Tuesday, December 23, 2014

politicizing the blood supply (X rated)

The decision to "allow" gay and "bisexuals" to donate blood was a purely political decision.

True, they might be HIV positive, but the testing will find that out. And the one year prohibition should catch the danger of spreading HIV before the screening test turned positive.

The problem? People lie....

But it's not the sexual orientation that is the problem: It's the anal sex.

This survey of people in "high risk" areas for HIV of "heterosexuals" suggest that anal sex is a major problem in the spread of HIV: And 30 percent of both men and women admit to anal sex...

but the main danger is drug use: 50 percent admit to using drugs (not necessarily IV, mostly oral).

and I found this interesting:

blacks or African Americans (hereafter referred to as blacks) and Hispanics/Latinos are disproportionately affected by HIV. Estimated rates of diagnosed HIV infection in 2011 were 9 times as high for blacks and 3 times as high for Hispanics or Latinos compared with the rate for whites.

in Latin cultures, sodomy is a way of humiliating women.

But the "high risk" areas apparently included a lot more African Americans than other groups.

Participant Characteristics

Approximately half (58%) of participants were aged 40–60 years. The majority of participants reported black race (72%) or Hispanic/Latino ethnicity (21%); the sample was evenly distributed by sex (Table 1). The majority of participants (64%) had never married and were not cohabiting. Most participants reported no more than a high school education (men: 86%; women: 83%) and very low incomes. For instance, most participants (87%) reported annual incomes of <$20,000, which is lower than the federal poverty guidelines for a family of four; approximately one in three (36%) reported annual incomes of <$5,000. Nearly three out of four (men: 72%; women: 73%) reported both income at or below poverty and no more than a high school education (data not shown). Approximately one third (31%) of participants were currently or had been homeless in the 12 months before the interview, and nearly half (46%) were uninsured.
With the exception of homelessness and health insurance, the demographic characteristics were similar for male and female participants. Approximately one third of male (35%) and female (27%) participants had been homeless at some time in the 12 months before the interview.  

and they tried to exclude high risk behaviors, but found some participants had done these things more than 12 months earlier

Although the analysis sample excluded data from participants who reported they had recently (within 12 months of interview) injected drugs or had male-male sex, 14% of male participants reported that they had injected drugs or had sex with another man >12 months before the interview; 5% of female participants had injected drugs >12 months before the interview (data not shown). Each participating area contributed an average of 442 interviews (range: 131–565) to this analysis. 

the number of average sexual partners was low: 3 for men, 2 for women.
And then you come to this:

A total of 4,467 (90%) female participants reported having vaginal sex without a condom with a male partner in the 12 months before the interview, and 1,420 (29%) reported having anal sex without a condom with a male partner (Table 3). The percentages of women who had vaginal sex without a condom were similar among women in all categories of education and income. Anal sex without a condom was more common among those with lower levels of income. 

anal sex requires a stronger better lubricated condom than vaginal intercourse.

and unprotected vaginal and  anal sex was more common when it was with a casual contact, and by white men.

 Vaginal or anal sex and vaginal or anal sex without a condom with female casual partners were less common among male participants who were married or cohabiting and among those with higher incomes and were more common among white men. 

another variable was lack of health insurance.

yet 70 plus percent had been tested for HIV, about 30 percent within the past year and most in community clinics or health centers.

much of the rest of the survey is about routine (one third got free condoms) (remember that some people overreport good behavior and underreport bad behavior).

the reason I bring up anal sex is that the passive partner is more likely to catch HIV, and in Africa, non vaginal intercourse was used during lactation to prevent pregnancy in some tribes (although in south Africa, intercrural intercourse was traditional to keep the girls virgins).

a broader cdc population survey suggested that 35 percent of women admit to having anal intercourse, and the average number of sexual partners lifetime was 4 for women and 6 for men. No link: A pdf that crashed my browser.

this estimate of anal sex is a lot higher than that found by Kinsey's survey, which was mainly in teens.

No, I'm not an expert on anal sex, mainly because it was not that common among the groups I worked with.

But one wonders why there is no outreach to people about this risky form of intercourse.

Finally, this caught my eye:

 Use of crack cocaine has been associated with HIV infection among heterosexuals in the United States (7,10,42). These results highlight opportunities for drug use prevention efforts among low-income urban populations. 

I've read anecdotes about homeless women trading sex for crack cocaine, and wonder how many traded anal sex for this (note the lower rate of anal sex with regular partner suggests it might be more common in those trading sex for money etc.).

So what does this have to do with the blood supply?

Well, if you don't want to offend the "gay" activists, just continue asking about anal sex for everyone. And ask about the past year.

But remember, the type who do such things often lie about it.

Sunday, December 21, 2014

Ebola update

Sheryl Atkinson at Fox news says that new cases of Ebola are no longer being reported in the news, or on the CDC news for political reasons.

The CDC has put out (finally) videos how to put out suits and protective gear, but no recent news of cases except in local papers.

So how many possible cases are there? 1400 are being monitored they told her.

MMWR homepage here. The Ebola page has mainly reports in Africa for the last two months.

so this should be in the monthly report of reportable diseases, yet their link gives a 2012 report. Huh?

my rss feed gives me the latest here.

but you have to find it in the footnotes:

There were no cases of viral hemorrhagic fever reported during the current week. In addition to the 4 cases of Ebola diagnosed in the United States to date in 2014, six residents of the
US have been medically evacuated to the US for care after developing Ebola in West Africa. Ten of the 11 VHF cases reported for 2014 are confirmed as Ebola and one as Lassa Fever. See Table II for dengue hemorrhagic fever.
So most cases being monitored haven't developed the disease, yet.

Friday, December 19, 2014



HIV protease inhibitors might work against Malaria

According to Parikh, there is more to the story than the direct antimalarial effects of the HIV drugs. His team has also found that a major reason for the significant anti-malarial protection in HIV patients is due to a beneficial “drug-drug interaction,” between the protease inhibitors and the antimalarial drug, artemether-lumefantrine, the most widely used treatment for malaria in the world.

the article includes this factoid:

Eighty-two percent of the world’s 198 million cases of malaria are in Africa, a WHO report states. Further, according to amfAR, 91 percent of the world’s HIV-infected children live in Africa.

this is important since malaria is becoming more resistant to antibiotics: SciAmerican  blames it on "overuse" but I suspect giving substandard doses because often the medicines are counterfeit (i.e. substandard, fake, or diluted so the dose is lower than the lablel)  might be behind the problem. This article points to drugs from India, but the counterfeits from China are a big problem, especially in SE Asia...

In total, 10.9 percent of the products collected failed an assessment of their active ingredients, 7 percent of which were considered substandard. The rest that failed were falsified, meaning they didn’t contain any active ingredient and were likely counterfeits from China, the researchers said.
they are discussing Cipro treatment in the article, and includes the factoid the Cipro is chemically related to Chloroquin, something I didn't know.

When I came down with a mild case of Falciparum Malaria while taking Chloroquin 35 years ago, I took a sulfa drug mixture. And for cerebral malaria, we used IM or IV Quinine. This is now not used due to resistance.

Friday, December 5, 2014

Shakespeare and the Great Pox

I'm busy listening to the medical history podcasts from Gresham College (UK). LINK

Syphilis was a bit more severe and easier to catch in those days (i.e. kissing could spread it if you kissed a cheek with an open wound).

it was syphilis that initially caused the most widespread suffering and death. However, by the mid-sixteenth century, observers were beginning to note that it was declining sharply in virulence. As Frascatoro noted in 1546, ‘although this pestilential disease is at present still fully active, it is no longer the same as it was at first.’ Pustules, he reported, were ‘now only to be found on a very small number of patients, and the pains are negligible or very slight…The sickness is in decline.’ Either people had developed some resistance to the most extreme symptoms, or the disease itself had mutated into a less virulent form. Whatever the reason, by the 1540s it settled into the form, or forms it has more or less persisted in taking up to the present day.

The change in the way a disease acts is not unknown in history...In the last week, news reports say the HIV is getting less virulent in recent years too, and often diseases of history are hard to identify because they differed from the modern versions.

So anyway, the disease is mentioned in a lot of plays by Shakespeare, making some speculate that he might have had it. And he even might have been cured of it: Because back then they treated it with very hot baths

From Shakespearenet:

I never definitively state that Shakespeare had syphilis, rather that he may have received treatment for syphilis, and may have suffered untoward side effects. Gonorrhea and syphilis were not differentiated clinically until the eighteenth century, and the Elizabethans regarded them as a single disease entity. This is because co-infection with more than one type of venereal disease is a common phenomenon, then as now. If Shakespeare had only a less dangerous venereal disease, such as gonorrhea, he likely still would have underwent conventional therapy for syphilis, namely, "the powdering tub of infamy." The unfortunate "scalded chickens" and "boiled stuff" were immersed in hot baths, and exposed to mercury vapor, in the form of volatilized cinnabar. The toxicity of mercury is dose-dependent. The inorganic mercury once used to treat syphilis is not highly toxic in low doses, but modern experience has shown that the symptoms of mild mercury poisoning may become manifest as the nervous system ages.

I don't think Shakespeare died of syphilis, or that it affected his cognitive and creative abilities. The Elizabethan treatment for syphilis was probably surprisingly effective, for those that could afford it. Treponema pallidum lacks heat shock proteins, and is thus susceptible to thermal lysis. The German psychiatrist Julius Wagner-Jauregg won the Nobel Prize for Medicine in 1927 for his use of deliberate malaria infection as a treatment for neurosyphilis. (The high fevers provoked by malaria killed off the spirochetes, but killed about 9% of patients.) Dissatisfaction with the toxicity of malaria therapy and arsenic therapy led to the revival of the Elizabethan hot bath treatment in the 1940s, just prior to the phenomenal success of penicillin.

a journal article from JMVH has more on treatment in the good old days:

 Beck (1997)  describes a typical mercury treatment :
“A patient undergoing the treatment was secluded in a hot, stuffy room, and rubbed vigorously with the mercury ointment several times a day.  The massaging was done near a hot fire, which the sufferer was then left next to in order to sweat.  This process went on for a week to a month or more, and would later be repeated if the disease persisted.  Other toxic substances, such as vitriol and arsenic, were also employed, but their curative effects were equally in doubt.” [9]
Mercury had terrible side effects causing neuropathies, kidney failure, and severe mouth ulcers and loss of teeth, and many patients died of mercurial poisoning rather than from the disease itself.  Treatment would typically go on for years and gave rise to the saying,
“A night with Venus, and a lifetime with mercury” [8]
the hot baths were part of the treatment with mercury, and ironically maybe the very hot bath was more efficient...

Herbs were also used, but not felt to be as successful.

all of which makes one wonder about "sweat baths" popularity in some AmerIndian traditions.

In Minnesota, it was a way to clean oneself and get some relief from arthritis and other ills, especially in the 8 months of cold weather, similar to the saunas of the Scandanavians or the Turkish baths.

NewWorldEncyclopedia article HERE.
I am impressed that when they noted the deaths of some white folks in a newage type sweat, they didn't get a pseudo Indian to comment, but asked Arvol LookingHorse of the Sioux, who is a true medicine man.

a discussion of the traditional Mexican sweat bath is found here.

a description of the sweat lodge of North American tribes can be found here.

As for baths: Yes, medieval people did take baths.

sometime they only did a "full body bath" twice a year, but they washed in between. Many dark age and medieval tales discuss the lady of the house getting a bath ready for the visiting knights.

Cracked has a list of myths about the middle ages...

...not only was it common for medieval folk to wash their hands before and after eating, it was also customary to offer to bathe with guests when they entered your home, something The Man has repeatedly reminded us is no longer acceptable in modern society. Medieval demand for soap (usually made from animal fats, with a variety of oils and salts added) was so great that by the 13th century, soap was being made on an almost industrial scale in Britain, Italy, Spain, and France.
So why do we picture everyone as wallowing in their own filth back then? Well, things changed all at once. If only an act of God could change Europe's epic bathing culture, they got one -- in the mid-14th century, the Black Death strolled up and kicked Europe right in the teeth with its pestilence boot. Suddenly, smart people were telling the previously washed masses that bathing was a surefire way to open your body's pores and invite in all the bad spirits or gremlins or whatever (they weren't too savvy on what caused illness back then).

Read more: http://www.cracked.com/article_20186_6-ridiculous-myths-about-middle-ages-everyone-believes.html#ixzz3L6FbRUty

Wednesday, December 3, 2014

HIV evolving?


a similar weakening in the lethality of Syphillis was seen in the 1500s, and the Strep germ has increased and decreased in lethality several times since the 1950's, when rheumatic fever and sepsis were common....in recent years, there have been sporadic outbreaks of this lethal strain, the most famous case being the death of Jim Henson of muppet fame, who was diagnosed with "flu" when he actually had strep sepsis with shock.