21st Century Prevention

This week sees the launch of A Shot In The Arm - my new podcast produced by NewsDoc Media and Hunuvat Global. It has the lofty aim of demystifying some of the more complex, and less explored areas of global health and human rights.

I have been asked why I couldn’t come up with anything more catchy. Three reasons, really. Firstly, It’s a reference to the infancy of public health in the aftermath of the second world war.  In the jolly, good old days, everybody was supposed to queue in an orderly fashion, and be injected with this or that (whatever the clever boffins were beavering away at). Then, we would send them merrily on their way, never to bother us again. Oh how wrong we were!

There is something sinister about it too. Healthcare so brings to mind needles. There is nothing pleasant about having a thin metal pipette poked through your skin. It is not surprising that we can be squeamish about. Yet, needles can also be seductive, We can use them to get ourselves high, to bring ourselves down – and in many countries, including some states of the USA, we can end the lives of people we decide should not be living.

And finally, there is something invigorating and uplifting about “A Shot In The Arm”. Like a brisk walk, a strong cup of coffee, or a dram of whisky.

Of course, there are many people who will think that “A Pain In The Arse” is more apt, if they think I should open my mouth at all. I confess it is an odd, and not altogether pleasant experience hearing your own voice for forty minutes. But the two special guests on the first episode, Gloria Lockett of CALPEP and Mary Ann Torres of ICASO, are really, really good , and compelling. They have very different histories in fighting AIDS, but both have a deep commitment to service, a raw dedication the least advantaged in society.

Gloria reflects on 34 years of advocating for and providing HIV testing, prevention and education to minority sex workers in the California Bay Area. Mary Ann gives an update on the horrific ramifications of the political and economic collapse in Venezuela.

The name of the first episode is “21st Century Prevention,” and Gloria and I consider how to incorporate and adapt biomedical advances, like Pre Exposure Prophylaxis (PrEP) and point of care HIV diagnostics into the back-breaking and relentless work of reaching out to communities on the margins of society, people who are not routinely connected to the fabulous world of HIV service organizations and networks.

Of course, the foundation of good HIV prevention is treatment. Treatment been the crowning achievement of the AIDS response to date, and with it, an understanding that if your virus is suppressed fully, you do not pass on the virus. The U=U movement has been a monumental achievement: The community has taken scientific evidence and given it deep personal meaning, enthusing all sorts of different communities from all over the world.

You’ll hear that I am more excited about PrEP than Gloria - although we both agree it is an important tool for any prevention strategy. I am fascinated at how it could encourage people to stay engaged, get regularly tested - not just for HIV, but for all sorts of health questions. She is concerned, rightly and understandably, about how its benefits and risks are not oversimplified and over-pomised. It is not like the AIDS movement has become obsessed with shiny new objects in the past, only to toss them away when we realize they aren’t the magic bullet after all.

We are both thrilled at how point of care HIV testing can bring real-time diagnoses to people, and enable them and their health workers to act promptly. The memory of my three week wait for HIV test results in 1989 still weighs heavily on my memory.

I confess I’m more excited about self-testing too. With everything a swipe of a smart phone away, HIV is just another thing that is easy to manage in the privacy of our own homes. Should we have a place to live. Gloria rightly observes that too many people are disconnected from the internet age. So how do we reach them? We can also reflect on the value of an internet search, if you end up with information that is just plain wrong, like, say AIDS-denialists or purveyors of alternative remedies. Gloria keeps me on my toes, and is going to be playing that role regularly, methinks, through this season.

And what happens to your social media-based health, if the power gets switched off?

That is the kind of ominous “crazy” Mary Ann describes in her analysis of the crisis in Venezuela. I am struck by how quickly things have fallen apart, and now, how little information we have - no details of the number of people with HIV still remaining in the country, how many have died, how rates of new infections have been affected. President Maduro’s forces have still not released the HIV treatment and infant formula they commandeered in mid February…

It is a stark reminder of how vigilant we all must remain. Nothing can be taken for granted, and we must consistently take responsibility for ourselves and each other.

Over the coming weeks, we will explore advances in hepatitis, immunology, and attempt to discern lessons from ebola, zika and (why?) measles. We will try to make sense of the opportunities and risks of data, how to act promptly and sensibly. I surprise myself at how optimistically I think our world can deliver on the promise of everyone being entitled to good health. Part of that enthusiasm is rooted in the exceptional people we will meet and chat with.

Enjoy the shows. Please like and subscribe @shotarmpodcast on twitter, facebook and youtube.

Right. Well, Im off for a dram of whisky.