Daily HIV Prevention Pill (PrEP): Why It’s Urged for Healthy People at Risk

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In more than 30 states, it is illegal for someone with HIV to have sex without first disclosing their status. Some are now pushing to change that, arguing that the laws are actually endangering public health.

More than 1 million people in the U.S. are living with HIV, and their HIV status could conceivably put them behind bars. That’s what happened to Michael Holder.

“I served 8 1/2 years in prison and three years after on parole,” Holder says.

Back in 2000, Holder’s ex-girlfriend testified that he didn’t disclose his HIV status before they had sex. That’s a crime in Michigan and in most states in the country.

He says the day after she said that, she came in and recanted.

“She testified the truth and said that she had lied and said that she was jealous, and she loved me and that I had told her just like I had testified and said I’d told her,” Holder says. “And she told the truth, but it was too late.”

Holder couldn’t prove that he told her. Public health experts say that’s one of many problems with HIV criminalization laws. Ohio, Tennessee and Florida are the top prosecutors, charging more than 120 people in the last decade.

“Would you want to have to disclose your sexual practices and your personal health in front of a medical professional and your partner?” asks Daphne Kackloudis, of the Ohio Health Modernization Movement. “I don’t think anyone wants to have that difficult conversation in front of a third party in order to prove that they’ve had the conversation.”

She’s part of a group of public health experts pushing to change Ohio’s 1999 statute.

“A lot has happened since 1999, and lawmakers don’t necessarily know that,” she says. “And let’s be honest. A lot of citizens, you know, who aren’t lawmakers don’t know the advances that have been made in science and the reasons that we believe this law should be modernized.”

Medical advancements have helped turn HIV from a fatal infection into a manageable chronic condition.

The Centers For Disease Control and Prevention recently announced that if people take antiretroviral drugs as prescribed, the amount of HIV in their blood can become undetectable. If it stays undetectable, they have little risk of passing the virus to a partner through sex, and can live long, healthy lives.

This past June, the American Medical Association called for the total repeal of HIV criminalization. That sparked action for reforms in Washington, Missouri, Georgia, Indiana, Tennessee and Florida.

“The data doesn’t support that any of these laws that criminalize HIV actually decrease transmission rates,” says Jada Hicks, with the New York-based Center for HIV Law and Policy.

In some places, the public health push has worked. California, Iowa and Michigan recently reformed their laws.

Ohio’s statute has been challenged multiple times since it was introduced. In a 2017 Ohio Supreme Court case, lawyer Samuel Peterson defended the law on behalf of the state.

“When you have sexual conduct, there are two parties to that conduct,” Peterson said in archival footage. “And the other person has a right to know and has a right to be party to the decision to engage in the sexual conduct.

Daphne Kackloudis says she understands that argument, but that’s only one part of the legal puzzle.

“We would never want someone who intentionally transmits HIV to not be able to be prosecuted under the statute. We think that’s not right,” she explains.

But she says, as it’s written, the law puts the burden on people like Michael Holder to prove that they disclosed.

She fears these laws, which intended to stop the spread of HIV, may actually be doing just the opposite, disincentivizing people to know their status in the first place.

“If they didn’t have the law, more people would come in and get tested, you know,” Holder says. “Because they wouldn’t have to risk having done to them what was done to me.”

According to the CDC, 1 in 7 people with HIV don’t even know they have the virus.

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The link between aspirin intake and a lower cancer risk is not a new discovery. But, a recent US study found that aspirin could also protect overweight people from colon cancer.

The link first appeared in 2012, in a research paper that analyzed over 100 studies. The paper published in The Lancet journal showed that “the regular intake of Aspirin could reduce the risk of many types of cancer.”

Three years later, another research paper published in the Annals of Oncology journal found that people aged 50 to 65 who consumed Aspirin over 10 years showed a relatively lower risk of cancer – 7 percent in women and 9 percent in men.

However, the recent study published in the American Medical Association journal in December, said aspirin should be taken three times a week, and found that protective effect appears particularly pronounced among people who are overweight.

According to the study authors, low-dose aspirin reduced overall cancer death risk by 15 percent and all-cause death by 19 percent among more than 146,000 people who participated in a cancer screening trial conducted between 1993 and 2008.

Overweight folks also experienced a marked decline in their risk of death from gastrointestinal cancer (28 percent) and colon cancer (34 percent).

In a report published on the institute’s website on December 4, Researcher Holli Loomans-Kropp, a cancer prevention fellow with the US National Cancer Institute, said: “Our primary focus was really on colorectal cancer deaths, since there’s a lot of evidence to suggest that aspirin use may lower risk of gastrointestinal deaths.”

The study results support the standing recommendation of the US Preventive Services Task Force (USPSTF), which says people 50 to 59 should take low-dose aspirin to prevent colon cancer if they’re not at increased risk for bleeding.

Daily aspirin use as a preventive health measure has become controversial over the past few years, however.

Remarkably, the new study recommended people to take Aspirin three times a week to avoid the negative effects underscored in another US study, which found that excessive intake of aspirin could cause ulcers. The former study carried out by researchers at Harvard University examined data by the National Health Interview Survey (NHIS) in 2017, and found that over half of the US population, aged 70 years and above, who didn’t suffer from heart diseases or strokes (around 10 million people), take Aspirin on daily bases to prevent cardiovascular diseases.

In their study published in the Annals of Internal Medicine journal in July, the researchers recommended doctors to ask their patients about their aspirin intake.

Dr. Ali Ezz al-Arab, liver cancer consultant, said people should consult their physician before adopting the new recommendations and taking aspirin three times a week.

“A person should undergo an upper GI endoscopy to determine whether he suffers from gastritis or not, as aspirin intake by people with gastritis could cause ulcers,” Ezz al-Arab told Asharq Al-Awsat.

Commenting on the new findings, the liver cancer consultant said: “Overweight people are more likely to develop colon cancer, so they are the most benefiting from the recommendations of this new study.”

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High blood pressure is one of the common ailments that people across the world suffer from. Hypertension is also known as a silent killer as the symptoms of the disorder is easily missed. That’s why the advice of regularly checking blood pressure is given. For the unversed, the ailment is one of the leading causes of death as hypertension, if left untreated, can lead to heart issues, brain, kidney and eye-related disorders and stroke among others.

The causes could be genetics, poor lifestyle and heavy smoking and drinking among others. Also, the risk of hypertension is more among the following: people over the age of 65, people who are obese, who eat salted and junk food moreover fruits and vegetables, those who hardly exercise and have poor sleep among others.

One of the common advice that doctors give is to increase the intake of potassium-rich foods such as tomato juice, orange juice, bananas, spinach, almonds, eggs, mushrooms and sweet potatoes among others. While sweet potatoes are nutrient-dense and helpful for high BP patients, white potatoes when consumed more can lead to a hike of BP level.

Potatoes, undoubtedly, are one of the commonly consumed foods and now we have learned that high and long term intake of this vegetable in the form either baked, fried, boiled or mashed can adversely affect high BP. The study was conducted on 187,000 men and women for three research for more than 20 years and one of them was potato’s impact on BP.

As per a study which was published in The BMJ, higher intake of potatoes is associated with increased risk of developing and increasing the levels of blood pressure among men and women.

The researchers added that when one serving of potatoes replaced with a non-starchy vegetable, the level of BP will be better and normal. The researchers also said that potatoes have a high glycemic index compared to other veggies and the same leads to a sharp rise in blood sugar levels as well.

An excerpt from the report read, “(Our findings) have potentially important public health ramifications, as they do not support a potential benefit from the inclusion of potatoes as vegetables in government food programs but instead support a harmful effect that is consistent with adverse effects of high carbohydrate intakes seen in controlled feeding studies”.

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State lawmakers and advocates objected Tuesday to what they say is President Donald Trump’s latest assault on federal protections for transgender people.

Connecticut is the latest state to join an alliance opposing a Trump administration proposal to repeal and replace an Obama-era regulation prohibiting health care providers from discriminating against transgender people. The new rule would eliminate an expanded definition of sex which recognized gender identity as an avenue for sex discrimination.

Under the Trump administration proposal, health care workers could object to performing procedures such as gender reassignment surgery, and insurance companies would not be required to cover all services for transgender patients. The public comment period for the new rule ends August 13.

The U.S. Department of Health and Human Services rule would impact approximately 12,400 transgender people in Connecticut, state officials said.

Ava Gold, a 13-year-old Ridgefield resident, said the proposal is disheartening because it means transgender people like herself would not have equal rights under the law.

“This would mean that I would not have blockers or hormones,” Gold said. “This is important to me because these services and medications make me my whole self.”

Gold said transgender people have one of the highest attempted suicide rates in the country — a national study estimates that approximately 41% of non-binary youth have at one-point attempted suicide. Gold said she is among that group.

“I felt out of place. I was made fun of daily and discriminated against so I tried to take my life because my body did not match who I am,” Gold said. “How would you feel if your loved one took their own life because they couldn’t get the emotional or medical support they needed to live their best life as their authentic self?”

Sen. Richard Blumenthal said he expects 29 of his colleagues to co-sign a letter objecting to the proposal.

“This administration, in effect, wants to turn back the clock, roll back the law and enable rampant systemic discrimination,” Blumenthal said. “The consequences here are severe and immediate. One out of every four transgender people reports some serious discrimination based on their gender identity. This is not some hypothetical problem in the future.”

Tony Ferraiolo, a North Branford resident and advocate, said he knows what it feels like to be denied health care because of his trans status, and echoed others’ predictions about the dire consequences of implementing the proposal.

“Eliminating the general prohibition on discrimination based on gender identity, as well as specific health insurance coverage protections for transgender individuals will literally kill members of the transgender and non-binary communities,” Ferraiolo said.

“We can’t go back to the days when health care providers and first responders could stand around a trans person and watch them die.”

Diana Lombardi, executive director of the Connecticut TransAdvocacy Coalition, said the health care coverage at risk is not frivolous but medically necessary and supported by the American Medical Association, American Psychiatric Association and the World Association of Transgender Health, among other groups.

Lombardi said a 2015 survey revealed that the majority of transgender people in the United States get their health insurance on the open market and not through an employer.

“We are concerned about health care providers being able to invoke religious exemptions and refusing to give medical care to us. There have been a number of cases where medical providers refused to provide care and resulted in death or serious injury,” Lombardi said. “In Connecticut, one woman was denied health care when she went into the emergency room and they found out she was trans. They told her to go home and take two Aspirin. She later found out she had a broken hip and spine.”

State Attorney General William Tong said the Obama-era regulation struck a balance between individual liberties, particularly the rights of the LGTBQ+ community and religious liberty, while but new federal regulation seeks to upset that balance by prioritizing health care providers’ right to deny care on religious grounds over a transgender person’s right to health care.

Tong said that his office will stand with the multi-state coalition, which includes Massachusetts and New York.

Prior to the Trump administration, transgender people with health insurance in Connecticut were protected by both state and federal law. In this latest rollback of federal protections however, there will no longer be a federal umbrella of protection, leaving self-insured plans at risk.

The Affordable Care Act forbids discrimination based on race, national origin, disability, age or sex in health-related programs that receive federal funding. The language includes gender identity as an aspect of sex.

A coalition of states and religious health providers challenged the law in court, however, and in December 2016 a federal judge in Texas temporarily blocked that portion of the regulation. The judge, Reed O’Connor, based his decision on the Supreme Court’s Hobby Lobby decision of 2014, ruling that the plaintiffs in the current case, three Christian-affiliated medical groups, should have the “religious freedom” to turn away transgender people.

O’Connor has yet to issue a final ruling, however, and a preliminary injunction remains in place.

The U.S. Justice Department agreed with O’Connor in court filings this year, and the Trump administration rewrote the rule. However, the new proposal would additionally eliminate protections for LGTBQ+ patients, patients who have had or are considering abortions, those with limited English proficiency, and populations that already experience worse health outcomes, said Lieutenant Governor Susan Bysiewicz.

Bysiewicz said a pattern is emerging in the Trump administration’s series of federal rollbacks that target transgender people. She said the administration’s gutting of anti-discrimination prohibitions at the Department of Housing and Urban Development and the ban on transgender people serving in the military are just a few examples of the pattern.

“I just want to put this in context because this is a constant battle against discrimination that we are fighting at the state and the federal level now,” Bysiewicz said. “What the president is trying to do is to institutionalize discrimination in yet another federal law and so we are here today to stand up and forcefully and clearly say that transgender people in our state and our country should have equal access to health care.”

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A new study suggests that middle-aged people with surgically confirmed endometriosis have a slightly lower mortality rate than their peers who don’t have endometriosis. The reasons for this aren’t totally clear, but researchers suggest they are likely related to differences in lifestyle and medical attention and care.

The study, “Mortality of midlife women with surgically verified endometriosis — a cohort study including 2.5 million person-years of observation,” was published in the journal Human Reproduction.

Endometriosis has been linked to an increased risk of life-threatening diseases, including heart disease and cancer. As such, one might assume that people with endometriosis have a higher mortality rate (a greater likelihood of death from any cause). However, there isn’t much data directly assessing this.

Thus, researchers used a combination of national databases from Finland to obtain information on 49,956 people with endometriosis verified through surgery. The patient data covered 1987 to 2012; the average patient age was 36.4 years at the beginning of follow-up and 53.6 years at the end of follow-up.

Data for a control (without endometriosis) cohort of 98,824 age-matched individuals was also obtained. In total, the study accounted for 2.5 million person-years’ worth of data.

The overall mortality rate was slightly, but significantly, lower in the endometriosis cohort than in the control cohort: 19.6 versus 25.9 per 1,000 people over 10 years.

This included 12% fewer deaths from cancer and 45% fewer deaths from heart disease in the endometriosis cohort. Deaths related to alcohol, violence, and respiratory and digestive diseases were also less common in the endometriosis cohort, but rates of death from nervous system diseases such as Alzheimer’s were similar in both groups, as were rates of suicide.

“We speculate that the decreased mortality is significantly due to different characteristics and factors related to women’s lifestyle and/or increased medical attention and care received among women with surgically verified endometriosis,” the researchers stated in their paper. They stressed, however, that this was strictly speculation; a major limitation of this study is that data on lifestyle factors that also greatly affect diseases such as cancer (e.g. smoking) were not included in the analysis.

The researchers also noted that “the present results can be applied only to midlife women with surgically verified endometriosis, and caution is needed when interpreting the results in terms of causality.” In other words, this paper only shows that two things are associated; it makes no claim that having endometriosis has a direct effect of decreasing the chance of death — and this paper only applies to a particular population of a particular age. “There is a need for more studies on this issue,” the researchers concluded.

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32 year old woman in Hanoi with the weigh of nearly 90 kilogram admitted that she bumped into difficulties and was ashamed of her weight.
Therefore, she went to the infirmary for treatment of obesity where physicians decided to conduct the bariatric surgery after examination and diagnosis. Military surgeons and their Korean peers performed the difficult surgery because positions of the woman’s organs were reversible; for instance spleen is normally in one’s left but the woman’s spleen in the right whereas liver in the opposite side. Nevertheless, the operation was a success; two months after the operation, she lost 19 kilogram feeling better than before. Surgery Department Deputy President Colonel Nguyen Anh Tuan said that the Department has carried out such kinds of surgeries on six obese patients from March, 2019; one of them weighing 130 kilograms and they were all in good condition after the operation. According to the Ministry of Health, the number of obese people in Vietnam increased substantially in adults and children. As per the National Nutritional Institute’s report, obese people aged from 25 to 64 account for 16.3 percent of the whole country’s population. Worse, the rate of obese people has gone up by ages and more female become fat than male and city dwellers are fatter than their peers in countryside. Factors are attributable to obesity are high-fat diet, eating in fast food, less exercise and alcohol abuse. The obesity epidemic is driving up the burden of several non-communicable diseases (NCDs) such as cancers, heart disease and diabetes. Fat people should take regular exercise and take heed of their diet. In cases that exercise and less fat diet prove no effectiveness, bariatric surgery can help very overweight people who have tried but failed to lose weight and face serious medical problems. Patients undertaking the surgery will be under physicians’ monitor. Globally, obesity is increasing quickly. Statistically, around 1.9 billion overweight people in the world and 609 obese people. It is estimated that 57.8 percent of the world population will be obese by 2030 leading to high medical cost.

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