Dr. Blackwell's BLOG

 The Associated Press released a summary of a research article appearing in this week’s Nature Medicine by University of Michigan scientist Dr. Kathleen Collins indicating HIV can lie dormant and become reinfective. This is big news. A few years ago I attended a very informative HIV research conference where a top researcher from Johns Hopkins was studying the life cycle of the HIV retrovirus. At the time, there was hope that if HIV could be suppressed for a 3-month period, the virus could effectively die and theoretically, an infected person might be able to sercovert back to a negative serostatus. However, this new data essentially destroys that theory:

“The virus is dormant in the bone marrow cells,” she said, “but when those progenitor cells develop into blood cells, it can be reactivated and cause renewed infection. The virus kills the new blood cells and then moves on to infect other cells. If we’re ever going to be able to find a way to get rid of the cells, the first step is to understand where a latent infection can continue,” Collins said. This indicates that unless HIV can be killed where it lies dormant, and as these data show, that includes the bone marrow, antiretroviral medications will not be able to fully cure HIV infection.

 Great news! I just received a confirmation E-Mail from the editor of Social Work in Public Health informing me my research article “Requests for Bareback Sex and HIV Serostatus among Men who Have Sex with Men Using Internet Sexual Networking Sites to Initiate Sexual Relationships” has been ACCEPTED for publication! Social Work in Public Health is a crucial journal focusing on all aspects of policy and social and health care considerations in policy-related matters, including its development, formulation, implementation, evaluation, review, and revision. By blending conceptual and practical considerations, Social Work in Public Health enables authors from many disciplines to examine health and social policy issues, concerns, and questions. Dr. Mary Lou Sole partnered with me in the work, providing great assistance in the statistical analyses of my research. Below is the APA Citation and Abstract:

Blackwell, C.W. & Sole, M.L.S. (In Press). Requests for bareback sex and HIV serostatus among sen who have sex with men using Internet sexual networking sites to initiate sexual relationships. Social Work in Public Health.

Abstract: The use of Internet sexual networking sites is becoming a more prominent means for men who have sex with men (MSM) to initiate sexual relationships. The widespread use of such sites provides quick and often more anonymous access to the initiation of sexual relationships, which research suggests can make an impact on sexual decision making. This article presents findings from an original research study assessing the association between active requests for condomless (bareback) sex through personal Internet sexual profiles and HIV serostatus in a sample of MSM in Florida (n = 483). The findings indicated a statistically significant association between those men who actively requested bareback (BB) sex in their profile and HIV status. The association was significant for HIV-positive serostatus and unknown/non-disclosed HIV serostatus.  This suggests clinicians should consider the possible use of Internet sexual networking sites when discussing safer sex practices with their MSM clients, and specific public health strategies should be designed that promote safer sex practices among MSM using the Internet to initiate sexual relationships.

I am happy to report that 2 articles I authored based on a study I completed several months ago looking at high-risk sexual activity among men who have sex with men (MSM) have been accepted for publication. The first, “Requests for Safer Sex Among Men Who Have Sex with Men Using the Internet to Meet Sexual Partners: Implications for Healthcare Providers” has been accepted for publication in the Journal of Lesbian, Gay, Bisexual, and Transgender Health Research. The article focuses on safer-sex requests by MSM using a popular Internet sexual networking site to find sex partners and examines specific sex behavior requests which places them at lower risk for HIV and sexually-transmited infections (STIs). The second article, “The Relationship Between Population Size, Requests for Bareback Sex, and HIV Serostatus Among Men Who Have Sex With Men Using the Internet to Meet Sexual Partners” was accepted for publication in the Journal of Human Behavior in the Social Environment. The article uses data from the same sample and focuses on differences in the rates of unsafe sex requests in-relation to the population size of specific geographic regions. Both articles can be viewed under “Research.” The publication dates, volume, and issue numbers for each are pending.

After a multitude of studies have found circumcision can reduce HIV infection by almost half in heterosexual men, the Centers for Disease Control and Prevention (CDC) is strongly considering making a national health recommendation that all newborn boys be circumcised. Research, largely conducted in Africa where circumcision is rare, indicated the cells which makeup the foreskin of uncircumcised men are highly susceptible to the HIV retrovirus, which greatly enhances the likelihood of HIV transmission and infection from female body fluids during sexual intercourse. While the recommendation is important, the research has not been replicated in gay and bisexual men, who continue to comprise the largest group of Americans who are infected or who are becoming infected with HIV.

 According to the Gay & Lesbian Medical Association, a new study indicates smoking rates are significantly higher among gay men and lesbians. Men and women who are gay or lesbian are more likely than their heterosexual counterparts to smoke, according to findings from a review study carried out by the University of North Carolina at Chapel Hill. The findings, published in the August issue of the journal, Tobacco Control, show that as many as 37 percent of lesbians and 33 percent of gay men smoke. That compares to national smoking rates of 18 percent for women and 24 percent for men in the 2006 National Health Interview Survey.  The authors reviewed findings from 42 studies of the prevalence of tobacco use among sexual minorities in the U.S. published between 1987 and May 2007. The findings suggest smoking is a significant health inequality for sexual minorities.

In an amazingly positive sign, President Barack Obama is working very closely with the nursing profession as he attempts to reform the nation’s healthcare system. Today, the American Association of Colleges of Nursing (AACN), the accrediting body for Schools and Colleges of Nursing within the United States, announced their participation in tonight’s forum on healthcare reform at the White House:

“AACN is pleased to be invited to this high-profile event to continue our work to advance the importance of nurses and nursing education in conversations about healthcare reform,” said AACN President Dr. Fay Raines. “We hope to use this platform to underscore the strategic role schools of nursing play in preparing a highly qualified nursing workforce able to meet the demands of tomorrow’s healthcare system.”

Registered nurses makeup the largest portion of healthcare workers in America and nursing’s input is unbelievably important as our President begins to restructure a system that is currently sailing as strong as the Titanic in-terms of the uninsured, negative reimbursement, and lack of primary care and community-based health. While input from physicians is also paramount, it is refreshing to see President Obama working closely with nursing leaders, who perhaps have a greater understanding of our nation’s healthcare problems, issues, and needs, than any other group of medical professionals.

As a Nurse Practitioner who has worked in Pulmonary/ Critical Care for the past several years, the news that Florida’s price for a pack of cigarettes is going up $1 effective July 1st is music to my ears! Today, in what will probably be one of the only positive actions of the hopefully short-lived career of Republican Governor Charlie Crist, legislation increasing the price of a pack of cigarettes by $1.00 was signed into law. Estimates indicate this should raise close to $900 million annually.

The funds will go to offset the costs of smoking-related illnesses currently being funded by Medicaid and help fund cancer-related research. The American Lung Association hailed the new legislation as a major victory in the fight to keep Florida smoke-free. Research suggests as costs of cigarettes increase, the number of new smokers decrease. In fact, if every smoker in the United States quit smoking, one out of every three hospitals could permanently shutter their doors! If you are a smoker–make the commitment to stop now! As someone with close to a decade of nursing experience, I can promise you, the road that lies ahead of you in-terms of your health is an awful and torturous one filled with major heart and lung disease. If you need help, visit the American Lung Association Web Site @ http://lungusa.org.

Some very exciting HIV-related research surfaced today from the Childen’s Hospital of Philadelphia. Headed by Dr. Philip Johnson, a team of scientists have developed genetic therapy which has shown to be highly effective at stopping immune system destruction and disease progression to AIDS. Mice infected with HIV (and monkeys infected with SIV–which elicits AIDS in primates) had an enhanced gene inserted into a piece of muscle tissue, which began developing antibodies which successfully fought-off their HIV infection and protected them from developing AIDS.

In humans, HIV specifically targets CD4 cells, which are essential to immune surveillance. HIV uses an enzyme called reverse transcriptase to convert the CD4 cell into what amounts to an “HIV factory.” Once the cell becomes completely filled with HIV particles, it bursts, which both destroys the cell and allows the virus to circulate and infect other CD4 cells. Eventually, as CD4 lines become depleted and fall to a value less then 200, the individual develops AIDS, marked by lethal opportunistic infections.

Highly-active antiretroviral therapy (HAART) targets HIV from various approaches, most of which stop the virus from attaching to CD4 cells or from replicating once inside. Because HIV is easily susceptible to mutation, finding a vaccination has been very difficult; all vaccine trials thus far have failed. Once an individual becomes infected with HIV, their immune system develops antibodies which are ineffective at killing HIV. HIV tests react to the presence of these antibodies, which is diagnostic for HIV infection.

By developing antibodies which are effective at destroying the virus, scientists would essentially have a cure. But these data shouldn’t be interpreted as a sign of an immediate end to the pandemic. An AIDS vaccine isn’t “in the wings.” Years of work may lie ahead before a product is ready for human use. Nevertheless, the work is a ray of hope for a future. Let’s hope all the new medical discoveries indicate HIV’s days are numbered. Congratulations to this team of scientists!

Connie Culp, the first woman ever to receive a full face transplant from a cadaver, gave her first press conference yesterday at the Cleveland Clinic. 5 years ago, a shotgun bullet blast a hole through Culp’s face. Lucky to even be alive and countless operations since, it is amazing to hear Connie speak about her ordeal and thank the nurses and physicians who assisted her. This women’s spirit really soars and she is to be commended for her courage and amazing resilience.