Falling Back In

After taking an unintended hiatus from writing the last month or so, I’m returning to writing like non-90 degree weather has returned to Washington, DC – finally! I have missed writing and the possibility it provides me to discuss and think about healthy stuff outside my day-to-day realm. And after a whirlwind summer, I’m hoping that like going back to school, I can get back to a regular schedule of posting. When thinking about this post, there have been so many things making headlines recently (MDGs, HIV/AIDS, Hepatitis, Syphilis, The Social Network, IVF, etc.), I found it difficult to zero in on just one of them.  Both here at home and globally, health and well-being have come to the forefront of our collective psyche (which is great!), and something that has come to the forefront of my personal psyche is my recent return to swimming.

I’ve mentioned my swimming history in the past – it has played a major role in my life. For the last 18 months however, I have spent my longest period of extended time out of the water since about 1992! Even in just 3 weeks of regular training there has been a noticeable change in both my physiology and mentality. I have literally been experiencing, in a micro-kind of way, what thousands of health experts tell millions of people every day – “just a small increase of regular physical activity will have a positive impact on your weight/heart/mood/you name it.”

I however, have the means to make this happen. The fees for joining a masters team and having access to a pool. The tools I need to appropriately participate (swimming suit, goggles, etc.). And the time to devote a few hours a week to getting in the water. Most of you can probably tell where I’m going with this, but I’m still going to say it… I am socio-economically and culturally situated in a position to swim. Many of those around us are not, and no amount of “advice” can change that overnight. A clear argument about social determinants and cultural perspectives on exercise – but perhaps a tired one?

I’ve fallen back into the water, but hoping not to fall back into the same patterns and arguments I’ve been making here. Broken records are not going to solve our local and global challenges, understandings and experiences with health. Fall is about getting back into routines, but it is also about starting fresh. My body knows how to move in the water and yet it is having a totally new experience. This blog is going to strive to continue starting fresh – I hope all of my colleagues do the same!

Paying Attention to Hepatitis

Today is World Hepatitis Day!

I have recently learned a lot about viral hepatitis and I’m just starting to understand how dynamic and complex a disease (multiple diseases, really) it is. In the United States, Hepatitis B (HBV) and Hepatitis C (HCV) are two distinct diseases, far more prevalent than can even be accurately counted, with intersecting social histories. Abroad, HBV, HCV and Hepatitis A (HAV) have reached epidemic proportions in several regions. (To be clear HAV is present in the U.S., but has a relatively low incidence rate.)

While each hepatitis has its own specific disease profile, the populations affected by hepatitis are having distinctive experiences with the virus too. Still in the U.S…. For HBV we have a vaccine and (theoretically) the opportunity to eradicate this strand – HBV is primarily being spread through sexual contact (so for example there are higher rates in the “men who sleep with men” (MSM) population). HCV on the other hand is both acute and chronic, and currently there is no treatment which can “cure” chronic hepatitis C (no vaccine). The population most affected by chronic HCV are baby boomers, many of whom are completely unaware of their status until they develop cirrhosis of the liver and liver cancer (it is thought that many of these individuals contracted hepatitis C during the 60s and 70s). New HCV infections are highly prevalent among injection drug users (IDUs) – a fringe population very hard to understand, reach out to, and treat.

There can often be HIV/hepatitis co-infection, of both HBV and HCV, which can complicate treatment. Like with HIV in the 80s and 90s, hepatitis comes with stigmas, a lack of understanding from both health care professionals and patients, and a series of cultural factors which makes it an unknown.

Asian Americans, African Americans, those incarcerated, the undocumented, immigrants from countries such as Egypt and China, pregnant women, baby boomers, and IDUs all have specific needs and circumstances (goldmine for medical anthropologists?!). With infection rates far greater than those of HIV(in the U.S.) and research funding about a 10th of what HIV research gets, its seems about time we start paying some attention to hepatitis.