS AGO WE GOT A
PILOT GRANT TO LOOK AT THE
CO-OCCURRING EPIGENETIC OF
SEXUAL TRAUMA AND HIV AMONG
SOUTH AFRICAN WOMEN BASED ON
QUALITATIVE INTERVIEWS, PILOTED
THE INTERVENTION, AND WERE ABLE
TO SHOW THAT -- I'LL TELL YOU
MORE IN A MOMENT BUT ESSENTIALLY
COULD WE ADDRESS TRAUMATIC
STRESS TO IMPROVE CARE
ENGAGEMENT IN GOVERNMENT CLINICS
IN THE CONTEXT OF HIV CAR USING
THIS TASK-SHARING APPROACH, SO
NOT MENTAL HEALTH SPECIALISTS.
NEXT.
SO, THIS ACTUALLY -- I LIKE TO
SHOW THESE VISUALS, DEVELOPMENT
OF CRITICAL EFFECTIVE
COMPONENTS, IN THE INTERVENTION
THAT IS THE EXPERIMENTAL IMPACT
PLUS THAT WE'RE TESTING ACTUALLY
REPRESENT WELL KNOWN
EVIDENCE-BASED TREATMENT
INTERVENTIONS, OR APPROACHES TO
THEM, SO THE PICTURE ON THE LEFT
OF WHAT WE CALL THE COPING
PEBBLES COMES FROM A THEORY OF
STRESS AND COPING THAT'S VERY
COGNITIVE, ONE THING WE LEARNED
THAT WE WANTED TO EMPHASIZE
AFFECTIVE AND RELATIONAL ASPECTS
OF PSYCHOLOGICAL INTERVENTION.
AND SO WE INSTEAD OF A COGNITIVE
MODEL AND EXPLAINING ALL THESE
PROCESSES LIKE HONESTLY WE HAD
DONE IN THE ORIGINAL LIST STUDY,
WE LITERALLY USE A BIG BAG OF
PEBBLES AND WE TALK ABOUT IT AS
A GLOBAL STRESSOR, THAT ONE
SEPARATES OUT THE CHANGEABLE AND
UNCHANGEABLE.
WE FOLLOW THIS THEORY IN AN
INTERACTIVE WAY NOT HIGHLY
COGNITIVE.
THE MIDDLE VISUAL TALKS ABOUT
THE IMPORTANCE OF BOTH WHAT YOU
THINK AND WHAT YOU FEEL, THE
HANDS MEAN INTERACTION WITH
OTHERS.
IT'S INTENDED TO MEAN SOCIAL
RELATIONSHIPS.
AND THE PICTURE ON THE RIGHT IS
CALLED THE IMBIZA POT, A COMMON
COOKING POT USED IN COMMUNITIES
WHERE THE WOMEN LIVE IN OUR
PROJECTS, RESEARCH PROJECTS,
THAT IS VERY OFTEN USED FOR
COMMUNAL COOKING, AND THE FOUR
FACTORS OF POWER, TRUST, SELF
ESTEEM AND SAFETY ARE FROM
COGNITIVE PROCESSING THERAPY, A
WELL-DOCUMENTED EVIDENCE-BASED
TREATMENT THAT THROUGHOUT
QUALITATIVE WORK WE THEN USE
THIS AS A REPRESENTATION OF
THOSE EXPERIENCES BECAUSE THE
INTERPRETATION AND TRANSLATION
IN BOTH LANGUAGE AND CULTURE WAS
IMPORTANT TO DO SOMETHING MORE
RELATIONAL TO THE POTENTIAL
PARTICIPANTS.
SO JUST A FEW EXAMPLES OF THE
PROCESS WE WENT THROUGH OVER A
COUPLE YEARS TAKING WHAT WE
THOUGHT WERE EFFECTIVE
COMPONENTS FROM THE U.S. MODEL
AND GETTING THEM INTO THIS
MODEL.
SO NEXT PLEASE.
SO THIS IS THE STUDY DESIGN FOR
THIS CURRENT TRIAL.
I KNOW I ONLY HAVE A FEW MORE
MINUTES.
THE POINTS I WANT TO MAKE ARE
THAT WE DECIDED TO FOCUS ON
WOMEN AS THEY INITIATE ART, THE
LIST STUDY IN THE U.S. AT ANY
TIME DIDN'T HAVE TO BE
INITIATING ART BUT WE CHOSE TO
DO THIS WITH THE IDEA OF HAVING
VIRAL LOAD SUPPRESSION AS OUR
OUTCOME BECAUSE FIRST WE SAW IT
AS A WINDOW OF OPPORTUNITY LIKE
SOMETIMES WE SAY PREGNANCY IS A
WINDOW OF OPPORTUNITY.
WE SAW INITIATING ART AS A WAY
ONE CAN REFLECT ON THEIR VALUES,
WHAT THEY WOULD LIKE TO ACHIEVE
BY TAKING ART AND USING THAT IN
A MOTION VACCINATIONAL WAY --
MOTIVATIONAL WAY.
THE IMPACT PLUS VERSUS THE
CONTROL CONDITION BUT IT'S
IMPORTANT TO POINT OUT THAT THIS
IS A BRIEFER VERSION OF PROBLEM
SOLVING THERAPY WHICH IS FULLY
ENDORSED BY THE W.H.O. AND BEING
IMPLEMENTED IN MANY COUNTRIES
AROUND THE WORLD, ESSENTIALLY
COMPARING TWO PSYCHOLOGICAL
INTERVENTIONS, AND THE
EXPERIMENTAL INTERVENTION
FOCUSES MUCH MORE ON SEXUAL
TRAUMA AND ADAPTIVE COPING.
AND THEY ARE FOLLOWED FOR A
YEAR.
DID I DO THAT?
OTHER DIRECTION.
THERE YOU GO.
SO JUST BRIEFLY IT'S SUCCESSION,
THERE ARE INDIVIDUALS SESSIONS
CONSIDERED THE MOST FEASIBLE TO
BE IMPLEMENTED, HOPEFULLY WE
THINK IN PRIMARY CARE CLINICS.
THAT'S WHERE THE STUDY IS.
WE HOPE IF IT'S SHOWN TO BE
EFFECTIVE IT COULD BE
IMPLEMENTED IN THESE SAME
SETTINGS.
WE HAVE A SYSTEMATIC WAY OF
SCREENING EVERYONE INITIATING
ART, AND THEN THEY FIND OUT IF
THEY ARE ELIGIBLE, IF THEY WANT
TO BE INVOLVED THEY GET
RANDOMIZED TO ONE OF THE TWO
CONDITIONS AND THEY ARE FOLLOWED
FOR A YEAR OVER TIME, WITH
BIOMARKERS FOR ADHERENCE, WE
TAKE BLOODS FOR VIRAL LOAD AND
GIVE PSYCHOLOGICAL ASSESSMENTS.
NEXT.
SO JUST A LITTLE PIECE OF DATA
SINCE WE'RE ALMOST TO THE
CONCLUSION OF OUR ENROLLMENT.
OUR SAMPLE SIZE TARGET IS 350
WOMEN, AFTER OVER A YEAR OF
COVID DELAY WE'RE GOING TO MAKE
IT.
WE'RE AT 340.
WE HAVE A REMARKABLE
COMMUNITY-BASED FIELD TEAM IN
CAPE TOWN THAT'S JUST BEEN
PHENOMENAL IN GETTING -- BEING
ABLE TO DO THE FIELD WORK
EFFECTIVELY IN A CONTEXT AS A
REMINDER IS VERY FULL OF OTHER
TRAUMATIC ISSUES HAPPENING IN
COMMUNITIES AND EXTREME POVERTY
AND LIMITED ACCESS TO RESOURCES.
SO THIS IS JUST QUICKLY A VISUAL
TO SHOW THAT THIS IS TRAUMATIC
STRESS ON THE LEFT, IN THE
GREEN, DEPRESSION ON THE RIGHT.
DOT TEL LINES ARE A CLINICAL
CUTOFF.
AVERAGES ABOVE, SUGGESTING A
DIAGNOSIS OF PTSD OR DEPRESSION.
BUT MY OWN APPROACH TO DOING --
OUR APPROACH IS NOT TO MAKE IT
DIAGNOSTICALLY ORIENTED.
I DON'T THINK ANY OF US BELIEVE
TWO MORE POINTS ON A TRAUMATIC
STRESS SCALE DOESN'T MEAN YOU
DON'T HAVE TRAUMATIC STRESS IF
YOU DON'T MEET DIAGNOSTIC
CRITERIA.
WE THINK THAT WILL BE
POTENTIALLY MORE SUSTAINABLE AND
REACH MORE WOMEN HOPEFULLY IF
IT GOES INTO SERVICE.
AND SO JUST IN SUMMARY, WE DO
FEEL DOING THIS INTERVENTION
RESEARCH TO ADDRESS SEXUAL
TRAUMA SPECIFICALLY IN THE
CONTEXT OF OTHER STRESSORS AND
TRAUMA IS NEEDED TO ACHIEVE
VIRAL LOAD SUPPRESSION THAT WE
CAN ACTUALLY DO THESE TRIALS
WITH VERY STRONG ETHICAL FOCUS
AS LONG AS THEY ARE COMMUNITY
ENGAGED AND REALLY DEVELOPED
COLLABORATIVELY WITH CLINIC AND
COMMUNITY PARTNERS.
WE HAVE HIGH LEVELS OF MENTAL
HEALTH SYMPTOMS REPORTED BUT WE
HAVE STRONG ATTENDANCE IN THE
INTERVENTION SESSIONS OVER 75%
COME TO 2/3 OR MORE OF THE
SESSIONS, AND WE HAVE RETENTION
THAT'S APPROACHING 80%, 75 TO
80% AT ONE-YEAR FOLLOW-UP.
WE THEY'LL THESE MENTAL HEALTH
INTERVENTIONS CAN BE CULTURALLY
ADAPTED, IMPLEMENTED BY
NON-SPECIALISTS, WHICH HOPEFULLY
NOT THAT WE DON'T HAVE TO BE
VERY AWARE OF IMPACT OF TRAUMA
ON THE INTERVENTIONIST AS WELL
FOR SECONDARY TRAUMA BUT THAT IF
WE THINK IF WE APPROACH THIS, IN
A WAY THAT'S CONSIDERATE OF
THOSE ISSUES, COULD BE DELIVERED
AND SUSTAINABLE.
LAST SLIDE.
WHICH IS THE NUMEROUS PEOPLE
THAT I MUST THANK FOR WHICH WE
WOULDN'T BE ABLE TO DO THE STUDY
BOTH IN THE STATES AND UCT.
SO THANK YOU.
>> I'M UP.
THANK YOU, CATHY, AND TO ALL THE
SPEAKERS FOR AN EXCELLENT AND
ENGAGING SET OF PRESENTATIONS.
I HAVE SOME COMMENTS COMING IN.
ONE FROM -- I'M READING THIS IN
THE PANEL HERE.
SO ONE COMMENT FROM THE GROUP
WAS FOR MARTHA.
THANK YOU FOR TRANSLATING THE
RESEARCH IMPLICATIONS FOR OUR
LIVED EXPERIENCE, I WOULD ADD I
THINK IT'S AWESOME THAT YOU ARE
FILLING THE CYCLE BY
PARTICIPATING IN THE RESEARCH AS
A RESEARCHER AND APPLYING IT AND
TRULY UNDERSTAND SORT OF THE
CONTEXT AS A RESEARCHER AND AS
THE SUBJECT OF RESEARCH.
THAT'S AWESOME.
AND WE HAVE A QUESTION HERE,
I'LL POP THEM UP.
FIRST FOR NADA.
THIS HAS TO DO WITH THE QUESTION
AROUND VACCINE HESITATION.
COULD YOU PLEASE TELL US MORE
ABOUT THE IMPORTANCE OF TRUST
FOR WOMEN AND PEOPLE LIVING WITH
HIV PARTICULARLY IN THE CONTEXT
OF COMORBIDITY AND
MULTI-MORBIDITY, AS RELATES TO
TRUST AND I WOULD ADD WHAT ARE
THE PEARLS OF WISDOM YOU'VE
LEARNED FROM STUDYING THE SPACE
AROUND TRUST OR MISTRUST OR
DISTRUST, AS RELATES TO
VACCINATION AND HOW MIGHT THAT
APPLY TO OTHER MEDICATIONS OR
OTHER CLINICAL SETTINGS, WHAT
CAN WE LEARN FROM THAT?
>> YEAH, GREAT QUESTION.
I WISH I HAD AN ANSWER TO THAT
QUESTION.
I THINK TRUST IS A VERY
COMPLICATED WORD, VERY DIVERSE.
IT'S NOT REALLY ALWAYS A
PROVIDER/PATIENT RELATIONSHIP
TRUST BECAUSE IT COULD BE TRUST
IN MEDICAL SYSTEM, POLICY
ESTABLISHMENT, POLICY SYSTEM IN
THE GOVERNMENT, COULD BE A
MULTI-DIMENSIONAL CONCEPT.
THAT SHOWED UP DURING THE COVID
PANDEMIC.
WE SAW THIS DISTRUST IN SCIENCE
IN GENERAL.
A LOT OF PEOPLE TRUST SCIENTISTS
BUT DON'T TRUST SCIENCE.
IT WAS HARD TO KIND OF ENTANGLE
THAT AND BRING THAT DOWN TO THE
PROVIDER/PATIENT RELATIONSHIP
LEVEL BECAUSE I HAVE PATIENTS
WHOM I HAD WONDERFUL
RELATIONSHIP WITH, THEY TRUST ME
WITH THEIR HIV MEDICATION, WITH
CARE OF HIV, BUT WHEN IT CAME TO
VACCINES IT WAS REALLY HARD TO
EXPLAIN THAT CONCEPT AND WHY ARE
THESE PATIENTS NOT TRUSTING ME
WHEN IT CAME TO THAT.
THAT'S WHEN IT BECAME CLEAR TO
ME THIS IS NOT ABOUT THAT
RELATIONSHIP.
THIS IS A MULTI-DIMENSIONAL
CONCEPT.
THESE ARE PATIENTS WHO ARE VERY
VULNERABLE TO DISTRUST BECAUSE
THEY HAVE BEEN MISTREATED BY THE
SYSTEM OVER AND OVER AND OVER
WHETHER IT'S CRIMINALIZATION
LAWS, THIS LAW OR THAT LAW THAT
KEPT TARGETING THEM, AND WITH
BEING IN A RACIAL/ETHNIC
MINORITY EXPERIENCING IMPACT OF
SYSTEMIC RACISM, SOCIAL
DETERMINANTS OF HEALTH, ET
CETERA, THEY ARE REALLY
VULNERABLE.
THE OTHER PART OF THIS, ACCESS
IN ADDITION TO DISTRUST, NOT
ALWAYS DISTRUST, I DON'T WANT
PEOPLE TO THINK THAT WAS ONLY
THE REASON.
A LOT OF PATIENTS WANTED TO GET
THE VACCINES, THEY WERE THINKING
ACCESS WAS NOT MADE AVAILABLE
EARLY ON, LIMITING EXPOSURE IN
THE COMMUNITY, PEOPLE THEY KNOW
AND TRUST.
IN MY COMMUNITY IS NOT
VACCINATED BECAUSE THEY DON'T
HAVE ACCESS I DON'T HAVE GOOD
EXPERIENCE, I DON'T KNOW WHAT
SIDE EFFECTS THAT HE EXPERIENCE,
ET CETERA.
THANK YOU FOR BRINGING THAT UP.
>> IT REMINDS ME OF DIFFERENCE
BETWEEN LOOKING AT ISSUES OF
RACISM AS A MATTER OF IDEOLOGY
VERSUS STRUCTURAL PROBLEM.
I THINK THAT IDEA THAT YOU CAN
TRUST SCIENTISTS OR CLINICIAN
BUT NOT THE HEALTH SYSTEM OR
SCIENCE AS AN ESTABLISHMENT.
>> CAN I ADD REAL QUICK TOO, WE
KNOW A LOT OF THE YOUNGER WOMEN
AMONG PEOPLE LIVING WITH HIV IN
GENERAL WERE WORRIED ABOUT
REPRODUCTIVE -- IMPACT ON
REPRODUCTIVE OUTCOMES FOR
PREGNANCIES AND SO ON.
AND THEN IN ADDITION TO THAT
THERE WERE QUESTIONS AMONG OUR
COMMUNITY, HOW COME THIS
HAPPENED SO FAST.
YET THEY HAVEN'T COME UP WITH AN
HIV VACCINE YET.
SO THOSE QUESTIONS HAVE BEEN
COMING UP I KNOW.
>> GREAT POINTS.
TO PRESS YOU MORE, ANY
MODIFIABLE FACTORS THAT OUR
COMMUNITY SHOULD FOCUS ON WHEN
TRYING TO IMPROVE SORT OF
TRUSTWORTHINESS OR, MARTHA,
PLEASE JUMP IN WITH IDEAS, WHAT
SHOULD WE TAKE AWAY, AREAS WE
SHOULD FOCUS ON.
>> GREAT QUESTION.
WE NEED TO UNDERSTAND THE ISSUE
A LITTLE DEEPER BECAUSE THERE IS
SO MANY DIMENSIONS, AND MARTHA
MENTIONED AN IMPORTANT POINT.
SO, WE REALLY NEED TO GET A
BETTER UNDERSTAND.
STUDIES JUST ON THAT BY ITSELF
WILL BE VERY HELPFUL TO FORM THE
INTERVENTION.
AND THIS IS A SPACE WHERE NOT
ONLY CLINICIANS, RESEARCHERS
NEED TO BE INVOLVED BUT EVEN
PEOPLE IN POLICY AND POLICY AND
ECONOMICS NEED TO BE INVOLVED TO
FIGURE OUT HOW TO EXPLAIN THIS
PHENOMENA BECAUSE IT'S REALLY
BEYOND JUST THE DIRECT
PATIENT-PROVIDER RELATIONSHIP.
I WOULD SAY STUDIES LOOKING AT
UNDERSTANDING THE ISSUE, BUT
ALSO IMPLEMENTING SOLUTIONS FOR
US.
>> YEAH, AND I WOULD JUST ADD
THAT EDUCATION, I THINK ONE --
THINGS NOW WE'VE SEEN, HOW
PEOPLE AMONG PEOPLE LIVING WITH
HIV ARE NOTICING THEY ARE HAVING
A WORSE IMPACT.
I THINK MY COLLEAGUE J.D. SPOKE
ABOUT LONG COVID AND WE KNOW
THAT AMONG PEOPLE LIVING WITH
HIV WHO ARE EXPERIENCING
SYMPTOMS THAT ARE NEW OR
ELONGATED OR EMPHASIZED, SO
EDUCATION IN THE COMMUNITY IS
REALLY, REALLY IMPORTANT.
>> LOVE IT.
NEXT QUESTION UP IS FOR JULIE.
SO WE LEARNED FROM YOUR TALK
ALTHOUGH RISK FACTORS ARE
SIMILAR ACROSS SECTS, WOMEN
EXPERIENCE HIGHER RATES OF
SERIOUS FALLS AND FRACTURES THAN
MALE COUNTERPARTS.
CAN YOU TELL US MORE ABOUT
POTENTIAL PROTECTIVE FACTORS OF
FALLS AND FRACTURES FOR THIS
POPULATION?
YOU'RE MUTED.
>> HOW MANY YEARS ON ZOOM AND I
STILL FORGET TO UNMUTE MYSELF?
YEAH, SO WHAT'S GREAT ABOUT
FALLS AND FRACTURES, IF YOU CAN
SAY THERE'S ANYTHING GREAT, THEY
ARE TRACKED TOGETHER.
WHAT YOU DO TO DECREASE RISK FOR
FALLS WILL OFTEN HELP DECREASE
RISK FOR FRAGILITY FRACTURES.
EXERCISE IS THE BIG THING THAT
STANDS OUT.
IF YOU CAN GO FOR A WALK,
STRENGTH TRAINING IS GREAT, BUT
REALLY IT'S ANYTHING THAT YOU
CAN DO TO MOVE MORE IS GOING TO
BE HELPFUL.
WITH FRACTURES OF COURSE GETTING
ADEQUATE AMOUNTS OF CALCIUM AND
VITAMIN D IN YOUR DIET.
YOU KNOW, GREEN LEAFY
VEGETABLES, DAIRY PRODUCTS, IF
YOU CAN CONSUME THEM.
ALL OF THOSE THINGS ARE GOING TO
HELP.
>> ONE AREA TO CONTINUE ON, I
WAS THINKING AND SPEAKING WITH A
COLLEAGUE RECENTLY IS ON DEEP --
IS THE RIGHT TERM DEPRESCRIBING?
SOME CHALLENGES, SHE'S A
PSYCHIATRIST, SOME CHALLENGES
AROUND DEPRESCRIBING AS IT COMES
TO LONGSTANDING PRESCRIPTIONS
FOR SOME MEDICATIONS LIKE A
BENZODIAZEPINE TO GO TO SLEEP
EVERY NIGHT, THAT SEEMS LIKE ONE
OF THE MORE NUANCED CHALLENGING
OR PROVOCATIVE AREAS OF THE WORK
THAT YOU PRESENTED, MAYBE YOU
CAN EXPLORE THAT A LITTLE BIT
MORE DEEPLY FOR THE COMMUNITY
AND EXPLAIN WHAT YOUR WISDOM IS
ON HOW TO APPROACH IT?
>> THAT'S A REALLY IMPORTANT
QUESTION.
SO DEPRESCRIBING, SO TRYING TO
DECREASE THE NUMBER OF
MEDICATIONS THAT PEOPLE ARE ON,
ALTHOUGH IT'S ALSO IMPORTANT TO
REMEMBER THAT WHILE DECREASING
TOTAL NUMBER IS IMPORTANT, YOU
CAN ALSO DECREASE THE DOSE.
THAT'S HELPFUL AS WELL.
SO, I THINK ANOTHER ISSUE THAT
SPEAKING AS A PROVIDER THAT WE
RUN INTO IS THAT YOU'RE LOOKING
AT MEDICATION LISTS, 20
MEDICATIONS LONG, YOU FEEL LIKE
HOW AM I GOING TO GET DOWN TO A
NUMBER THAT'S GOING TO HAVE AN
IMPACT ON FALL RISK AND FRACTURE
RISK?
THE GREAT NEWS IS FROM THE WORK
THAT WE'VE DONE WE SEE THAT THE
ASSOCIATION BETWEEN NUMBER OF
MEDICATIONS AND FALL RISK AND
FRACTURE RISK IS PRETTY MUCH
LINEAR, SO EVERY DECREASE IN
MEDICATION NUMBER IS GOING TO
DECREASE BY AT LEAST A SMALL
AMOUNT YOUR RISK OF FALL OR
FRACTURE.
SO, IT'S A REALLY IMPORTANT
THING, DOING -- ALL PROVIDERS
DOING THEIR DUE DILIGENCE, GOING
THROUGH MEDICATION LISTS,
UNDERSTANDING EXACTLY WHAT ALL
OF OUR PATIENTS ARE ON AND WHAT
THEY ARE TAKING, AWARE OF WHAT
THEY ARE TAKING THAT WE'RE NOT
PRESCRIBING AND HAVING A
CONVERSATION ABOUT WHERE CAN WE
CUT BACK, WHERE CAN WE DECREASE
THE DOSE.
I MEAN, YOU KNOW, DOWN THE LINE
HOPEFULLY WE CAN GET MORE WITH
PRECISION MEDICINE AND
UNDERSTAND, OKAY, WHO IS REALLY
AT RISK FOR CARDIOVASCULAR
DISEASE?
YOU KNOW, WHERE CAN WE CUT BACK
ON THOSE MEDICATIONS?
A NUMBER OF OTHER OUTCOMES.
AND REALLY BEING ABLE TO PICK
AND CHOOSE WHO ABSOLUTELY NEEDS
TO BE ON CARDIOVASCULAR
PREVENTION AND WHO PROBABLY
DOESN'T NEED IT OR DOESN'T NEED
IT AS MUCH OR DOESN'T NEED IT AS
EARLY AS SOMEBODY ELSE.
UNFORTUNATELY WE'RE NOT THERE
YET.
BUT I THINK KNOWING WHAT OUR
PATIENTS ARE ON AND HAVING THOSE
CONVERSATIONS ABOUT, YOU KNOW,
STOPPING MEDICATION IF YOU CAN
OR JUST DECREASING THE DOSE OR
FREQUENCY IF YOU CAN'T GET RID
OF THE MED, THOSE ARE REALLY
IMPORTANT CONVERSATIONS TO HAVE.
>> SEEING PATIENTS AT A
HOSPITAL, IT'S SO CHALLENGING
WHEN PEOPLE DON'T HAVE A MEDICAL
HOME AND THERE'S NOBODY STEERING
THE SHIP.
AND YOU WANT TO STEP ON THE TOES
OF OTHER CLINICIANS WHO HAVE
GOOD REASONS FOR STARTING
MEDICATIONS, THERAPEUTIC
ALLIANCE OF THE PATIENT RELATED
TO AN ISSUE, AT THE SAME TIME
THE CUMULATIVE PICTURE BECOMES
EITHER UNSUSTAINABLE OR HAVING
LIABILITIES OF IT'S OWN
DANGEROUS INTRODUCING NEW
PROBLEMS IS THE NEW BIGGEST
PROBLEM, THE FRACTURE IS NOW THE
LIFE-THREATENING THING.
IT MAKES SENSE.
THERE'S NO GOOD ANSWER.
JUST TO PRESS FURTHER, --
>> I WOULD LIKE TO CONTRIBUTE
SOMETHING AS WELL.
>> PLEASE.
MY QUESTION, SEE IF THIS
DOVETAILS, MARTHA, WHAT ABOUT
THOSE BENZOS SPECIFICALLY.
ARE THOSE REALLY SOME OF THE
HIGHEST RISK AND ARE THOSE THE
ONES HARDER TO DEPRESCRIBE?
AND ARE THERE ANY PARTICULAR
CONSIDERATIONS AROUND THAT?
MARTHA, PLEASE JUMP IN AS WELL.
>> YES, SO, YES, I MEAN, YOU
KNOW, WE'VE LOOKED AT
BENZODIAZEPINES A NUMBER OF
DIFFERENT WAYS, THEY ARE HUGELY
PROBLEMATIC BUT THEN YOU HAVE A
CONVERSATION WITH YOUR PATIENT,
HEY, CAN WE GET RID OF THIS, AND
THEN YOU START ON THE
CONVERSATION ABOUT HOW IS YOUR
SLEEP AND ARE YOU SLEEPING, AND
WHAT TIME DO YOU GO TO BED, HOW
LONG DOES IT TAKE YOU TO FALL
ASLEEP?
MOST OF MY PATIENTS WHO ON A
BENZOWERE PRESCRIBED IT MANY
YEARS US A BECAUSE THEY COULDN'T
FALL ASLEEP.
BUT, YOU KNOW, AT THAT POINT IN
TIME THE WHOLE PROCESS ENDED
WITH PRESCRIBING A BENZO, AND
THEN YOU FIND OUT LATER ON THAT
BENZOS CAN ERUPT YOUR SLEEP MORE
THAN HELP.
YOU GET STUCK ON THEM.
IT'S REALLY LARD TO GET OFF OF
THEM.
YOU HAVE THE -- IT'S HARD TO GET
OFF OF THEM.
I WANT TO GET OFF OF IT BUT
WE'VE GOT TO WEAN YOU OFF SO YOU
DON'T HAVE ADDITIONAL PROBLEMS
FROM IT.
BUT I THINK ONE OF THE THINGS,
WE'RE DOING INTERVENTION IN THE
CLINIC WHERE I WORK, TRYING TO
OPTIMIZE, YOU KNOW, FALL AND
FRACTURE PREVENTION FOR ALL OF
OUR PEOPLE WHO ARE OVER THE AGE
OF 50, AND WE'RE FINDING THAT
SLEEP DISTURBANCE IS A HUGE
DRIVER OF MEDICATIONS AND HUGE
DRIVER OF A NUMBER OF VERY
NEGATIVE OUTCOMES.
IF I COULD PUT IN A PLUG FOR
ASSESSING PEOPLE FOR SLEEP,
THAT'S A HUGE ISSUE.
>> AND, YOU KNOW, I ABOUT TEN
YEARS AGO WAS DIAGNOSED WITH A
THING THAT MIMICKED A HEART
ATTACK, AT LEAST TO KNOW HISTORY
OF PRE-EXPOSURE, MY DOCTOR WAS
TALKING, SOMETHING DO WITH A
COUPLE MEDICATIONS I WAS
PRESCRIBED WHICH AS PEOPLE
LIVING WITH HIV WHEN WE COMPARE
NOTES WE'RE TAKING ONE PILL FOR
HIV, TWENTY PILLS FOR ALL THOSE
OTHER THINGS GOING ON WITH US.
BUT SO, AGAIN, I KIND OF WANT TO
DIFFER IN THE SENSE I FEEL LIKE
YOU ALREADY DO KNOW THOSE PEOPLE
THAT ARE PRE-DISPOSED TO
CARDIOVASCULAR FROM THEIR
RESEARCH AND SOMETIMES IT'S
CONNECTED WITH INCOME, CONNECTED
WITH OUR RACE AND ETHNICITY,
THAT WE CAN ALMOST PREDICT AND
KNOW THOSE COMMUNITIES THAT ARE
PRE-DISPOSED AND WE'VE HEARD
ABOUT RESEARCH, FOR EXAMPLE, AT
JOHNS HOPKINS THAT USED OZEMPIC
TIED WITH LIVER DISEASE BUT
IMPROVED OBVIOUSLY WEIGHT LOSS
AND PREDISPOSURE TO DIABETES, I
WANT TO EMPHASIZE THIS POINT, WE
HAVE ALL THIS INFORMATION, YOU
ALL HAVE, AND I FEEL LIKE IF IT
DID COME TOGETHER WE COULD HAVE
BETTER INTERVENTIONS FOR PEOPLE
BECAUSE THERE ARE PEOPLE WHO
ALREADY KNOW THIS AND PEOPLE WHO
ALREADY KNOW THIS AND PEOPLE MAY
HAVE TESTED THIS OUT, BUT IT'S
NOT HELPING US.
WE ALREADY KNOW THAT IN OUR
COMMUNITY WE'RE OBESE, A LOT OF
US HYPERTENSION AND SO ON, IF
THEY COULD JUST INCLUDE IN OUR
CARE FREE MEMBERSHIP TO THE GYM,
ENCOURAGEMENT TO SEE NUTRITION
SPECIALIST, SMALL THINGS THAT
CAN START IMPROVING OUR CARE AS
RELATES TO THESE THINGS IT WOULD
SHALL HELPFUL.
>> I THINK THAT'S A REALLY GOOD
POINT TO END ON.
I'M GOING TO READ OUT THE OTHER
QUESTIONS TO STIMULATE THOUGHTS
AND MAYBE FUTURE DISCUSSIONS
AMONG THE GROUP, WHICH ARE WE
DIDN'T GET TO, AROUND FOR KATHY
AROUND SUSTAINABILITY OF
INTERVENTION THAT LEVERAGE
NON-SPECIALISTS AS A WORKFORCE,
NEXT STEPS FOR THE NETWORK
APPROACH THAT LEAH WAS
DESCRIBING, THAT WAS SOMETHING
NEW FOR A LOT OF US TO HEAR
ABOUT.
THERE SEEMS TO BE A LOT OF
INTEREST IN LEARNING MORE ABOUT
WHAT ELSE WE CAN DO WITH THOSE
TECHNOLOGIES AND THAT APPROACH.
AND THEN THE LAST QUESTION HERE
IS -- I'M FORGETTING WHAT IT
STOOD FOR, THE QUESTION ABOUT
VAX, LOOKING AT HOW TO IMPROVE
COLLABORATION AND REPRESENTATION
IN THOSE POPULATIONS BEING
STUDIED.
AND LAST QUESTION HERE, FOR
MARTHA, WHAT YOU WOULD LIKE TO
SEE MORE OF IN TERMS OF POLICY
CHANGES AND HOW DO WE WORK TO
ACHIEVING THEM.
WE'LL END ON IN A NOTE, WITH A
QUESTION MARK, BUT I THINK I'M
EXCITED FOR THE PEOPLE IN THIS
ROOM TO CONTINUE THE
CONVERSATION AND THIS WAS REALLY
THE TIP OF THE ICEBERG AND SUCH
A GREAT OPPORTUNITY TO LEARN
ABOUT THE WORK THAT EVERYBODY
HAS BEEN DOING TO DEVELOP THIS
SPACE.
THANKS, EVERYONE.
>> GO AHEAD, REBECCA.
>> YOU WANT US TO START?
>> YES, THANK YOU.
>> OKAY.
WELCOME.
THANK YOU FOR JOINING US TODAY
VIA NIH VIDEOCAST FOR TODAY'S
SESSION ON CANCER AND HIV.
I'M REBECCA HUPPI, CO-MODDAT
RATER IS GERALDINE DOMINGUEZ,
FROM THE NATIONAL CANCER
INSTITUTE.
TODAY'S SPEAKERS ARE SHOWN HERE,
FULL BIOS CAN BE FOUND ON THE
EVENT WEB PAGE.
DR. CARLA CHIBWESHA, ASSOCIATE
PROFESSOR AT UNIVERSITY OF NORTH
CAROLINA AT CHAPEL HILL UNC.
MAJORITY OF HER WORK IS FOCUSED
ON CERVICAL CANCER PREVENTION,
SPECIAL INTEREST IN INTERVENTION
BETWEEN HPV AND HIV.
DR. JOEL PALEFSKY TRAINED IN
MEDICINE AND INTERNAL MEDICINE
AT MCGILL UNIVERSITY, AND IN
INFECTIOUS DISEASE AT STANFORD,
INTERNATIONALLY RECOGNIZED
EXPERT ON THE MOLECULAR BIOLOGY,
TREATMENT, PATHOGENESIS AND
NATURAL HISTORY OF HPV INFECTION
IN HIV.
DR. ANNA COGHILL, MOFFITT CANCER
CENTER AND RESEARCH INSTITUTE,
PRINCIPAL INVESTIGATOR FOR THE
MOFFITT SITE.
DR. KIMBERLY LEVINSON, JOHNS
HOPKINS SCHOOL OF MEDICINE IN
BALTIMORE, DIRECTOR OF JOHNS
HOPKINS GYNECOLOGIC ONCOLOGY
GREATER BALTIMORE MEDICAL
CENTER, FOCUSING ON LOWER
GENITAL TRACT DISEASE
SPECIFICALLY CERVICAL CANCER.
BENDA KITHAKA USES POWER OF
STORY TELLING TO HARNESS LIVED
EXPERIENCES AS TOOLS FOR
ADVOCACY, HIGHLIGHTING CANCER
SURVIVOR 14*EU7 CHALLENGES AND
ADVOCATE FOR POST TREATMENT
EMPOWERMENT OF CANCER SURVIVORS.
GIRLS AND WOMEN MAKE OF HALF THE
PEOPLE LIVING WITH HIV.
THESE GIRLS AND WOMEN AGE WITH
HIV, THE RESPONSE MUST ALSO
INCLUDE FOCUS ON CANCER
PREVENTION AND TREATMENT
PARTICULARLY GYNECOLOGIC CANCER.
AFRICA HAS THE LARGEST NUMBER OF
WOMEN LIVING WITH HIV.
CANCER HAS BEEN A MANIFESTATION
OF HIV/AIDS SINCE THE BEGINNING
OF THE EPIGENETIC, AND IS A
LEADING CAUSE OF MORBIDITY,
PRIOR TO THE USE OF HIGHLY
ACTIVE ANTIRETROVIRAL CANCER
THERE WAS A RISE IN KAPOSI
SARCOMA SUGGESTING A PERSON
MIGHT HAVE AIDS, THEY TERMED
THESE AIDS DEFINING, AS MORE
WOMEN WERE DIAGNOSED CANCER WAS
RECOGNIZED AS AIDS DEFINING,
WITH SUCCESSFUL USE OF HAART
THERE'S BEEN A DECREASE, PEOPLE
WITH HIV LIVING LONGER, I'VE
HIGHLIGHTED THREE TYPES OF
CANCER, CERVICAL, ANAL, AND HEAD
AND NECK, ALL THREE CAUSED BY A
VIRUS, THE HUMAN PAPILLOMAVIRUS,
AND HPV IS A MAJOR ASPECT OF THE
TALK IN THIS SESSION.
HUMAN PAPILLOMA -- I'M SURE EACH
SPEAKER IS GOING TO GO MORE IN
DEPTH IN THEIR TALKS BUT I WANT
TO GIVE A BRIEF OVERVIEW OF
HPV-ASSOCIATED CANCERS.
HPV IS A GROUP OF 200 RELATED
VIRUSES OF WHICH ABOUT 12 TYPES
ARE CONSIDERED HIGH RISK, CAN
CAUSE CANCER.
HOWEVER, TWO HIGH RISK TYPES, 16
AND 18, ARE RESPONSIBLE FOR MOST
CANCERS.
INFECTION IS COMMON AND MOST
SEXUALLY ACTIVE PEOPLE ARE
INFECTED WITH HPV.
FOR THE MOST PART, HPV
INFECTIONS GO AWAY ON THEIR OWN
WITHOUT CAUSING CANCER.
HOWEVER, WHEN HPV INFECTIONS ARE
NOT SUCCESSFULLY CONTROLLED BY
YOUR IMMUNE SYSTEM, HIGH RISK
HPV INFECTION PERSISTS FOR MANY
YEARS, IT CAN LEAD TO CELL
CHANGES, SHOWN IN THE PICTURE TO
THE RIGHT, IF UNTREATED CAN GET
WORSE OVER TIME AND BECOME
PRE-CANCEROUS AND THEN CANCER.
CANCER CAN OCCUR IN ANY TISSUE
THAT BECOMES EXPOSED TO HPV, IN
THE TALKS YOU'LL BE HEARING
TODAY, FOCUS WILL BE ON CERVICAL
CANCER, ANAL AND GYNECOLOGIC.
FIRST SPEAKER IS DR. CHIBWESHA.
>> THANKS FOR THE INTRODUCTION.
HELLO.
AGAIN I'M CARLA CHIBWESHA,
OBSTETRICIAN GYNECOLOGIST,
ASSOCIATE PROFESSOR OF GLOBAL
WOMEN'S HEALTH UNIVERSITY OF
NORTH CAROLINA AT CHAPEL HILL.
I LIVE AND WORK IN SOUTH AFRICA
WHERE MY RESEARCH IS FOCUSED ON
CERVICAL CANCER PRESERVE.
I'LL SHARE AN OVERVIEW IN WOMEN
LIVING WITH HIV.
NEXT SLIDE PLEASE.
SO, IT'S ESTIMATED THAT NEARLY
98% OF CERVICAL CANCERS ARE
CAUSED BY HPV, WHICH IS
TRANSMITTED SEXUALLY AS DR.
HUPPI MENTIONED.
AND AFFECTS CELLS OF THE SKIN,
GENITAL AREA, THROAT.
HPV INFECTION IS EXTREMELY
COMMON, AS YOU'VE JUST HEARD.
ABOUT 60% OF SEXUALLY ACTIVE
WOMEN WILL BECOME INFECTED WITH
HPV WITHIN FIVE YEARS OF
BECOMING SEXUALLY ACTIVE.
THERE ARE APPROXIMATELY 200
TYPES, CLASSIFIED AS HIGH RISK
OR LOW RISK.
THERE ARE THOUGHT TO BE 12 HIGH
RISK TIMES WHICH CAUSE CERVICAL
CANCER, 16 AND 18 RESPONSIBLE
FOR 2/3 OF CERVICAL CANCERS
GLOBALLY.
NEXT SLIDE PLEASE.
ALTHOUGH HPV INFECTION IS COMMON
AS MENTIONED PREVIOUSLY IT'S
OFTEN CLEARED BY THE IMMUNE
SYSTEM.
IF IT'S NOT WE ALSO HAVE SEVERAL
EFFECTIVE WAYS TO PREVENT HPV
AND CERVICAL CANCER.
FIRSTLY IN THE PINK BOX
INFECTION CAN BE PREVENTED
THROUGH VACCINATION.
AND SEVERAL VACCINES HAVE BEEN
ON THE MARKET FOR NEARLY 20
YEARS NOW, TARGETING 16 AND 18,
INCLUDING GARDASIL AND CERVARIX,
ALL SAFE, HIGHLY EFFECTIVE.
VACCINATION IS RECOMMENDED PRIOR
TO SEXUAL DEBUT BUT CATCH-UP
VACCINES CAN BE GIVEN UP TO AGE
46.
AND IF WE HAVE COVERAGE RATES
APPROACHING 90% SET BY W.H.O.
HALF OF ALL CERVICAL CANCERS
COULD BE PREVENTED.
SECONDLY IN THE GRAY BOX
CERVICAL CANCER CAN BE PREVENTED
BY SCREENING FOR PRE-CANCEROUS
CHANGES IN THER CERVIX OR
TREATING.
PAP SMEARS SCREEN, AND IN
WELL-ORGANIZE SYSTEMS SCREENING
AND ATTENDANT TREATMENT HAS
BROUGHT RATES OF CERVICAL CANCER
DOWN DRAMATICALLY.
NEXT SLIDE PLEASE.
UNFORTUNATELY, ACCESS TO
CERVICAL CANCER SCREENING
INITIALLY WITH PAP SMEARS AND
NOW HPV TESTS IS HIGHLY VARIABLE
AROUND THE WORLD.
AND DESPITE HAVING TWO EXCELLENT
WAYS TO PREVENT IT, NEARLY
700,000 WOMEN ARE STILL NEWLY
DIAGNOSED EACH YEAR.
THIS IS A DISEASE OF INEQUALITY,
AND THE HIGHEST BURDEN OF
CERVICAL CANCER CASES ARE SHOWN
IN DARK BLUE, BOLD ON POOREST
REGIONS, IN AFRICA, ASIA, PARTS
OF LATIN AMERICA.
THESE GEOGRAPHIC VARIATIONS IN
RATES ARE DUE TO DIFFERENCES IN
AVAILABILITY OF HPV VACCINATION
AND CERVICAL SCREENING AS WELL
AS DIFFERENCES IN THE PREVALENCE
OF HPV AND HIV.
NEXT SLIDE PLEASE.
SIMILARLY CERVICAL CANCER DEATHS
ARE HIGHEST IN AREAS OF THE
WORLD WHERE WOMEN DON'T HAVE
ACCESS TO SURGICAL CARE OR
RADIATION AS SHOWN IN DARK RED.
AND CANCER THAT'S PREVENT
ANDABLE CURABLE KILLS 400,000
EACH YEAR.
I'D LIKE TO SPEND REMAINING TIME
DRILLING DOWN ON SOME OF THE
ISSUES THAT MAKE CERVICAL CANCER
SO DEADLY FOR WOMEN WHO DON'T
HAVE ACCESS TO GOOD HEALTH CARE
WHETHER IN THE U.S. OR GLOBALLY.
LOOKING AT THE LEFT-HAND SIDE OF
THE SLIDE THERE'S A LOT OF MYTHS
AND MISCONCEPTIONS, MOST
COMMONLY IN OUR SETTING IN SOUTH
AFRICA I FOUND MANY TYPES OF
CANCER GET LUMPED TOGETHER, AS
EITHER HEREDITARY,
ENVIRONMENTAL, OR LIFESTYLE
DISEASES.
MOST OF OUR PATIENTS AND
PARTICIPANTS ARE SURPRISED TO
LEARN CERVICAL CANCER IS CAUSED
BY A VIRUS AND CAN BE PREVENTED
BY VACCINATING YOUNG PEOPLE.
WITH RARE EXCEPTIONS IN SOME
HIGH-INCOME COUNTRIES HEALTH
SYSTEMS HAVE DONE A TERRIBLE JOB
WITH HPV VACCINATION SO FAR.
60% OF YOUNG PEOPLE IN THE U.S.
HAVE BEEN VACCINATED, 20% OF
BOYS, NEARLY NO BOYS IN THE
HIGHEST REGIONS THE WORLD HAVE
BEEN VACCINATED WITH THE HPV
VACCINE.
IF YOU THINK CANCER IS
HEREDITARY THERE'S A FATALISM
AROUND SCREENING AND PREVENTION,
FIT RUNS IN YOUR FAMILY YOU
CAN'T ESCAPE IT.
TURNING TO THE RIGHT-HAND SIDE
OF THE SLIDE IF WE CONSIDER
SCREENING AND TREATMENT FOR
CERVICAL PRE-CANCER ACCESS TO
CARE IS HUGELY IMPORTANT.
THERE ARE SPECIAL CONSIDERATIONS
FOR WOMEN LIVING WITH HIV.
NEXT SLIDE PLEASE.
BECAUSE OF THE BIOLOGICAL AND
BEHAVIORAL OVERLAP BETWEEN HPV
AND HIV, WE SEE MUCH HIGHER
RATES OF HIV INFECTION AMONG
WOMEN LIVING WITH HIV.
SYSTEMS ARE LESS EFFICIENT,
RATES OF CERVICAL PRE-CANCER,
FOR EXAMPLE, IN WOMEN LIVING
WITH HIV ARE TWO TO THREE TIMES
HIGHER THAN WOMEN WHO DON'T HAVE
HIV.
PRE-CANCER IS HARDER TO TREAT
AND PROGRESSES MORE QUICKLY TO
INVASIVE CANCER.
NEXT SLIDE PLEASE.
OF COURSE EVERYONE IS FAMILIAR
WITH THIS SLIDE, A VISUAL
REMINDER THAT HIV IS MOST
PREVALENT, SAME REGIONS OF THE
WORLD, WHERE THE CERVICAL CANCER
BURDEN IS HIGHEST.
NEXT SLIDE PLEASE.
THE STORY OF CERVICAL CANCER IN
SOUTH AFRICA WHERE I LIVE AND
WORK REALLY ILLUSTRATES THE
INEQUALITY.
SOUTH AFRICA IS ONE OF JUST 37
COUNTRIES IN WHICH CERVICAL
CANCER REMAINS THE LEADING CAUSE
OF CANCER DEATH AMONG WOMEN.
SOUTH AFRICA ISN'T NECESSARILY
POOR.
SOCIOECONOMIC AND RACIAL
INEQUALITY TRACK TOGETHER WITH
RISK FOR BOTH HPV AND HIV IN
SOUTH AFRICA AND POOR WOMEN HAVE
THE FEWEST CHOICES WHEN IT COMES
TO THEIR HEALTH CARE, OFTEN
FACING YEAR-LONG WAITING TIMES
FOR CARE OR RECEIVING
SUBSTANDARD CARE.
THE RESULT IS THAT CERVICAL
CANCER RATES FOR BLACK SOUTH
AFRICANS ARE TWO TIMES HIGHER
THAN WHITE, AND TREATMENT
OUTCOMES ARE EQUALLY DISPARATE.
SKIP TWO SLIDES PLEASE.
THANK YOU.
RETURNING TO A MORE GENERAL
DISCUSSION OF SCREENING AND
PRE-CANCER TREATMENTS, CERVICAL
CANCER SCREENING APPROACHES AND
SCREENING RECOMMENDATIONS
PARTICULARLY FOR PAP SMEARS AND
HPV TESTS ARE SIMILAR REGARDLESS
OF A WOMAN'S HIV STATUS, SOME
DIFFERENCES IN THE FREQUENCY OF
SCREENING BUT OTHER THAN THAT
APPROACHES DON'T DIFFER MUCH.
WE STILL NEED ACTIVE RESEARCH
AND HOW TO IMPROVE PRE-CANCER
TREATMENT FOR WOMEN LIVING WITH
HIV.
AS I MENTIONED, IT IS QUITE A
LOT HARDER TO CURE PRE-CANCER IN
WOMEN LIVING WITH HIV, WITH THE
EXISTING SURGICAL TREATMENTS WE
HAVE WOMEN LIVING WITH HIV
EXPERIENCE PRE-CANCER TREATMENT
FAILURE OR RECURRENT CERVICAL
DISEASE IN UP TO 50% OF CASES.
THIS IS THOUGHT TO BE DUE TO
RESIDUAL DISEASE THAT'S NOT
COMPLETELY REMOVED DURING
SURGERY, TO REINFECTION WITH
ANOTHER HPV TYPE OR REACTIVATION
OF UNDERLYING HPV INFECTION IN
THE GENITAL TRACT.
NEXT SLIDE PLEASE.
SEVERAL GROUPS ARE WORKING ON
THE IMPORTANT TASK OF IMPROVING
CERVICAL CANCER, CERVICAL
PRE-CANCER TREATMENT IN WOMEN
LIVING WITH HIV.
ON THIS SLIDE I'VE INCLUDED TWO
EXAMPLES OF STUDIES MY TEAM IS
PARTICIPATING IN.
FIRST INCORPORATION HPV
VACCINATION AT THE TIME OF
TREATMENT FOR CERVICAL
PRE-CANCER.
AND IS AIMED AT PREVENTING NEW
HPV INFECTIONS, AND THE SECOND
USES A CHEMOTHERAPY CREAM IN
COMBINATION OF STANDARD SURGICAL
TREATMENT WITH PURPOSE OF
TREATING RESIDUAL DISEASE.
BOTH OF THESE STUDIES ARE FUNDED
BY THE NIH, WHICH WE'RE GRATEFUL
FOR AND LOOK FORWARD TO RESULTS
IN ABOUT 2026.
NEXT SLIDE PLEASE.
SO SUMMARY, THE
SOCIODEMOGRAPHIC, BEHAVIORAL AND
BIOLOGICAL OVERLAP BETWEEN HPV
AND HIV RESULTS IN A HIGH
BURDEN.
VACCINATION IS SAFE AND
EFFECTIVE IN INDIVIDUALS WITH
HIV AND SHOULD BE DOING MORE TO
SCALE UP VACCINATION FOR YOUNG
PEOPLE GLOBALLY.
WHEN COUPLED WITH TREATMENT FOR
PRE-CANCEROUS CELLS, SCREENING
WITH PAP SMEARS AND/OR HPV
PREVENT CANCER, WE SHOULD DO
MORE TO ACCESS SCREENING.
HOWEVER, ADDITIONAL RESEARCH IS
NEEDED TO DEVELOP MORE EFFECTIVE
PRE-CANCER TREATMENTS FOR WOMEN
LIVING WITH HIV.
OF COURSE IT GOES WITHOUT SAYING
THAT CERVICAL CANCER PREVENTION
SERVICES OUGHT TO BE INTEGRATED
INTO HIV CARE, AS A WAY TO
EXPAND ACCESS FOR WOMEN LIVING
WITH HIV.
I THINK THAT'S MY LAST SLIDE.
>> THANK YOU SO MUCH, DR.
CHIBWESHA.
PLEASE SUBMIT QUESTIONS,
COMMENTS, VIA THE "LIVE
FEEDBACK" OPTION BELOW THE
VIDEOCAST.
NOW WE'LL HEAR FROM DR. JOEL
PALEFSKY.
PLEASE GO AHEAD.
>> THANK YOU VERY MUCH FOR
INCLUDING ME IN THIS VERY
IMPORTANT WEBINAR.
I'M GOING TO TALK ABOUT THE
ANCHOR STUDY WHERE ANCHOR STANDS
FOR ANAL CANCER RESEARCH STUDY,
THE REASON FOR THIS PRESENTATION
AND THE WORK WAS NICELY OUTLINED
BY DR. HUPPI IN THE
INTRODUCTION, THAT ALTHOUGH
CERVICAL CANCER IS THE MOST
IMPORTANT CANCER CAUSED BY HPV,
THERE ARE SEVERAL OTHER CANCERS
THAT ARE CAUSED BY HPV THAT MAY
POTENTIALLY BE AMENABLE TO
PREVENTION AND THESE CANCERS
HAPPEN TO BE MORE COMMON IN THE
SETTING OF PEOPLE LIVING WITH
HIV THAN THOSE WITHOUT.
JUST A LITTLE WORD ABOUT THE
DIFFERENCE BETWEEN CERVICAL AND
ANAL CANCER, TWO DIFFERENT
ANATOMIC ORGANS, CERVICAL CANCER
IS THE MOST COMMON OF THE
HPV-ASSOCIATED CANCERS, AND YOU
CAN SEE IN THIS GRAPH ON THE
LEFT THAT THE PREVALENCE OF
CERVICAL CANCER IS LATE 40s,
EARLY 50s, STARTS TO DECLINE.
ANAL CANCER IS LESS COMMON IN
THE GENERAL POPULATION, BUT I
WILL SHOW YOU SOME DATA ABOUT
THE INCIDENCE OF THIS CANCER IN
PEOPLE LIVING WITH HIV.
THIS IS A CANCER THAT CAN AFFECT
ANYBODY, AND SO WE SEE IT IN
BOTH MEN AND WOMEN, AND HERE YOU
CAN SEE ON THIS SLIDE THAT
UNLIKE CERVICAL CANCER WHICH
PEAKED AT THAT EARLIER AGE, ANAL
CANCER CONTINUES TO INCREASE IN
INCIDENCE AS WOMEN GET OLDER
SHOWN IN BLUE GRAPH AND THEN IN
MEN ANAL CANCER INCREASES WITH
AGE, PLATEAUS OFF.
TWO IMPORTANT POINTS ON THIS,
ONE IS YOU'LL SEE HERE THAT
ANNAL CANCER IS MORE COMMON
THIS IS A GROUP OF PEOPLE WHO
RESEMBLED U.S. HIV POPULATION
DEMOGRAPHICS, AND TO IDENTIFY
THE 4400 OR SO PEOPLE RANDOMIZED
WE SCREENED 10,723 PEOPLE LIVING
WITH HIV, AND WHAT THIS SHOWS IS
THE EXTRAORDINARILY HIGH
PREVALENCE OF THESE
PRE-CANCEROUS LESIONS, 53 OF
MEN, 47% OF WOMEN, EARLIER
STUDIES HAVE SHOWN WOMEN WERE
SUBSTANTIALLY LOWER RATES THAN
AMONGST MEN, HERE THAT WASN'T
THE CASE, ALMOST AS MUCH HSIL
WOMEN AS MEN.
, TRANSGENDER HIGHEST RATES OF
ALL.
WHEN YOU SCREEN MORE THAN 10,000
YOU EXPECT TO FIND PREVALENT
CASES OF ANAL CANCER, WE DID, 17
INDIVIDUALS, 160 PER 100,000.
NEXT SLIDE.
THE MAIN RESULTS WERE SHOWN
AFTER DEMOGRAPHICS, MEDIAN AGE
OF 51 YEARS, AND THEY WERE 17
YEARS OUT ON AVERAGE, AFTER HIV
INFECTION.
WE FOLLOWED FOR 2 1/2 YEARS ON
AVERAGE, 17% OR SO OF THE
POPULATION WERE FEMALE.
AND 3.1% WERE IDENTIFIED AS
TRANSGENDER.
NEXT SLIDE PLEASE.
A THIRD OF THE POPULATION
NON-HISPANIC WHITE, 42% AFRICAN
AMERICAN, 15% WERE HISPANIC
NON-AFRICAN AMERICAN.
23% HETEROSEXUAL, 78.5%
HOMOSEXUAL, AND 8% REPORTED
INJECTION DRUG USE.
57% REDUCTION, STATISTICALLY
SIGNIFICANT.
YOU CAN SEE PROGRESSION RATES IN
HSIL TO CANCER, 173 IN THE
TREATMENT ARM, THE DELTA
RESULTED IN THE STATISTICAL
SIGNIFICANCE, WHILE WE CAN
PREVENT ANAL CANCER WE CAN DO
EVEN BETTER WITH BETTER
TREATMENT FOR ANAL HSIL GIVEN
HIGH RATES OF PROJECTION IN
TREATMENT ARM.
ALMOST ALL OF THEM WERE TREATED
WITH AN OFFICE-BASED TECHNIQUE,
A FORM OF ELECTRIC CAUTERY, AND
RELATIVELY STRAIGHTFORWARD, DONE
IN THE OFFICE, IN 10 TO 15
MINUTES, AND THE NEXT SLIDE
SHOWS YOU THAT THE ADVERSE EVENT
RATE WAS VERY, VERY LOW, AND
TREATMENT ARM DESPITE MANY
THOUSANDS OF PROCEDURES, WE HAD
ONLY 7 STUDY-RELATED SERIOUS
ADVERSE EVENTS, THAT CLEARED UP
OVER A WEEK TO TWO WEEKS,
PRIMARILY BLEEDING OTHER PAIN.
THIS IS A PROCEDURE THAT CAN BE
DONE EASILY IN THE OFFICE, AND
IS QUITE SAFE.
NEXT SLIDE.
WOMEN HAVE A HIGH PREVALENCE OF
ANAL HSIL, AT RISK OF ANAL IN
ADDITION TO CERVICAL CANCER.
WE CAN REDUCE THE RISK AMONGST
THOSE WITH ANAL HSIL AND SEVERAL
ENTITIES HAVE PUT OUT A
GUIDELINE THAT MAKES SCREEN FOR
AND TRAINING STANDARD OFCARE IN
THE UNITED STATES, FOR PEOPLE
LIVING WITH HIV.
AND FOR WOMEN LIVING WITH HIV
SPECIFICALLY, WE RECOMMEND
STARTING AT AGE 45 YEARS FOR THE
SCREENING THAT MAY LEAD TO
IDENTIFICATION OF LESIONS.
FIRST ENTITY THAT CAME OUT WITH
THESE GUIDELINES IS
INTERNATIONAL ANAL NEOPLASIA
SOCIETY, WE EXPECT CDC
GUIDELINES SOON.
NEXT SLIDE PLEASE.
WHAT DOES THAT SCREENING LOOK
LIKE?
IT WILL INCLUDE DIGITAL EXAM TO
FEEL FOR LESIONS THAT MAY BE
CANCEROUS AND A COMBINATION
USING SWAB OF EITHER CYTOLOGY
LIKE PAP SMEAR OR HPV TESTING OR
BOTH AGAIN STARTING AT AGE 45
YEARS, AND THEN CDC GUIDELINES
FOR THOSE SHOWN TO HAVE A BIOPSY
PROVEN HIGH GRADE LESION
RECOMMEND TARGETED ABLATION AS
FIRST LINE THERAPY.
WE HAVE A LOT OF WORK TO DO.
THIS IS STILL NEW.
WE'VE LEARNED WHATS THAT TAKEN
THOSE INVOLVED IN PREVENTION OF
CERVICAL CANCER MANY DECADES TO
FIGURE OUT.
WE'RE STILL YOUNG AT THIS.
WE NEED TO OPTIMIZE SCREENING
ALGORITHMS.
WE NEED TO IDENTIFY MARKERS,
HAVE MARKERS OF WHO IS LIKELY TO
PROGRESS, SO THAT IN THE FUTURE
PERHAPS WE DON'T HAVE TO TREAT
EVERYBODY.
WHO HAS A HIGH GRADE LESION.
WE NEED TO DETERMINE BEST
FOLLOW-UP METHODS AFTER
TREATMENT AND BECAUSE SO MANY
PEOPLE HAVE THESE PRE-CANCEROUS
LESIONS THAT MEANS MANY PEOPLE
ARE GOING TO NEED AN HRA AND
TREATMENT AND WE NEED TO ADDRESS
A HUGE GAP IN NEED AND NUMBER OF
PEOPLE CURRENTLY TRAINED TO DO
THIS TECHNIQUE WHICH TAKES QUITE
A BIT OF TIME AND DETERMINATION
TO ACQUIRE NECESSARY LEVEL OF
COMPETENCE.
SO WE NEED TO LEARN HOW TO TRAIN
MORE PEOPLE MORE QUICKLY.
BECAUSE I SHOWED THAT WE HAD
LEVELS OF PROGRESSION DESPITE
TREATMENT THAT WERE STILL TOO
HIGH WE NEED BETTER TREATMENT
METHODS FOR ANAL HSIL IN THE
FUTURE.
WITH THAT, AGAIN, THANK YOU VERY
MUCH FOR LISTENING.
AND LOOK FORWARD TO AN
INTERESTING DISCUSSION.
NEXT DR. ANNA COGHILL.
PLEASE GO AHEAD.
>> THANK YOU, REBECCA.
I'M AT MOFFITT CANCER CENTER.
YOU CAN GO TO THE NEXT SLIDE.
AND TODAY WE'LL FOCUS ON
ESSENTIAL TREATMENT DOES MEAN
PEOPLE WITH HIV ARE LIVING
LONGER, UNINTENDED CONSEQUENCE
THOSE INDIVIDUALS ARE DEVELOPING
DISEASES OF OLD AGE, CHRONIC
CONDITIONS LIKE CANCER MORE
FREQUENTLY.
WE'VE DONE RESEARCH TO
DEMONSTRATE PEOPLE WITH HIV DO
NOT ALWAYS RECEIVE APPROPRIATE
LEVELS OF TREATMENT, AND HAVE
OUTCOME DISPARITY.
THIS PROJECTS THROUGH 2030,
REPRESENTING DIFFERENT AGE
GROUPS.
YOU CAN SEE THE RED AND PURPLE
BARS ARE INCREASING OVER TIME.
THOSE BARS REPRESENT INDIVIDUALS
AGED 65+ IN RED, TO 64 IN
PURPLE, TAKE HOME MESSAGE LIFE
EXPECTANCY IS INCREASING.
THERE ARE CANCERS THAT
INDIVIDUALS WITH HIV DEVELOP
MORE FREQUENTLY, HPV-RELATED
CANCERS, HIV DOES NOT INCREASE
RISK OF EVERY CANCER TYPE.
MANY CANCERS NOT ASSOCIATED WITH
INFECTION DO NOT NECESSARILY
HAPPEN MORE FREQUENTLY.
HOWEVER, AS THE POPULATION WITH
HIV AGES AND THERE ARE MORE
INDIVIDUALS REACHING AGES WHERE
THOSE DISEASES LIKE BREAST
CANCER WOULD BE DIAGNOSED, THE
BURDEN INCREASED.
MOVING FORWARD, IN THE UNITED
STATES, YOU'LL SEE A RATHER
LARGE CHANGE EVEN OVER COURSES
OF TWO DECADES FROM THE BAR IN
2010 ON THE LEFT WHERE
NON-HODGKIN'S LYMPHOMA WAS MOST
COMMON CANCER DIAGNOSED IN THE
SETTING OF HIV IN THE U.S., TO
2030 PROJECTIONS, YOU STILL SEE
THE RED SECTION OF THE BAR ON
THE RIGHT, CANCERS OF AGING LIKE
PROSTATE, LUNG, LIVER CANCER ARE
GOING TO BECOME MORE COMMON,
CANCERS OF AGING.
AND YOU CAN SEE ALL THE
DIFFERENT CANCERS THAT ARE
PULLED OUT BY THEIR COLORS ON
THE RIGHT ANAL IN PURPLE,
OROPHARYNGEAL, HEAD AND NECK
SHOWING UP, LONGER LIFE
EXPECTANCY, INCREASING CANCER
BURDEN.
NEXT SLIDE.
WHY THAT'S IMPORTANT, WE'VE
DEMONSTRATED IN THE SETTING OF
HIV CANCER MORTALITY IS HIGHER.
SO, THESE DATA ARE FROM A
ARTICLE PUBLISHED WHEN I WAS AT
NCI A FEW YEARS AGO, THE GRAPH
ON THE RIGHT WE LOOKED AT THE
HIV/AIDS CANCER MATCH STUDY,
OVER 6,000 CANCER PATIENTS WITH
HIV, AND WE COMPARED MORTALITY
RATES, ON THE Y-AXIS, TO THE
MORTALITY RATE IN CANCER
PATIENTS WITHOUT HIV.
YOU CAN SEE ALONG THE BOTTOM
THERE'S EACH DIFFERENT CANCER
TYPE LISTED OUT, WITH TWO BARS,
SO THE BAR ON THE LEFT ARE
PATIENTS WITH, BAR ON THE RIGHT
PATIENTS WITHOUT HIV.
TAKE HOME MESSAGE, THE BAR ON
THE LEFT IS HIGHER, MORTALITY
RATE IS ALWAYS HIGHER IN CANCER
PATIENTS WITH HIV.
BUT EVEN MORE IMPORTANTLY, THE
BLUE SECTION OF THAT BAR WHICH
REPRESENTS MORTALITY DUE TO
CANCER IS ALSO HIGHER.
IF YOU GO TO THE TABLE ON THE
LEFT, THIS IS ILLUSTRATED, WE'LL
USE BREAST CANCER, THIRD ROW
HERE, THAT HAZARD RATIO OF 2.61,
THAT CAN BE INTERPRETED AS A
WOMAN WITH BREAST CANCER
PRESENTING BUT HAS UNDERLYING
HIV INFECTION EVEN IF SHE HAS
THE SAME STAGE DISEASE, SAME
RACE, SAME AGE FROM THE SAME
AREA OF THE UNITED STATES, SHE
STILL IS 2.6 TIMES MORE LIKELY
TO DIE AFTER BREAST CANCER
DIAGNOSIS OF BREAST CANCER, NOT
JUST OVERALL.
WE SEE ELEVATED CANCER-SPECIFIC
MORTALITY.
THAT'S NOT LIMITED TO THE UNITED
STATES, EXAMPLE FROM BRAZIL,
HPV-RELATED CANCER THE OTHER
SPEAKERS MENTIONED, AND THIS WAS
A COLLABORATION WITH THE
BRAZILIAN NATIONAL CANCER
INSTITUTE.
WE COMPARED RATES OF RELAPSE IN
CERVICAL CANCER PATIENTS WITH
AND WITHOUT HIV, ALL TREATED IN
THE SAME HEALTH SYSTEM, HAD THE
SAME STAGE OF DISEASE, AND THESE
WOMEN WERE WOMEN WHO HAD
RESPONDED TO TREATMENT
INITIALLY, BUT ON THE GRAPH YOU
CAN SEE DURING FOLLOW-UP AFTER
THEIR TREATMENT HAS BEEN
COMPLETED YOU SEE THE TWO BARS
DIVERGING AND THERE WAS A HIGHER
RATE OF RELAPSE FOR WOMEN WITH
HIV.
THE WOMEN WITH HIV WERE ALMOST
FOUR-FOLD MORE LIKELY TO RELAPSE
AFTER THEY HAD INITIALLY
RESPONDED.
SO, AGAIN, MORE EVIDENCE OF AN
OUTCOME DISPARITY.
ONE REASON, WE HYPOTHESIZED
DIFFERENCES IN DISPARITIES AND
TREATMENT.
THIS IS THE SAME POPULATION AS
THE FIRST MORTALITY SLIDE I
SHOWED WITH DIFFERENT BARS.
SO, SAME POPULATION, SAME YEARS,
AND THE QUESTION HERE WAS ARE
PATIENTS WITH HIV MORE LIKELY TO
NOT GET ANY CANCER TREATMENT,
NOT EVEN GUIDELINE CONCORDANT,
JUST ANYTHING.
ODDS RATIOS ACROSS THE BOARD WE
DO SEE, FOR EXAMPLE, LUNG
CANCER, PATIENTS WITH HIV WERE
MORE THAN TWICE AS LIKELY TO
HAVE NOT RECEIVED TREATMENT.
COLORECTAL, PROSTATE, LYMPHOMA,
NOT RECEIVING TREATMENT AS
OFTEN.
NEXT SLIDE.
AND WE'VE ALSO LOOKED AT THIS
MORE RECENTLY WITH JESSICA ISLAM
AND NATIONAL CANCER DATABASE
USING MORE RECENT YEARS, SO
THROUGH 2018, WE HAD OVER 50,000
PATIENTS WITH HIV IN THE STUDY
AND WE WERE ASKING THE QUESTION
ARE WE STILL SEEING DIFFERENCES
OR DISPARITIES IN THE WAY CANCER
TREATMENT IS BEING APPLIED TO
PATIENTS WITH HIV, NOT JUST ANY
TREATMENT BUT APPROPRIATE
TREATMENT.
THERE'S CURATIVE TREATMENT, IF A
PATIENT IS DIAGNOSED WITH STAGE
1 TO 3 DISEASE, THE TREATMENT
PLAN WILL COME TOGETHER AND IT
HAS CURATIVE INTENT.
INTENT IS TO COMPLETELY
ERADICATE THE CANCER.
THERE'S ALSO PALLIATIVE
TREATMENT, OFTEN GIVEN IN THE
SETTING OF STAGE 4 DISEASE,
WHERE THE THOUGHT IS THAT CANCER
PROBABLY CANNOT BE CURED OR
ERADICATED SO TREATMENT IS GIVEN
TO MAINTAIN FOR SYMPTOM
MANAGEMENT, NOT ESSENTIALLY TO
CURE DISEASE.
WE LOOKED AT STAGE 1 TO 3 CANCER
PATIENTS AND COMPARED THOSE WITH
VERSUS WITHOUT HIV, TO SEE IF
THEY WERE RECEIVING CURATIVE OR
PALLIATIVE TREATMENT.
WE FOUND EVEN THOUGH THEY SHOULD
BE RECEIVING CURATIVE TREATMENT,
THEY WERE ONLY HALF AS LIKELY TO
IF THEY HAD HIV COMPARED TO THE
HIV UNINFECTED PATIENTS.
SO THEY WERE MORE THAN TWICE AS
LIKELY TO BE GIVEN, YEAH, SOME
CANCER TREATMENT BUT MAYBE NOT
THE APPROPRIATE CANCER
TREATMENT.
SO, AGAIN, WE SEE OUTCOMEDIES
PARTIES AND WE ALSO SEE
TREATMENT O SEE TREATMENT
DISPARITIES, AND MOVING FORWARD
PATIENTS DO REPORT DIFFERENT
SYMPTOMS DURING TREATMENT.
DATA FROM A MOFFITT DATABASE,
PATIENTS RATE A SCALE 0-10
SYMPTOMS DURING CANCER
TREATMENT.
AND WE LINK THAT WITH HIV
DATABASE.
SHIFTING TO THE RIGHT FOR
PATIENTS WITH HIV, SHIFT TO
HIGHER SCORES.
I'VE PULLED OUT EXAMPLE HERE OF
PAIN.
SO, THESE ARE SIGNIFICANT
DIFFERENCES, THESE ARE PATIENTS
WITH THE SAME DISEASE, TREATED
THE SAME CANCER CENTER, DURING
THE SAME YEARS, BUT EXPERIENCE
WITH CANCER TREATMENT IS MORE
SEVERE SYMPTOM SET, MORE SEVERE
PAIN, UNFORTUNATELY AS THE GRAPH
ON THE RIGHT SHOWS, THESE
SYMPTOMS ARE RELATED TO --
HIGHER IN PATIENTS WHO ARE
DECEASED DURING THEIR FOLLOW-UP.
SO AS WE THINK ABOUT ADDRESSING
TREATMENT DISPARITIES TO IMPROVE
OUTCOMES, WE DO NEED TO BE
COGNIZANT OF THE FACT THAT
PATIENTS DO APPEAR TO EXPERIENCE
CANCER TREATMENT DIFFERENTLY AND
THAT NEEDS TO BE SOMETHING THAT
THE ONCOLOGIST IS AWARE OF.
NEXT SLIDE.
LASTLY, JUST AS A BASIC FIRST
STEP, WE NEED TO MAKE SURE ALL
ONCOLOGISTS ARE AWARE OF PATIENT
HIV STATUS.
IN THE UNITED STATES HIV CARE
AND CANCER CARE ARE SILOED,
THESE DATA ARE FROM MOFFITT.
WE HAVE OUR HIV DATABASE, WE
KNOW WHO HAS HIV, AND SETTING,
THERE'S A PATIENT INTAKE
QUESTIONNAIRE ADMINISTERED SO WE
LOOKED AT THE SURVEY THAT DOES
HAVE A QUESTION ON HIV STATUS TO
SEE IF THIS WOULD BE SOMETHING
THAT'S ACTUALLY FILLED OUT AND
ANSWERED DURING THE INTAKE VISIT
SO THAT WHILE THE TREATMENT PLAN
IS BEING MADE THE ONCOLOGIST IS
AWARE OF THEIR STATUS, MAYBE
BEFORE THE RECORDS ARE
TRANSFERRED OVER, FROM THEIR
INFECTIOUS DISEASE DOCTOR, AND
WHAT YOU CAN SEE HERE, HEIGHT OF
THE BAR REPRESENTS CANCER
BURDEN, AND HIV STATUS WAS ON
THE INTAKE QUESTIONNAIRE, LESS
THAN A THIRD ARE ANSWERING THIS
QUESTION, IT'S BEING FILLED OUT,
OFTEN MISSING, SO THAT'S A REAL
FIRST STEP TO MAKE SURE THAT
STATUS IS KNOWN, HIV TESTING IS
NOT UNIFORMLY DONE IN THE UNITED
STATES, THAT'S A FIRST STEP TO
ADDRESS OUTCOMEDIES PARTIES.
KEY MESSAGES, CANCER IS NOW
LEADING CAUSE OF DEATH IN
PATIENTS WITH HIV, PARTICULARLY
RELATED TO AGING, INCREASING
PATIENTS WITH HIV DO EXPERIENCE
POOR OUTCOMES, RELAPSE AND
SURVIVAL.
DEMONSTRATED INEQUITIES AND
RECEIPT OF CANCER CARE AS WELL
AS PATIENT-REPORTED SYMPTOMS,
COORDINATING HIV AND CARE IS AN
IMPORTANT FIRST STEP TO ADDRESS
THESE DISPARITIES.
>> THANK YOU.
PLEASE SUBMIT QUESTIONS AND
COMMENTS VIA THE "LIVE FEEDBACK"
BOX.
NEXT DR. KIMBERLY LEVINSON.
>> I WANT TO THANK THE
ORGANIZING COMMITTEE FOR THE
OPPORTUNITY TO BE WITH YOU TODAY
AND TALK ABOUT A TOPIC I FEEL
PASSIONATE ABOUT.
I'M GOING TO ECHO WHAT SOME
OTHER SPEAKERS TALKED ABOUT.
WOMEN WITH HIV ARE AT INCREASED
RISK FOR CERVICAL CANCER AND
OTHER DISEASES THAT ARE RELATED
TO THE HUMAN PAPILLOMAVIRUS OR
HPV.
CERVICAL CANCER IS MOST COMMON
IN WOMEN LIVING IN HIV, BURDEN
IN LOW- AND MIDDLE-INCOME
COUNTRIES, PRIMARILY IN AFRICA.
WITH REGARD TO OTHER GYNECOLOGIC
CAN SERIES INCLUDING VULVAR AND
VAGINAL THERE'S MINIMAL
RESEARCH.
FOR THOSE CANCERS NOT RELATED TO
HPV SPECIFICALLY, IT IS
IMPORTANT TO RECOGNIZE AS OTHERS
HAVE DISCUSSED THAT WOMEN WITH
HIV ARE LIVING LONGER PUTTING
THEM AT RISK FOR OVARIAN AND
ENDOMETRIAL CANCERS, FURTHER
RESEARCH NEEDED IN THESE AREAS
AS WELL.
IN WOMEN LIVING WITH HIV DUE TO
ALTERED CELL MEDIATED IMMUNITY,
HPV IS MORE LIKELY TO PERSIST IN
INFECTIONS THAT PERSIST ARE MORE
LIKELY TO PROGRESS TO
HPV-RELATED CANCERS.
WE KNOW THAT THE VAST MAJORITY,
APPROXIMATELY 98% OF CERVICAL
CANCERS ARE RELATED TO HPV, AN
AIDS DEFINING ILLNESS.
VULVAR IS ALSO RELATED.
WE HAVE THE NON-HPV RELATED
GYNECOLOGIC CANCERS, UTERINE AND
OVARIAN.
THIS SHOWS INCIDENCE WORLDWIDE.
THIS HAS BEEN ECHOED IN PREVIOUS
TALKS, BUT I THINK IT'S
IMPORTANT TO UNDERSTAND THAT
CERVICAL CANCER IS MOST COMMON
HPV-RELATED CANCER WITH
INCIDENCE OF OVER 650,000 PER
YEAR AT THIS POINT.
AND THE GEOGRAPHIC MAPS
SYMBOLIZE SINCE IN
MORTALITY-RELATED CERVICAL
CANCER, HIGHEST INCIDENCE OF
MORTALITY IN LOW- AND
MIDDLE-INCOME COUNTRIES,
LMICs.
NINE OUT OF TEN WOMEN WHO DIE
FROM CERVICAL CANCER LIVE IN
LOW- AND MIDDLE-INCOME COUNTRIES
AS PREVIOUSLY DISCUSSED.
I THINK IT'S VERY IMPORTANT TO
UNDERSTAND THIS GLOBAL
PERSPECTIVE AS WE TALK ABOUT
THIS DISEASE AND OTHER GYN
CANCERS IN WOMEN LIVING WITH
HIV.
NEXT SLIDE.
ON THE RIGHT SIDE OF THE GREEN
IS A FIGURE WHICH SHOWS THE
VARIOUS STUDIES DONE TO ESTIMATE
INCIDENCE OF CERVICAL CANCER IN
WOMEN LIVING WITH HIV.
THESE DEMONSTRATE POOLED RISK
SIX TIMES THAT OF THE GENERAL
POPULATION.
THIS FOUND ALMOST 6% OF NEW
CERVICAL CANCER CASES ARE IN
WOMEN LIVING WITH HIV, AND
ALMOST 5% ARE SPECIFICALLY
ATTRIBUTED TO HIV.
AND I THINK THAT SOME OF THE
STATISTICS HERE ARE PRETTY
ASTONISHING SUCH THAT IN
SOUTHERN AFRICA 64% OF CERVICAL
CANCERS CASES OCCUR IN WOMEN
LIVING WITH HIV, AND IN EASTERN
AFRICA ABOUT 27% OF CERVICAL
CANCER CASES OCCURRING IN WOMEN
LIVING WITH HIV.
NEXT SLIDE.
SO THIS BURDEN IS REALLY QUITE
ASTONISHING BUT I THINK WHAT'S
EVEN MORE ASTOUNDING IS THE
LIMITED ACCESS TO TREATMENT IN
THESE SAME AREAS.
SO AS SEEN IN FIGURES HERE,
ACCESS TO SURGERY OR RADIATION
THERAPY IS REALLY SIGNIFICANTLY
LIMITED IN THESE AREAS, WHERE
THE VAST MAJORITY OF THE BURDEN
LIES.
THIS LIMITED ACCESS TO BASIC
STANDARD THERAPY IMPACTS WOMEN
WITH HIV DIAGNOSED WITH CERVICAL
CANCER, ABILITY TO GET
APPROPRIATE TREATMENT.
NEXT SLIDE.
WHEN WOMEN ARE ABLE TO GET
ACCESS, DATA SUGGESTS FOR THOSE
WHO ARE ON ANTIRETROVIRAL
THERAPY, THERE MAY BE DIFFERENCE
IN TOXICITIES BUT OVERALL WOMEN
TOLERATE TREATMENT WELL.
ONE OF THE MOST CRITICAL POINTS
ABOUT THIS DISEASE IN WOMEN
LIVING WITH HIV IS THE STORY IS
SIMILAR TO WHAT WE'RE SEEING
OVERALL.
WE'VE GOT TO FOCUS ON
PREVENTION AND EARLY DETECTION.
THE VAST MAJORITY ARE IN LOW-
AND MIDDLE-INCOME COUNTRIES AND
ACCESS TO TREATMENT IS CRITICAL
BUT EXTREMELY LIMITED.
IT'S IMPORTANT TO RECOGNIZE VAST
MAJORITY OF RESEARCH IN
GYNECOLOGIC CANCER HAS BEEN DONE
IN CERVICAL CANCER.
IN RECOGNIZING MY GROUP WENT TO
DO A META-ANALYSIS TO EVALUATE
WHAT LITERATURE EXISTS IN THE
OTHER GYN CANCERS IN WOMEN WITH
HIV, AS YOU CAN SEE WE FOUND
VERY LIMITED ARTICLES WHICH
REALLY FOCUS ON THIS RESEARCH,
ONLY THREE ON ENDOMETRIAL, FOUR
OVARIAN.
I THINK ONE SLIDE BACK.
THEY DID NOTE THERE HAS BEEN
INCREASED INCIDENCE OVERALL OF
NON-AIDS DEFINING CANCERS,
THAT'S INCREASING OVERALL.
SO IN OUR REVIEW WE FOUND THAT
THERE WAS AN INCREASED INCIDENCE
OF ENDOMETRIAL CANCER FOUR TIMES
THAT OF THE POPULATION.
THE RISK OF OVARIAN CANCER IS
INCREASED TO THREE TIMES THAT OF
THE POPULATION.
AND THE RISK OF VULVAR AND
VAGINAL AS HIGH AS 22 TIMES
THAT, ALMOST 22 TIMES THAT OF
THE GENERAL POPULATION.
HALF HAD EARLY STAGE DISEASE,
43% ON ANTIRETROVIRAL THERAPY.
AGE OF DIAGNOSIS WAS QUITE
YOUNG.
NEXT SLIDE.
TO FURTHER UNDERSTAND TREATMENT,
OUR GROUP PERFORMED STUDY AT TWO
INSTITUTIONS TO EVALUATE
ADHERENCE TO GUIDELINE
CONCORDANT CARE.
WE HEARD ABOUT TREATMENT
DISPARITIES AND TREATMENT
INEQUALITIES, WE'LL TALK MORE
ABOUT THAT HERE.
BUT ESSENTIALLY WE FOUND ONLY
HALF OF THE WOMEN LIVING WITH
HIV INCLUDED IN THIS STUDY DID
RECEIVE GUIDELINE CONCORDANT
CARE, AND WHILE THE MAJORITY OF
WOMEN WITH EARLY STAGE OR STAGE
1 DISEASE RECEIVED GUIDELINE
CONCORDANT CARE, MAJORITY WITH
ADVANCED STAGE DISEASE DID NOT.
THE MOST COMMON REASON WE FOUND
FOR NOT RECEIVING GUIDELINE
CONCORDANT CARE WERE
PATIENT-RELATED FACTORS SO
INCLUDING COMORBIDITIES OR
SPECIFIC BARRIERS TO CARE,
DEPENDING ON BARRIERS THAT MAY
EXIST, THOSE THINGS ARE CRITICAL
TO IMPROVING OUTCOMES IN THIS
POPULATION, AND FURTHER
UNDERSTANDING PHYSICIAN-RELATED
BIAS IN TREATMENT IS CRITICAL.
OVERALL BY CANCER TYPE, UTERINE
CANCER DID VERY WELL.
OVARIAN CANCER DID QUITE POORLY,
CONSISTENT WITH EXPECTATION.
ON THE RIGHT-HAND SIDE WHEN WE
LOOK AT SURVIVAL BY GUIDELINE
ADHERENCE, WE FOUND FOR PATIENTS
WITH ADVANCED STAGE DISEASE SO
THAT INCLUDED STAGE 2 TO STAGE
4, TWO YEAR SURVIVAL WAS
IMPROVED FOR THOSE WHO DID
RECEIVE GUIDELINE CONCORDANT
CARE, SO COMPARE A ACTIVELY 60%
VERSUS 28%.
THERE ARE CONFOUNDING FACTORS
HERE RELATED TO REASONS WHY
PATIENTS DID OR DID NOT RECEIVE
GUIDELINE CONCORDANT CARE THIS
DATA SUGGESTS WHEN WE'RE ABLE TO
GET WOMEN LIVING WITH HIV THE
APPROPRIATE TREATMENTS, THEY DO
BETTER.
NEXT SLIDE.
BASED ON AVAILABLE DATA WE HAVE,
THE CALL TO ACTION THAT I WANT
TO FOCUS ON HERE IS THAT THE
RISK OF CERVICAL CANCER IS
SIGNIFICANTLY INCREASED IN WOMEN
LIVING WITH HIV, VAST MAJORITY
OF DISEASE IN LOW- AND
MIDDLE-INCOME COUNTRIES.
THEREFORE ACCESS TO PREVENTION
AND TREATMENT ARE CRITICAL AND I
THINK WE NEED TO FOCUS ON
IMPLEMENTATION STRATEGIES TO GET
PREVENTION AND TREATMENT
MODALITIES TO WOMEN WHO NEED
THEM.
FOR OTHER HPV CANCERS OF THE
LOWER GENITAL TRACT THERE NEEDS
TO BE RECOGNITION OF INCREASED
RISK, FOCUS ON EARLY DETECTION
WITH REGULAR EXAMS TO DETECT
LESIONS EARLY.
AND FINALLY FOR NON-HPV RELATED
GYNECOLOGIC CANCERS AS WOMEN
LIVING WITH HIV ARE LIVING
LONGER INCIDENCE OF THESE
CANCERS ARE INCREASING, AND THEY
ARE OCCURRING AT YOUNGER AGES
COMPARED TO GENERAL POPULATION,
AT LEAST THAT'S WHAT EVIDENCE
SUGGESTS.
MORE RESEARCH IS NEEDED TO
BETTER UNDERSTAND INCIDENCE,
TREATMENT, TOXICITY, SURVIVAL,
AND TO BETTER UNDERSTAND IMPACT
OF PROVIDER BIAS AND TREATMENT
OF WOMEN LIVING WITH HIV
DIAGNOSED WITH GYNECOLOGIC
CANCERS.
NEXT SLIDE.
THANK YOU FOR YOUR ATTENTION AND
OPPORTUNITY TO DISCUSS THIS
IMPORTANT TOPIC.
THANK YOU.
>> THANK YOU, DR. LEVINSON.
REMINDER, AGAIN, TO THE
AUDIENCE, PLEASE SUBMIT
QUESTIONS OR COMMENTS THROUGH
THE "LIVE FEEDBACK" OPTION BELOW
THE VIDEOCAST.
OUR FINAL PRESENTATION IS FROM
BENDA KITHAKA.
HAVE YOU BEEN ABLE TO JOIN US,
BENDA?
>> YES, I'M HERE NOW.
>> GREAT.
>> HI, EVERYBODY.
I'M JOINING FROM NAIROBI, KENYA,
QUITE LATE HERE, 23 HOURS IN THE
EVENING.
GOOD EVENING, GOOD NIGHT TO ALL
OF YOU.
I INVITE YOU TO JOIN ME AS WE
DISCUSS CERVICAL CANCER AND
AIDS.
I WORK IN THE COMMUNITY, I CAME
INTO THIS SPACE BECAUSE MY
SISTER WAS TOLD SHE HAD CANCER,
IT WAS PRE-CANCER OF THE SERVE
-- CERVIX.
IN THE VILLAGE, I WAS IN
NAIROBI, INVITED HER TO SEEK
TREATMENT.
WITH THIS, IT WAS AN AWAKENING
BECAUSE MY SISTER WAS TREATED,
SHE RECOVERED, SHE GOT BETTER,
SHE HAD A BABY.
HER FERTILITY WAS PRESERVED.
I COULD NOT SAY IN MY JOB
SETTING BECAUSE WHEN THERE WAS A
MESSAGE THAT NEEDED TO REACH
EVERY WOMAN NOT EVERY CANCER
LEADS TO FATAL OUTCOMES, WE HAVE
TO TAKE CHARGE.
HAVING LISTENED TO OTHER
SPEAKERS, NEXT PLEASE, I WOULD
LIKE TO FOCUS ON WHAT WE CAN DO
FROM A COMMUNITY PERSPECTIVE.
I THINK ALL THE EXPERTS WHO HAVE
SPOKEN BEFORE ME HAVE SPOKEN HOW
TO HIV AND AIDS MOVEMENT HAS
MOVED AND GOTTEN TOGETHER AND
DONE A LOT OF RESEARCH AND
BROUGHT A LOT OF CHANGES TO THE
COMMUNITY, TO ENSURE THE PEOPLE
ARE BEING SEARCHED WELL WITH
INTERVENTIONS AVAILABLE AND MORE
RESEARCH.
IN THE CANCER SPACE WE'RE
LAGGING HOW TO GO TOGETHER.
AS YOU HEARD FROM THE
INTRODUCTION, MY TEAM AND I
CLIMB MOUNTAINS, LITERALLY AND
FIGURATIVELY TO ENSURE WE CAN
BRING UNUSUAL METHODS OF
CREATING AWARENESS IN THE
COMMUNITY, AND YOU CAN SEE US ON
MOUNT KENYA HIGHLIGHTING THE
NEED FOR QUALITY OF LIFE CARE IN
CANCER.
NEXT PLEASE.
WE HAVE FOUR PROGRAMS, STARTS
WITH CHALLENGING PERCEPTION BY
CLIMBING MOUNTAINS, ALSO DEALING
WITH QUALITY OF LIFE WHERE WE
TAKE HOME EXERCISE AND PHYSICAL
FITNESS AS WELL AS MENTAL
WELLNESS TO EQUIP SURVIVORS AND
CAREGIVERS WITH KNOWLEDGE AND
SKILL.
THEN WE GO TO DEPCASS, TRAINING
ON ADVOCACY, LETTING PEOPLE KNOW
LIVED EXPERIENCES WE CAN TAKE TO
THE FIELD TO EQUIP OTHERS WITH
KNOWLEDGE OF PREVENTION AND
EARLY DETECTION.
AFTER THAT WE EQUIP, DEPLOY THE
SURVIVORS, THAMANI IS SWAHILI
FOR VALUE, TO GET EVERY WOMAN TO
APPRECIATE THEIR VALUE AND EVERY
GIRL IS APPRECIATE THEY HAVE THE
TOOLS.
AND WE'VE COALESCED AN
ORGANIZATION, ACHA, AFRICAN
CERVICAL HEALTH ALLIANCE.
IN OUR PROGRAMS WE'RE LOOKING AT
ADDRESSING THE TRIPLE VAGINAL
DISEASE.
YES, MOST PEOPLE TALK ABOUT THE
NON-COMMUNICABLE DISEASES BUT
WE'RE DEALING WITH
COMORBIDITIES, AND I LIKE TO SAY
POVERTY IS ONE OF OUR BIGGEST
ISSUES THAT WE HAVE TO ADDRESS
BECAUSE IT'S NOT JUST ABOUT
POVERTY OF RESOURCES BUT ALSO
POVERTY OF AN UNDERSTANDING OF
THE NEEDS THAT ARE EXISTING IN
OUR COMMUNITY, ALSO THE
UNDERSTANDING OF INTERVENTIONS
THAT COULD POTENTIALLY IMPROVE
THE QUALITY OF LIFE FOR ALL OF
OUR PEOPLE.
AND WHEN WE TALK ABOUT RISK AND
WE TALK ABOUT THE CHALLENGES
THAT WE FACE, FOR EXAMPLE IN HIV
AND AIDS AS WELL AS IN CANCER
WE'RE DEALING WITH A LOT OF
STIGMA, MISCONCEPTIONS, AND ALSO
FAKE NEWS THAT OFTEN TENDS TO BE
DETRIMENTAL IN INTERVENTIONS
WE'RE DOING.
SECONDLY, QUITE A NUMBER OF
SPEAKERS HAVE SPOKEN ABOUT
ACCESS, FINANCIAL ISSUES,
ADHERENCE, ALL LEADS TO POORER
OUTCOMES FOR OUR PEOPLE THAT
WE'RE SERVING.
SO BECAUSE OF THAT WE'VE COME TO
REALIZE BEHAVIOR CHANGE,
COMMUNICATION
CREATING AWARENESS LEADING TO
ACTION IS THE WAY TO GO FOR US
TO BE ABLE TO COMBAT THE ISSUES
THAT PLAGUE OUR PEOPLE.
NEXT.
SO HOW DO WE ADVOCATE?
WHAT WE'RE DOING IS UTILIZING
OUR LIVED EXPERIENCES AS TOOLS
FOR EDUCATION.
IN THAT THIRTEEN YEARS WHEN I
SPEAK TO A COMMUNITY, I TELL
THEM ABOUT MY SISTER, I TELL
THEM ABOUT ALL THE THINGS WE'VE
HAD TO DO IN THE COMMUNITY, AS A
PERSON WHO HAS LIVED EXPERIENCE,
LITERALLY A CANCER SURVIVOR OR
SOMEONE LIVING WITH HIV AND AIDS
AND ALSO CERVICAL CANCER COMES
TO THE TABLE AND SPEAKS ABOUT
IT, THEY WILL GET MORE NOTICE
BECAUSE THEY ARE SPEAKING FROM
EXPERIENCING THE ISSUES THAT
WE'RE TALKING ABOUT HERE,
SCIENTIFIC KNOWLEDGE, SPEAKING
FROM EXPERIENCES OF THE HEALTH
CARE SYSTEM, AND THEREFORE WE
UTILIZE OUR LIVED EXPERIENCES TO
DISPEL MYTHS, ENCOURAGE BETTER
OUTCOMES TO BE ABLE TO GET
PEOPLE TO UNDERSTAND THAT THIS
MAY BE MY STORY BUT IT NEED NOT
BE YOURS.
THEREFORE WE ARE ADVOCATING FOR
ACCESS TO INFORMATION TO
RESOURCES BUT ALSO FOR POLICY
THAT CAN CHANGE THE TRAJECTORY
FOR THE TWO DISEASES IN OUR
COMMUNITIES.
SOME OF THE THINGS THAT WE'VE
DONE SUPPORTED BY AMERICAN
CANCER SOCIETY OR PREVENT CANCER
FOUNDATION WE'VE BEEN ABLE TO
BRING POLICYMAKERS TO THE TABLE
WITH COMMON KNOWLEDGE WE ALL
WANT THE SAME THING, ENHANCE
ACCESS TO SERVICES, TO SHOW
WOMEN HAVE BETTER OUTCOMES, BUT
WARNS HEALTHY PEOPLE CAN BE ABLE
TO GOVERN, BETTER CONTRIBUTORS
TO THE ECONOMY.
AND SO SOME OF THE MESSAGES THAT
WE BRING TO THE TABLE IS, ONE,
PRIORITIZE WOMEN-CENTRIC
SERVICES.
HERE WE'RE TALKING ABOUT, FOR
EXAMPLE, HIV AND AIDS MOVEMENT
YOU WERE EQUIPPED TO BRING ON
THE ESSENCE OF RAPID TESTING, IN
CERVICAL SANER IS FOR OVER 60
YEARS WE'VE HAD PAP SMEARS THE
BEST TOUTED METHOD AND NOW HPV
TESTING AND CAN STILL SEE
ELEMENTS OF RESISTANCE TO
SELF-SAMPLE COLLECTION, SOME OF
THE ISSUES THAT WE BRING TO THE
TABLE IN SAYING WOMEN ARE
DEMANDING AND ASKING THEY BE
GIVEN POWER TO BE ABLE TO ACCESS
THESE SERVICES SO THAT WE CAN
REDUCE INCIDENCE OF DISEASE.
SECONDLY, INTEGRATION.
IT'S A PITY WE GOAT HAVE
SPECIALIZED FOR CANCER CARE FOR
HIV AND AIDS CARE, MATERNAL AND
REPRODUCTIVE HEALTH CARE, THE
SAME WOMAN COMES TO THE
FACILITIES AND HAS TO DO ALL
THESE THINGS IN TANDEM, WHY NOT
BRING SERVICES TOGETHER SO THE
WOMAN CAN BE ABLE TO BENEFIT
FROM ALL INTERVENTIONS TOGETHER?
LASTLY, HOLISTIC SUPPORT TO OUR
INDIVIDUALS WITH MULTIPLE HEALTH
CONDITIONS AND CHALLENGES.
MENTAL WELLNESS WAS MENTIONED
TODAY, QUITE A NUMBER OF THE
TOPICS DISCUSSED TODAY, AND
MENTAL WELLNESS IS ONE OF THE
ISSUES WE SEE OFTEN.
WITH STIGMA COMES FEAR OF
TALKING ABOUT DISEASE AND
COMORBIDITIES.
WE KNOW IF A WOMAN HAS HIV AND
AIDS, AND SHE GETS CERVICAL
CANCER, RISK OF PROGRESSION, IF
IT WAS DIAGNOSED EARLY, RISK OF
HIGHER PROGRESSION IS SO MUCH
HIGHER YET WE'RE AFRAID TO TALK
ABOUT THESE CONDITIONS BECAUSE
OF STIGMA.
THINGS WE'RE LOOKING FOR,
PARTNERSHIPS FOR CHANGE.
I'M HERE TODAY TO APPEAL TO ALL
OF YOU.
I'VE LISTENED TO QUITE A NUMBER
OF SCIENCE AND QUITE A NUMBER OF
RESEARCHERS THAT HAVE BEEN DONE,
SOME OF THE PILOTS THAT HAVE
BEEN DONE THAT ARE GREAT,
BRINGING GREAT INTERVENTIONS TO
THE CONTINENT.
HOW WELL ARE THESE IMPLEMENTED
IN THE COMMUNITY?
MY COMMUNITY, FOR EXAMPLE, IN
KENYA ALONE WORKING WITH OVER
200 SURVIVORS AND CAREGIVERS.
YET WE DON'T HAVE A RESEARCH
THAT IS ADDRESSING QUALITY OF
LIFE BEYOND THE TREATMENT THAT
WE GET.
SOME OF THEM ARE LIVING WITH
BOTH HIV AS WELL AS CANCER, AND
YET THEY ALSO HAVE TO DEAL WITH
ISSUES OF QUALITY OF LIFE.
NO ONE IS ADDRESSING THAT.
HOW ABOUT WE PARTNER TO BRING
SOME OF THE INTERVENTIONS THAT
YOU ALREADY HAVE TO THE
COMMUNITIES THAT REALLY NEED IT?
IN TERMS OF YOUR EXPERTISE, IN
TERMS OF THE RESOURCES, AS WELL
AS TO ENSURE THAT YOUR
INTERVENTIONS ARE SUSTAINABLE.
LASTLY, POLICY CHANGE, I KNOW
WHEN WE HAVE SCIENCE THAT'S BEEN
PROVEN TO WORK AND WE BRING IT
TO THE TABLE FOR DECISION
MAKERS, IT'S AN EASY TOOL TO
UTILIZE COUPLED WITH LIVED
EXPERIENCES, SO HOW CAN WE
WELCOME COMMUNITY LEVERS IN OUR
REGION TO REMOVE THE BARRIERS
AND THAT HINDER CARE BUT ALSO
BRING SYSTEMIC CHANGE THAT IS
SUSTAINABLE.
NEXT.
LASTLY I WANT TO TALK ABOUT THE
CERVICAL HEALTH ALLIANCE,
LOOKING AT BEYOND KENYA, BEYOND
ONE COUNTRY, WE KNOW FOR
CERVICAL HEALTH AND FOR HIV THE
MESSAGING IS SIMILAR, AND WE CAN
BE ABLE TO AMPLIFY THIS
MESSAGING ACROSS COMMUNITIES.
LET'S GO TO THE NEXT SLIDE.
AND SO SOME OF THE THINGS WE'RE
SAYING IS THAT AS WE BRING
EQUITY, WE LOOK AT BOTH ADVOCACY
AND RESEARCHERS JOINT TOOL
BECAUSE WITH EVIDENCE BASE WILL
BE BETTER ABLE TO ADVOCATE FOR
ISSUES WE'RE BRINGING TO THE
TABLE, AGAIN CIVIL SOCIETY AS A
CONTRIBUTOR, IN CLINICAL TRIALS
AS MUCH AS WE DON'T HAVE AS MANY
IN OUR REGION FOR THE ONES WE
HAVE ENGAGE US TO BRING THE
PEOPLE THAT WE'RE WORKING WITH
FOR THEM TO BE ABLE TO BENEFIT
FROM THE INTERVENTIONS THAT YOU
HAVE.
AND LASTLY, WHEN WE'RE LOOKING
AT COMMUNITY ENGAGEMENT, I THINK
WE'RE THE LAST MILE TO THE
COMMUNITY AND HIV MOVEMENT HAS
SHOWN THAT.
WE CAN BE ABLE TO WORK TO BRING
CHANGE WHERE IT IS NEEDED.
SO MY INVITATION TO ALL OF US,
DON'T DROP THE BALL.
AM THE BALL IS IN OUR COURT.
LET'S MAKE SURE WE CAN BE ABLE
TO WORK TOGETHER BOTH IN CANCER
AS WELL AS HIV, TO REDUCE
STIGMA, BRING INTERVENTIONS THAT
WORK AND IMPROVE ON THE
IMPLEMENTATION OF THE SCIENCE
THAT IS ALREADY ONGOING.
THANK YOU SO MUCH FOR YOUR TIME.
THANK YOU FOR INVITING US TO
SPEAK WITH YOU.
THANK YOU.
>> I'LL BE MODERATING THIS PART
OF THE SESSION.
I DON'T SEE ANY QUESTIONS.
YOU STILL HAVE TIME TO PUT SOME
IN.
I'LL TAKE THE PREROGATIVE OF THE
MODERATOR AND I HAVE A COUPLE OF
QUESTIONS THAT I CAN ADD.
BOTH TO CARLA, JOEL, AND AS WELL
AS ANNA, YOU MENTIONED THAT ONE
OF THE PROBLEMS THAT PEOPLE
LIVING WITH HIV AND FOCUS FOR
THIS WORKSHOP IS WOMEN, THEY DO
NOT RECEIVE APPROPRIATE
TREATMENT FOR CANCER.
AND SO IS THIS REALLY -- HAS
ANYBODY LOOKED TO SEE WHETHER
THIS IS DUE TO THEY CAN'T AFFORD
THE CANCER CARE, HIV CARE, THERE
ARE MANY PROGRAMS THAT SUPPORTS
THEIR HIV TREATMENT, ONCE YOU
GET A CANCER IT JUST BECOMES
VERY DIFFICULT AND SOMETIMES
HARD TO NAVIGATE TO GET THE
APPROPRIATE CARE.
AND I GUESS I'LL START WITH
CARLA AND THEN IF ANY OF THE
OTHER PANELISTS HAVE ANYTHING TO
ADD I WOULD LOVE TO HEAR YOUR
COMMENTS.
>> THANKS.
I THINK IT'S MULTI-FACTORIAL AS
MANY OF THE INTRACTABLE THINGS
ARE, CERTAINLY CANCER CARE IS
MORE COSTLY AND COMPLEX, AS YOU
POINT OUT MAY NOT BE COVERED OR
COVERED IN FULL THROUGH NATIONAL
PROGRAMS.
SO I THINK THAT'S ONE PART OF
IT.
ADJACENT TO THAT IS THE FACT
THAT IN MANY LMICs, YOU WOULD
NEED TO TRAVEL VAST, VAST
DISTANCES, TO BE ABLE TO ACCESS
CANCER CARE.
SO THERE'S THE COST ASSOCIATED
WITH TRAVEL, EVEN IF CARE ITSELF
IS PROVIDED IN THE PUBLIC
SYSTEM.
AND THEN I THINK AS WAS
MENTIONED PREVIOUSLY, THERE IS A
FAIR AMOUNT OF PROVIDER BIAS,
AND, YOU KNOW, OPTING OUT OF
CURATIVE TREATMENT PROTOCOLS
WITHOUT INITIALLY BEGINNING A
CURATIVE TREATMENT PROTOCOL AND
UNDERSTANDING WHETHER OR NOT THE
PATIENT CAN TOLERATE THAT.
I'M SURE THERE ARE PERSPECTIVES
FROM OTHERS.
>> ACTUALLY THERE'S ONE THAT
CAME FROM THE AUDIENCE THAT I'M
GOING TO -- THIS WAS MAINLY FOR
BRENDA, HOW MUCH OF CERVICAL
CANCER IN AFRICA IS ASSOCIATED
WITH TRADITIONAL GENITAL
MUTILATION AND OTHER PRACTICES?
I GUESS CARLA OR BRENDA CAN
ADDRESS THIS BECAUSE YOU HAVE
PROBABLY THE CLOSEST LOOK INTO
AFRICA.
>> I CAN GO FIRST.
AND SO THIS IS ONE OF THE AREAS
THAT I WOULD WANT FOR US TO ALSO
LOOK INTO AS PART OF THE
RESEARCH THAT CAN BE CARRIED
OUT.
ONE OR TWO STUDIES MENTIONED
ABOUT THE INFLAMMATION, RISK OF
INFLAMMATION IN FEMALE GENITAL
MUTILATION.
I'M LOOK FOR THAT AND POST IT ON
THE CHAT RIGHT NOW BUT EVEN AS
WE'RE DOING SO I THINK LIKE FOR
EXAMPLE WE HAVE A DEMONSTRATION
PROGRAM IN (INDISCERNIBLE)
COUNTY WHERE THAT'S ONE OF THE
TRADITIONAL CULTURAL PRACTICES
CARRIED OUT.
WE DON'T WANT TO GO TO THE
COMMUNITY AND START STIGMATIZING
WOMEN AND SAYING BECAUSE YOU'VE
GOTTEN A CULTURAL PRACTICE THAT,
YES, IT'S REPRESSIVE BUT
AFFECTED YOUR HEALTH THAT YOU
ALSO ARE PUTTING YOURSELF AT
RISK BECAUSE SOMETIMES WOMEN
DON'T HAVE THE CHOICE.
IT IS A CULTURAL THING.
SO PROBABLY IF WE HAD A STUDY
THAT COULD LOOK AT WOMEN WE'RE
FINDING AS POSITIVE WE HAVE A
QUESTIONNAIRE THAT ASKS THEM
ABOUT THEIR HEALTH STATUS IN
TERMS OF FGM, THEN WE COULD SAY
THAT CORRELATION IS REAL AND
ALSO START MESSAGES THAT CAN
BRING WOMEN TO UNDERSTAND RISK
FACTOR FOR OUT.
RIGHT NOW SPEAKING FROM THE
HEART I WOULD HESITATE TO GO TO
THE COMMUNITY THAT WE'RE
TELLING, BRING YOUR GIRLS TO BE
VACCINATED, AND AT THE SAME TIME
ALSO TELLING THEM YOUR CULTURAL
PRACTICES ARE PUTTING WOMEN AT
RISK OF CARVEEL IS CANCER,
THAT'S DOUBLE STIGMA, THEY ARE
DOUBTING THE VACCINE AND WE'RE
TELLING THEM ABOUT FGM, THEY
HOLD DEARLY, WITHOUT EVIDENCE I
WOULD HESITATE.
I INVITE YOU LET'S WORK
TOGETHER.
THANK YOU.
>> CARLA, ANYTHING TO ADD?
>> JUST TO ADD OR JUST TO ECHO
THERE ISN'T A LOT OF RESEARCH ON
FGM AND ITS ASSOCIATION,
POTENTIAL ASSOCIATION WITH RISK
FOR HPV INFECTION.
BUT THERE'S SOME RESEARCH ON
VAGINAL DRYING PRACTICES, YOU
KNOW, WHICH TAKE DIFFERENT
FLAVORS ACROSS THE CONTINENT BUT
ARE RELATIVELY COMMON AND ARE
THOUGHT TO CHANGE THE VAGINAL
MICROBIOME.
>> WE HAVE SOME QUESTIONS NOW.
HIGH RISK HPV COMMON AMONG A
COHORT OF WOMEN WITH FEMALE --
OH, OKAY.
THERE'S A CITATION THERE WHERE
IT SHOWS WOMEN WHO HAD FEMALE
GENITAL MUTILATION HAD HIGHER
RISK OF HPV.
AND I APPRECIATE THE IDEA OF
DOUBLE STIGMA BUT OUR YOUNG
GIRLS ARE DEFINITELY BEING
EXPOSED MORE BECAUSE OF MANY
PRACTICES, THIS IS AN ISSUE WE
DON'T REALLY NORMALLY TALK ABOUT
WHEN IT COMES TO CERVICAL CANCER
PREVENTION, CERTAINLY IS ONE
THAT'S QUITE INTERESTING.
I DON'T KNOW IF WE'RE RUNNING
OUT OF TIME, IF NOT I CAN ASK
MORE QUESTIONS.
I DON'T SEE ANY ON THE CHAT.
ACTUALLY, I HAD ONE QUESTION FOR
JOEL PALEFSKY IF YOU'RE STILL
ON.
>> I'M STILL ON.
>> YOU KNOW, ONE OF THE THINGS I
NOTED WAS THERE WAS QUITE -- IN
BOTH GROUPS, DO YOU KNOW WHAT
DEATHS WERE DUE TO?
>> YEAH, ON THE DEATH RATES,
THEY WERE HIGH BUT NONE RELATED
TO THE STUDY.
AND THIS IS A POPULATION THAT
HAD A LOT OF LIFE CHALLENGES, I
THINK DEATH RATES WERE IN LINE
WITH WHAT WOULD HAVE BEEN
EXPECTED GIVEN THE CHALLENGING
LIFE CIRCUMSTANCES OF MANY OF
OUR PARTICIPANTS.
>> SO, IN THE ANCHOR TRIAL YOU
SHOWED ON YOUR SLIDES YOU HAD A
GROUP THAT WAS TRANS, BUT DIDN'T
BREAK IT DOWN TO TRANSWOMEN OR
TRANSMEN.
>> ALMOST ALL BORN MALE.
TRANSITIONED TO FEMALE.
>> OKAY.
I THINK WE'RE ASKED TO CUT OFF,
RIGHT?
>> YES, I WAS JUST EXTENDING MY
THANKS ALSO.
>> THANK YOU, EVERYONE.
IT WAS A GREAT SESSION.
AND THANK YOU FOR STAYING ON.
>> WE'LL HAND IT OVER TO CORETTÉ
BIRD AND MELISSA HERRERA TO
MODERATE OUR CONCLUDING SESSION.
>> SO WONDERFUL.
THANK YOU ALL.
GOOD AFTERNOON, AND EVENING.
I JUST THANK YOU FOR YOUR
PATIENCE, AS WE HAVE MADE IT TO
THE FINAL SESSION OF THE HIV AND
WOMEN SCIENTIFIC WORKSHOP,
HEALTH DISPARITIES AND EQUITY.
I DO WANT TO THANK OUR SPEAKERS
AND VIEWERS FOR YOUR FLEXIBILITY
AS WE'VE HAD SOME VERY RICH
DISCUSSIONS.
WE'VE GOTTEN BEHIND SCHEDULE FOR
THE LAST SESSION, I THANK YOU IN
ADVANCE.
AS I'M CORETTÉ BYRD, WITH THE
NIH OFFICE OF AIDS RESEARCH, I'M
JOINED BY MY COLLEAGUE, MELISSA
HERRERA, ALSO FROM OAR, TO
MODERATE THIS SESSION.
AS WAS NOTED IN THE WORKSHOP
INTRODUCTION YESTERDAY THIS
WORKSHOP IS PART OF A SIGNATURE
PROGRAM ON HIV AND WOMEN.
THE CORNERSTONE OF THE PROGRAM
IS AN INTERSECTIONAL
EQUITY-INFORMED AND DATA-DRIVEN
APPROACH TO RESEARCH ON HIV IN
WOMEN.
IT HAS BEEN WELL DOCUMENTED THAT
SOCIAL AND STRUCTURAL FACTORS
INTERACTED WITH BIOLOGICAL
FACTORS TO CREATE INEQUALITIES
FOR TRANSGENDER WOMEN, WOMEN OF
COLOR, AND THE OTHER COMMUNITIES
OF WOMEN DISPROPORTIONATELY
IMPACTED BY HIV.
STRUCTURAL RACISM, RESTRICTIONS
ON HEALTH CARE, AND OTHER SOCIAL
AND STRUCTURAL BARRIERS TO
PREVENTION, DIAGNOSIS, AND CARE,
EXACERBATE RACIAL AND GENDER
IDENTITY AND INEQUITIES IN THE
HIV EPIDEMIC.
WE'RE HONORED TO BE JOINED BY
LEADERS FROM ADVOCACY, HELD
CARE, AND RESEARCH SECTORS TO
HIGHLIGHT PROMISING STRATEGIES
TO ADDRESS HEALTH DISPARITIES
AND PROMOTE HEALTH EQUITY FOR
ALL WOMEN AND GENDER DIVERSE
PEOPLE.
TODAY SPEAKERS ARE SHOWN HERE,
FULL BIOS ON THE EVENT WEB PAGE.
KARIE STEWART IS A PRACTICING
MIDWIFE, UNIVERSITY OF ILLINOIS
HEALTH CENTER AND DEPARTMENT OF
ON THE -- OBSTETRICS AND
GYNECOLOGY.
SARI REISNER IS TENURED
ASSOCIATE PROFESSOR, DEPARTMENT
OF EPIDEMIOLOGY, UNIVERSITY OF
MICHIGAN SCHOOL OF PUBLIC
HEALTH.
TRAINED AS SOCIAL AND
PSYCHIATRIC EPIDEMIOLOGIST, HIS
RESEARCH SEEKS TO IDENTIFY AND
MITIGATE HEALTH INEQUITIES WITH
FOCUS ON TRANSGENDER AND GENDER
DIVERSE POPULATIONS, AND
ADOLESCENTS.
HIV PREVENTION.
MALLERJ JENNA ROBINSON IS
TRANSGENDER ADVOCATE, CREATOR OF
HATEFUL HOMICIDE, TRUE CRIME,
INVESTIGATIVE JOURNALISM PODCAST
COVERING HATE CRIMES, IN THE
UNITED STATES AND ABROAD.
MARTHA THOLANAH IS A HUMAN
RIGHTS ACTIVIST, HAS
DEMONSTRATED ABILITY TO ENGAGE
INFLUENCE, SHAPE POLICY AND
PRACTICE, GRASS ROOT AND GRASS
TOP LEVELS IN ZIMBABWE, HAS
HELPED LEADERSHIP ROLES IN THE
AIDS MALIGNANCY CONSORTIUM
INTERNATIONAL COMMUNITY ADVISORY
BOARD.
AND THE AIDS CLINICAL TRIALS
GROUP'S GLOBAL COMMUNITY
ADVISORY BOARD AND GAY AND
LESBIAN ASSOCIATION OF ZIMBABWE.
WE'VE JUST LEARNED MARTHA'S
HAVING NETWORK CHALLENGES FROM
ZIMBABWE AND MAY NOT BE ABLE TO
JOIN US TODAY.
HOWEVER, WE'RE KEEPING OUR
FINGERS CROSSED THAT SHE WILL BE
ABLE TO JOIN US.
AND AS I TURN IT OVER TO KARIE,
A REMINDER TO SUBMIT YOUR
QUESTIONS USING THE "LIVE
FEEDBACK" FORM AND WE'LL ANSWER
THEM AS POSSIBLE.
KARIE, PLEASE GO AHEAD.
>> THANK YOU FOR HAVING ME.
I'M A CERTIFIED NURSED MY WIFE,
FOUNDER AND OWNER CEO, A FULL
SCOPE MIDWIFE UNIVERSITY OF
ILLINOIS CHICAGO.
I WOULD LIKE FOR US TO EXAMINE
MATERNAL MORTALITY RATES IN THE
UNITED STATES.
EXAMINE HIV RATES AMONG WOMEN IN
THE UNITED STATES AS WELL.
ALSO EXAMINE INFLUENCE HIV,
RATES AND INFLUENCES ON BOTH
RATES AS WELL AS DISCUSS CALLS
TO ACTION.
NEXT SLIDE PLEASE.
IF YOU'VE NOT SEEN THIS SLIDE,
THIS IS THE CURRENT U.S.
MATERNAL MORTALITY RATES, THE
MATERNAL DEATH IS DEFINED BY THE
WORLD HEALTH ORGANIZATION AS
DEATH OF A WOMAN WHILE PREGNANT
OR WITHIN 42 DAYS OF TERMINATION
OF PREGNANCY IRRESPECTIVE OF
DURATION AND SITE OF PREGNANCY.
THE NUMBER OF MATERNAL DEATHS
PER 100,000 LIVE BIRTHS ARE
SHOWN IN THIS REPORT BY AGE
GROUP AND RACE AND HISPANIC
ORIGIN.
THIS UPDATES A PREVIOUS ONE,
2018 TO 2020.
IN 2021, 861 IN 2020, 754 IN
2019.
THE RATE FOR 20201 WAS 32.9 PER
100,000 LIVE BIRTHS COMPARED
WITH RATE OF 23.78 IN 2020 AND
20.1 IN 2009.
IN 2020 THE RATE FOR
NON-HISPANIC BLACK WOMEN WAS
69.9 DEATHS PER 100,000 LIVE
BIRTHS, DRASTIC INCREASE FROM
PREVIOUS YEAR FROM 55.3.
SO RATES INCREASE ALSO, WHICH
ISN'T DISPLAYED, WITH MATERNAL
AGE.
THOSE RATES IN 2021 WERE 20.4
DEATHS PER LIVE BIRTHS, AND
INCREASED TO 31.3.
NEXT SLIDE PLEASE.
THIS SHOWS THAT THERE'S SPECIFIC
TIMING THAT CAN BE EXAMINED AS
WELL, EVEN FURTHER, AND THIS IS
COURTESY OF NIH AND CDC, SOME OF
THE INFORMATION, WE CAN LOOK AT
THIS SLIDE AND DETERMINES THAT
IT SHOWS THAT 31% OF THOSE THAT
PASS AWAY, THAT OCCURS DURING
PREGNANCY, BUT THE MAJORITY OF
THAT OCCURS IN THE POSTPARTUM
PERIOD, AND SO, YOU KNOW,
PREVIOUSLY WE HAD PROGRAMS IN
UNDERSTANDING AND THINGS THAT
WOULD OCCUR, EVENTS OR
IMPLEMENTATION PROGRAMS I SHOULD
SAY THAT FOCUSED ON ONE ENTITY.
OR FOCUSED ON PREGNANCY, HOW WE
FIX MORTALITY THROUGH PREGNANCY
OR AT DELIVERY BUT WE SHOULD
FOCUS ON THE ENTIRE PROCESS BUT
NOTICING POSTPARTUM IS WHEN THEY
ARE OCCURRING AND WHAT ARE WE
DOING DURING THAT PERIOD.
APPROXIMATELY 700 WOMEN DIE,
ANNUALLY, FROM PREGNANCY
COMPLICATIONS IN THE UNITED
STATES, YOU CAN SEE HOW THEY ARE
DISTRIBUTED HERE.
AND I WOULD HAVE TO -- I WOULD
BE REMISS IF I DIDN'T SAY MOST
PREGNANCY-RELATED DEATHS ARE
PREVENTIBLE.
WE NEED TO DEMONSTRATE NEED TO
IDENTIFY STRATEGIES TO ADDRESS
THE MULTIPLE CONTRIBUTING
FACTORS.
NEXT SLIDE.
MATERNITY CARE IS FAILING BLACK
WOMEN.
BLACK WOMEN ARE EXPRESSING THEIR
EXPERIENCES AND DISCRIMINATORY
CARE.
WOMEN ARE PASSING AWAY AT
ALARMING RATES.
AND THEY ARE HAVING INSUFFICIENT
CARE, INSUFFICIENT CARE OF
COORDINATION WRAPAROUND
SERVICES, AGAIN AS WE SHOWED IN
THE PREVIOUS SLIDE A THIRD OF
THOSE DEATHS OCCUR IN THAT
POSTPARTUM PERIOD SPECIFICALLY.
WE NEED TO FOCUS ON
INTERVENTIONS THAT TARGET
INDIVIDUAL LEVEL COMPLICATIONS
FOCUSING ON POSTPARTUM PERIOD.
80% OF MATERNAL DEATHS ARE
PREVENTIBLE.
FOR EACH ONE WHO DIES, 50 TO 100
EXPERIENCE A NEAR-DEATH
EXPERIENCE, THAT'S UNACCEPTABLE.
NEXT SLIDE PLEASE.
IN THE DATA IT SHOWS CDC JUST
REPORTED LAST YEAR THAT, YOU
KNOW, WHAT WOMEN ARE ACTUALLY
SAYING, WHAT THEIR EXPERIENCES
ARE, WHEN THEY GIVE BIRTH, WHEN
THEY ARE PREGNANT, AND
SPECIFICALLY ABOUT THEIR
MISTREATMENT DURING THIS TIME
PERIOD.
ABOUT 20% OF WOMEN REPORTED
MISTREATMENT WHILE RECEIVING
MATERNITY CARE.
ABOUT 30% OF BLACK WOMEN, BLACK
HISPANIC AND MULTI-RACIAL WOMEN
REPORTED MISTREATMENT.
AND ABOUT ALMOST HALF, 45%, HELD
BACK FROM ASKING QUESTIONS AND
SHARING CONCERNS DURING
MATERNITY CARE PERIOD.
SO YOU CAN SEE, YOU KNOW, THESE
EXPERIENCES ARE CAUSING SOME
BARRIERS TO THEIR CARE.
AND SO WHAT DO WE NEED TO DO
ABOUT IT?
LET'S TAKE THE CORRELATION AND
TALK ABOUT HIV.
NEXT SLIDE.
SO, AS YOU CAN SEE HERE, IN 2019
IN THE UNITED STATES BLACK
AFRICAN AMERICAN FEMALE ADULTS
AND ADOLESCENTS MADE UP 13% OF
THE FEMALE POPULATION, BUT
ACCOUNTED FOR 55% OF DIAGNOSIS
OF HIV INFECTION AMONG FEMALES.
WHITE FEMALE ADULTS AND
ADOLESCENTS MADE UP 62% OF THE
FEMALE POPULATION, ACCOUNTED FOR
22% OF DIAGNOSIS OF HIV
INFECTION.
HISPANIC LATINA FEMALE ADULTS
ANDED AND -- ADOLESCENTS 17%.
YOU CAN SEE WHO IT AFFECTS.
NEXT SLIDE.
SPECIFICALLY, PEOPLE, PREGNANT
PEOPLE WITH HIV, ARE
EXPERIENCING SOCIAL AND ECONOMIC
FACTORS, ESPECIALLY POVERTY.
THERE'S STIGMA ASSOCIATED WITH
HIV, PEOPLE WITH HIV.
BUT MORE IMPORTANTLY WE'RE
NOTICING PREGNANT PEOPLE ARE
FACING MORE BARRIERS, WITH HIV.
BLACK AND BROWN INDIVIDUALS VERY
VULNERABLE POPULATIONS ARE
ALREADY EXPERIENCING BARRIERS,
BUT THIS POPULATION IS
EXPERIENCING EVEN MORE OF THOSE
BARRIERS.
AND THAT CAN BE, YOU KNOW,
ATTRIBUTED TO STAYING
SPECIFICALLY ASSESSING HEALTH
CARE, STAYING ON TREATMENT, IF
THEY INJECT DRUGS, USE OF
SUBSTANCES, EXPERIENCE WITH
HOMELESSNESS, INCARCERATION,
MENTAL ILLNESS AND UNINSURED.
HOW DOES RACISM PLAY?
THERE ARE BIASES AND
DISCRIMINATION IN MATERNITY CARE
SETTINGS THAT IMPACT CARE.
AND AS WE JUST SHOWED YOU, THERE
ARE POOR COMMUNICATION, CAN
WORSEN MATERNAL OUTCOMES.
WE NEED TO UNDERSTAND HOW WE
ADDRESS THAT SPECIFICALLY
MISTREATMENT BY MATERNITY CARE
PROVIDERS WAS REPORTED MOST
OFTEN BY BLACK, HISPANIC,
MULTI-RACIAL MOMS.
PEOPLE WITH NO INSURANCE
EXPERIENCE MORE MISTREATMENT
THAN PEOPLE PRIVATELY INSURED.
AND SO SOMETIMES IT'S HARD FOR
PREGNANT PEOPLE TO ASK QUESTIONS
OR SHARE CONCERNS, MATERNITY
CARE PROVIDERS CAN IMPROVE THEIR
COMMUNICATION BY CREATING AN
ENVIRONMENT OF TRUST.
PROVIDERS CAN TAKE TIME TO HEAR
CONCERNS AND OFTEN HAVE OPEN
CONVERSATIONS TO MAKE SURE
ISSUES ARE ADEQUATELY ADDRESSED.
AND WHEN THERE'S GOOD
COMMUNICATION ABOUT HEALTH
CONCERNS BETWEEN MOMS AND
PROVIDERS IT IS MORE LIKELY
THERE WILL BE ACCURATE TIMELY
DIAGNOSIS AND TREATMENT AND
POTENTIAL LIFE-THREATENING
COMPLICATIONS ARE PREVENTED.
SO FROM THIS SLIDE HERE YOU CAN
SEE SPECIFICALLY HOW IT WAS
BROKEN DOWN, COMMUNITY
DETERMINATION ON DISCRIMINATION
CONTRIBUTING TO DEATHS.
NEXT SLIDE.
AND SO WHAT CAN WE DO?
WE NEED TO RALLY AROUND
RESPECTFUL CARE.
SO THE CDC HAS PUT OUT
SPECIFICALLY AREAS THAT CAN
ADDRESS THIS, HEALTH CARE
SYSTEMS, MATERNITY CARE
PROVIDERS, AND EVERYONE AS A
WHOLE.
AND SO THESE ARE JUST SOME
IDEAS, YOU KNOW, HIRING DIVERSE
WORKFORCE, ENCOURAGING SUPPORT
WITH CARE, DOULAS, LISTENING
PATIENTS, ALLOWING THEM TO BE
HEARD, FOLLOWING THROUGH ON
THEIR CONCERNS THEY ARE BRINGING
TO US, AND REALLY ENCOURAGING
WOMEN TO SEEK CARE, AND
SUPPORTIVE CARE, GETTING SECOND
OPINIONS, GOING PLACES WHERE
THEY FEEL SUPPORTED, RACIAL
CONCORDANT CARE, THESE THINGS
TOGETHER COLLABORATIVE CARE IS
GOING TO ADDRESS OR SUPPORT
ADDRESSING THESE CONDITIONS.
NEXT SLIDE.
AND SO MY CALL TO ACTION IS
RECOGNIZING THAT RACE IS NOT A
BIOLOGICAL REALITY.
RACISM IS A PROBLEM.
SPECIFICALLY HERE IN ILLINOIS,
WE ARE ADDRESSING THINGS THROUGH
POLICY SYSTEMS AND STRUCTURAL
CHANGES AND WE HAVE, YOU KNOW,
ADDRESSED MEDICARE BENEFITS AND
CONTINUING THAT OVER 12 MONTHS,
WE'VE PASSED LEGISLATION TO
COVER IN-HOME POST PARTUM VISITS
UNDER MEDICAID, SUPPORTIVE OF
MOMNIBUS, GOVERNOR SUPPORTED A
BILL TO PUT $20 MILLION TO
MATERNAL HEALTH CARE AND SUPPORT
BIRTH CENTERS SO WE'RE TRYING TO
BE PRO-ACTIVE IN OUR STATE AND
IT SHOULD BE DONE IN EVERY STATE
TO REALLY HIGHLIGHT THE THINGS
THAT NEED TO BE DONE TO SUPPORT
OUR MOMS OF COLOR.
NEXT SLIDE.
AND SO I WANT TO THANK NIH FOR
INVITING ME HERE.
UNIVERSITY OF ILLINOIS AND
OBSTETRICS DEPARTMENT, THE TEAM,
AS WELL AS MY RESEARCH TEAM,
MIDWIFERY CARE TEAM.
THANK YOU.
>> THANK YOU SO MUCH FOR YOUR
PRESENTATION.
SO NOW WE WILL MOVE ON TO HEAR
FROM SARI REISNER.
>> I'M GOING TO SHARE SOME WORK,
SPEAKING ABOUT VULNERABILITY IN
THE LATIN AMERICA CONTEXT.
THE FIRST THING TO SET THE STAGE
LOOKING AT TRANSGENDER WOMEN AND
PEOPLE OF TRANSFEMININE
EXPERIENCE, A META-ANALYSIS
SHOWS HIGH RATES IN THE
POPULATION, YOU CAN SEE ON THE
FINAL ROW STUDIES IN LATIN
AMERICAN CONTEXT, PREVALENCE IS
26%, IF YOU COMPARE THAT TO
ADULTS OF TEENAGE OR OLDER IN
REPRODUCTIVE AGES, IN THOSE
SPECIFIC COUNTRIES, IT ENDS UP
BEING 96-FOLD INCREASED ODDS FOR
TRANSFEMININE PEOPLE, REALLY
HIGH BURDEN.
NEXT SLIDE PLEASE.
SOME PROCESSES WHAT'S DRIVING
THE EPIGENETIC FOR TRANSWOMEN
AND TRANSFEMININE PEOPLE, THIS
IS SITUATING BIOLOGICAL RISK FOR
INFECTION SO INCLUDING THROUGH
SEXUAL PRACTICES, DRUG NEEDLES,
HIGH RISK OF CO-INFECTION,
MENTAL HEALTH, INTERPERSONAL
VIOLENCE, SOCIAL NETWORK
CHARACTERISTICS, COMMUNITY,
LASTLY BUT NOT LEAST STRUCTURAL
FACTORS.
IN LATIN AMERICA SETTING IN
PARTICULAR THESE ARE DATA FROM
TRANSGENDER MONITORING PROJECT,
THE DARKEST AREA SHADED IS IN
LATIN AMERICA SETTING, 74% IF
YOU LOOK THE MOST RECENT DATA
FROM OCTOBER 2022 TO 2023, 74%
IN LATIN AMERICA CONTEXT.
WE HAVE UNDERSTOOD IN THE
CONTEXT OF LARGER EPIDEMIC OF
VIOLENCE.
THESE ARE PHOTOS FROM A PROJECT
IN PERU, WHERE I'M SHOWING WORK,
YOU CAN SEE THE CONTEXT OF
STIGMA, A FAMILY ON THE RIGHT,
TRANSWOMEN ON THE LEFT, BROADER
CONTEXT PEOPLE ARE WALKING
AROUND LIVING IN THE WORLD, THAT
IS A MAJOR SHAPER AND
CONTRIBUTOR.
THERE IS DIFFERENT THINKING OF
VIOLENCE, ECONOMIC VIOLENCE THAT
IS HAPPENING AT STRUCTURAL LEVEL
IN PART DUE TO TRANSPHOBIA, IN
PART RACISM, AND SO FORTH.
SEX WORK IS MAIN SOURCE OF
OCCUPATION FOR MANY TRANSWOMEN,
AND WE GET EXPOSURES IN THAT
SETTING TO MANY THINGS SUCH AS
STRUCTURAL VIOLATIONS FROM
POLICE AND SO FORTH.
WE HAVE LEGAL VIOLENCE, LACK OF
RECOGNITION AROUND GENDER THAT'S
HAPPENING, ABILITY TO CHANGE
GENDER MARKERS, LEGAL NAME
CHANGE, THOSE THINGS.
SO THERE'S HETEROGENEITY ACROSS
LATIN AMERICAN AREA IN TERMS OF
COUNTRIES MORE PERMISSIVE, FOR
EXAMPLE ARGENTINA, OTHER PLACES
LIKE PERU ARE NOT.
WHEN I TALK ABOUT LATIN AMERICA
THERE MANY COUNTRIES IN LATIN
AMERICA, TODAY I'M FOCUSING
PRIMARILY ON WORK I'VE DONE IN
PERU.
NEXT SLIDE.
SO IT'S ALSO IMPORTANT TO THINK
ABOUT DEVELOPMENTAL CONTEXT, SO
SOCIAL ECOLOGICAT MODEL, THIS IS
HAPPENING OVER TIME, NOT STATIC.
IF WE THINK ABOUT PARTICULARLY
PEOPLE GROWING UP, IN CHILDHOOD,
ADOLESCENCE, YOUNG ADULTHOOD, WE
REALLY START TO UNPACK THE WAYS
OF THESE ECOLOGIES OPERATE IS
DIFFERENT.
THERE MAY BE SCHOOL CONTEXTS AT
ONE AGE, MAY BE MORE EMPLOYMENT
CONTEXT AT ANOTHER MORE RELEVANT
AND SO FORTH.
WITH PARTNERSHIPS, PEOPLE ARE
FIRST EXPLORING SEXUALITY THAT'S
DIFFERENT THAN LATER IN LIFE
WITH OTHER SEXUAL EXPERIENCES.
A STUDY FUNDED BY NIMH, R21
LOOKING AT CONTEXT OF HIV
VULNERABILITIES FOR YOUNG
TRANSWOMEN IN THE CONTEXT OF
PERU PARTICULARLY IN LIMA.
WE DID SOME QUALITATIVE
INTERVIEWS, IDENTIFIED THEMES IN
FORMATIVE WORK AND A PIECE
AROUND DEVELOPMENTAL
CONSIDERATIONS.
THAT THERE WERE FAMILY REJECTION
WAS PATTERNING ALONGSIDE
MIGRATION, MIGRATING FROM OTHER
AREAS OUTSIDE OF LIMA INTO THIS
VICINITY, INTRANATIONAL, FROM
THE JUNGLE TO LIMA FOR BETTER
OPPORTUNITY, VENEZUELA AND
DIASPORA, EVOLUTION COMING TO
DEVELOPMENTALLY ONE'S GENDER IS
PART OF THIS IN THE CONTEXT OF
PEER BULLYING AND SO FORTH IN
RELATION TO THAT.
WE THINK ABOUT HIV VULNERABILITY
AND PREVENTION AND TREATMENT
WE'RE WORKING IN THIS FRAMEWORK.
WE FOLLOWED THIS WITH A SURVEY,
SEROEPIDEMIOLOGIC SURVEY TO
UNDERSTAND.
THIS WAS FIELDED FROM FEBRUARY
TO JUNE IN 2022.
WE RECRUITED YOUNG TRANS-WOMEN
16-24 RESIDING IN LIMA, WORKED
WITH COMMUNITY ORGANIZATION
FEMINAS, A WONDERFUL GROUP,
WORKING WITH THEM MANY YEARS,
DOING INCREDIBLED A ADVOCACY
WORK.
WE PARTNERED WITH THEM.
THEY HAVE BEEN WANTING TO DO
MORE WORK WITH YOUTH AND THAT
WAS A PART OF THIS AS WELL,
INCREASING EVERYBODY'S CAPACITY
TO WORK WITH THIS POPULATION AND
REACH THIS POPULATION.
IT WAS A NON-PROBABILITY SAMPLE,
211 INDIVIDUALS WITH BEHAVIORAL
SURVEY, HIV TESTING, OVERALL STI
TESTING, 78% PROVIDED BLOOD
SPECIMEN.
PEOPLE WERE COMPENSATED WITH
INCENTIVE, CONDOMS, IRB
APPROVED, DONE IN COLLABORATION
WITH THE UNIVERSITY OF PERU, AND
UNIVERSITY OF TORONTO.
NEXT SLIDE PLEASE.
SO LARGELY IN TERMS OF THE
SAMPLE WE DID UNFORTUNATELY FIND
HIGH PREVENTIBLE LENS OF THE
BURDENS I'VE PREVIOUSLY
ARTICULATED THAT WE SEE, THE
SAMPLE ARE MEDIAN AGE OF 23,
LARGELY NON-WHITE.
INDIGENOUS PERUVIAN AND MESTIZA,
ECONOMIC PRE-CARITY, 51%.
17% CONDOMLESS STRESS FOR MONEY,
50% REPORTED MIGRATING, HIGH
HOMELESSNESS, CHILDHOOD
EXPERIENCES LIKE ASKING PEOPLE
ABOUT THEIR CHILDHOOD BULLYING
EXPERIENCES WERE COMMON.
ACEs ARE ADVERSE CHILDHOOD
EXPERIENCES, VALIDATED SCALE,
ALSO UNFORTUNATELY COMMON IN
FAMILY REJECTION REPORTED BY
ABOUT 1 IN 5.
ADOLESCENT VIOLENCE WAS HIGH,
60%.
WE FIELDED A SCALE SPECIFIC TO
TRANSGENDER INTIMATE PARTNER
VIOLENCE ASKING PEOPLE ABOUT
COERCION AND CONTROL AROUND
THINGS RELATED TO GENDER LIKE,
FOR EXAMPLE, NOT LETTING THEM
DRESS OR PRESENT IN A WAY THEY
WOULD WANT TO AND SO FORTH,
REPORTED BY 25%.
MENTAL HEALTH UNFORTUNATE RATES
HIGH, 24% SUICIDE, AND PSYCH
DISTRESS, PTSD AND AUDIT.
20% ACCESSED HORMONES, VERY FEW
RECEIVING SUPERVISION FOR
HORMONES, AND HEALTH CARE
DISCRIMINATION PRACTICES, 17%
REPORTED FILLERS.
SO, THE SEROPREVALENCE WAS 41%.
79, THIS IS A SAMPLE THAT'S 23
YEARS OLD RANGING FROM 16-24.
79% WERE NEW HIV DIAGNOSES.
CO-INFECTION RATES WERE HIGH,
OVERALL GREATER THAN 64% ARE
MORE THAN ONE STI, HIGHLY
ASSOCIATED WITH HIV, SO
CO-INFECTION.
WE ALSO LOOKED AMONG THOSE NOT
LIVING WITH HIV AT THE PrEP
CASCADE, PRE-EXPOSURE
PROPHYLAXIS TO PREVENT HIV.
HERE IS THE CASCADE.
YOU CAN SEE THE PERCENTAGES AT
THE TOP OF THE BARS ARE OF THE
FULL SAMPLE, 140, YELLOW ARROWS
ARE THE PERCENTAGE OF THE BAR
PRIOR, PRIOR STEP.
YOU CAN SEE ABOUT 60% HAD BEEN
TESTED FOR HIV, 44% PrEP
INDICATED.
NEXT SLIDE.
INDICATIONS WERE MOST COMMONLY
SEXUALLY, CONDOMLESS SEX.
34% NEVER HEARD OF PrEP.
SEX WORK AND HOMELESSNESS BOTH
ASSOCIATED WITH PrEP
INDICATIONS.
AND IN TERMS OF HAVING HEARD OF
PrEP, 34% HEARD OF PrEP.
THE UPTAKE WAS VERY LOW, 9%
EVER.
ALMOST ALL THOSE FOLKS HAD
GOTTEN IT FROM A RESEARCH STUDY.
THE REASONS FOR NON-PrEP USE
WERE NOT KNOWING WHERE TO
ACCESS, A LOT OF CONCERNS ABOUT
SIDE EFFECTS AS WELL AS
INTERFERING WITH GENDER
AFFIRMING HORMONES AS WELL AS
COST.
NEXT SLIDE PLEASE.
THEY REPORTED HIGH WILLINGNESS.
SO WHEN WE THINK ABOUT
POPULATION, WHAT WE'VE BEEN
LEARNING IS NEED FOR COMBINATION
PREVENTION APPROACHES THAT
ADDRESS THIS MULTIPLE LEVELS OF
INFLUENCE, INCLUDING ON THE
RIGHT THINGS AROUND GENDER
AFFIRMATION, SOCIAL,
PSYCHOLOGICAL, MEDICAL, THERE
ARE TREND SPECIFIC DETERMINANTS
SHAPING THE LIVES OF
TRANSFEMININE PEOPLE INCLUDING
TRANSGENDER YOUNG PEOPLE SO
THAT'S AN IMPORTANT PIECE.
NEXT SLIDE.
EXAMPLE IS WORK THAT IS FUNDED
BY NIH WHICH IS HIV PREVENTION
TRIALS NETWORK, THIS IS AN
INTERVENTION TESTING APPROACH
THAT CO-LOCATES GENDER AFFIRMING
CARE WITH PrEP SO THIS IS AN
IMPORTANT ASPECTED OF
INTEGRATING TRANSSPECIFIC SOCIAL
DETERMINANTS, IF YOU WELL, BEING
FIELDED IN FIVE SITES INCLUDING
RIO DE JANEIRO, BRAZIL.
THERE'S ALSO -- I TALKED ABOUT
THE VULNERABILITY AND NEGATIVE
PIECES, THERE'S ALSO A NEED TO
UNDERSTAND THE RESILIENCIES.
WE KNOW MUCH LESS ABOUT THIS,
SUCH AN IMPORTANT AREA.
I THINK PEOPLE ARE LIVING LIVES
EVERY DAY, RESISTING OPPRESSION
AND THERE ARE SO MANY WONDERFUL
THINGS TO BUILD ON.
SO AT EACH LEVEL OF INFLUENCE
INCLUDING NETWORKS AND TRANS
KINSHIP STRUCTURES, PARTICULARLY
MOTHERS WERE PROFOUND.
FOR EXAMPLE THERE ARE
ORGANIZATIONS, THIS IS A QUOTE
FROM A PARTICIPANT ABOUT
FEMINAS.
I CAME TO THE COMMUNITY
ORGANIZATION, I LIKED IT, I GO,
THEY GIVE ME CONDOMS, I THOUGHT
HIV TRANSMITTED THROUGH SALIVA
BECAUSE OF A KISS, THIS HELPED
ME GET INFORMATION, THIS SENSE
OF BEING SEEN IN THIS CONTEXT.
FORWARD, CALL TO ACTION, ADDRESS
THE MULTI-LEVEL DRIVERS OF HIV
EPIDEMIC AND IDENTIFY THOSE
MULTI-LEVEL RESILIENCIES THAT
CAN BE LEVERAGED FOR FUTURE
INTERVENTIONS.
WE SEE LIKE A LARGE GAP BETWEEN
HIV PREVENTION INDICATION AND
UPTAKE.
WE ALSO SEE THAT FOR FOLKS
LIVING WITH HIV IN TERMS OF NOT
BEING VIRALLY SUPPRESSED, HAVING
ACCESS TO CARE.
SO THERE'S A HIGH NEED FOR
COMBINATION APPROACHES.
MANY OF WHICH INCORPORATE PEERS.
SOME PHOTOS HERE ARE FROM LAYLA
AND TEAM AT FEMINAS.
THERE'S A HUGE NEED FOR
STATUS-NEUTRAL INTERVENTIONS.
THE HIGH PREVALENCE THAT WE
FOUND OF HIV OVER 40% IN THE
SAMPLE SPEAKS TO THE SOCIAL
NETWORKS ARE NOT DELINEATED BY
HIV OR HIV PREVENTION, RIGHT?
IT'S LIKE EVERYBODY IS IN
COMMUNITY WITH EACH OTHER.
STATUS NEUTRAL APPROACHES ARE AN
IMPORTANT DIRECTION FOR US TO
MOVE IN.
CONTINUING TO TAILOR
INTERVENTIONS WITH TRANS
COMMUNITIES, WORKING WITH
COMMUNITIES TO DO THE WORK, NOT
JUST THE RESEARCH BUT ALSO
IMPLEMENTATION STRATEGIES.
PEOPLE SAY TRANS COMMUNITIES ARE
DIFFICULT TO RECRUIT.
THAT HAS NOT BEEN MY EXPERIENCE.
IT WAS NOT OUR EXPERIENCE IN
THIS STUDY.
WE AS TRANS PEOPLE ARE HERE AND
ARE WILLING TO PARTICIPATE AND
CONTINUE TO DO SO IN PARTNERSHIP
WITH COMMUNITIES, REALLY THE
BEST PRACTICE.
AND LASTLY, ALL THE FACTORS ARE
DRIVEN BY THE STRUCTURAL
INEQUALITIES.
AND IN ORDER FOR US TO MAKE A
DENT IN THE EPIDEMIC FOR HIV WE
HAVE TO ADDRESS THOSE.
PARTICULARLY FOR TRANSFEMININE
PEOPLE VIOLENCE IN THE CONTEXT
OF LATIN AMERICA, WHETHER
PARTNER VIOLENCE, STRUCTURAL,
LEGAL AND SO FORTH.
I WANT TO THANK THE TEAM WHO
WORKED ON THIS PROJECT, ALFONSO,
MAYA, LAYLA, THE FEMINAS TEAM
GOT MATCHING OUTFITS AS PART OF
THE FIELD WORK.
THEY HAVE A CUTE OUTFIT,
DELIVERING CLINICAL SERVICES,
DOING THE TESTING, AND THE OTHER
FOLKS, ESPECIALLY THE YOUNG
TRANS WOMEN WHO PARTICIPATED IN
THE PROJECT.
SORRY I WENT OVER A COUPLE
MINUTES.
THANK YOU VERY MUCH.
>> THANK YOU SO MUCH FOR THAT
PRESENTATION.
AND NOW WE WILL MOVE TO MALLERY
ROBINSON.
YOU HAVE THE FLOOR.
>> THANK YOU.
GREAT JOB.
HIGH AGAIN, SUPER HAPPY TO BE
HERE WITH YOU.
I'M TAKING A MOMENT TO SHARE MY
TRANSGENDER EMPATHY TRAININGS.
I COME AS A TRANSGENDER ADVOCATE
FROM CALIFORNIA.
SOME DATA COMES FROM THERE.
NEXT SLIDE.
WHY DID I CREATE TRANSGENDER
EMPATHY?
I'VE HEARD A LOT OF
CONVERSATIONS.
HAVE YOU SOMEONE WITH THE LIVED
EXPERIENCE.
I KNOW WHAT THE COMMUNITY FACES,
ON A DAILY BASIS.
MY GOAL IS TO SHARE OUR
TGI/TGNC.
RECEIVE EQUITY AND JUSTICE BY
INCREASING EMPATHETIC APPROACHES
ARE ALLIES, ACCOMPLICES,
COMMUNITY PARTNERS.
I WANTED TO ADD MY QUOTE AROUND
EMPATHY.
EMPATHY IS THE CAPACITY TO
UNDERSTAND OR FEEL WHAT ANOTHER
PERSON IS EXPERIENCING FROM
WITHIN THEIR FRAME OF REFERENCE,
AND AGAIN EMPATHY IS THE
CAPACITY TO UNDERSTAND OR FEEL
WHAT ANOTHER PERSON IS
EXPERIENCING FROM WITHIN THEIR
FRAME OF REFERENCE.
THAT'S THE CAPACITY TO PLACE
ONESELF IN ANOTHER POSITION.
NEXT SLIDE PLEASE.
SO WE'RE GOING TWO STATISTICS
AND STORIES.
RAISE YOUR HAND IF YOU OR
SOMEONE CLOSE TO YOU HAD BEEN
SEXUALLY ABUSED AS A CHILD.
THANK YOU.
THANK YOU, SARI.
THANK YOU.
VULNERABILITY.
NEXT SLIDE.
MELISSA, I SEE YOU.
THANK YOU.
AONE OUT OF FOUR GIRLS, ONE OUT
OF SIX GIRLS EXPERIENCES SEXUAL
ABUSE BY 18.
THESE RATES ARE EVEN HIGHER FOR
GENDER NON-CONFORMING.
ASSIGNED MALE AT BIRTH, I'LL
MAKE SURE YOU GET ACCESS TO THE
TERMS, WE DIDN'T GO THROUGH THAT
TODAY, I HAVE NORMALLY A 2-HOUR
PRESENTATION, THIS IS THE
ENGAGEMENT PIECE, THIS IS WHAT
WE'RE DOING RIGHT NOW.
PLEASE KNOW I'LL MAKE SURE YOU
GET THOSE KEY TERMS TO REFER TO
WHAT I'M REFERRING TO NOW.
ESPECIALLY VULNERABLE, SIX TIMES
LIKELIER TO BE SEXUALLY ABUSED.
MANY TRANS CHILDREN CHILDHOOD
TRAUMA, ESPECIALLY CHILD SEXUAL
ABUSE SURVIVORS.
NEXT SLIDE PLEASE.
RAISE YOUR HAND IF YOU OR
SOMEONE CLOSE TO YOU WAS BULLIED
IN ELEMENTARY OR HIGH SCHOOL.
AGAIN, THANK YOU FOR YOUR
VULNERABILITY.
SOME QUESTIONS CAN BE DAUNTING
BUT IT TIES INTO EMPATHY.
NEXT SLIDE.
ACCORDING TO GAY LESBIAN
STRAIGHT NETWORK, 75% OF
TRANSYOUTH FEEL UNSAFE AT
SCHOOLS.
THOSE THAT STAY IN SCHOOL HAVE
SIGNIFICANTLY LOWER GRADE POINT
AVERAGES, MOST LIKELY TO MISS
SCHOOL OUT OF CONCERN FOR
SAFETY.
FOR EXAMPLE MY GROUP THAT'S HERE
TODAY, MAYBE THEY ARE ANGRY,
MAYBE THEY SEE RED, OH, THEY
HAVE A CHIP ON THEIR SHOULDER,
THESE ARE SOME STORIES AS TO WHY
THEY ARE COMING IN UPSET,
ALREADY FACING BEING SURVIVORS
OF SEXUAL ASSAULT AND SEXUAL
ABUSE AS A CHILD.
THEY ALSO HAVE TO GO TO SCHOOL,
LEAVE HOME FROM ABUSE, OR
WHEREVER, AND GO TO A SCHOOL
WHERE THEY ARE SUPPOSED TO FEEL
SAFE AND UNFORTUNATELY FACE
BULLYING.
WHEN WE HAVE TRANS MEMBERS WHO
COME IN UPSET, IT'S EASY TO
WRITE THEM OFF AS PROBLEMATIC OR
ANGRY PERSON BUT PLEASE KEEP IN
MIND THOSE ACTIVITIES GIVE YOU
AN IDEA OF WHAT WE'RE COMING
INTO AND DEALING WITH ON A
DAY-TO-DAY BASIS.
NEXT SLIDE.
PLEASE RAISE YOUR HAND IF YOU OR
SOMEONE CLOSE TO YOU WAS EVER
REJECTED BY FAMILY MEMBERS
SIMPLY BECAUSE OF WHO THEY ARE.
APPRECIATE EVERYONE'S
VULNERABILITY.
ABSOLUTELY.
I SEE YOU, REBECCA.
ABSOLUTELY.
THANK YOU.
NEXT SLIDE.
ACCORDING TO THE WILLIAMS
INSTITUTE 40% OF HOMELESS YOUTH
ARE LGBTQ.
68% OF THESE YOUTH INDICATE
FAMILY REJECTION WAS A MAJOR
CONTRIBUTING FACTOR TO
HOMELESSNESS.
GIVEN YOU HAVE COMMUNITY
MEMBERS, CLIENTS, PATIENTS
COMING IN, UNHOUSED, BEING
BULLIED AT SCHOOL, ON TOP OF
THAT SURVIVORS OF SEXUAL ABUSE,
SO AGAIN YOU HAVE A LOT OF
PEOPLE ESPECIALLY TRANS
COMMUNITY COMING IN RED HOT AND
ANGRY BECAUSE OF SOME OF THESE
FACTORS.
NEXT SLIDE PLEASE.
RAISE YOUR HAND ON THIS ONE.
I SEE A FEW HANDS.
THANK YOU.
NEXT SLIDE PLEASE.
ACCORDING TO █THE WILLIAMS
INSTITUTE 29% OF OUR TRANSADULTS
IN THE UNITED STATES STILL LIVE
IN POVERTY.
THANK YOU.
NEXT SLIDE.
PLEASE RAISE YOUR HAND IF YOU OR
SOMEONE CLOSE HAS EVER FEARED
FOR THEIR LIFE DUE TO HATE
VIOLENCE?
I SEE A FEW MORE HANDS.
THANK YOU.
THANK YOU FOLLOW YOUR
VULNERABILITY.
NEXT SLIDE PLEASE.
THANK YOU, ELIZABETH.
I SEE YOU.
ACCORDING TO NATIONAL COALITION,
72% OF HATE VIOLENCE VICTIMS IN
2013 WERE TRANSGENDER WOMEN, 67%
WOMEN OF COLOR.
THE NUMBER FROM 2013 STEMS FROM
HUMAN RIGHTS CAMPAIGN
ORGANIZATION, STARTED DATA
COLLECTING BACK IN 2013, BECAUSE
OF THE RATE OF TRANS FOLKS BEING
MURDERED ESPECIALLY THOSE OF
COLOR.
I'VE BEEN OUT SINCE 2006, IN
MONTGOMERY, ALABAMA, I COULD
HAVE FALLEN INTO THIS STATISTIC.
PEOPLE CAME TO ME, BEING
MISREPRESENTED, RESULTED IN ME
CREATING A HATEFUL HOMICIDE, MY
TRANSGENDER PODCAST, TRUE CRIME
PODCAST FOCUSING ON MURDER OF
OUR TRANS COMMUNITY MEMBERS IN
THE UNITED STATES AND ABROAD.
NOTE YOU CAN SEE WHERE WE'RE
AVAILABLE AT SPOTIFY, APPLE, I
HEART RADIO, AUDIBLE,
YouTube.
THIS IS REPORTING ACCURATELY FOR
OUR COMMUNITY MEMBERS,
ESPECIALLY THOSE WITH TRANS
EXPERIENCE, OFTENTIMES
MISGENDERED, BLAMED FOR A CRIME.
ONE ARTICLE THAT CAME OUT, NEX
BENEDICT, THE 16-YEAR-OLD
NON-BINARY MURDERED IN OKLAHOMA
DUE TO BULLYING AND VIOLENCE,
THIS IS WHY WE DO THE WORK.
PLEASE SHARE AND SUPPORT THE
PODCAST, MY FRIENDS.
PLEASE RAISE YOUR HAND IF YOU
HAVE PERSONALLY EXPERIENCED
BEING UNHOUSED.
I SEE A FEW HANDS.
THANK YOU.
NEXT SLIDE.
ONE IN FIVE MEMBERS OF THE TRANS
COMMUNITY ESPECIALLY IN
CALIFORNIA WHERE I'M LOCATED
REPORT BEING UNHOUSED AT SOME
POINT SINCE FIRST IDENTIFYING AT
TRANS.
THERE'S A NATIONAL TRANS SURVEY
EVERY SEVEN YEARS, 2015 AND 2022
WAS THE MOST RECENT, BUT
ACCORDING TO THE 2015 SURVEY
BLACK TRANSGENDER PEOPLE FACEED
MOST SERIOUS UNHOUSING EFFECTS.
42% ARE EXPERIENCED BEING
UNHOUSED AT SOME POINT IN THEIR
LIVE.
I'M ONE OF THOSE PEOPLE.
NEXT SLIDE PLEASE.
RAISE YOUR HAND IF YOU
EXPERIENCED ANTI-BLACK RACISM?
I SEE A FEW HANDS.
THANK YOU.
NEXT SLIDE PLEASE.
ACCORDING TO "L.A. TIMES," BLACK
PEOPLE COMPRISE 8% OF POPULATION
IN LA COUNTY, 34%. OF THE
HOMELESS POPULATION.
RAISE YOUR HAND IF YOU OR
SOMEONE CLOSE TO YOU BECAME
UNEMPLOYED DUE TO THE COVID-19
PANDEMIC.
THANK YOU.
NEXT SLIDE.
ACCORDING TO U.S. TODAY 19% OF
TRANS PEOPLE AND 26% OF
TRANSPEOPLE OF COLOR BECAME
UNEMPLOYED BECAUSE OF COVID-19
COVID-19 COMPARED TO 12% OF THE
GENERAL U.S. POPULATION.
DURING COVID-19, IT'S NOT OUR
SURVIVOR SEX WORKERS, IT'S NOT
COMMUNITY WORKERS WHO ARE IN
ORGANIZATIONS SUCH AS NON-PROFIT
ORGANIZATIONS, IT WAS OUR RIDE
SHARE COMMUNITY MEMBERS WHO DID
LYFT AND UBER AND ALL OF THOSE
DELIVERY SERVICES BECAUSE OF THE
PANDEMIC, ISOLATING AND
QUARANTINING AND SOCIALLY
DISTANCING, WE HAD A LOT OF
COMMUNITY MEMBERS OUT OF JOBS
FOR A WHILE AND THIS IS WHERE WE
SAW SOME OF THAT DATA COME IN.
I WANTED TO GIVE YOU A LOOK.
I'VE HAD THIS IN OTHER
TRAININGS.
WELL, YOU KNOW, WHAT HAPPENED?
NO, NO, A LOT OF US KNOW WHEN
THE PANDEMIC HAPPENED THERE WAS
A LOT OF TELEHEALTH PIVOTING, WE
PIVOTED TO TELEHEALTH AND KEPT
IT MOVING, FOR SURVIVORS OF SEX
WORK, SEX WORK NEVER STOPS,
DURING THE PANDEMIC IT WAS A
HIGH COPING MECHANISM.
IT WAS THOSE WHO WERE ABLE TO
HAVE A VEHICLE AND HAVE MODES OF
TRANSPORTATION TO PROVIDE THOSE
ESSENTIAL SERVICES LIKE
DELIVERIES THAT WERE GREATLY
IMPACTED.
I WANT TO PROVIDE CLARIFICATION
THERE AS WELL.
I WANT TO ASK QUICKLY, HOPEFULLY
MR. THAT -- MARTHA CAN JOIN US,
DID ANY OF THESE STATISTICS
SURPRISE YOU?
CONSIDER THE FACTS YOU'VE HEARD
HAS YOUR ORGANIZATION, YOUR
MEDICAL PRACTICE, CREATED AN
AFFIRMING AND EMPATHETIC CULTURE
SAFE AND WORKING FOR THE TRANS
COMMUNITY AND INTERSECTION
COMMUNITY MEMBERS.
THERE'S 24 STATES THAT HAVE
ANTI-TRANS LEGISLATION, I'LL END
WITH IT FOR MYSELF WHO CAME OUT
AS A TRANS YOUTH IN 2006, THE
GEORGE W. BUSH ERA IN
MONTGOMERY, ALABAMA, THE
EXPECTATION WAS AFGHANISTAN AND
IRAQ WAR, I'LL TELL YOU I
ENCOURAGE YOU TO BECOME MORE 'EM
EMPATHETIC AND WELCOMING.
IF YOU HAVE TRANS PATIENTS AND
CLIENTS IF THEY SEEM ANGRY,
FRUSTRATED, I HOPE THESE GIVES
YOU MON CONTEXT WHAT WE GO
THROUGH ON A DAILY BASIS.
THANK YOU SO MUCH FOR OUR TIME.
PLEASE FEEL FREE RESPOND IN THE
CHAT.
>> THANK YOU, MALLORY, FOR YOUR
PARENTHESES VACCINATION.
I WAS KEEPING MY FINGERS CROSSED
HOPING TO GET MARTHA'S
CONNECTION WORKING,
UNFORTUNATELY SHE WON'T BE ABLE
TO JOIN US TODAY.
WE APOLOGIZE THERE.
WHAT WE'LL DO NOW IS MOVE TO THE
Q&A PORTION AND AS A FINAL
REMINDER FOR ME YOU CAN SUBMIT
QUESTIONS VIA THE "LIVE
FEEDBACK" FORM ON THE WEB PAGE,
OR VIA E-MAIL.
I'LL TURN IT OVER TO MELISSA.
>> GREAT PRESENTATIONS.
WE'VE GOTTEN REALLY POSITIVE
FEEDBACK FROM DIFFERENT VIEWERS,
YOU CAN SEE IT IN THE CHAT.
GREAT SERIES OF PRESENTATIONS
AND DISCUSSIONS, LOOKING FORWARD
TO MORE, GREAT PRESENTATION FROM
ALL THE SPEAKERS.
WE DO HAVE A FEW QUESTIONS FROM
THE AUDIENCE.
I'M GOING TO POST THEM IN THE
CHAT.
YOU CAN READ THEM AS WELL.
WHAT ARE THE POTHOLES WE NEED TO
AVOID TO ADDRESS THE GAP IN
WOMEN'S HELD RESEARCH AND
SPECIFICALLY HIV AND WOMEN?
>> I CAN START US OFF ON THAT
ONE.
FROM A TRANS LENS I'LL QUICKLY
ADD THAT AGAIN SO MANY TIMES FOR
MYSELF I HAVE THE LIVED
EXPERIENCE OF BEING TRANS AND
ALSO LIVING WITH HIV, SOMEONE
WHO LIVES UNDETECTABLE FOR THE
PAST 13 YEARS, I WILL TELL YOU
COMING FROM ALABAMA, IT'S
INTERESTING WHEN I TELL FOLKS
THIS, HAD I NOT GOTTEN DIAGNOSED
WITH HIV, I WOULD NOT HAVE HAD
ACCESS TO MY HORMONE REPLACEMENT
THERAPY BECAUSE OF THE LAWS THAT
IMPLEMENT AND IMPACT OUR TRANS
COMMUNITY SO MUCH, ESPECIALLY
OUR TRANSWOMEN.
THERE'S A LOT MORE GENDER
JOURNEYS FOR OUR FEMININE FOLKS
TO EVEN PRESENT AS FEMININE IN
SPACES, LIVING WITH HIV CAN BE
OVERWHELMING.
I HAD A STUDENT, I USED TO TEACH
MIDDLE SCHOOL, SECONDARILY HIGH
SCHOOL, I HAD A STUDENT TRANS,
ALSO LIVING WITH HIV, ONE OF THE
THINGS THEY SHARED WAS PROBLEMS
OF BEING ABLE TO HAVE ACCESS TO
RESTROOMS AND BEING ABLE TO
SELF-ADMINISTERS HRT AND ART,
THINGS THAT IMPACT US ON A
FEMININE LEVEL AND AS A HUMAN
LEVEL.
>> I FEEL LIKE I TOTALLY AGREE.
A LOT OF PIECES AROUND AVOIDING
RESTIGMATIZING, YOU KNOW,
AVOIDING THAT IN THE CONTEXT OF
CARE, CONTEXT OF HIV IS ANOTHER
HEALTH CONDITION LIKE ANY OTHER
CONDITION.
SO TAKING THAT, THERE'S A LOT
OF -- IN THE CONTEXT OF LATIN
AMERICA, THERE'S STIGMA AROUND
HIV, SO MUCH OF IT.
SOMETIMES I TALKED ABOUT
PREVENTION AND TREATMENT
APPROACHES, THE RESULT, WE NEED
TO BRING THOSE TOGETHER.
NOT HAVE THINGS BE ZERO STATUS
SEPARATE BECAUSE THAT CREATES
ADDITIONAL STIGMA.
THE OTHER THING IS IN TERMS OF
LIKE THE SCIENCE, I THINK WE
NEED TO PUT THE GENDER BACK IN
TRANSGENDER.
THAT'S WHERE FOR ME WOMEN IN
HIV, THERE ARE GENDERED PATHWAYS
TO THIS, ADDRESSING THE EPIDEMIC
THAT WE NEED TO TAKE.
THERE ARE SEXED PATHWAYS TOO,
BUT THERE ARE GENDERED PIECES
AROUND SOCIAL AND CULTURAL
THINGS PUTTING PEOPLE NOT ONLY
LIKE MADE VULNERABLE COMMUNITIES
VULNERABLE BUT ACCESS TO CARE,
ACCESS TO TREATMENT, MINE --
THOSE ARE MY INITIAL THOUGHTS.
>> DO YOU WANT TO JUMP IN OR WE
HAVE ANOTHER ONE IN THE CHAT.
>> NO, I'M AGREEING WITH THE
REST OF THE PANELISTS.
WE DON'T WANT TO STIGMATIZE.
ANSWERED VERY WELL.
>> THANK YOU.
THE NEXT QUESTION IS HOW CAN WE
SUPPORT TRANS PEOPLE WITH
HOSTILE ENVIRONMENTS INCLUDING
ANTI-TRANS LEGISLATION AND HIGH
RATES OF STIGMA?
>> I CAN START US OFF ON THIS
ONE TOO.
I WOULD JUST SAY FOR SOMEONE
WITH LIVED EXPERIENCE, THE
BIGGEST SUPPORT, IN CALIFORNIA,
WHEREVER YOU'RE LOCATED AS TRANS
PEOPLE, EVERYWHERE, EVEN AS DR.
SARI MENTIONED IN LATIN AMERICA
AND EVERYBODY WHERE , THE
BIGGEST SUPPORT IS HAVE AN
EMPATHETIC EAR, BE WILLING TO
UNDERSTAND THESE ARE HUMAN
RIGHTS FROM HEALTH CARE TO
HOMELESSNESS, TO FOOD RESOURCES,
TRANSPORTATION.
EVEN JUST ACCESS TO DATING
WEBSITES IS REALLY A BIG THING.
I HAD A BEAUTIFUL BIG
TRANSWOMAN, A LAWYER, THERE'S SO
MUCH THINGS CAN YOU DO, SHARE
OUR STORIES.
BE WILLING TO SAY OUR NAMES.
IF YOU SEE SOMEONE WHO IS OF THE
TRANS EXPERIENCE OR NON-BINARY
EXPERIENCE, FACING HARASSMENT,
AGAIN WE HAVE ALLIES, THOSE WHO
SAY OUR NAMES, UPLIFT US,
ACCOMPLICES WILL GET IN FRONT OF
US, I'LL TAKE THAT LICK FOR YOU.
DON'T YOU HIT HER, DON'T YOU HIT
HIM, I'LL TAKE THAT LICK.
WE NEED THAT LEVEL OF GROUNDS,
FEET PLANTED, LIKE YOU'RE READY,
YOU'RE IN THIS AS MUCH AS WE
WOULD FOR YOU ALL.
TRANS PEOPLE THE STARTED
STONEWALL.
IF YOU KNOW ANYTHING ABOUT THE
1973 MARCH , THE BEAUTIFUL
TRANSLATINA WOMAN, THEY TREATED
HER POORLY, WE STILL GET TREATED
THAT WAY 50 YEARS LATER.
SAY OUR NAMES, HEAR OUR STORIES,
VALUE OUR VOICES, THAT'S THE
BEST WAY YOU CAN SUPPORT.
THANK YOU.
>> I MEAN, I THINK I'M AGREEING,
JOUST NODDING.
MALLERY, I COULD NOD TO YOU.
THERE'S THIS PIECE AROUND
LETTING PEOPLE KNOW YOU SEE
THERE'S SOMETHING GOING ON.
AND I THINK EVEN IN HEALTH CARE
CONTEXT, A LOT OF PEOPLE,
THERE'S A LOT OF -- LETTING
PEOPLE KNOW THAT IT MAKES SENSE
TO BE DISTRESSED ABOUT THIS
RIGHT NOW.
AND ALSO THERE IS SUPPORT.
I THINK THAT'S THE MAJOR THING,
WE WERE DOING FOCUS GROUPS,
NIH-FUNDED STUDY, SUICIDE
PREVENTION TRIAL, INTERVIEWS AND
FOCUS GROUPS.
PEOPLE ARE SCARED WITH YOUTH AND
THEIR CAREGIVERS.
THEY ARE VERY SCARED.
AND BUT SORT OF IDEA AROUND
LIFTING UP AND AND ENHANCING,
BRINGING THOSE BACK TO THE
SURFACE LIKE WE'RE TALKING
ABOUT, TRYING TO HAVE -- LEAD
WITH THAT.
>> OVERALL WE JUST NEED TO BE
BETTER HUMANS.
WE JUST NEED TO BE BETTER
HUMANS.
>> WE HAVE ANOTHER QUESTION,
THERE HAVE BEEN A LOT OF EFFORTS
TO BRING DOWN THE UNACCEPTABLE
RATES OF MATERNAL MORTALITY SO
WHAT NEW STRATEGY CAN WE TRY?
ANYTHING IN THE WORDS
PARTICULARLY PROMISING?
>> MY APOLOGIES.
I WAS HAVING TECHNICAL
DIFFICULTIES.
I COULDN'T HEAR THE QUESTION
PROPERLY.
>> I'LL REPEAT IT.
THERE HAVE BEEN A LOT OF EFFORTS
TO BRING DOWN UNACCEPTABLE RATES
OF MATERNAL MORTALITY, SO WHAT
NEW STRATEGIES CAN WE TRY,
ANYTHING IN THE WORKS
PARTICULARLY PROMISING?
>> YOU KNOW, IT HAS TO BE
COLLABORATIVE.
WE HAVE A LOT OF ENTITIES
WORKING IN SILOS DOING THINGS
SEPARATELY.
IT'S NOT WORKING.
HASN'T BEEN WORKING.
PEOPLE ARE DOING THE SAME
THINGS.
AND STILL NOT ACCOMPLISHING, YOU
KNOW, THE GOALS.
WE NEED TO ACTUALLY WORK
TOGETHER.
AND ACTUALLY FUND THOSE
ORGANIZATIONS THAT ARE ACTUALLY
GRASS ROOTS ORGANIZATIONS
WORKING SIDE BY SIDE WITH
INDIVIDUALS THAT ARE IN THE
ACTUAL COMMUNITY.
A LOT OF INSTITUTIONS JUST DON'T
HAVE THE GREAT RELATIONSHIP WITH
THE COMMUNITY LIKE THEY SHOULD.
THEY KNOW OF THE NUMBERS BUT DO
THEY HAVE A RELATIONSHIP?
ARE THEY GOING INTO THE
NEIGHBORHOODS AND ASKING THE
COMMUNITY WHAT THEY NEED, WHAT
THEIR DESIRES ARE, WHAT THEIR
EXPERIENCE AT THOSE HOSPITALS OR
INSTITUTIONS OR HEALTH CARE
CENTERS SO THEY CAN CORRECT THAT
AND USE THOSE PLACES IN THEIR
NEIGHBORHOODS.
SO THEY GOT TO DO MORE FOOT
WORK.
COME OUT OF THE OFFICE.
THEY GOT TO GO OUTSIDE.
>> THANK YOU.
ANYTHING TO ADD TO THAT?
>> YEAH, I WOULD ADD AS WELL,
BEING WILLING, ONE OF THE THINGS
I'LL SAY, PUBLIC ACTION, RIGHT?
I KIND OF SEE IN ONE OF THE
BOXES TELEVISION OPS.
GO TO THE MEDIA.
THEY WANT TO HEAR.
ESPECIALLY RIGHT NOW, YOU ALMOST
HATE TO SENSATIONALIZE, VOICESES
OF BLACK WOMEN HAVE BEEN
ELEVATED BECAUSE WE'VE BEEN
SILENCED, IN SILOS.
PEOPLE WANT TO HEAR WHAT'S GOING
ON, OUR STORIES.
I ENCOURAGE ANYONE IN A SPACE
WHERE YOU'RE BEING DISCRIMINATED
AGAINST, SIGN AN NDA, MAYBE YOU
SAW A BLACK WOMAN BE
DISCRIMINATED AGAINST, WHITE
GIRL DIDN'T GET TREATED THAT
WAY, WE HAVE TO OVERLOOK NDAs,
WE HAVE TO TAKE IT TO THE MEDIA.
IT'S HOW WE GET THOSE STORIES
OUT AND I'M TELLING YOU WHEN YOU
CIRCULATE, YOU'LL NEVER BELIEVE
HOW MANY PEOPLE RAISE THEIR HAND
LIKE YOU ALL DID.
NO, THAT APPLIES TO ME TOO.
THIS HAPPENED TO YOU TOO?
I THOUGHT I WAS THE ONLY ONE.
IT BUILDS CAMARADERIE AND
SISTERHOOD, CAN YOU EVEN FILE A
CLASS ACTION SUIT, TAKE IT TO A
LEGALITY LEVEL.
FURTHER THAN HAVING THOSE
CONVERSATIONS INTERNALLY BUT
MAKING SURE PEOPLE ARE AWARE.
THANK YOU.
>> WE HAVE ONE LAST QUESTION.
SARI, DO YOU WANT TO ADD
ANYTHING?
>> I'M HERE.
THANK YOU.
>> WHERE CAN RESEARCH MAKE
PROGRESS IN ADDRESSING GAPS IN
TRANSGENDER AND GENDER DIVERSE
PEOPLE?
>> I CAN JUMP IN.
FUNDERS HAVE AN IMPORTANT ROLE
TO PLAY.
SO MUCH INTERNAL ADVOCACY THAT
HAPPENS FOR FUNDING ENTITIES
TOO.
I KNOW THAT'S AN IMPORTANT PART
OF WHAT FUNDING OPPORTUNITIES
GET WRITTEN AND DISSEMINATED.
INTERN ADVOCACY, SEEING THE NEED
TO ADDRESS HIV WITHIN
COMMUNITIES IS EXCELLENT.
THERE'S A NEED TO KIND OF
LEVERAGE ACROSS SECONDER
PARTNERSHIPS.
PUBLIC HEALTH, A LOT OF WHAT
WE'RE TALKING ABOUT TODAY IS
POVERTY, EDUCATION, SOCIAL
DETERMINANTS OF HEALTH, LEGAL
ISSUES.
SO THIS REQUIRES CREATIVE
SOLUTIONS THAT ARE OUTSIDE OF
MEDICINE AND THAT BRING IN
MULTI-SECONDERS --
MULTI-SECTORS, THAT WILL BE
HELPFUL AND NECESSARY TO
AADDRESS KNOWLEDGE GAPS AND MAKE
A DENT IN THE EPIDEMIC FOR TRANS
POPULATIONS.
THIRDLY THE IDEA HOW CAN WE
SHORTEN TIME BETWEEN SCIENTIFIC
KNOWLEDGE AND IMPLEMENTATION OF
THE STRATEGY.
BY THE TIME WE DO TRIALS AND
FIND THE KNOWLEDGE AND WE'RE --
IT TAKES A LONG TIME BETWEEN
WHEN WE GET THE KNOWLEDGE AND
THEN INTERVENTION.
SO SOMETHING THAT WOULD LESSEN
THAT OR ALLOW FOR MORE RAPID
RESPONSE EFFORTS OF THE
KNOWLEDGE, FILLING KNOWLEDGE
GAPS BUT HAVING IMMEDIATE
RESPONSES SHORTENED IS
IMPORTANT, AND CALLS THAT
INTEGRATE RAPID RESPONSE EFFORTS
WITH THE KNOWLEDGE CREATION.
>> I DON'T KNOW IF YOU WANT TO
ADD SOMETHING.
THANK YOU.
THIS CONCLUDES TODAY'S SESSION
ON HEALTH DISPARITIES INEQUITY.
THANK YOU ALL FOR YOUR
PARTICIPATION, YOUR
PRESENTATIONS WERE INSIGHTFUL,
AND WE LOOK FORWARD TO BEING
ABLE TO COLLABORATE AND MOVE
FORWARD IN FILLING THOSE GAPS.
AND I'M PLEASED TO INTRODUCE
CORETTÉ BYRD, PROVIDING CLOSING
REMARKS.
>> THANK YOU, MELISSA.
I WANT TO SAY THANK YOU SO MUCH
FOR SUCH AN ENGAGING AND
INFORMATIVE SESSION.
AND I FEEL EXTREMELY FULL OVER
THE PAST TWO DAYS.
IT'S BEEN EXTREMELY
ENLIGHTENING.
I WANT TO SAY ON BEHALF OF NIH,
OFFICE OF AIDS RESEARCH, I WANT
TO THANK YOU FOR ATTENDING AND
PARTICIPATING IN THIS WORKSHOP.
OVER THE PAST COUPLE DAYS WE'VE
HEARD ABOUT INNOVATIVE RESEARCH
TO ADDRESS THE INTERSECTION OF
HIV AND WOMEN'S HEALTH.
MEANINGFUL ENGAGEMENT OF
AFFECTED COMMUNITIES IS A KEY
PRINCIPLE OF EQUITY-INFORMED
RESEARCH.
WE INVITE CONTINUED ENGAGEMENT
AND ONGOING DISCUSSION.
THIS EVENT WILL BE ARCHIVED VIA
THE NIH VIDEOCAST, WE INVITE YOU
TO SHARE THE RECORDINGS WIDELY.
WE WANT YOU TO LEARN MORE ABOUT
OUR SIGNATURE PROGRAM, AND REACH
OUT TO US USING THE QR CODE
SHOWN HERE ON THE SLIDE.
NEXT SLIDE.
I WANT TO EXPRESS GRATITUDE TO
THE WORKSHOP PLANNING COMMITTEE,
LED BY MYSELF AND DR. BARR, WITH
SUPPORT OF THE MEMBERSHIP HERE,
WE'RE GRATEFUL TO THE EXTERNAL
PLANNING COMMITTEE MEMBERS.
THANK YOU ALL FOR CONTRIBUTING
YOUR TIME AND EXPERTISE TO THE
SUCCESS OF THIS EVENT.
WITH THAT, THANK YOU AGAIN.
TODAY'S WORKSHOP IS OFFICIALLY
ADJOURNED. 10552 07:31:15,081 [END OF PROGRAM]