Bikila Balis

Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Western Oromia, Ethiopia

Correspondence: Bikila Balis
School of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
Tel +251 921788619
Email bik.balis2008@gmail.com

Background: Human immunodeficiency virus infection has been one of the top health-related challenges for the past four decades. Ethiopia is extremely infected by HIV pandemic every year, whereby 22,300 people were newly infected and 690,000 were living with HIV at the end of 2018. Sexual behavior of HIV positive individuals visiting treatment clinics is a neglected issue. Nonetheless, it has been a significant way of HIV transmission to serodiscordant partners.
Methods: A facility-based cross-sectional study design was used on a sample of 432 women attending treatment clinics in west Oromia from February 26 to March 26, 2019. Systematic sampling was used to select the study participants. A pretested and structured interviewer-administered questionnaires were used to collect the data. The data were coded, entered, cleaned and exported to SPSS version 20.0 for analysis. Descriptive statistics were used to present frequency distributions. Variables with P-value < 0.25 during bivariate analysis were entered into multiple logistic regression models to control for all possible confounders. Odds ratio along with 95% CI were estimated to measure the strength of the association. Level of statistical significance was declared at a p-value less than 0.05.
Results: Out of total respondents, 240 (56.9%), 95% CI: (52.1– 61.6%) were involved in risky sexual practices in the prior 12 months. Urban residence [AOR: 3.24, (95% CI: (1.52, 6.89)], those with no formal education [AOR: 2.77, (95% CI: (1.18, 6.54)], being on ART for > 2years [AOR: 2.74, (95% CI: (1.13, 6.65)] and CD4 count ≥ 200 cells/mm³ [AOR: 3.20, (95% CI: (1.50, 6.82)] were factors significantly associated with risky sexual practice.
Conclusion: A considerable number of respondents were involved in risky sexual practices 240 (56.9%) due to being rural residence, not attending formal education, being on ART for > 2 years and CD4 count ≥ 200 cells/mm³.

Keywords: women, HIV/AIDS, risky sexual practices, Oromia, Ethiopia

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Intensive behavioral therapy can provide additive weight-loss benefits for adults with obesity when combined with medication and diet, and online therapy could improve access to therapy at a lower cost, according to a speaker.

“Obesity can be treated using well-established behavioral treatments either in person or online,” Louis J. Aronne, MD, FACP, FTOS, DABOM, Sanford I. Weill Professor of Metabolic Research at Weill Cornell Medical College, told Healio. “The use of anti-obesity medication plus diet and behavior produces enough weight loss to significantly reduce metabolic disease risk, like type 2 diabetes, in the majority of patients.”

Aronne discussed intensive behavioral therapy for individuals with obesity at the virtual Cardiometabolic Health Congress.

Intensive behavioral therapy has become a key part of obesity treatment, according to Aronne. Guidelines published in Obesity in 2014 suggest that adults with overweight or obesity participate in a comprehensive lifestyle program for at least 6 months to lose 5% to 10% of initial weight. Participants should take part in 14 or more on-site, high-intensity weight-loss intervention sessions provided in an individual or group setting.

Shared decision-making between the provider and patient is crucial to developing the best diet, exercise and medical interventions, according to Aronne. Providers should set realistic goals, monitor food intake, activity and weight, and practice cognitive restructuring with participants.

Maintenance visits should also continue for individuals who lose weight at 6 months. Maintenance visits take place in an office or over the phone for at least 1 year with a trained interventionist. High levels of physical activity and a reduced-calorie diet appropriate for a lower body weight should be developed.

A randomized controlled trial published in Obesity in 2019 showed behavioral therapy combined with liraglutide (Saxenda, Novo Nordisk) and diet results in the greatest weight loss. Participants who had only intensive behavioral therapy had a 5% mean weight loss, whereas those who had behavioral therapy and liraglutide had a 9.5% mean weight loss. Participants who had intensive behavioral therapy, liraglutide and a meal replacement had a 14% mean weight loss.

Additionally, therapy can be provided by registered dietitians, health counselors and medical assistants. The trial showed there was little difference in weight loss for participants treated by a physician vs. a registered dietitian. There was also no difference for participants who went to a novice interventionist and those who had an experienced interventionist.

Intensive behavioral therapy is beginning to transition to more online care. Aronne said online visits could reach a larger number of people at potentially lower costs. Online services can also connect devices such as activity monitors and digital scales to allow providers to receive live data. Aronne said optimal intervention therapy would combine live visits, video visits and remote monitoring of weight, diet and other variables.

“We have developed a platform, Intellihealth Evolve, that allows providers to deliver this kind of care remotely or in the office setting,” Aronne told Healio. “It has education about obesity treatment, treatment recommendations and all the behavioral tools needed for this type of care. We are beginning to implement it as part of our electronic medical record system at Weill Cornell. A large-scale trial is coming out on Nov. 3 in JAMA, which documents the effectiveness of our program delivered remotely.”

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State Department employees complained this month after members of Secretary of State Mike Pompeo’s advance team discovered overtly anti-gay flyers when scoping out the site of a Florida event with a conservative Christian group that promotes conversion therapy for LGBTQ individuals.

Pompeo’s decision to address the Florida Family Policy Council was initially flagged by members of his advance team to their supervisors, and other State Department employees also complained after finding the group offers LGBTQ individuals “help leaving the gay lifestyle” on its website, according to two sources familiar with the internal protest.

Lisa Kenna, executive secretary at the State Department, was alerted to the concerns and attempted to mitigate fallout from the event.

Pompeo ultimately addressed the Florida group’s Oct. 3 event virtually. The gathering — which filled a ballroom in Orlando with roughly 700 guests — coincided with an outbreak of COVID-19 at the White House that infected President Donald Trump and some of his closest aides.

The State Department frequently condemns conversion therapy programs abroad in its human rights reports as among “acts of violence, discrimination, and other abuses based on sexual orientation and gender identity.” Conversion therapy is a discredited practice that aims to change the sexual orientation of lesbian, gay, bisexual and transgender individuals.

One source described several aides as “appalled” the event still took place despite the concerns, and that afterward, the secretary highlighted his appearance in his latest “Miles with Mike” message to department employees.

The event was opened by Jannique Stewart of Missouri, a speaker who described her work as training others in opposing abortion and in “countering some of the agenda when it comes to LGBTQ.”

Before joining the Trump administration, first as CIA director and then as secretary of State, Pompeo made his views on LGBTQ rights explicit, opposing same-sex marriage and once alluding to homosexuality as a “perversion.”

The Florida Family Policy Council says on its website the phrase “conversion therapy” is an ideological term used to discredit therapeutic practices, but it also explicitly opposes efforts to restrict conversion therapy.

“Conversion therapy bans disguise themselves as bans on ‘abuse.’ Rather, such bans place unconstitutional limits on freedom of speech because they do not consider the patient’s (or minor patient’s parents) right to pursue avenues of therapy consistent with their beliefs and choices,” the website states.

The group’s website also includes links to multiple religious-based organizations that offer help “Leaving Gay Lifestyle” and a YouTube video titled “If Conversion Therapy Is Bad, Why Is Sex Reassignment Good?”

A spokesperson for the State Department downplayed internal dissension over Pompeo’s appearance at the event, but did not address the group’s views or answer questions on whether the secretary supports conversion therapy.

“The Secretary was asked to speak to this group about the mission of the State Department and he did. The Secretary believes that organizations like Florida Family Policy Council are entitled to hear from him on important national security policy matters,” the spokesperson said.

“The Secretary was not made aware of any concerns with respect to speaking before this group given that other major leaders have addressed this event,” the spokesperson said.

John Stemberger, president of the Florida Family Policy Council, in an emailed statement said there had been nothing on conversion therapy related to the event.

“There were no flyers about anything, let alone conversion therapy at our dinner, either from us or other organizations,” Stemberger said. “We did not talk with the State Department about conversion therapy. We did meet with members of the Diplomatic Security and advance team to do a walk through before the event. The State Department never asked about conversion therapy, and we as an organization, do not [do] any therapy or counseling at all.”

DOMESTIC POLITICAL SPEECHES

Pompeo and his wife have been the subjects of an ongoing internal inquiry from the State Department inspector general looking into whether they used taxpayer dollars and official personnel for personal errands.

The Democratic-led House Foreign Affairs Committee is now also investigating whether Pompeo has used State Department resources to deliver a series of domestic political speeches ahead of the Nov. 3 presidential election, including the Oct. 3 Orlando event, a Sept. 23 visit to the Wisconsin State Capitol and a Sept. 20 speech to a Texas church.

“It is concerning that the Secretary is suddenly crisscrossing the country at taxpayers’ expense,” Democratic Reps. Eliot Engel of New York and Joaquin Castro of Texas wrote to the State Department on Oct. 5. “The nexus of speeches about the Secretary’s personal religious beliefs, to a swing-state legislature accompanied by a former senior Republican party official, and at a paid-access event for an anti-abortion advocacy group, to the Secretary’s official duties as America’s lead diplomat is unclear and possibly illegal.”

Pompeo was initially scheduled to address the Orlando event in person, and an invitation to the gala obtained by CNN offered a “personal visit” with Pompeo for those who sponsored a table for $10,000. Access to a VIP reception was also being offered as part of tickets that were sold for $3,000 and $5,000.

The Florida Family Policy Council is a state-based affiliate of the national group, Focus on the Family, which has long opposed same-sex marriage. Pompeo has repeatedly engaged with the national group over the years to promote religious freedom.

The state group is a well-known advocacy organization for social conservative issues in Florida and has hosted several national Republican politicians, such as former Rep. Michele Bachmann of Minnesota, Sen. Marco Rubio of Florida, and Dr. Ben Carson, before he became Housing secretary. Former Kansas Sen. and Gov. Sam Brownback addressed the group in 2007 ahead of his unsuccessful run for president in 2008, and now is the State Department’s ambassador at-large for international religious freedom.

Stemberger, an Orlando lawyer who is also a registered lobbyist in Tallahassee, is a longtime supporter of Republican politicians, including Trump, and has pushed for legislation like a bill signed into law by Florida Gov. Ron DeSantis that requires minors seeking an abortion to obtain parental consent.

The Florida Family Policy Council’s events, including the annual awards dinner and forums with candidates running for political office, are often important stops for Republican politicians seeking to win influence with conservative Christians, particularly in contested Republican primaries.

Stemberger has also been at odds with some Florida Republicans, including Rep. Matt Gaetz, over issues like legalizing medical marijuana.

ANGER AMONG LGBTQ

Progressive groups that fight for gay rights said it was an inappropriate venue for a speech from a secretary of State.

“The Florida Family Policy Council is an anti-LGBTQ extremist group that has sought to undermine and attack our community’s most vulnerable at every opportunity,” Alphonso David, president of the Human Rights Campaign, said. “The highest levels of the State Department clearly knew about FFPC’s extremism and yet, even over the objections of staff, chose to embrace it anyway.”

Tom Witt, the executive director of Equality Kansas, the leading LGBTQ rights organization in Pompeo’s home state, criticized Pompeo’s decision to address a group that promotes conversion therapy.

“I’m stunned that our secretary of state would be spending his time going to local organizations whose actions drive kids to suicide, to drop out of school, to otherwise dangerous behaviors because the adults around them are trying to force them to change their sexual orientation or gender identity, which is not something that can be done,” Witt said, noting the State Department’s advocacy for LGBTQ rights abroad.

Witt lives in Wichita, the largest city in Pompeo’s former congressional district.

During his four successful runs for Congress, Pompeo opposed several key LGBTQ rights measures, including the legalization of same-sex marriage and the 2010 repeal of the “Don’t Ask, Don’t Tell” policy to allow openly gay individuals to serve in the military.

“He’s never supported equality for LGBT Americans, even the ones who are fighting for our country,” Witt said.

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Acubalance Wellness Centre in Vancouver has the expertise and training to use Low Level Laser Therapy to treat everything from infertility to headaches

Laser therapy might sound like the stuff of science fiction, but it’s a clinically proven treatment that can help boost fertility, reduce inflammation, accelerate healing, relieve pain, and much more.

Acubalance Wellness Centre is a leader in Low Level Laser Therapy (LLLT), also known as photobiomodulation, for fertility. Founded by Lorne Brown—doctor of Traditional Chinese Medicine, certified laser technician, and clinical hypnotherapist—the centre has the expertise and experience to effectively treat a range of conditions with laser therapy, all within its holistic approach to health and well-being.

“What’s really exciting is Acubalance has been pioneering the use of laser for fertility in Vancouver and North America,” says Brown, noting that Acubalance is the first natural fertility clinic in BC to offer the service, which uses LLLT to stimulate blood flow to reproductive organs, regulate inflammation, and boost cellular energy production. It’s especially promising for couples coping with aging-related reproductive problems or who have been through repeated unsuccessful invitro fertilization (IVF) cycles. But the health and healing potential of LLLT reaches much further than fertility.

“We also use laser therapy for pain and injuries: neck pain, herniated disc, knee and low back pain, and for headaches,” Brown says. “We’ve used it along with acupuncture for frozen shoulder, polycystic ovarian syndrome, and shingles. We know how important the microbiome is for gut health; research has shown benefits of laser therapy for the microbiome, too.

“We see enormous potential for women who are struggling to conceive and for people dealing with chronic pain,” he adds. “You can read patient success stories on our website.”

All of our cells are powered by little structures called mitochondria, Brown explains. Eggs have about 200 times more mitochondria than any other cell. When follicles are maturing, they use a tremendous amount of energy. And early embryo division and implantation require lots of energy.  After 35 years, the mitochondria wear down. At age 40, nine out of 10 eggs can be abnormal.

Studies show that the mitochondria of older eggs are capable of producing significantly less adenosine triphosphate (ATP), which is the source of cellular energy. This has a significant impact on fertility, as the rate of division and successful implantation of embryos has more to do with the amount of energy (ATP) than with maternal age per se, Brown says. Consequently, the capacity of cold laser to improve ATP production of eggs may have an effect on their viability. 

Increasing energy level (ATP) in the cells, improved blood circulation, softening of scar tissue and a reduction in inflammation: these factors are all beneficial to female reproduction in general and to the receptivity of uterine lining.

Brown came across studies out of Japan by a doctor named Toshio Oshiro at Sanno Hospital. Oshiro had been treating a 55-year-old woman in menopause for back pain. Part of his protocol was to stimulate blood flow from head to toe with LLLT. Her pain resolved—and her period returned. Another patient, also in menopause, visited him for back pain. After being successfully treated with laser therapy, she resumed menstruation as well.

Oshiro went on to lead an extended trial of LLLT in 701 infertile patients. Of those, 22 percent became pregnant, and the treatment resulted in a successful live birth rate in 50 percent of pregnancies.

LLLT studies have also pointed to the efficacy of laser treatment in raising the quality of the male partner’s semen, in particular motility.

It’s a growing body of investigation that Acubalance is building on. Acubalance’s on-site laser acupuncture treatment protocol for frozen embryo transfer (FET) day for comprehensive chromosome screened (CCS) embryos has had a higher pregnancy rate and lower miscarriage rate in women compared to some who did not receive the treatment at a local fertility clinic. Acubalance is about to embark on a study with that clinic to see if they can repeat these results in a more controlled setting.

Brown cautions that not all lasers are alike. The type and quality of equipment matter. Weak-powered lasers are not going to have desired health effects. The lasers in use at Acubalance are sophisticated and effective. Dosage is critical as well. If you’re not in the care of trained, qualified experts, it is possible to underdose or even to have too much of a good thing.

In addition to LLLT, Acubalance uses naturopathic medicine, acupuncture, nutrition, Chinese medicine, mind-body medicine, nutritional IV therapy, and Maya massage to maximize egg and sperm quality, uterine receptivity, and overall health.

“Laser therapy leads to the regeneration and repair of abnormal cells,” Brown says. “The process results in the elimination of symptoms, including pain, and enhances the body’s immune system response for natural healing.”

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A drug used to treat type 2 diabetes could offer a simple and cheap solution to reduce dangerous side effects of steroid treatment, new research from Queen Mary University of London suggests.

The phase 2 clinical trial, funded by Barts Charity, looked at the effects of the diabetes drug metformin on patients currently receiving high doses of glucocorticoids, a type of steroids used to treat chronic inflammatory diseases.

The researchers analysed results from over 50 non-diabetic patients on glucocorticoid treatment from Barts Health NHS Trust and found that patients treated with metformin showed improved clinical outcomes. This included a 30 percent reduction in the rate of infections and lower hospital admissions, in comparison to the placebo group.

They also observed that treatment with metformin strengthened the intended anti-inflammatory effects of glucocorticoids and had beneficial results on several cardiovascular, metabolic and bone markers over the 12-week trial period.

The study is published today in the journal The Lancet Diabetes & Endocrinology, funded as part of a wider £25m commitment by Barts Charity to support innovative medical research at Barts and the London School of Medicine and Dentistry at Queen Mary.

Since the discovery of their therapeutic effects in the 1950s glucocorticoids, such as prednisolone, have revolutionized treatment of patients with chronic inflammatory disease. Now glucocorticoids are used to treat a range of conditions where the immune system is overactive, including rheumatoid arthritis, asthma, inflammatory diseases, and in cancer therapy.

However, prolonged use of these medicines at high doses can lead to serious metabolic side effects such as weight gain, high sugar levels, loss of bone and muscle mass, and increased risk of infection and thrombosis.

Long-term, these features can lead to Cushing’s syndrome, a potentially fatal disorder which also exists in patients where the body makes too much of the stress hormone cortisol.

Several biological medicines have been developed as alternatives to steroids but these drugs are expensive and can present their own adverse effects.

Previous research from Professor Márta Korbonits and colleagues found that steroids are able to influence a key metabolic protein, called AMP-kinase or AMPK. Other experimental studies have suggested that metformin acts, at least partly, via the AMPK protein and in the opposite way to steroids. Based on this evidence, the researchers reasoned that the diabetes drug held the potential to reverse the unwanted side effects of steroids.

Professor Márta Korbonits, Professor of Endocrinology at Barts and the London School of Medicine and Dentistry at Queen Mary, said: “Our findings are strikingly positive and suggest that a simple and immediately available intervention, treatment with the diabetes drug metformin, can improve the clinical status of patients on glucocorticoid treatment, even if they do not have diabetes. The results could have a huge impact on the large number of patients on long-term glucocorticoids, improving treatment-related complications and their cardiovascular prognosis.

“Whilst developed countries may be increasing the use of biologics or other steroid-sparing agents, in many other parts of the world there’s still a heavy reliance on glucocorticoids. Therefore, doctors and patients have been waiting for a safe, cheap and effective treatment that can prevent the major metabolic complications of these medicines, but does not affect, or could even improve, their anti-inflammatory properties. Our results suggest metformin has the potential to help these patients.”

Fiona Miller Smith, Chief Executive of Barts Charity, said: “At Barts Charity we are funding research to pioneer improvements in healthcare that not only enhance the lives of patients in our hospitals and local community but can also have an impact worldwide.

“Steroids are used to treat a vast range of conditions, from cancer to rheumatoid arthritis, and a large number of over 60s need to take these drugs to manage chronic conditions that could otherwise become extremely debilitating. The promising findings of this study show how funding innovative research can help us rethink long-standing problems facing patients and healthcare professionals, and in this case, even deliver new, simple and cost-effective treatment options for the NHS.”

It is estimated that around three percent of the general adult population and up to 11 percent of over 80s are currently prescribed long-term steroid treatment for chronic inflammatory disease.

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A Paediatric Antiretroviral Therapy (ART) centre has been started under a public-private partnership model at Bai Jerbai Wadia Hospital for Children, Parel, in association with the National AIDS Control Organisation (NACO) to tackle HIV in children.

Dr. Ira Shah, a paediatric infectious diseases specialist who has been looking after HIV-infected children since 2001, will head the centre that was inaugurated by Dr. Srikala Acharya of Mumbai District AIDS Control Society recently.

“With the establishment of the centre, children with HIV can get holistic paediatric treatment under one roof with the help of a team of experts. Earlier, around 1.5% infants in Mumbai would get HIV from their mothers. But now the percentage is lower than that.”

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The district health authorities have brought out a special patient book with a menu card for preventing overweight and obesity.

The initiative is a part of a campaign against non-communicable diseases (NCDs). The programme, first of its kind in the State, is in the process of getting implemented in all NCD clinics in the district.

According to Dr. K.R. Vidya, deputy district medical officer who is heading the NCD cell, the preventive action consists of food therapy and exercises, and there is no medication. “It is for those who volunteer for the therapy,” she said. However, those who are diagnosed with diabetes and hypertension are provided medication.

Those identified as overweight and obese are referred to the NCD clinics for the therapy. A registration book and a patient book are maintained for those coming in. The patient book contains menu cards with different combination of foods to be taken every day.

“We have set the menu card for 1,500 kilo calories as the daily intake,” said Dr. Vidya.

Patients who come for the therapy need to follow the menu that is set for Monday to Sunday. Jotting down on the foods in the book will help follow the extra intake each day. People who register for the therapy have to consult the doctor after a week’s programme and then regularly every month.

After the initiation into the food therapy, exercises would also be suggested for weight loss.

The district has added 43,491 new diabetes patients in 2018-19 to the already registered 3.49 lakh patients on a follow-up programme. The year also saw an addition of 23,445 new hypertension patients to the existing 3.23 lakh patients.

This year, 4,426 patients having both diabetes and hypertension were added to the existing 2.35 lakh patients.

While females were more in numbers for diabetes, hypertension and a combination for both, more males were detected with cardiovascular diseases and stroke.

As part of preventive activities, 76,570 people, which included 34,415 males, were given counselling against tobacco use, while 1,75,337 were counselled for preventive NCD and health.

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