Public Health FINAL EXAM!

In the US, HIV spreads through high risk groups (concentrated epidemic) or in the general population?

high risk groups

the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.

public health

According to Green and Ruark, as of 2010 (when the book was published), what two interventions had been shown to reduce the spread of HIV at the population level in epidemics in which HIV spread in the general population? (Note: If I were writing this book now I would also include widespread treatment, but we didn't have that evidence yet in 2010. Note that we were also advocating in our book for working with communities and traditional and religious leaders, but that such partnerships aren't the interventions I'm looking for. I'm looking for the two HIV prevention actions or behaviors that had been shown through epidemiological evidence to significantly reduce risk of HIV infection.

reduction in number of partners and male circumcision

the Hebrew word meaning wholeness; multidimensional, complete well-being; all relationships put right

shalom

A vaccine for one of history's great killers was invented in 1796, and then mandated by multiple European countries in the 1800s in one of the first modern public health campaigns. In 1980, the World Health organization declared this disease to be the first (and so far only) human disease to be eradicated globally - one of the greatest public health achievements of all time. Which disease is it?

smallpox

The conditions in the social and physical environments where people live, work, attend school play, and pray, which influence health outcomes, are known as

social determinants of health

(1) is negative attitudes, while (2) is negative actions towards obese people (or another marginalized group)

stigma, discrimination

Several presentations (by Emily Sharpe as well as student groups) mentioned the multiple challenges faced by black MSM living with HIV, particularly men who have been recently incarcerated: poverty, stigma, homelessness, and poor mental health (to name some). What is the name for this "synergistic intertwining of certain problems"?

syndemic

T/F: Drug overdose is now the leading cause of death for Americans under the age of 50.

true

T/F: Genetics play a role in how people tolerate drugs and how easily they become addicted to opioids

true

T/F: Globally, women are more likely to be obese than are men.

true

T/F: Most heroin users start to use heroin after first using physician-prescribed opioids.

true

T/F: Nationally, physicians prescribe painkillers, including prescription opioids, to people of color at lower rates than they do to whites.

true

What relationship do you see between marriage (or commitment to a partner) and parenting?

- Partner churning - so much instability, start with the point that a lot of these pregnancies are totally unplanned, these are really fragile relationships so they keep breaking down, it's not that these men and women don't esteem marriage, they just can't ever get there so they churn through relationships that fall short of what they want in life - Multiple partner fertility - people are not having children with one partner, having children with multiple partners -flipped package deal - opposite, father and child bond and mother and child bond is central, but husband and wife bond is fragile, bond to the children that become the important ones, often father and child bond is not strong and enduring because of relationship between mother and father, not possible for father to maintain bond w/out bond w/ mother even though he tries

Scott Ickes guest lecture w/ Hellen Sankaine

- she is a working mother, sometimes her husband is away for a while, lives in Kenya -Uganda and Kenya have many women that report some experience of sexual violence by their partner - number of children per women is dropping **In Kenya, more availability of family planning sources shows that women are making better decisions, being able to decide the size of the family that they want to have -- on average, women are marrying later in age - increase in women using contraception Ickes' work in Uganda

Esther Kuhn guest lecture

Healthy Families and Communities PRogram AIDS program, where there was a lot of stigma towards people with HIV/AIDS Region of Linguere has a large HIV infection rate, extramarital sex for people moving around, Renew has helped provide for those with HIV/AIDS Mostly women who join group, meet monthly to break isolation of people living w HIV/AIDS, support their children through school supplies, etc Nutrition program included in HIV program Live in families, can't individually decide what to eat Most participants do not have much money, only so much they can buy Community vegetable gardens for women to grow vegetables Thanks to the garden, the women meet regularly to exchange ideas and work together, since eating vegetables, they have noticed a decrease in the number of cases of anemia, anemia is normally very high there - also an adolescent health and rights program that educates children - theatre groups

How does maternal agency and social support influence infant and young child feeding and children's nutrition status?

Maternal and Child undernutrition Short term consequences - mortality, morbidity, disability Long term consequences - adult size, intellectual ability, economic productivity, CVD

guest speaker Hannah Sanders

Often people are unwilling to share HIV diagnosis with family/close friends, because of stigmatization and loss of job offerings Intense feelings of loneliness Community council meetings Talked about putting in a bakery where they can bake bread and sell to the community Such a network and motivation for people to be advocates for their own change In Senagal, major taboos of talking about puberty with your mother, but only with your father's sister, but they usually live far

Breastfeeding and working mothers in Uganda

Provision of three months paid maternity leave Extremely progressive in African countries, some policies are better than they've experience in other places Employers are supposed to give break intervals to breastfeed Multi-level components of an "enabling environment for breastfeeding" Some employers were really good and embraced giving them free time to breastfeed, but can still be hard because of factors such as lack of transport All employers were willing to provide a room Comparing formerly employed mothers to not employed, started breastfeeding around the same rates, but when you start to look at when maternity leave ends, people who reported breraskfeeting their babies dropped significantly

How would you characterize children's experiences, as described in these chapters, and what consequences do you see resulting from these childhood experiences?

Traumatic Don't have the parental support they need, don't have a father there to go to for help, father's try to be a friend Two responses: very attached to their dads or child was super disrespectful Problems: attachment (+/-) One reaction is being desperate for attachment

How does violence affect families and contribute to family breakdown?

Violence of father against mother, affects the child's understanding of relationships Structural violence refers to systematic ways in which social structures harm or otherwise disadvantage individuals - Poverty - Little access to jobs for people with lower education, not enough availability of jobs, divided by race as well - White fathers have connections that will allow them to get jobs, only one black father had that Incarceration - Court system tending to favor mother over father, not something that the book talks about, father is seen as a paycheck Housing: homeownership is often unavailable for blacks Both the problems that lead to family breakdown as well as the problems that the family breakdown creates Obvious violence in the book: father and sister were both sexually abused by their father, now taking on a more protective role for their children Father abusing mother Physical violence towards children Emotional violence - Father overheard mother talking about his job and was embarrassed by it

Manuscript 3: Life-course perspective

• Power of social learning: participants replicated the circumstances of their own childhoods • some chose not to follow the "blueprints" • power of role models, positive and negative • Lifelong affects from adverse childhood experiences • lack of secure attachment to parents/caregivers • growing up without one or both parents • Misplaced expectations create risk for young women, and having children threatened goal of marriage • Marriage, maturity, & monogamy desired by men and women, but "not yet" • Long, rocky road to marriage for many women

Manuscript 2: Relationship Quality

•Couple relationships in Swaziland vs. elsewhere: much is the same •Characteristics of a "good relationship" in Swaziland are similar to constructs identified in US research •Not true that "all sex among the poor [is] the product of violence, lust, or need"* •Poor RQ may have consequences for health •low RQ = poorer adherence to ART (Ware et al., 2012) •insecure emotional attachment = mental distress •sexual satisfaction associated with sexual fidelity (Kwena et al, 2014) •Do Swazi women have lower RS than men?

antibodies

"mop up" (get rid of) the viruses that are floating around outside the cells

Which of the following is NOT a challenge faced by opioid treatment programs (OTPs) offering methadone maintenance treatment (MMT)?

***Medicare and Medicaid do not fund methadone maintenance through OTPs, which means that OTPs can only be funded through private insurance or cash payments. OTPs have been forced to serve many more clients over the past two decades as the number of clients has soared but the number of OTPs has not increased. By law, OTPs can only dispense methadone one day at a time, so every client must attend the OTP every day, leading to large numbers of clients who must be seen daily. By law, methadone can only be distributed through OTPs, which means that OTPs cannot divert clients to pharmacies or other healthcare facilities.

Why do couple relationships matter?

- linked to wide range of health outcomes, morbidity, and mortality - type and state of relationships linked to HIV risk in Swaziland -- women who were not married or living with partner had 3x higher incidence South Africa -- cohabiting individuals had 5x higher incidence than married individuals

context of Swaziland

- polygamy allowed, marriage esteemed but not normative - men are likely to have multiple partners

Relationship satisfaction in Swaziland

- women more likely to report low satisfaction, men reported high, even with partners with whom they were unfaithful

As presented in Dr. Ickes' lecture, order the following phases of the nutrition transition (globally and historically).

1. Hunter gather society; diet high in carbs, proteins, and fiber, low in fat; high activity 2. Agrarian society; food insecure; diet low in calories, protein, and fat; high activity; childhood malnutrition 3. Increasing consumption of fruits, vegetables, and animal proteins; increasing activity 4. Increasing affluence, fat intake, and stress; markedly sedentary lifestyle 5. Awareness of benefits of balanced diet and activity; healthy behavior adapted initially by the wealthy and educated

From a public health perspective, how could the individuals in this book be better supported to make good choices (dads)? (If you're stuck on this question, think about the 6 public health perspectives we have studied. Which of those could apply to the problem of family breakdown and instability, and what possible solutions would those perspectives suggest?)

1. biomedical - treatments for alcohol and drug addicted, this would allow fathers to better support child 2. sociocultural - extended family and community supporting relationship -- family counseling - need more positive role models in community -courtship 3. Human rights/ethics - equal opportunity for job connections of all races (book describes white men having easier time than blacks, this results in black men having to turn to selling drugs for income) 4. Epidemiologic - public awareness and education about what is required of the role of a father, explain how father and mother relationship is important 5. Political economic - money, more support for father in court so that they are seen as more than just a paycheck - economics and job prospects are essential 6. Health systems - schools can do a better job at keeping dads in school, drop outs decreases job opportunities

Rank the following routes of HIV transmission in the U.S. from the route of transmission that accounts for the MOST new HIV infections to the route of transmission that accounts for the LEAST new HIV infections

1. male-to-male sexual contact 2. heterosexual contact 3. injection drug use 4. mother-to-child transmission

What are the four feasible pro-marriage public policies mentioned in class?

1. transferring direction of healthy marriages and relationship initiatives (HMRIs) from fed gov to state 2. downsizing current policy that awards federal grants to a variety of community organizations delivering educational services and reallocating most of these funds to reimburse states 3. supplementing TANF funds by setting aside $10-20 of each marriage license fee (TANF stands for Temporary Assistance for Needy Families. The TANF program, which is time limited, assists families with children when the parents or other responsible relatives cannot provide for the family's basic needs) 4. using state directed funds to support strategic relationship education services delivered by community organizations targeted primarily to young at-risk individuals or couples

Historical context: Southern Africa

20th century: colonization, urbanization, industrialization, migration - separation of families and sexual partners - declining marriage rates - unjust land policies, collapse of rural farming economies

What percentage of the opioid addicted die of overdose every year?

4%

What percent of higher quality marriages by not living with romantic partner other than future spouse?

About 10% higher quality marriages when have not lived with romantic partner other than future spouse - 42% vs 35% - Few had a high quality marriage if they had a child before marriage with a college degree, bc lots of finances to worry about

Which continent is home to over half of people living with HIV globally?

Africa

How did the practice of "enriched enrollment" skew drug trials (such as for OxyContin) and weaken the Food and Drug Administration (FDA) approval process?

Drug companies excluded people from their trial who didn't respond well to the drugs, biasing the studies towards including people who did respond well

In 1-2 sentences, describes why many in the homosexual community (to use Shilts' term; now we would say MSM) were skeptical of or opposed to HIV testing. Shilts' book lists 2 reasons, and you have to describe at least 1 reason. I'll give 1 point extra credit if you can give both reasons. Hint: the reason I think you're going to have a harder time thinking of is related to your answer in part C of the last question.

Being tested or found to be HIV+ would "out" them as being MSM and might result in their name being put on a registry. This could result in ostracization/discrimination, loss of reputation, loss of insurance (or higher payments), loss of jobs, or even forcing HIV+ MSM into quarantine camps. (Although we didn't talk about this in class, Cuba did do this during the late 1980s and early 1990s, and some American evangelicals called for people living with HIV to similarly be put in camps.) Some of you noted that homosexuality was still illegal in many states into the 1980s and that robust laws to protect patient confidentiality did not yet exist. • The "test doesn't matter", based on skepticism regarding the link between HIV infection and AIDS. Recall that many HIV+ individuals had not yet developed AIDS, that the long latency period was not understood, that no one yet knew that 100% of HIV+ individuals would eventually develop AIDS (in the absence of treatment), and that many people still thought that other factors besides HIV infection might be causing AIDS. In the absence of a clear link between HIV and AIDS (which hadn't yet been proven), many MSM didn't see any point in knowing whether or not they were infected with the HIV virus

President Biden Reestablishes the White House Office of Faith-Based and Neighborhood Partnerships

Biden-Harris administration commits to promoting partnerships with faith-based and neighborhood organizations to help people in need, using executive orders

What was the name of the U.S. Surgeon General who authored the influential 1986 report "Surgeon General's Report on Acquired Immune Deficiency Syndrome", and was the first Surgeon General to author such a report on AIDS?

C. Everett Koop

How do the relationships described reflect God's design? How do the relationships described not reflect God's design? Try to dig deeper than simply saying that God wants children to be born to married parents within loving, healthy families. Think about how people's beliefs and values about family and relationships do or don't reflect God's design. What is your understanding of God's design for marriages, families, and the communities that surround and influence families?

Does - Father's desire to support the child - Want to set a good example and be their for their kids as much as possible - Want their kids to be better than them, - Esteemed marriage, wanted to be married - unconditional love desired and selflessness desired Not - Father and mother often don't support the child together, but try to support them individually by partial support - Superficial: desires don't reflect their actions - Primary bonds to be between the children does not reflect God's design, primary bond should be between father and mother - Scripture teaches us that God is a provider: women put men in this role of demanding that they provide financially in ways that they actually couldn't - often families and community don't support the relationship, makes it harder for them to work through tough times

According to Conroy and Ruark's research of couples living with HIV and using alcohol in Malawi, how does alcohol use in a relationship harm either the wife's or the husband's adherence to ART? In 1-2 sentences, list at least 2 reasons (there are 6 or more), and specify whether the wife or husband's adherence is affected.

Factors affecting wife's adherence: • Food insecurity (this is due to man spending money on alcohol and woman having less money available to buy food; I gave you half a point if you mentioned other ways that husband spending money on alcohol could negatively impact the household, as those are likely also happening although weren't explicit findings of the research) • Husband unavailable as treatment guardian/supporter • Intimate partner violence (IPV) Factors affecting husband's adherence: • Weakened relationship support system (with wife or others) • Negative peer influence • Forgetting ART pills when drunk

As described in Shilts' book, the HIV virus was discovered independently and at nearly the same time in labs in the U.S. and another country. What is the other country?

France

Finkelstein and Zuckerman write in their book, "America's obesity epidemic has been shaped by economics." In 2-3 sentences, describe at least one reason why this is true.

Government subsidies to farmers to grow crops such as wheat and soy which are major components of high-calorie, processed foods - and these subsidies make those foods cheap • Healthier food is more expensive, and low-income families are not as able to buy healthy food • Advertising/marketing of processed foods is a lucrative industry and drives demand for these foods • The moral hazard argument that treatments for obesity and related health conditions are paid for by the government and insurance rather than by consumers, which lessens the "cost" to the consumer of obesity • With economic development has come a shift towards more sedentary desk jobs, leading to less physical activity and more obesity • Shifts in our economy (and culture) have also led to more women in the workforce, less home cooking, and more consumption of processed foods

Which of the following does NOT result when the federal government declares a Public Health Emergency?

Greater coordination between local, state, and federal governments, as well as between public health officials and law enforcement Greater ability to get things done under "emergency measures"; the usual government red tape and privacy laws may not apply Federal government allocates additional funding, including for research ***States affected by the PHE are also required to declare a PHE and allocate additional funding

In 3 sentences, list 3 ways that HIV/AIDS is exceptional, compared to other diseases or pandemics including other viral diseases. (Green & Ruark discuss AIDS exceptionalism in their book, and we also discussed a number of reasons in class.)

Long latency period between HIV infection and disease - typically 7-10 years in absence of treatment • Pre-exposure prophylaxis (PrEP) to prevent HIV infection has become standard of care (covered by many insurance companies and U.S. government), despite its high cost ($2000/month) and the fact that HIV is fully preventable through behavioral means • No vaccine yet exists, despite decades of research • People can never clear the virus (as opposed to many viral diseases from which people recover) • No cure exists (current treatments can reduce viral load to undetectable, but the person will always be HIV-infected, and people tend to accumulate chronic health issues as a result of a long time on treatment) • Virus leads to disease 100% of time in absence of treatment (with very rare exceptions; some individuals such as the famous "Nairobi prostitutes" do have genetic mutations which means they never develop AIDS) • 100% mortality rate in absence of treatment (with very rare exceptions; see above) • Degree of viral mutation (all viruses mutate, but HIV mutates particularly rapidly) • Level of stigma and discrimination (this isn't totally unique, as many other diseases including sexually transmitted infections have been similarly stigmatized through the centuries, but HIV probably stands alone in terms of stigma in the late 20th/early 21st century, so I will accept it as answer) • Lack of U.S. government response early in the epidemic (related to the last point) • Degree of confidentiality around HIV testing; positive cases are not reported to health authorities and contact traced the way many infectious diseases are (this is of course related to its exceptional level of stigma and early fears among MSM about how HIV+ test results could be used against them) • Severity and length of symptoms (once again not really unique compared to all the horrific diseases other there, but I will accept it as an answer) • Expense of treatment - although other diseases such as cancer are probably as expensive to treat per month, there are relatively few other diseases in which someone has to be on lifelong very expensive treatment • Amount of money given to global response (e.g. the President's Emergency Plan for AIDS Relief, PEPFAR, was the single largest amount of money that had ever been spent on a global health issue or disease, when it was announced in 2003) • Degree to which the response has been driven by ideology (particularly a resistance to encouraging abstinence, faithfulness, or partner reduction, and a commitment to risk reduction and technological solutions) rather than data, evidence, and sound public health (point made by Green & Ruark)

In Villarosa's article "America's hidden HIV epidemic: Why do America's black gay and bisexual men have a higher HIV rate than any country in the world?", she quotes an HIV counselor (who is himself a black MSM living with HIV) as saying, "Growing up, I was taught that God was not fixing to forgive a person who was homosexual. The Bible supposedly said that you're going straight to hell, automatically, there's no forgiveness." How would you respond to this man? Please write a thoughtful response in 2-4 sentences (100-200 words). I am not looking for one "right answer". I am looking for something thoughtful and real. Please include at least one Bible verse in your response. It's fine if you don't know the reference or can't quote it exactly. I don't want you to go Google for a Bible verse; I want you to share something that is deep enough in your heart that you actually could share it with someone if you were in a conversation like this in real life.

I would respond to this man by saying that God is willing to forgive everyone for their sins as long as we repent and turn to him. This forgiveness is not something to reflect his own perfection, but to reflect his love for us and his desire to fix our brokenness, though we don't even deserve it. There is a passage in Lamentations that describes how His mercies are new every morning, meaning that not only is the Lord willing to forgive, but he is willing and eager to forgive us and make us new every single morning.

In 2-3 sentences, describe: A) how long it usually takes someone to progress from HIV infection to AIDS (if not on ART); B) how the length of this "incubation period" contributes to the spread of HIV; and C) how this incubation period caused scientists to come to false conclusions about the relationship of HIV to AIDS early in the epidemic.

If not on ART, it usually takes someone around 7-10 years to progress from HIV infection to AIDS. This "incubation period" contributes to the spread of HIV because people will likely have the virus without symptoms and not know it, so they will not attempt risk reduction or risk avoidance and likely infect other people. Early in the epidemic, this incubation period caused scientists to come to false conclusions about the relationship of HIV to AIDS because they only thought AIDS was only transmitted by male to male sexual contact, so they had a lack of understanding of how many people were infected and/or infectious.

As described in Lawrence Wright's article "The Plague Year", a 2019 simulation exercise called Crimson Contagion and carried out by the U.S. government identified many weaknesses in the U.S.'s ability to respond to a pandemic. In fact, the fake pandemic envisioned in the simulation exercise was eerily similar to the real pandemic that began at the end of 2019, and many of the weaknesses in the U.S.'s response were the same weaknesses identified in the exercise. In 3-4 sentences, describe at least 3 of these weaknesses - in policy, government action, and/or political leadership. If you can't remember details of Crimson Contagion, think about ways that the U.S. should have been prepared and wasn't, or failures of policy and political leadership, as described in the Wright piece.

Lack of a national/federal policies: Government policies were inadequate and "often in conflict"; in the real world, most policy-making was left to the states • Lack of national coordination and leadership: Federal agencies couldn't tell who was in charge; lack of effective inter-agency coordination at the national level • School closing not enforced: Schools did not follow CDC guidelines about closing • Depleted national public health funding and national stockpile of PPE/supplies: The Public Health Emergency Fund and Strategic National Stockpile were depleted (I wasn't looking for you to name these exactly, but rather identify that the federal government was low on public health funds and supplies needed to fight a pandemic) • Lack of PPE and supplies at other levels: Personal protective equipment (PPE) such as masks, and other medical supplies, were in short supply nationwide and the federal government did not take leadership in ensuring supply • Lack of manufacturing ability for critical supplies: Domestic manufacturing capacity to produce PPE and other medical supplies was insufficient (recall the example in the Wright piece of the factory in Texas that could have produced PPE with government support, but the Trump Administration didn't take them up on the offer)

Wapner's article "How a small town became the capital of HIV in America" also describes the "synergistic intertwining of certain problems." Identify at least 4 issues in the web of community problems that led to such high HIV transmission in Austin, Indiana. You may name more than 4 issues if you want to; I identified 13 in the article. 1 point extra credit if you identify an issue that no one else in the class did.

Lack of jobs / unemployment • Lack of recreational activities (connected to crumbling town infrastructure) • Lack of healthcare • Lack of needle exchange programs (due to laws against such programs, which were eventually changed) • Prostitution / sex work / sex with minors (statutory rape) • Substance abuse (particularly injecting drug use, but alcohol and other drugs also fuel many of the other issues listed here) • Violence • Depression • Family breakdown, children experiencing sexual abuse, parents' drug use, and other Adverse Childhood Experiences (ACEs) • Poverty Lack of education and educational opportunities • Overprescription of pain pills / opioids • Out-migration (especially of young) / declining population • Rise in itinerant population • Lack of social safety net and assistance (including drug treatment programs)

As described in the Kisner article "What the chaos in hospitals is doing to doctors," what would be inequitable and unjust about hospitals adopting a policy of giving care to the people most likely to survive, during a crisis when there is not enough healthcare for everyone? (Hint: this relates to racial justice.) Explain your answer in 2-3 sentences.

Less advantaged groups (racial minorities, the elderly, people with disabilities or pre-existing conditions) are less likely to survive, so having a policy of offering care to the people most likely to survive would disadvantage these groups. Many of these same populations are also more likely to be exposed to Covid-19, so giving them less access to care would doubly disadvantage already marginalized populations.

Beth Macy quotes Sister Beth, a nun and activist, as saying, "Greed makes people violent." In I Timothy 6:9, Paul writes, ""Those who want to get rich fall into temptation and a trap and into many foolish and harmful desires that plunge people into ruin and destruction." In 3-4 sentences, describe how this is true of the opioid crisis, drawing on specific case studies from the book, lectures, or information presented in class.

Many aspects of the opioid overdose crisis can be described as the violent consequence of greed because Big Pharma was marketing the drug as less dangerous as it was, manipulating research studies, and supporting sale representatives in "swag and dash" tactics to encourage doctors to overprescribe opioids. In many ways the treatment of pain was seen as a business model where companies, sales representatives, and prescribers could financially benefit instead of responsibly managing the patient's pain. As a result many people became addicts and came to "ruin and destruction" such as moving to stronger drugs like heroin, committing crimes to fight off dopesickness, and/or dying from overdose.

According to the Ed Yong article "How science beat the virus," the legacy of miasma theory caused many scientists to develop an incorrect understanding of how SARS-CoV-2 was spreading, and overlook key evidence. In 2-3 sentences, explain this. Make sure you explain what miasma theory is, how the scientific community explained the spread of SARS-CoV-2 at the beginning of the pandemic, what they got wrong and why, and how our understanding of the spread of SARS-CoV-2 has changed over the course of the pandemic.

Miasma theory was the dominant theory of disease transmission in 19th century Europe (you don't have to know this although you should if you took Epidemiology!) - and held that disease was caused by "bad air". Miasma theory was obviously discredited as scientists learned more about how diseases actually spread, but the legacy of miasma theory has led scientists to miss evidence that some diseases can be spread through the air (i.e. aerosolized). In the case of SARS- CoV-2, scientists believed early in the epidemic that it could only be spread through surfaces (fomites) or droplets, and evidence that it could also be aerosolized was not taken seriously enough for some time.

According to data presented by Dr. Ickes comparing rural/urban differences in obesity in the U.S. and Africa,

Obesity in African countries is more common in urban environments than rural environments, while the opposite is true in the U.S.

In 1-2 sentences, explain how long after infection with HIV someone is most infectious, during which of these two periods (there are two periods of high infectivity) they are most likely to pass HIV on to other people, and why this is.

Once someone is initially infected with HIV, they are most likely to pass HIV on to other people for the first 2-3 months. This is because the initial infection results in a viral load spike, which makes it easier for them to transmit the virus to someone else when engaging in risky behavior. They are more likely to infect people during this time, rather than the later period of high infectivity, at the end of their lives when they have developed late-stage AIDS, because they are more noticeably sick in the later period, so they are less likely to engage in risky behavior.

In 1-2 sentences, describe at least one way that social networks can be a positive influence and one way that social networks can be a negative influence regarding abuse of opioids or other drugs.

One way that social networks can be a positive influence is during recovery, because family or peer emotional support will promote positive outcomes and help prevent future opioid abuse. One way that social networks can be a negative influence regarding abuse is that peers or family who abuse opioids may introduce opioids to others and cause more people to abuse opioids.

In 2-3 sentences, describe why you think it WAS or WAS NOT appropriate for the Trump administration to declare the opioid crisis a Public Health Emergency (PHE). In your answer, you must mention at least 2 reasons why declaring the opioid crisis a PHE was somewhat unique or unusual.

PHEs are nearly always declared for a sudden crisis such as an infectious disease epidemic or a natural disaster ("act of God"); the opioid crisis is neither • the crisis is ongoing, and the repeated renewal of the PHE (every quarter for 4 years and running) is highly unusual 4 • the death toll from the opioid crisis has been steady for some years, and it is better understood as a hyper-endemic rather than epidemic disease, with no signs of abating • opioid use disorder is a behavioral, chronic illness rather than being an infectious disease • there were already a lot of programs in place to address the opioid crisis, so the government was not starting from ground zero in crafting a response (as in some PHEs) • Republican administrations are generally more conservative regarding government's role in health, healthcare, and public health; the Trump Administration investing in public health through this years-long PHE is thus somewhat unusual • the government was partly responsible for causing this crisis through failure to properly regulate pharmaceutical companies and drugs • the opioid crisis is so far-reaching (affecting urban and rural populations, and many different racial and socioeconomic groups, across the whole U.S.) - although one could argue that it didn't become considered a PHE until it affected certain groups of white voters who were politically valuable to the Republican party • the opioid crisis is better understood as a syndemic than a clearly defined disease (i.e. it involves multiple drugs, and multiple serious social and economic problems besides the direct health impact and deaths from opioid use)

The church is one of the most powerful institutions in the world, and some public health programs recognize this and work with the church to address social and public health issues. Imagine that you were employed by a U.S. government-funded program to strengthen fragile families for the well-being of infants and young children, and that you wanted to work with and through churches. How would you do that?

Relational counselors - figure out each person's role Community outreach - gym, park, adult rec league Mentorship programs between older and younger couples in the church Church could help provide positive role models At the bottom of pg 124, talking about a white guy Dave always getting jobs from people he knew, there was only one black man who had access to resources like that What if the church were a place where we actually were integrated across socioeconomic and racial lines?

Which region of the U.S. accounted for over half of new HIV diagnoses in 2018?

South

A CD4 count measures the number of CD4 cells in the blood of a person infected with HIV, as a measure of the strength of their immune system. What are CD4 cells? To help you answer this, I'm including an excerpt from Yong's article "Immunology Is Where Intuition Goes to Die," in which he describes how the immune system responds to SARS-CoV-2. This description also applies to the body's response to HIV. When cells sense molecules common to pathogens and uncommon to humans, they produce proteins called cytokines. Some act like alarms, summoning and activating a diverse squad of white blood cells that go to town on the intruding viruses - swallowing and digesting them, bombarding them with destructive chemicals, and releasing yet more cytokines. Some also directly prevent viruses from reproducing (and are delightfully called interferons)... Messenger cells grab small fragments of virus and carry these to the lymph nodes, where highly specialized white blood cells - T-cells - are waiting. The T-cells are selective and programmed defenders. Each is built a little differently, and comes ready-made to attack just a few of the zillion pathogens that could possibly exist... [Some] helper T-cells activate the B-cells that produce antibodies - small molecules that can neutralize viruses by gumming up the structures they use to latch on to their hosts.

T-cells

some are killers which blow up infected cells, while some are helpers which boost the rest of the immune system

T-cells

In Supersize Me, in what city did the filmmaker (Morgan Spurlock) live? In 1-2 sentences, name one way that this city isn't typical of the rest of America, in a way that influences obesity risk. (Remember that he even took a walk with an expert on the topic, to talk about it.)

The city was New York City (1 point). NYC has a very high density of McDonalds restaurants, and New Yorkers walk much more than the average American (1 point for mentioning either of these things - I was thinking about the second when I wrote the question, but the first is also true!) Some of you got the point about walking backwards and thought New Yorkers walk less. They walk more than the average American, which is why he had to limit his steps and start taking cabs (so that he was walking a daily distance more typical to the average American).

"social pathology" of syphilis in South Africa

The development of an urban life... has profoundly disturbed the family stability and sexual mores of several million African people... This system of migratory labor of adult men has led to instability and pathology in family relationships. The code of morals of the men who have been to town appears to have arisen through the realization of a new, free, sexual life, one that does not regard sexual intercourse in a serious light, but as a cheap commodity for temporary pleasure.

As reported in the Meyer & Madrigal article "The U.S. has passed the hospital breaking point," the proportion of Covid-19 cases who are hospitalized has been stable at 3.5% for much of the pandemic. In November and December 2020, this percentage began to decline, meaning that a smaller proportion of Covid-19 cases were being hospitalized. In 1-2 sentences, explain why this was a cause for alarm.

The falling percentage of Covid-19 cases who were being hospitalized was a sign that hospitals were at or past capacity, and that sick patients were not able to be admitted. In other words, it wasn't that Covid-19 cases were becoming less likely to get seriously ill, but rather that cases who would have been admitted earlier in the epidemic could no longer be admitted.

In 1-2 sentences, describe why a more infectious variant of SARS-CoV-2 (i.e. a variant with higher R-naught) is actually a much bigger threat than a more deadly variant of SARS-CoV-2 (i.e. a variant that kills a greater proportion of people it infects).

The key point is that a more infectious variant will result in exponential growth and thus an exponential increase in deaths, while a more deadly but not more infectious variant will only create a linear increase in the number of deaths.

Why have young children experienced relatively few life-threatening cases of Covid-19?

Their immune systems are highly active and effective, and because their immune systems are already in a state of constant inflammation, they are much less likely to experience life-threatening immune responses when infected with the virus.

Beth Macy writes that in the 1920s, opioid users were "reclassified as criminals, not patients." In 2-3 sentences, explain why this happened, including how the typical user changed during this era.

To get full credit (3 points) you need to mention the following: 1. opioids were legal and prescribed by doctors prior to the 1920s (including heavily prescribed to Civil War soldiers) 2. opioids became illegal during the 1920s 3. the race and class profile of opioids users changed after opioids were made illegal, and public perceptions of users changed - Poorer Americans and children of immigrants were seen as addicts and criminals in a way that Civil War veterans and southern white women had not been, not because their patterns of usage and addiction were different, but because of people's race and class prejudices.

PrEp is

antiretroviral therapy (ART) that a person takes prophylactically (preventively) if they are at high risk of exposure to HIV

A physician practicing in a county with a high rate of prescription drug abuse wrestles with the decision of whether or not to prescribe Oxycontin to a patient reporting chronic, severe pain after a back injury. The physician realizes that there is a significant possibility that the patient may abuse or divert the drug (sell it to other drug abusers), but reasons that she would rather risk this outcome than allow a patient to live with debilitating pain. Of the four tenets of medical ethics, which tenet guided the physician's decision?

beneficence

What is not a way that HIV can be transmitted to another person?

by sharing saliva

Why do Swazi men have high-risk sexual partners?

concurrent sexual partners cause: - lust and sexual desire - love and emotional attachment high number of sexual partners cause: - alcohol use lust and sexual desire ** men will only tolerate partner's concurrency in case of casual partner

Why do Swazi women have high-risk sexual partnerships?

concurrent sexual partners cause: loneliness, financial need/desire for consumer goods, love and emotional attachment, revenge high number of sexual partners cause: alcohol use lust and sexual desire - risk of HIV transmission partner's concurrency -creates risk of HIV transmission

a shared set of (implicit and explicit) values, ideas, concepts, and rules of behavior that allow a social group to function and perpetuate itself.

culture

these are proteins which act as alarms when they sense a virus, including activating white blood cells

cytokines

Name one type of endogenous opioids (opioids produced naturally by the body).

endorphins

T/F: Globally, the number of people infected with HIV every year has been steadily climbing since the early 2000s.

false

T/F: In the US, teenagers and young adults in their early 20s are at the highest risk for HIV infection of any age group

false

T/F: In their article "Obesity stigma: important considerations for public health," Puhl and Heuer argue that people tend to express more negative attitudes and stigma towards health conditions if they perceive low levels of personal responsibility for those conditions.

false

T/F: Most of the top 10 U.S. public health issues, as identified by the CDC, are infectious diseases.

false

T/F: Only people who have developed AIDS can infect other people with the HIV virus

false

T/F: There is a linear relationship between body mass index (BMI) and disease risk; adults with low BMI have, on average, the lowest disease risk, and adults with high BMI have, on average, the highest disease risk.

false

T/F: U.S. government agencies specializing in opioid use disorder (OUD) have endorsed indefinite or lifelong medication-assisted treatment (MAT) as being more effective than abstinence-based rehab for OUD, and most rehab programs have therefore shifted their protocols to offer MAT rather than abstinence-based programs.

false

T/f: approximately 9 in 10 residents of Illinois live in a county where Medication Assisted Treatment is accessible

false

According to Green and Ruark's book, an HIV epidemic in which HIV spreads in the general population rather than among certain high-risk groups is a

generalized epidemic

includes the resources, actors, and institutions related to the financing, regulation, and provision of health actions.

health system

According to the article by Mary Annette Pember "Quarantined and on their own," Native American populations have been particularly hard-hit by Covid-19 for all of these reasons EXCEPT

housing is scarce on reservations, leading to overcrowded conditions in which the virus spreads rapidly housing is scarce on reservations, leading to overcrowded conditions in which the virus spreads rapidly rates of diabetes, obesity, asthma, and high blood pressure are high among Native American populations rates of diabetes, obesity, asthma, and high blood pressure are high among Native American populations **reservations are often in close proximity to petrochemical manufacturers, and pollution from these plants leads to high rates of asthma** contact tracing is difficult because many Native Americans do not have working phones

these stop viruses from reproducing

interferons

How does an opioid antagonist work?

it blocks opioid receptors in the brain and suppresses cravings for opioids

According to Helen Tak Kingery's guest lecture, the Centers for Disease Control is no longer promoting Medication Assisted Treatment (MAT) as best practice for physicians treating opioid use disorder (OUD) because:

it is not realistic to expect physicians to offer a model of care that includes medication as well as additional assistance (such as psychosocial counseling or support)

A physician practicing in a county with a high rate of prescription drug abuse wrestles with the decision of whether or not to prescribe OxyContin to a patient reporting chronic, severe pain after a back injury. The physician realizes that there is a significant possibility that the patient or other members of the family could abuse or divert the drug (sell it to others). The physician is particularly concerned that the drug may be abused or diverted by the patient's teenager, who the physician knows was recently admitted to the hospital after a drug overdose. The physician eventually decides that as she would would prescribe OxyContin to a similar patient who did not have a drug-abusing teenager in the home, it is not right to withhold OxyContin from a patient with a drug-abusing teenager in the home. Which principle of medical ethics guided this decision? [Note: If you find yourself giving the same answer that you did on the other medical ethics question, look again - there is a better answer.]

justice

these produce, store, and release white blood cells

lymph nodes

Brad Wilcox

marriage and kids: - connection between structure of family and love of family - two married parents are better than one, single-parent homes are 2-3x more likely to experience negative outcomes - psychological: suicide, drug abuse, depression - social: delinquency, crime, teenage pregnancy - economic: poverty -- increased risk in ending up in prison, 11% single parent compared to 5% husbands and wives: - sexually active teenage males do significantly poorer in their academic work - clueless and confused about courtship and dating - marriage binds men to their families

these recognize a virus that's been seen before and launch the adaptive branch of the immune system in response

memory cells

these transport small fragments of virus to lymph nodes

messenger cells

Finkelstein & Zuckerman argue in "The Fattening of America" that the tremendous increase in the medical, surgical, and pharmacological treatments available for obesity and obesity-related diseases has resulted in people eating more and exercising less, in part because obesity is no longer so detrimental to their health. This lack of incentive to guard against risk where one is protected from its consequences is known to economists as

moral hazard

Compared to children in two-parent households, children in single-parent households are:

more likely to try illicit (illegal) drugs

Which two of these are narcotic blockers, or antagonists?

naloxone buprenorphine naltrexone

What became known as the fifth vital sign in the late 1990s?

pain

According to Macy's book, which of these was NOT true of Oxycontin when it was introduced in the late 1990s

prescription of OxyContin was felt to be moral and responsible OxyContin was formulated with a slow-release delivery mechanism which was believed to discourage abuse the manufacturer of OxyContin claimed addiction rates to OxyContin of less than 1% ***doctors who prescribed OxyContin were required to report these prescriptions to state-wide databases

Green and Ruark argue in their book that while there is a place for harm or risk reduction (reducing the harm or risk of inherently harmful or risky behaviors), the fundamental goal of HIV prevention should be primary prevention (preventing harm or risk). Which of the following are primary prevention strategies and which are risk reduction strategies?

prevention: abstinence program and drug treatment programs risk reduction: needle exchange and condom promotion

T/F: One reason that African Americans have died of Covid-19 at more than twice the rate of white Americans is that they have much higher rates of underlying health conditions - such as hypertension, cardiovascular disease, obesity, diabetes, and chronic lung disease - that are associated with higher risk of death for people infected with SARS-CoV-2.

true

Researchers have determined that African Americans experience physiological effects, or "wear and tear" on their bodies, as a result of the stress of continually facing bias, discrimination, and racism in their everyday lives. This phenomenon is known as "accelerated aging," or

weathering

these bombard viruses with toxic chemicals, swallow and digest viruses

white blood cells

Manuscript 1: Risky sexual relationships

young adults in Swaziland • MCP, partner with MCP, low condom use • lack of clear-cut break-ups & transitions • high rates of violence & abuse, alcohol abuse • sexual double standards, although not rigid • Difference between ideals of behavior and what people actually do • descriptive vs. injunctive norms • for men, respectability vs. reputation (Siu et al., 2013) • Love and material exchange- it's complicated!

Explain what is meant by UNAIDS' 90-90-90 goals. Write 1 sentence for each of the 3 goals

• 90% of all people living with HIV will know their HIV status. • 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. • 90% of all people receiving antiretroviral therapy will have viral suppression.

the article "The coronavirus is evolving before our eyes," James Hamblin described how more infectious (although not necessarily more deadly) variants of SARS-CoV-2 are currently spreading around the globe. That article was written in January, and evidence continues to accumulate that these new variants are driving transmission worldwide. In 1-2 sentences, describe at least one reason why social distancing and mask wearing are more important than ever as the virus evolves into more infectious forms. (We discussed two reasons in class; you need to identify at least one.)

• The more the virus spreads, the more it mutates. In other words, the more "copies" there are out there, the more likely that some of those copies will be more infectious or more deadly. Therefore we need to limit transmission through mask wearing and social distancing in order to limit the development of dangerous new mutations. • As the virus mutates, there is the possibility that our vaccines will become less effective. So to protect the efficacy of our vaccines, we need to limit the "copies" that are being made.

Puhl and Heuer write, "There is a perception that stigmatizing obese individuals may instill motivation to engage in healthier eating and exercise behaviors... stigma may be a useful tool of social control to discourage unhealthy behaviors and improve the health of stigmatized individuals." They adamantly disagree with this notion that stigmatizing obese individuals can be helpful, and point to a number of pieces of evidence and research to back up their position. In 2-3 sentences, describe at least one piece of evidence or research (as cited in the article) that supports the argument that weight stigma does not promote healthier life-style behaviors or weight loss. Be as specific as you can in your description.

• Weight stigma and discrimination have increased over the past few decades, but has not decreased obesity (obesity has increased) • Studies have demonstrated that when people experience weight stigma, they are also more likely to engage in unhealthy eating behaviors, binge eating, refusing to diet, and lower levels of physical activity and exercise • Overweight children who experience weight-based teasing or victimization are more likely to binge-eat, later practice extreme weight-control practices (even years later), develop eating disorders, and have lower participation in physical activity and sports • Weight stigma is associated with lower participation and success in weight loss programs

Social and structural enablers for CSPs in Swaziland

•Geographical separation • Poverty and economic inequality •Social pressure and norms • Low social trust

Relationship dissolutions in Swaziland

•Most common reason given for ending relationship- and only reason given by men- was partner's infidelity; one's own infidelity never a reason •Women mentioned alcohol use, violence, deception as reasons