The American Public Health Association posted the video of Dr. Cornel West’s opening speech tonight.  I’ve listened to it twice now, and am still in awe.  I strongly recommend watching it.

Today was a much more relaxed day, as I have finally bought into the “marathon not a sprint” mentality for this conference.  I also ventured out of the HIV/sexual health into a data and practice session.  But, in summary, here is some of what I learned (~1500 words for 10 hours of conventioning… I think that’s pretty good):

MRSA infections in MSM associated with PNP.  Popular media was very quick to label Methicillin-resistant Staphylococcus aureus (MRSA) as the new “gay STD” but that’s not entirely accurate.  MRSA is spread by close contact with someone who is a carrier or infected, so in a sense, it could be sexually transmitted.  There was an outbreak in men-who-have-sex-with-men (MSM) in New York City in 2006.

Qualitative research by the New York City Department of Health and Mental Hygiene found that this outbreak was caused by three issues:  Party-n-play (PNP – drug use and sex) activities, MRSA misinformation, and stigma.  Participating in PNP caused people to have sex for longer periods of time increasing their exposure.  Also, HIV-positive individuals and PNPers were less likely to use condoms and water-based lube, opting for grease or oil-based.  This has a tendency to clog pores, further facilitating transmission.  Once someone was infected, they’d attempt a variety of home-remedies, including alcohol-baths, peroxide, and lancing the pustule.  This would further insult the skin integrity while not resolving the infection.  Finally, individuals felt MRSA carried an additional stigma, thinking that, as one individual said, it’s just “another gay disease, one more thing conservatives can use” against them.

HIV-positive men mostly feel responsible for preventing HIV transmission. Is an HIV-positive individual responsible for keeping an HIV-negative individual safe?  Or is it always the HIV-negative individual’s responsibility to protect themselves?  A study by Dr. Hugh Klein discussed the locus of control among HIV-positive men who have sex with men with HIV-negative partners.  He found that 70% of HIV-positive men felt they had an obligation to keep their partners safe, while 49% thought it was also the negative partners responsibility (these are separate questions, so they don’t add up to 100%).

Further analysis showed five factors, explaining 21.6% of variance, helped explain HIV-positive individuals external locus of control:  having HIV “burnout”, being younger, partner communication problems, knowing fewer people with AIDS, and being a meth user.  Partner communication was  related to the need to improve communication, making it a two-way street.  Ultimately, most HIV-positive men believe they have a duty to keep HIV-negative men safe, although more than 1 in 6 disagree, and more than 1 in 3 think the HIV-negative individual is also responsible.

Internal ejaculations don’t always happen in unprotected anal intercourse. There’s a general assumption in HIV research and practice that if you’re having sex without a condom, you’re also ejaculating inside your partner (or being ejaculated inside).  This, according to Dr. Klein and Mr. David Tilley, is not always true.  Only 50.2% of sex involved internal ejaculation.

When examining factors related to internal ejaculations, they found four issues that explained 18% of the variance: knowing people who died of AIDS, use of the internet to seek partners, perceived accuracy of their partner’s HIV status, and a negative attitude towards condoms.  They also found significant associations with other risk activities, including felching and snowballing.  If you don’t know what those are, you should probably google them from your non-work computer.  This information makes a very compelling case for encouraging harm reduction — people may not be practicing “safer sex” by using a condom, but they are taking steps to reduce their risk of HIV infection by at least not allowing their partner to ejaculate inside them.

“Boys must be men, and men must have sex with women.” Dr. Scott Rhodes did a qualitative study of risk taking among African American, Latino, and White MSM.  His findings, similar to what I learned from yesterday’s sessions on HIV, seemed to show a lot of similar issues among different groups of people.  Latino men reported loneliness and social isolation, largely related to being secluded in rural North Carolina where their jobs and families were.  African American men reported feeling isolated from their church.

Condom use was also an issue.  One African American man said that “condom use is antithetical to love.”  And, dealing with their own coming-out process left feeling a bit overwhelmed and not ready to also use condoms:  ”having sex with another man is a step in the right direction.”  Participants also expressed that alcohol/drug use was sometimes used an excuse — if someone “didn’t want him to cum inside him, he wouldn’t” let it happen.

This study suggested a number of recommendations for HIV prevention, including implementing a coupon system for non-department of health testing venues, using more social media, implementing chat room interventions, and operating hotlines and websites specific to MSM of Color.

Submissive men use condoms (or don’t) when their partner tells them to. Continuing research that Dr. David Moskowitz has previously done relating to leathermen and condom use, he explored the relationship between being more dominent or submissive (i.e., sexual control) and condom use.  I’ll be honest — this is one of the few presentations where I got a bit lost (mostly because I was just so concerned about how power bottoms fit into this picture).  However, my take away was that dominent men are in control of whether condoms are used.  Further, when someone is in their non-preferred role (e.g., dom men being submissive), they’re more likely to eschew condoms.  This suggests that perhaps condom negotiation should be done prior to sexual activity — perhaps condoms should be discussed when chatting online or in a bar, so there’s less pressure to have that conversation in the heat of the moment, after you’ve already been tied up.

Data-Driven Public Health Practice.  My one non-HIV session that I went to  Ms. Ami Shah with Mount Sinai in Chicago talked about their use of data to implement public health changes in the community.  They received a Robert Wood Johnson grant to do local, neighborhood-level surveys relating to health.  They did this in a about 10 neighborhoods in Chicago, based on certain ethnic/racial groups or mixes of interest.  This data allowed people to identify local issues, create private-public partnerships, generate news coverage, and help inform elected officials about public health issues.  Some Jewish Synagogues, now having data about obesity rates in their children, implemented programs to reduce childhood obesity.  Another community in northern Chicago found poorly controlled diabetics in their neighborhood, so some diabetes centers opened up in those neighborhoods.

In New York City, they produced local data based around 10 metrics, and then provided data back to the individual neighborhoods.  Their rationale is that neighborhoods become empowered by having access to their data, and then the Department of Health and Mental Hygiene becomes empowered to help the neighborhoods with issues.  This work has informed elected officials about needs in their communities, and has led to policy changes.  For example, New York City, already saturated with food carts, is allowing 1000 “green carts” in designated neighborhoods in order to provide healthier food options to citizens.  Certain farmers markets have “health bucks” which provide a $2 voucher for every $5 EBT transaction.

King County, the county containing Seattle, has developed CommunitiesCount.org.  This was the product of a community process to develop indicators for local municipalities.  This information is made available back to the municipalities to allow them to inform elected officials and budget decisions.  As they continue developing their web presence, they intend to make this data available in a more user-friendly and dynamic manner.

This presentation sparked a lively conversation with some of the presenters, myself, and a few former classmates of mine from the University of Illinois-Chicago.  We discussed the need for public access to raw data, and the desire to put this data into the hands of the neighborhoods.  As one of my former classmates pointed out, she doesn’t have the staff in her health department to analyze all of the data.  But if local colleges or Schools of Public Health (or even high schools!) were to take on data projects using *real* data, they could get a much stronger bang for their buck and even further empower their local communities. NYC has started doing this, and King County has plans to do similar work.

There’s a lot of exciting things happening and there’s an overwhelming amount of information out there.  So, even though I can’t possibly go to every session and poster presentation, I think that’s ok.  The networking, conversations, and socializing have been inspiring; and the presentations have been enlightening.  I’m excited for the conference to wrap up, the opportunity to really process everything that’s happened, and then to get back to work.  It’s our world to change, as Dr. Cornel West said, because we are the American Public Health Association.