Tuesday, April 24, 2012

Dont call me "Non-White" its just racism

Human beings with any sense of intellectual prowess are known to be full of rhetorics. These rhetorics are most times their ways of either exercising their wealth of intelligence or simply showing how they can be more stupid than the rest of of us. And if it is the latter, then they find themselves in a situation where they are boxed to the corner and fighting for survival.
David Starkey on Newsnight.

One of such is Prof David Starkey the notable Historian (well many will question my use of "notable" for this honourable gentleman, but you will have to forgive me for that) behaviour during the London riot when he in his almighty stupidity argued on BBC newsnight (you can watch the video here)  that "white has become black" and that is the reason for white kids involvement in the right. 

The fury that followed was one that hell could not contain and this Professor will end up covering his head in shame. Not that it really matters when it comes to David Starkey, he was the same man that made controversial statement about gay people on BBC question time. And for clarification purpose, David himself is gay.

Now this blog is not about David in anyway and I am not sure I want to write about David. This blog is about two presentations at the just conclude British HIV Association (BHIVA) conference held in Birmingham United Kingdom. The two controversial presentations where those from Dr Anthony Mills from Los Angeles and Dr Chloe Orkin from Bart and the London NHS. 

It will be important to note that it was not the content of the presentation that made some people uncomfortable and that includes me but the ethic classification in the presentation. During his presentation on the "non- inferior efficacy and favourable safety of Quad compared to efavirenz/emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects" He classify the race as "white and non-white". I almost jumped on my seat. My immediate reaction is what really is racially non white? Black, Indians, Chinese, Hispanic or any other race that is not white? 

Also in considering metabolic assumption of HIV drugs in HIV positive people, racial classification is very important because of genetic make up. Saying white and non- white gives no explanation to what is happening to "African American" as they account for the emerging epidemic in America and likely to be on treatment and possibly react to the drugs in a different way compared to their white counterpart.

As if that was not enough insult for one day, Dr Chloe came on and made a presentation on "Efficacy, safety and pharmacokinetic results of an ongoing international phase 3 study comparing Quad with ritonavir-boosted atazanavir plus emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects at 48 weeks". In the same fashion talked about white and non white.

Angered by this blatantly act of intentional or unintentional racism, I went on twitter and vent my anger about the attitude of clinicians/researchers on not just race classification but recruitment of Black and Hispanic people into HIV trials. The reactions on twitter was nothing but that of anger and disgust. However, I did not stop there, I stood up and went to the microphone to challenged the notion of the concept of "White and non-white". 

I was not doing this to be a hero or become controversial, but to put the record straight that knowing how people are doing differently will help in designing and development of care and support service for HIV positive people from different ethnic background.

To my utter dismay, I was shocked at the way my concern was ignored not just by the researchers but by the chair of the session.

As if ignoring my concerns was not enough, afterwards, I was challenged by many clinician and researchers accusing me of raising a non issue to distract many people from the main issue of the conference.

I left Birmingham not angry, but determined to put this right once and for all. As an African living in the UK already given the Black identity I did not asked for, being tagged "non-white" in 2012 is nothing but blatant act of racism and bigoted insult.

Thursday, April 19, 2012

Growing older with HIV: What do we know?

Its been over 30 years into the HIV epidemic, when the world came to the realisation of what would end up to be a global challenge. However with more advanced drugs to treat the virus, there are evidence of HIV positive people growing older.

This sounds as great news for many people infected and affected by HIV. However, the downside of this is the increasing challenges of co-morbidity, HIV drugs toxicity, and aging. As we grow older, our body will go through a process of breakdown that will require more medical attention. We have to deal with the issue of Alzheimer, Cancer, Diabetes and ever increasing difficulties of care.

Dr Graeme Moyle of Chelsea and Westminster, in a presentation at one of British HIV Association Conference in London, quoting the SMART study concluded that HIV viral load can also be contributing risk to Cardiovascular disease in people over 50 years. This is further compounded with the challenge of late presentation of HIV.

Dr. Graeme Moyle
Increasing the challenges for older HIV positive people is the type of drugs prescribed for the treatment of the virus. Certain protease inhibitors  like Lopinavir and Idinavir have shown an increase in fat accumulation called Lipid in older people living with HIV. This means that these drugs will increase the risk of other diseases like hypertension, Diabetes and other diseases like renal dysfucntion, reduce bone mineral density, fraility, non-AIDS defining cancer and neurocongnitive dysfunction.

 Another factor increasing the risk for older HIV positive people is the CD4 nadir at the time of diagnosis. The lower the CD4 cell counts the more possibility of aggravated old age diseases as listed above.

As HIV positive people grow older and more people get diagnosed late, the challenges to manage the disease in line with other old age diseases will come with more community advocacy around lifestyle changes.

Prof. Peter Kroker of Chelsea and Westminster Hospital London suggested that we should start addressing factors that will increase co-morbidity at old age, these include: Smoking, alcohol, diet, and inactivity. Coupled with this should be the regular assessment of risk factors like: blood pressure, lipids, cardiovascular fitness, vitamin status and renal functions.

Prof. Peter Kroker
He stated that the important thing to know is that living with HIV is a life time challenge on its own, this challenge gets complicated with aging, and old age defining diseases. Supporting older people living with HIV and other diseases should be a priority not just for the community but for the health care providers and the government.

There should also be more community led advocacy and training on HIV and aging. This is because according to the words of Prof Kroker " In 1996, I would never have thought I will stand here today, 30 years after the epidemic to be talking about HIV and aging? Back then we thought living over 5 years               will be more to luck than reality but here we are today"

Wednesday, April 18, 2012

Mandatory HIV testing: Public health vs Human rights

At the ongoing British HIV Association conference (BHIVA) taking place in Birmingham UK, a session on Late presenting of HIV highlights the characteristics of the epidemic in the UK raising the need for more community awareness amongst Men who have sex with Men (MSM) and people of African origin

Dr Valerie Delpech of the HPA in her presentation stated that as at the end of 2011, there are almost 120,000 people living with HIV in the UK, and that since the breakout of the epidemic 30 years ago, the UK has seen 20,000 AIDS related death and of the people living with HIV as at 2012, 25% of them are unaware that they have the virus. And these are mainly the population driving the epidemic. Furthermore, she started the epidemic is concentrated between MSM and African communities in the UK.

However, there is something that sets the African community aside from the MSM, and this is CD4 cell counts at the time of diagnosis. In the UK, African communities account for the highest number of late diagnosis of HIV. In this article, late diagnosis of HIV will be diagnosis of HIV at a CD4 cell count less than 350. This is because at this stage, the immune system (the cells that protect the body from disease attacks and they are the cell the virus needs to reproduce in the body) has weakened and do not have the power to fight the virus anymore.

Dr Valerie Delpech

At this stage of low CD4 cell counts, a person will start developing what is known as opportunistic infections and this will eventually leads to AIDS if not treated on time. The only treatment for HIV still remains Anti-HIV drugs.

In the UK we are seeing the rate of late diagnosis to be as high as 50%, however while more MSM are testing on time for HIV (Prompt testing), we are seeing an increase in late diagnosis amongst Heterosexual men from Africa. Of the 50% of people that presented late for HIV testing last year, 63% of them are heterosexual men of African origin. This data from HPA reaffirms the challenges African HIV charities are facing in the UK.

Age has also been identified as one of the key areas where there is an increasing rate of late diagnosis with 62% of people over 50 years diagnosed so far are diagnosed late.

Dr Marthin Fisher from the Royal Sussex Hospital Brighton raised the challenges of late diagnosis in relations to treatment adherence and effectiveness. He argued the later someone present for HIV the more difficult it is for the person to have better Quality of Care (QoC) and this will further reduce the chances of the individual to respond to treatment and even reduce their options for further treatment with new drugs.

Therefore the question is, should we offer mandatory HIV testing for everyone from high risk population? (When I say high risk, I am talking about the people that belong to the population with high rate of HIV epidemic MSM and Africans). If the answer to this question is yes, then how do we deal with the issue of fundamental human rights of an individual to say NO to HIV testing?

How do we make HIV testing attractive and easy to take up for people and most importantly for African heterosexual men? With the advent of better treatments that are prolonging life span of HIV positive people, it is not then a good public health issue to test people early and put them on treatment as soon as possible?

Dr Marthin Fisher
The other positive outlook to treating HIV early is that as we put people on treatment we reduce the transmission risk of HIV as seen in a study called HPTN 052. And this can only be possible if we test more people and put as many people in treatment as possible.

This is indeed an advocacy need of African communities in the UK but most importantly the need for African men to take the mantle of leadership in the fight against HIV and late diagnosis in the UK.

Though there will continue to be controversy over mandatory testing of HIV and fundamental human rights, but there is always a way out and one of it will be that everyone be offer routine HIV testing irrespective of race, gender or sexual orientation. Another important solution will be looking at the option of non conventional testing centers like community testing.

Finally we need to talk more about the advantages of testing for HIV and confront stigma and discrimination attached to HIV most especially within the African communities in the UK.

Tuesday, April 17, 2012

Funmi Iyanda: A Hero or A Villain

Funmi Iyanda

This lady has created an image for herself, one many people that grew up with her New Dawn with Funmi Iyanda will basically call "amazon". However to many who have loved to loathe her, she is nothing but a thorn in the flesh and one that they will be very happy to get rid off.

 Funmi has an imagine of a non nonsense woman, a social critics and one you will not expect from a social corrupt setting like Nigeria. She reminds one of the "The Man" in Ayi Kwei Armah "The Beautyfuls Are Not Yet Born". And more important many will attribute the personality of a fearless feminist, one who will crush every obstacle on her path.

 Her breakfast show that ran for over 10 years in Nigeria (New Dawn with Funmi Iyanda) was the talking point of social discourse in the 90s, she treats her issues with passion while at the same time tries to remove herself from her passion. During her time on TV, she quizzed many people from high flying politicians to celebrities and to ordinary citizens who are trying to salvage their country. No wonder she got the title "Oprah Winfrey" of Nigeria, one title she does not take lightly to as she believes she is an enigma on her own.

 The major issue in Funmi television history came on the morning of 6th October 2004 when innocently (Yes! innocently)she interviewed Bisi Alimi, the controversial Nigerian gay rights activist. This simple interview sent a shocking waves round Nigeria, and the aftermath left Funmi coming to the reality of the country she so loved.

 So it was not surprising recently when on twitter she started a conversation about a newspaper report of the sexuality of Nigeria female singer Asa.  The backlash was overwhlming. The hate tweet that followed was beyond believe and it was interesting to see her losing many of her followers that day for saying as a matter of principles that she is open to discuss on LGBTI issues in Nigeria, and that she will not in any way discriminate against anyone based on their sexual orientation or gender identity.

 Her religious conservative followers threw tantarum, they called her names and stated in clear terms what a disgrace she is. Many even accused her of being a Lesbian. However, while these group of people were busying themselves slagging her off, there was another group of progressive Nigerians who got drawn into the debate and the interesting thing was, for every one religious conservative she lost, she got 3 progressive followers.

 This shows that even in Nigeria, the war of homosexuality is fought on both sides, and Funmi with her controversial views on the issues and many other issues ranging from Women's rights, abortion and single parenthood is found right in the middle of it. No matter what you think of these fearless woman, whether you see her as someone to love or loathe: Funmi has come to stay as Nigeria mermite.