Global Health – What Has It Got To

Do With Me and You?

Timothy Flanigan, MD Professor of Medicine and Infectious Diseases

GLOBAL SHARE OF HIV INFECTIONS

HIV and AIDS care: Antiretroviral therapy works!

Picture Slides

Treatment requires ART and support: both medical and social. Family support very important

St Mary Mission Hospital In Nairobi, Kenya 6,500 deliveries80% agree to HIV testing with excellent PMTCT

Kibera slum in Nairobi, Kenya

Dynamics of TB and HIV in Kenya

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HIV-Nairobi

Stigma: HIV is the leprosy of our age

Stigma is a key impediment to testing and treatment

Love and acceptance are the antidotes to stigma “We can not do great things on this

earth…only small things with great love” Mother Teresa of Calcutta

Stigma linked to abandonment, lack of testing and treatment, and continued

spread of the HIV epidemic

Global Health: Is it for me?

• A: It’s fun! (and an adventure…) Indiana Jones Syndrome

• B: Save the world! Paul Farmer Jr Syndrome

• C: Learn! Experience….Be present

It’s great to be here…how can I help

• D: Friendship Solidarity and help in partnership We would like to share your struggle, hope, laughter, joy, sorrow

Global Health: Is it for me? LET’S RANK THESE GOALS?

• #3: It’s fun! (and an adventure…) Indiana Jones Syndrome Who doesn’t like to travel?

• #99: Save the world! Paul Farmer Jr Syndrome The potential harm caused by those planning to save others is

immense

• #1: Learn! Experience….Be present

It’s great to be here…how can I help…be very patient What is most important for you? What are your priorities?

• #2: Friendship Solidarity and help in partnership We would like to share your struggle, hope, laughter, joy, sorrow Wonderful when this happens…builds lifelong partnerships

Brown MHIRT

The Goal:

Mentor underrepresented* undergraduates, graduate and medical students to pursue careers in biomedical sciences, by providing exposure and training in global health programs and research.

*Underrepresented in the sciences, as defined by the NIH

Case Study- Cambodia Sex Workers HIV PREP Study In 2004, university researchers from the U.S and Australia, worked in collaboration with the Cambodian Ministry of Health, to launch a clinical trial in Phnom Penh. The objective of the study was to assess if the drug has a protective effect in reducing the risk of HIV infection. The drug had been prescribed to HIV-positive people and it was proven to be safe for widespread use. Overall it was well tolerated, with some possible serious side effects including bone-density loss and kidney toxicity. At that time, no studies had been published on the possible safety consequences of the use of the medication among HIV-negative people.

The proposed study was a double blind placebo-controlled trial, involving HIV-negative female sex workers. The study was to recruit up to 960 female sex workers in both arms, and they were take a daily dose of medication or placebo up to one year with regular follow-ups during which blood testing and counseling were to be performed. All participants were to receive HIV prevention counseling and condoms to protect themselves from infection. All participants were encouraged to use a condom as much as they can during the course of the study. Before the recruitment of the participants a series of community meetings were conducted to explain the objective of the study, the procedures, the possible risks and benefits. Informed consent was to be given by all study participants. The participation was to be completely voluntary and participants had all the rights to withdraw from the study at any time without giving reasons and with no punishment or penalty.

• Participants would receive $U.S.3 per month compensation for their participation in the trial for 12 months. (The monthly income of a rural female sex worker was documented as $US14.5 at the time) • All volunteers would be screened for HIV in order to identify HIV-negative women eligible to enroll in the trial. Positive women who were identified during the trial screening process would be referred to the HIV clinics but would not receive preferential access to the clinic services or other services from the trial. • During the trial, participants were to receive counseling about risky behavior, free condoms, and free screening and treatment of STI. • Each participant was to receive an HIV test monthly. Participants who tested positive during the trial would be given preferential access to free, comprehensive care and treatment at government clinics including access to anti-retroviral therapy if medically indicated, in accordance with Cambodia’s national treatment guidelines. • Participants would receive treatment for side effects during the trial, but aside from the HIV care noted above, no treatment would be available for side effects or illnesses developed after the trial had finished.

Questions- What, if any, are the ethical issues raised by the study design? Are the risks of the research reasonable? What are the possible benefits? What is the appropriate standard of care for trial participants? What obligation does the sponsor have towards the research participants if the preparation either fails or has undesirable effects?