ad-free
Channel / Source:
TEDx Talks
Published: 2016-07-08
Source: https://www.youtube.com/watch?v=tYxokaUKLZg
so I I'm infectious disease doctor and that means I spend an enormous amount of my time thinking and talking about wounds soarers toss poop on and let me tell you if you actually do that at a dinner party it's a guarantee of away never to be invited back but up my specialty is actually HIV prevention I mean I first became interested in HIV %HESITATION when I
was in medical school and as part of medical school training you spend your third and fourth years of medical school in the hospital in a serve apprenticeship to to actual doctors on and and I remember very clearly in my third year of medical school I was in my starched white coat and I was making our medical rounds on the on the ward of a hospital and
I was helping take care of the forty year old man who have very severe brain faction %HESITATION and the reason he had that brain infection was because he had HIV arm and HIV causes severe immuno deficiency called aids %HESITATION and he'd clearly been HIV infected for very long time but had never been tested until he came in with his very severe brain infection and I remember
making rounds one day and and the the patient's long term Dr %HESITATION was on the ward that morning I'm as we made rounds and %HESITATION I sort of gathered my wits and I went up to him and I said why didn't you ever test this patient for HIV and he was a very senior physician gray hair and glasses perched on the end of his nose and
it took a moment me looked over his glasses at me and he said I don't do aids and I thought to myself what is that even mean does that mean that it's it's too complicated but he's just not up on on on current treatments or or is it something more sinister does he not want to take care of people who get aids and I was very
disturbed by that and I said in that moment I'm gonna be the best HIV aids doctor I can possibly be fast forward to now when I have medical students of my own and I teach them about HIV and aids I would start by saying who are the people that you worry about getting HIV infection who would you cast and invariably that the students list off a
long list of correct epidemiologic groups game and people who inject drugs transgender individuals and people from areas of the world where HIV is very prevalent people who exchange sex for drugs or money and that's all true but I was cut them off and I say well isn't sort of the final common issue that someone had condom was Saxon and on the most common way we have
children is to have Khandoba Saxo maybe of children and invariably some of the students have children and they've raised their hand I sit will you ever been tested for HIV and silence on at and the CDC you know other U. S. government organization that gives us recommendations on the sorts of things tells us that anyone age thirteen to sixty five should be tested for HIV at
least once and people from those more historically on epidemiologic groups I'm should be tested more often than that and it is so it you know if you believe me that that's true armed and if you also believe me that HIV treatment has gotten so much better over the thirty years of the epidemic that people who are HIV infected if they're in care and treated and can
take their medications can leading nearly normal length life I'm but there are still complications that happen from HIV infection on it that make it something that you would rather avoid on wax question that obviously comes up is what can we do to prevent getting HIV infection if we are in fact at risk which is anyone who has sex without a condom %HESITATION and it would be
great if we had a vaccine we use vaccines to prevent a lot of infectious diseases with a lot of experience with that but we don't have a vaccine and it's a really unclear when or if we're ever gonna have a vaccine for HIV on and it you know there turns out that there is something else on their condoms %HESITATION and you might hurt them %HESITATION in
condoms you people have a complicated relationship with them I mean number one they're not perfect om and number two people seem to not enjoy using condoms %HESITATION so when you add that together it results in in sort of a scary statistic and and that's every year in the United States there are still fifty thousand new HIV infections every year worldwide there are still four million new
HIV infections and so we need something more everything we're doing right now help prevent new HIV infections isn't making a dent so is there anything more and the answer is maybe yes %HESITATION I I like to think so there's a new technology it's called pre exposure prophylaxis %HESITATION prophylaxis in this case I used mean prevention and we abbreviate that crap and prep is this concept of
taking up Pelton anti HIV Pell new ticket every day and it prevents you from getting HIV infection now you might stop right there and say hold up that's crazy that's absolutely nots why would you give an anti HIV medication to someone who doesn't have HIV it must have side effects probably expensive I'm gonna have to go to the doctor and I have to have blood tests
what a pain in the neck that's insane or is it we are actually part of an era of medicine we're we're changing from the past where people would only go to the doctor when they already had a disease or a problem to get treated to this sort of mmhm this model where we try and prevent disease a preventive revolution if you will I'm Anne and if
you think about it we do this all the time people take aspirin a blood pressure medications cholesterol lowering medications to prevent heart attacks and strokes people take calcium and vitamin D. to prevent fractures from osteoporosis are weak bones and I wanna be very clear that I'm aware of that pregnancy is not a disease arm but don't some women take a birth control pill every day regardless
of whether or not they're planning to have sex without a condom on that day because they don't want to get pregnant if they do when they want the confidence to be able to not have to worry about it and be prepared well it turns out prepped for HIV is exactly the same thing it's a pill that you take every day regardless of what your plans are
regarding having sex at all much less condiments sacks because you don't want to get HIV if you happen to come in its way so you might say okay well that sounds interesting but does it work %HESITATION and I get asked this a lot the answer is yes a clinical trial data show us that if taken every day as prescribed on its more than ninety percent protective
against getting HIV infection on some people say as much as ninety nine percent protective against HIV infection nothing's perfect nothing's a hundred percent that's important to remember but it's pretty darn good and you might say then alright if I believe you about that it must have horrible side effects must be incredibly toxic on it and it turns out it's kinda not we have a lot of
experience with some of these medications because it's a piece of an HIV cocktail that you would treat to someone is HIV infection so we know it's safety profile and short requires some blood test monitoring in some careful understanding of things to watch out for but there aren't any show stoppers that would make you say this isn't safe don't do that luckily for people who are at
risk so if you say okay I'll grant you that %HESITATION want why on earth don't I know about that %HESITATION well I actually give prep to a fair number patients who come to see me and clinic %HESITATION and I'm surprised by how many people have never heard about this a it kind of blows my mind this is sort of been approved by the FDA that I'd
states since two thousand twelve and the clinical trials have had the data to support it since twenty ten on but even more concerning %HESITATION is I've heard some horror stories of patients who have heard about this who've gone to doctors on and some of those doctors have no idea what this is and patients have to educate the doctors about this so I'm more and more encouraging
people to educate themselves before they go to the doctor so that they can educate providers who might not have heard about this I find that scary but what's even more disheartening is there some providers out there who are completely anti prep don't tell people not to do it worse they'll shame people who come in asking for it we call that slut shaming they'll say your promiscuous
if you want to go on this can't you just use a condom there's a Billboard in Hollywood that went out this week that says grow up America use a condom both the number of new infections were having every year clearly that's not working I think that really has no place that sort of moralism has no role and we have a public health issue of this kind
we need new inventions interventions and I also worry a lot about whether people who are most at risk for HIV have never heard about this people who are less plugged into mainstream communities into medical systems have medical miss trust and and I worry about how we can do a better job about letting people know that this works and it's available and and just a cat a
curiosity on how many of you have an iPhone yeah and how many of you had to go out there the first day the new iPhone was available and get the new I found yeah arm so apple clearly has done something right in making us think a brand is sexy and want that I need it I think it's integral on there so much stigma so much shame
around HIV that we can even talk about HIV prevention openly how do we let people know how we market that's I do think we have some pages to take out of apples book to learn how to teach people about public health interventions were not good at it were not trained to do it no I am not saying that they should come out with direct consumer marketing
on television ask your doctor or pharmacist about because I hate that literally you can ask my family went to commercials for medicines come on TV I start throwing things at the television I hate that I think it's inappropriate but I do think that there is a lot to be learned about how we educate people about this really powerful and exciting new technology I'm and you know
like I mentioned to you before one of V. most common things that I get asked when I talk about crap %HESITATION to people who might use it is if this is all true if you're not lying to me if in fact there is this technology which someone who's HIV negative can use to protect themselves and doesn't rely on somebody else's using a condom or not or
someone else's behavior were in parts of the world where people might not have a say in whether or not they're going to have sex that day because of power dynamics or other issues much less if there's any condom use how if this is that new powerful technologies available how come I haven't heard about it well now you all have heard about and so my challenge to
you today to go out and talk about it talk about it with your friends who might be at risk talk about it to anyone who might have sex without a condom talk about it at the water cooler talk about it in the office start removing this shame and the stigma that is associated with HIV and HIV prevention for me future is tremendously exciting with regard to
prop you might say daily pills complicated it's not the end on before I came up here I took a Tom's %HESITATION and but when Thomas was available for reflux disease on for heartburn wouldn't stop with Tom's right we made zantac or pepcid or something else and after that we made the little purple pill Nexium because we wanted something better something safer something more effective and we're
not done with the currently available pill a day that is available on approved by the FDA for prop on there are really exciting things coming down the pike there a long acting injectable versions of prep that could be given as infrequently as every two or three months there are %HESITATION maybe some implantable rods that can go under the skin to deliver sustained amounts of these anti
HIV medications they're intravenous infusions that could be given very occasionally there are pills that could be taken every couple of days or maybe even once a week or less frequently there are sort of flexible rains that women could use intravaginal a where impregnating arm lubricants with these anti HIV medications to combine the function of the lubricant with anti HIV properties all tremendously exciting so personally my
journey has evolved a lot since I was that third year medical student on the wards I'm no longer quite as focused on being the best HIV aids doctor that I can be I'm focused on giving people options for HIV prevention because no one size is going to fit all the more options we have for people the more likely something is going to be acceptable to a
given person some people are great with condoms and to them I say good on you keep using them don't stop but some people for whatever reason can't won't or don't use a condom and we need something more for them I have one patient who comes to see me like clockwork on every three months and he's on crap and he tells me how much more comfort this
is given a menace in his sex life but more importantly every time he comes in to get tested used to have a panic attack because he was concerned of what he would find on that HIV test and now he doesn't have that panic anymore I believe that with these new technologies that help us prevent HIV we actually can end the HIV aids epidemic worldwide thank you
