PrEP, HIV, and Continuing Barriers to Access

As a gay man navigating the complex landscape of health care, I never expected to encounter judgment, stigma, and discrimination in my pursuit of preventative measures against HIV. In a world that’s constantly evolving, it’s disheartening to see how outdated attitudes still hinder access to essential services like pre-exposure prophylaxis (PrEP). My personal experience may shed light on the urgent need for an update on PrEP for HIV prevention.

The human cost of judgment and stigma.

Like many in the LGBTQIA+ community, I faced the harsh reality of being told not to have sex, to pursue monogamy and marriage as the only path to a healthy life. These societal expectations, fueled by ignorance and prejudice, led me to suppress my desires, inadvertently putting my health at risk. Denial of access to prevention services like PrEP left me feeling isolated, vulnerable, and frustrated.

My wake-up call came through a close friend who, unfortunately, lived out the consequences of societal judgment. Despite being vulnerable and at risk, he was denied access to PrEP because of the same archaic beliefs that I had encountered. The result was a diagnosis of HIV that forever altered his life and left me grappling with the reality that I […]

2023-12-18T09:33:20-05:00December 18th, 2023|equity, infectious diseases, Nursing|0 Comments

RSV Prophylaxis for Infants and Children: Now Available, But Is it Accessible?

July, a month typically characterized by the relative hibernation of communicable respiratory illnesses, brought with it the U.S. Food and Drug Administration’s (FDA’s) approval of nirsevimab-alip (brand name: Beyfortus) and thus a reminder of the gearing up necessary for the respiratory disease season ahead. Nirsevimab, approved for the prevention of respiratory syncytial virus (RSV), is poised to mitigate the staggering effects of this lower respiratory tract disease. Since significant barriers remain related to distribution, accessibility, and insurance reimbursement for this drug, it is especially important for primary care RNs and nurse practitioners in clinics and medical homes to be well informed on this topic.

RSV: a significant public health burden.

Transmission electron microscopic image revealing morphologic traits exhibited by a human respiratory syncytial virus (RSV)/ CDC

RSV is primarily of concern in the youngest and most vulnerable of the pediatric population, such as those born prematurely, with chronic lung or congenital heart disease. As many of us know all too well, RSV carries significant public health burden, causing more hospitalizations than any other illness in U.S. infants and accounting for 100 to 300 deaths each year in children under five […]

2023-09-21T11:10:58-04:00September 21st, 2023|infectious diseases, Nursing, pediatrics, pediatrics|0 Comments

Why Should You Care About Malaria?

malaria parasite Colorized electron micrograph showing malaria parasite (right, blue) attaching to a human red blood cell. The inset shows a detail of the attachment point.

In June and July, eight locally acquired cases of malaria were diagnosed in the U.S.—seven in Florida and one at the southern tip of Texas. Cases in the two states appear to be unrelated, and all patients are recovering. In both geographic areas, it’s likely that malaria in people with travel-related cases was transmitted by local (U.S.) mosquitoes to the people who developed the locally acquired cases.

Malaria was endemic in this country until the early 1950s, when mosquito control programs and public health campaigns brought the disease under control. Since that time, virtually all cases in the U.S—now at almost 2000 per year—have been travel related.

Malaria transmission.

Malaria is caused by several species of the Plasmodium parasite, transmitted by the bite of a female Anopheles mosquito infected by the parasite. In less than one percent of cases, transmission occurs congenitally or via transfusion, organ transplant, or unsafe needle sharing.

Why it matters.

If you’re […]

Respiratory Illness Surge: Differentiating and Treating RSV, COVID, and Flu in Children

Concern about a respiratory ‘triple-demic.’

Electron micrograph image of respiratory syncytial virus (RSV)/Image source: CDC

Take a walk through many of the country’s pediatric emergency departments (EDs) and inpatient units right now and you will be greeted with the sounds of pinging monitors, suction, and coughing as “respiratory season” settles in.

This will be the first fall and winter that many young children have been back at schools and day cares, largely unmasked, in nearly three years. While respiratory syncytial virus (RSV) and influenza are yearly problems in pediatrics, an unseasonably early and severe surge in RSV is causing an unprecedented number of hospital admissions that is already straining many health systems.

Public health officials are already warning of a “triple-demic” this year as the current RSV surge coalesces with expected rises in influenza and COVID cases. This, of course, does not include the dozens of other respiratory viruses that affect children each winter, including the atypically severe cases of rhinoviruses/enteroviruses and parainfluenza that have already been reported this year.

RSV, influenza, COVID have subtly different symptoms.

While RSV, COVID, and influenza are all viral infections that cause acute respiratory symptoms, they can present with subtly different symptoms. The […]

Message from a Concerned School Nurse

Robin Cogan

In case you have not seen the new Centers for Disease Control and Prevention (CDC) guidelines for schools, published on August 11, 2022, here they are: Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning.

Key changes in CDC guidance for schools.

The CDC has chosen the path of least resistance as schools are about to reopen or are in their first few weeks of the new school year. Although the word “prevention” is included in the CDC’s name, this central goal seems to have been removed from these guidelines, including crucial pieces of the mitigation strategies that in the past prevented the school-level spread of the virus:

  • The recommendation to cohort has been removed—its absence will increase class sizes, removing a layer of mitigation.
  • The recommendation to conduct screening focused on high-risk activities during times of high COVID-19 spread or an outbreak has been changed, mostly leaving it up to individual districts to determine what constitutes an outbreak, with little guidance from local health departments.
  • The recommendation to quarantine has been removed, except in high-risk congregate settings. I would suggest that schools are congregate settings. We can quibble about use of the term “high-risk,” but we certainly do have high-risk staff, students, and community members […]
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