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Mistakes in handling HIV/AIDS pandemic could hinder monkeypox response, advocates say – CBC News

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Top health officials say they are trying to limit the spread of the monkeypox virus while also preventing stigma against those most affected — particularly gay, bisexual and other men who have sex with men — but their messaging may be a part of the problem, according to some advocates.

More than 21,000 people, in over 70 countries, have contracted the virus, which causes painful sores and blisters among other symptoms. An estimated 98 per cent of confirmed cases are in men who have sex with men.

This week, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, warned stigma “can be as dangerous as any virus and can fuel the outbreak.” At the same time, he urged men who have sex with men to reduce their number of sexual partners or to reconsider having new sexual partners “for the moment.” 

The Public Health Agency of Canada (PHAC), which has reported at least 745 cases since the first two cases were detected in late May, also urged men who have sex with men to limit sexual partners, especially casual acquaintances. 

“I think when we try to tell people ‘Stop doing this. Stop doing that,’ it doesn’t really work,” Devan Nambiar of the Gay Men’s Sexual Health Alliance in Toronto told CBC News. “It hasn’t worked in any infection.” 

Devan Nambiar, manager of capacity building at the Gay Men’s Sexual Health Alliance in Toronto, said the stigma of HIV/AIDS is still prevalent after more than 40 years. (Submitted by Devan Nambiar)

It is important to make people aware of the risk factors so they can make informed decisions, and to be compassionate and concise in the messaging, he said, but not to stigmatise people for their sexual activity and behaviour – something gay men, in particular, have endured since the early years of the HIV/AIDS pandemic when the illness was widely considered a “gay disease.” 

Lessons learned from that era have been applied to public health care today, but there are criticisms that history is repeating itself with the handling of the monkeypox outbreak.

Some advocates attending the International AIDS Conference (AIDS 2022) in Montreal from July 29 – Aug. 2 say health officials need to prevent the perception that a viral threat, like HIV/AIDS or monkeypox, only affects one portion of the population. 

“[We] lived that with the HIV epidemic. We certainly saw that with COVID-19. Let’s not do it with monkeypox, right?” said Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town’s Institute of Infectious Disease and Molecular Medicine in South Africa and a past president of the International AIDS Society, which organized the AIDS 2022 gathering. 

Engagement key to combating health threats

The conference returns to Montreal for the first time since 1989, a time when access was limited to drugs that could prolong the lives of people infected with HIV. The majority of those dying from AIDS at that time were gay, bisexual and other men who have sex with men, transgender women, as well as injection drug users. 

WATCH | Is monkeypox messaging missing the mark? 

Concerns over public health messaging around monkeypox

2 days ago

Duration 2:05

As monkeypox cases spread worldwide, overwhelmingly among men who have sex with men, there is growing concern that public health messages targeting that community have missed the mark.

The monkeypox virus, however, is not a sexually transmitted infection like HIV, the virus that causes AIDS; it’s transmitted through close personal contact with someone who is infected, but also through direct contact with materials that have touched the bodily fluids or sores of an infected person, such as bed sheets or clothing. 

Bekker believes that without proper communication and engagement with affected groups — whether it concerns HIV/AIDS or monkeypox — there is a risk of discrimination that may lead to people not seeking or being able to access the services they need.

Gay men take health into their own hands

Nambiar, who will also be attending the AIDS 2022 conference which begins Friday, said gay and bisexual men have long been their own health-care advocates, having to “figure a lot of things out for ourselves” because of “indifference” to the LGBTQ community. 

“We have led the work in many things actually, in terms of getting self checks, taking [on] advocacy, taking autonomy in terms of our well-being, fighting for our rights,” he told CBC News.

With monkeypox, he said, gay and bisexual men have been speaking up loudly since early on, calling for paid leave so they can properly quarantine, and to demand access to testing and vaccines.

He said it’s an individual decision to get vaccinated to protect against monkeypox, something about 27,000 eligible people have done so far in Canada, according to PHAC.

Some public health authorities have set up pop-up vaccination clinics at locations frequented by men who have sex with men, including gay bars, bathhouses and cruising areas. The response to monkeypox has been “pretty decent” in Canada, Nambiar said, though he can’t say the same for other countries.

In the U.S., which now has the highest number of recorded cases of monkeypox, the response to the outbreak has been criticized. One AIDS advocate compared the U.S. government’s initial response to monkeypox to their handling of the COVID-19 pandemic, when the country led the world in deaths and less than 70 per cent of the population is fully vaccinated. 

LISTEN |  Dr. Anthony Fauci on HIV/AIDS, monkeypox and COVID-19: 

The Current20:50Dr. Anthony Fauci on the lessons learned from COVID-19, HIV/AIDS and monkeypox

We talk to Dr. Anthony Fauci about the COVID-19 pandemic, the lessons he learned from the fight against HIV/AIDS, and what the world needs to do to get rising monkeypox cases under control.

HIV/AIDS overshadowed by converging threats

As fears grow over monkeypox, and with COVID-19 case numbers again rising, health professionals gathering in Montreal worry about whether the world will be able to meet the UN’s 2030 target to end HIV/AIDS as a global health concern. 

There were an estimated 38.4 million people living with HIV/AIDS globally in 2021, with approximately 1.5 million new HIV infections last year. The United Nations said that is a million cases higher than global targets and a sign of “faltering progress.”

This week, at the launch of a new UNAIDS report titled In Danger, UNAIDS Executive Director Winnie Byanyima warned “the response to the AIDS pandemic has been derailed by global crises,” including the war in Ukraine and international economic instability. 

“The actions needed to end AIDS are also key for overcoming other pandemics,” she said. 

Over the four days of the AIDS 2022 conference, there will be a push to “counter apathy” in combating HIV/AIDS globally and a call “to re-engage and follow the science.”

A woman holds up a red booklet with the words "In Danger" on the front.
Winnie Byanyima, executive director of UNAIDS, holds up the 2022 update on the global AIDS situation at a news conference in Montreal, ahead of the World AIDS Conference this weekend. (Ryan Remiorz/The Canadian Press)

“Some of this is going on the offensive,” said Bekker, noting there is an additional challenge with the polarization around science that has emerged in the COVID-19 pandemic. 

Nambiar said some of that apathy towards HIV/AIDS comes from being “inundated with viruses,” with the mutated variants and subvariants of COVID-19, and now monkeypox.

But he said one of the important lessons that has been learned over the years, that certainly applies today, is that a successful response to a public health emergency requires cooperation between governments, public health workers and community organizations. That didn’t happen immediately with HIV/AIDS, but he sees it developing now in response to monkeypox. 

Though there have been remarkable achievements in the last four decades to prevent the transmission of HIV and allow people to live with the infections as a chronic illness, Bekker wants to remind people that doesn’t mean the HIV/AIDS pandemic is over.

“I would say we’ve got the hardest mile to come,” she told CBC News. “We really do need to gird our loins, pull ourselves together as a community and say, ‘What can we do to reach that last mile?'”

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Helping people living with dementia ‘flourish’ through dance

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Dr. Pia Kontos, a Senior Scientist at UHN’s KITE Research Institute, is co-leading an initiative to help people living with dementia flourish. (Photo: Tim Fraser/UHN KITE Studio)

Dr. Pia Kontos believes in the power of the arts to support people to live well with dementia.

The Senior Scientist at UHN’s KITE Research Institute focuses on challenging policies and practices that discriminate against those living with dementia and developing and evaluating arts-based and digital knowledge translation initiatives to reduce stigma, improve social inclusion and quality of care for them.

“The predominant assumption is people living with dementia don’t have the capacity to be creative,” says Dr. Kontos, who is also a professor in the Dalla Lana School of Public Health at the University of Toronto. “However, we know through extensive research that dance…powerfully supports people living with dementia to be creative and to flourish.

“And flourishing should be a goal that we all have.”

Dr. Kontos co-produced in 2023 Dancer Not Dementia, a short documentary film. It captured the power of a dance program for seniors – Sharing Dance Older Adults (SDOA) – to challenge the stigma associated with dementia, support social inclusion and enrich lives. It’s told through the eyes of residents and staff at Alexis Lodge Dementia Care Residence and Cedarhurst Dementia Care Home in Toronto.

SDOA was jointly developed by Canada’s National Ballet School (NBS) and Baycrest Centre in 2013 for older adults with a range of physical and cognitive abilities, including dementia.

Typically, dance programs in dementia care settings are provided as a therapeutic intervention for older adults. However, SDOA’s goal is to provide a creative outlet for participants and opportunities for social interaction with other people living with dementia, staff and loved ones.

Now, Dr. Kontos will look to incorporate traditions from marginalized communities into SDOA through a $750,000 Canadian Institutes of Health Research (CIHR) Institute of Aging Implementation Science Team Grant. Dr. Rachel Bar, Director of Research and Health at NBS is co-principal applicant for the grant.

This CIHR funding supports projects that evaluate the effectiveness of existing programs, services and models of care that show promise for those impacted by cognitive impairment and dementia. An important focus is improving equitable and inclusive access to care and support.

The three-year grant to Drs. Kontos and Bar will support SDOA efforts to partner with organizations in Black, Chinese and South Asian communities to integrate their cultural practices into its programming.

Training dancers from these communities to teach the adapted program is central to these partnerships.

“People living with dementia from marginalized communities rarely have their traditions honoured with art and leisure programming,” says Dr. Kontos.

“It’s important to align dance programs with the cultural traditions of these communities. Otherwise, the music and movements wouldn’t reflect the experiences of ethno-culturally diverse populations, and the programs wouldn’t be inclusive.

“We wouldn’t be supporting their capacity to be creative or to be in relationships with others through dance. We would be falling short.”

SDOA has already partnered with Alexis Lodge, Alzheimer Society of Canada, Baycrest, NBS, Indus Community Services, Social Planning Council of Ottawa, and Yee Hong for this initiative.

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CDC: Heat may have contributed to four human cases of bird flu in Colorado

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Credit: Alexas Fotos from Pexels

Heat probably played a role in at least four cases of bird flu in poultry workers confirmed by U.S. health officials Sunday—the first cases in poultry workers in two years.

Sweltering temperatures in Colorado rose to at least 104 degrees, which is suspected to have contributed to the human cases, according to Dr. Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention. The barns where poultry workers were culling chickens were “no doubt even hotter,” Shah said during a press conference on the most recent outbreak of bird flu in humans.

The new cases bring the U.S. total to at least nine cases since the first human case of the current outbreak was detected in 2022, also in a Colorado poultry worker. Eight of the nine were reported this year.

The workers were separating chickens that were going to be killed to stop the spread of the virus. The fans may also have contributed to the human infections because, while helping to keep the environment cooler, they “also spread things like feathers around which are known to carry the virus,” Shah added.

The large and strong fans also make it difficult for protective goggles and face masks to stay in place, he said.

About 60 workers at the poultry farm showed symptoms of illness and were tested for bird flu. Four tested positive for bird flu and one additional presumptive case is awaiting confirmation.

The illnesses were relatively mild, with symptoms including conjunctivitis and common respiratory infection symptoms like fever, chills, coughing, and runny nose, according to the CDC. None were hospitalized, officials said. The other U.S. cases have also been mild.

Officials said they are bracing for more cases.

The CDC says the risk to the general public remains low and the health agency is not recommending livestock workers be vaccinated against bird flu given the “mild symptoms noted thus far,” Shah said.

An initial analysis of virus samples from an infected poultry worker does not show any changes in the virus that would make it easier to spread among people and there is no evidence of person-to-person spread in the U.S.

“It’s important to note that this assessment is based on what we know today and may change,” Shah said. “CDC is constantly looking for key changes that may alter our risk assessment of the virus, such as the severity of illness that it causes, the ease with which it can transmit to humans or changes to its genetic fingerprint.”

At the request of Colorado’s officials, the CDC sent a 10-person team to Colorado to help the state manage the bird flu outbreak in humans and poultry. The team included epidemiologists, veterinarians, clinicians and industrial hygienists.

Shah also noted it was a bilingual team. Overall in the U.S., it is estimated about half of farm workers are Latino.

An analysis of the virus from an infected worker indicates that the infections at the chicken farm are “largely the same” as the strain detected in dairy herds in Colorado and other states, according to Shah. But an investigation is ongoing to determine exactly how the outbreak is spreading between wild birds, chicken and cattle.

Since 2022, a highly contagious strain of bird flu has spread across the U.S. at an unprecedented rate.

Georgia’s powerhouse poultry industry, which produces more broiler chickens than any other in the country, has mostly dodged the kinds of major outbreaks that have resulted in the deaths of more 90 million birds in commercial and backyard poultry flocks in the U.S.

About 1.8 million chickens will be killed at the Colorado poultry farm after these latest bird flu cases were detected.

In late 2023, ducks at a commercial breeding farm in Sumter County, Georgia, tested positive for H5N1. This year, in March, the virus made a jump to a mammal species that surprised many scientists: cows.

With a significant dairy industry, plus even larger beef and poultry interests, the potential arrival of the virus here threatens Georgia’s economy and the health of residents.

As of Monday, the H5N1 virus has been confirmed in 158 dairy herds in 13 states, according U.S. Agriculture Department.

So far in Georgia, there have been no bird flu cases in cattle, and there have been no human cases.

Since the unprecedented spread of H5N1 in poultry in 2022, the Georgia Department of Public Health has quietly monitored 132 people for signs of the virus, according to DPH spokeswoman Nancy Nydam. Those tracked were either first responders to one of the state’s few virus outbreaks in backyard and commercial poultry flocks or farmworkers where the infections occurred. Of those monitored, fewer than 10 people were tested for H5N1 and none came back positive.

Since the virus was discovered in cattle, a small number of first responders from Georgia who went to other states to help with investigations—fewer than 15—have also been monitored for signs of illness.

Federal officials said Tuesday they still believe they can eliminate the bird flu virus from , even as the number of herds infected continues to grow. The latest state to recently report infected dairy cattle was Oklahoma. North Carolina is the only state adjacent to Georgia to report an infected dairy herd.

Eric Deeble, acting senior adviser for the H5N1 response at the USDA, said investigations show the is spreading among cattle through cattle moved from one herd to another and the shared use of milking equipment. It can be contained through enhanced biosecurity measures such as thoroughly cleaning milking “parlors” and equipment, separating sick cows, and having dairy workers wear protective equipment.

Deeble also noted USDA scientists are also working with partners to develop a cattle-specific H5N1 vaccine—a process requires many steps and will take time.

The USDA is also exploring the possibility of developing a poultry vaccine as the number of cases soar, and outbreaks lead to the slaughter of millions of farmed birds. But USDA and industry stakeholders point to challenges that would hinder a vaccination program.

The biggest sticking point is around trade.

Mike Giles, president of the Georgia Poultry Federation, said mass vaccination would be impractical for several reasons, including the fact that the industry would lose its lucrative export market: The United States and many of its trade partners restrict the import of products or eggs from countries affected by the highly pathogenic strain or flocks that have been vaccinated against it.

“(Bird flu) has been, from an animal health standpoint, our top concern,” Giles said. “The challenge, and I think the industry has responded to it well, has been maintaining the state of preparedness and urgency and focus on biosecurity, and I think that has been accomplished.”

2024 The Atlanta Journal-Constitution. Distributed by Tribune Content Agency, LLC.

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Here is the new guidance for RSV vaccines

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Health officials recently changed the guidelines for respiratory syncytial virus vaccines. Here’s what Canadians need to know about the guidance and the virus itself.

New guidance on vaccines

As of July 12, the National Advisory Committee on Immunization (NACI) now recommends RSV vaccines for individuals who are 75 years old and older, especially those who have a greater risk of developing severe RSV.

Based on current evidence and expert opinion, NACI said in a news release, it also strongly recommends vaccines for those aged 60 and older who live in nursing homes and other chronic care facilities.

What is RSV?

RSV is a common contagious virus that often causes bronchiolitis, a lung infection, and pneumonia.

Infants face the highest risk of developing severe RSV disease, however, this risk also increases with age and with certain medical conditions, according to the Public Health Agency of Canada (PHAC). It can lead to serious complications for older people, including hospitalization and death.

What are the symptoms?

RSV typically causes mild, cold-like symptoms that usually begin two to eight days after exposure to the virus, according to PHAC.

Those with RSV may experience a runny nose, coughing, sneezing, wheezing, fever and less appetite and energy. Infants may be irritable, have trouble breathing and have less appetite and energy.

What is the treatment?

RSV infections are usually mild and last about one to two weeks. If you are infected, health officials recommend you stay home and limit contact with others.

They also recommend lots of rest and drinking plenty of fluids. Take over-the-counter products, such as acetaminophen or ibuprofen, if you have a fever. Seek immediate care or go to the hospital if you’re having trouble breathing or become dehydrated, PHAC adds.

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