Map of life expectancy at birth from Global Education Project.

Monday, August 06, 2018

One step forward and two steps back

I spent 15 years as the Research Director for a community-based public health agency in Massachusetts. We offered substance abuse treatment and mental health services for people at risk for HIV; broader community-based HIV prevention and counseling and testing; housing services for people with HIV; and clinical case management. All of that is about saving the lives of individuals, and also preventing HIV transmission and protecting public health. In principle, if we do all that well and work at it hard enough, we can stop the epidemic.

We were making progress. The number of new infections kept declining. The prevalence of HIV among injection drug users fell substantially, to the point where a symposium I attended a couple of years ago featured arguments that HIV transmission among injection drug users in Massachusetts was no longer a significant problem.

No longer is this true. As the linked article in the Puffington Host informs us, the presenters at the symposium might have been a bit too complacent but they weren't crazy: from 2012 to 2014, an average of just 41 cases of HIV linked to injection drug use were diagnosed per year in the entire state of Massachusetts. And now? That many cases in two cities alone, Lowell (where we had an office) and nearby Lawrence (where we did extensive outreach). 

The proximate cause is of course the opioid epidemic, and particularly fentanyl, which is shorter acting than heroin, therefore injected more frequently, thereby increasing the risk of needle sharing. 
Contributing is an epidemic of homelessness, which means that treatment is interrupted. (People who are successfully treated for HIV are not infectious). Also, complacency by providers who, perhaps having attended the symposium, stopped routinely testing injection drug users for HIV. Neither city had a formal needle exchange program prior to the outbreak.

This is really depressing. I spent nearly half of my working life trying to put an end to this, and here it comes again. Just like a lot of other bad shit we thought we'd left behind.


Don Quixote said...

It's distressing to see bad ideas come back again and again. I spoke with a health care professional this past week who theorizes that faulty ideologies (which I see as usually linked with so-called conservativism) are physiologically-based. He cannot find any other explanation. In fact, if you consider the Paradoxical Theory of Change (Arnold Beisser--see, these ideas are all consistent. It is through acceptance/awareness of ourselves that we are changed. If we have no awareness that we are flawed, then we cannot change at all. And if we TRY to change, we do not.

I know you've discussed the Dunning-Kruger effect. I believe its implications are not inconsistent with this theory. Dunning-Kruger's effect is obviated once awareness is attained. But how do we achieve awareness? That is where the idea of physiologically-based daftness comes in. Why are some people seemingly immune to the incorporation of new ideas and diverse perspectives?

Don Quixote said...

PS I would postulate the answer to my question (above) as follows: People who do not, or seemingly cannot, change perspective or incorporate new perspectives do not accept themselves--and that is why they manifest conflict, judgmentalism, and strife. They project their own unconscious lack of acceptance onto others. They are unconsciously at war with themselves, so they make war on others. However, this is inherently different from muckraking, for example; in other words, a lawyer working for social justice is inherently different (in his/her motivation and methods) from a parasitic conspiracy theorist. One acts from compassion; the other from self-loathing.

Anonymous said...

Also off topic, but much more interesting:

Green party spoiler candidate in Ohio election whose 1,100 votes could tilt outcome says his ancestors were from another planet.

Don Quixote said...

"Interesting" is a vague and indiscriminate word.

Interestingly ... "Anonymous" did not catch that my comments were ON topic. Oh, well.