The Young and Invincible.

The Young and Invincible. Sounds like the title to a soap opera, but actually it’s the attitude that many young adults have about getting sick or injured. Young people think they are invincible and as a result neglect the most important thing that they possess: there health! Listed below are ten medical issues in young adults that I see in my Family Practice that I want to discus with you.

HIV/AIDS
The human immunodeficiency virus (HIV) has become one of the most devastating sexually transmitted diseases ever known to man. Once infected with HIV, the body’s immune system can become weakened and the infected individual will develop the acquired immune deficiency syndrome (AIDS). According to statistics reported by the Centers for Disease Control (CDC): an estimated 38,500 young people (age 13-24) in the United States received a diagnosis of AIDS; African American youth were the largest group of young people affected by HIV, accounting for 56% of all infections; young women, especially of African American and Hispanic decent are at increasing risk. Risk factors for infection with HIV include unprotected sex, multiple sex partners, use of IV drugs, the presence of an undiagnosed sexually transmitted disease, lack of awareness, and poverty. The key is to get tested if you don’t know your status, and if you decide to have sex, Rap It Up!

Obesity
In the past 20 years, there has been a significant increase in over weight and obese individuals in the United States. The Food and Drug Administration (FDA) estimates that almost two-thirds (64%) of all Americans are overweight; almost one third are obese. Childhood obesity is on the rise and we are now seeing shocking increases in diabetes, heart disease, and hypertension in this previously active and healthy population. Today, approximately 17 percent of young people are seriously overweight. One main problem that I see is the decrease in mandatory physical education classes for school aged children. Lack of exercise, poor diets high in fat and calories, and the fast food epidemic are the main reasons for this epidemic. Young people are stuck on computers and hove video games and don’t bike and or play outside as much studies have shown. So get moving! Exercise at least 20-30 minutes most days of the week and eat foods low in calories and fat.

Cervical Cancer
Cervical cancer, a disease of the female reproductive system, is more common in young women. It accounts for 6% of all cancers in women and is caused by the human papilloma virus (HPV) in 90-95% of the cases. The virus is passed from person to person usually by unprotected sex and in most cases the woman has no symptoms. Risk factors for HPV include multiple sex partners, cigarette smoking, and unprotected sex. The key point is that all women who are sexually active need to have a pap smear at least once a year whether you wear condoms or not. Even if you are not sexually active, annual pap smears are still recommended by the age of 18. Cervical cancer can be detected and treated if diagnosed early by pap smears. Talk to your doctor about the vaccine currently in use that may reduce your risk of cervical cancer.

Anabolic Steroids
Barry Bonds is not the first person accused of using steroids and won’t be the last. His situation, however, has brought much needed attention to the topic of steroids. The desire to be competitive and to gain an edge on one’s competitor is natural, however the facts still remain: steroids are illegal and are associated with short and long term effects which can be very damaging to the body. Don’t get it twisted; they do help to build muscle mass, however, with side effects like elevated cholesterol, high blood pressure, balding in men, breast development in men, facial hair in women, and mood swings just to name a few, there is no way I would recommend to anyone using them. The National Institutes of Drug Abuse (NIDA) reported an increase in steroid use among 8th and 10th grade boys in 2000. The primary reasons for using steroids among these young men where to enhance athletic performance and physical appearance. If you want to be the best, work hard and don’t use a substance that is illegal and might permanently damage your body. Also remember, never take or rub a substance on your body if you don’t know what’s in the solution.

Cigarette Smoking
Cigarette smoking is the single most preventable cause of death in the United States. Twenty three percent of high school students and 8% of middle school students in this country are regular smokers. There are more deaths each year from tobacco use than by HIV, drug abuse, alcohol abuse, motor vehicle injuries, suicides, and murders all together. The active ingredient in cigarettes and smokeless tobacco is the very addictive substance called nicotine. Cigarette smoking is associated with cancers of the lung, bladder, and cervix; heart disease; low birth weight babies; sudden infant death syndrome, and chronic obstructive lung disease (COPD). Smoke free facilities are becoming the norm as society is becoming more aware of the harmful side effects of second hand smoke. If you plan on living longer, then you need to stop smoking.

Mental Disorders
Mental health is just as important as physical health and everyone should be comfortable discussing these topics with their doctor. The most common mental health issues seen in my practice are anxiety and depression. Approximately 25% of young adults experience depression by the time they are 24 years old, but very few seek help. This is alarming and depression, if left untreated, can lead to suicide. Anxiety, the most common form of mental disturbance in the U.S., affects approximately 28 million Americans each year. Both anxiety and depression are major problems for society as they can interfere with work, school and family life. They contribute to high rates of substance abuse and alcohol abuse. If you or a loved one has been diagnosed with anxiety or depression, it is important to take your medicines as prescribed and see your doctor and/or therapist on a regular basis.

Suicide
Suicide is the end result of severe depression that is untreated or under-treated. Suicide is common in young adults and the elderly. In general women attempt more suicide than men; men are more “successful” in suicide attempts. Signs of depression include disturbances in sleep, loss of interest in things the person normally does, guilty feelings about a situation or situations, decreased energy, decreased concentration, decreased or increased appetite, abnormal and unintentional weight loss or weight gain, decrease sex drive, and suicidal or homicidal thoughts. These symptoms have to be present for more than two weeks for the diagnosis to be made. The challenge is to recognize these signs and symptoms and to get help for the affected person before a suicide attempt (s) occurs. Suicide is the permanent answer to a temporary problem. If you are someone you love is talking about suicide, get him or her help immediately!

Substance Abuse
Despite what some might try to convince you, drugs of abuse are mind altering and can put you at risk for STD’s, accidents, and time in jail. The trends of abuse have shifted in young adults somewhat from the gateway drugs marijuana and cocaine, to designer drugs such as ecstasy and the date rape drug, GHB. There are more potent forms of marijuana, which make them more addictive, and crystal meth is slowly becoming a drug of choice for many young Americans. The results of substance abuse are quite evident: mental disorders such as depression and anxiety, incarceration, STD’s including HIV, destruction of families, and untimely deaths due to accidental overdose, suicide, or crimes as a result of the drug’s influence. While under the influence of these mind-altering substances, an individual often makes poor decisions and will participate in behaviors that he or she would normally avoid. Education and awareness about the different drugs available and how they affect the body is one of the major ways to decrease abuse.

“Staph” Infections
Community acquired methicillin resistant staphylococcus aureus (CA-MRSA) infections are on the rise! What the hell is that you ask? Well if you have ever had a boil that was hard to treat and it came back to visit you on several occasions requiring multiple doctor visits, drainage by a physician, and sometimes hospitalization and antibiotics through an IV, chances are you had a staph (staff) infection. MRSA was at one time primarily seen in hospital patients with wounds and in individuals with weak immune systems. As a result of antibiotic overuse by physicians to treat simple skin infections and patient noncompliance with medications (not taking them like they are suppose to), these very intelligent bacteria have become resistant to the very basic and inexpensive antibiotics that we have available in our local pharmacies. Staph infections can be very dangerous and are now being associated with pneumonias in healthy individuals. MRSA can kill! If you develop a painful to the touch, red and swollen area on your body that produces pus (drainage), you could have a staph infection. See your doctor right away so that this can be treated quickly and effectively.

Sexual Transmitted Diseases/Sexually Transmitted Infections (STDs/STIs)
Chlamydia, gonorrhea, herpes, HPV, syphilis, and HIV are on the rise again. One out of every 2 Americans will have an STD/STI by the there 25th birthday. The reasons are many and include lack of education and awareness, having unprotected sex, and substance abuse. If a person is infected with one STD/STI, then he or she is at risk of getting another. The concept that oral sex is safe sex or not sex at all is garbage. Herpes, HPV, and gonorrhea can be spread via oral sex. The likely hood of being infected with HIV is very low in someone receiving oral sex compared to the “giver”. However, there is still some risk. Abstinence is still the best way to prevent the spread of sexually transmitted diseases, however, this method is not always practiced. If you choose to have sex protect yourself. Know your HIV status, practice monogamy, wear condoms, and if you perform oral sex learn how to use dental dams. They come in tasty flavors and colors.

This by no means is a comprehensive list of all the potential problems young people encounter, but it’s a great start. Hopefully this will give you a good foundation and help guide your own research regarding the medical issues that I commonly see in my practice.

(c) 2007 Rani Whitfield. This article was published November 2007 by Ozone Magazine.

HIV/AIDS: An Epidemic in the African-American Community

When the media announced that Eric “Easy E” Wright had full blown AIDS in 1995, I grab my Straight Outta Compton CD and head nodded for a few. Four years prior to his announcement, Magic Johnson shocked the world with a similar message… “I have the HIV virus…” It hit me like a rock as my best images of Magic and Eazy E came from the times when they where young and hungry for success. I believed that only gay men got the disease, not realizing that a second cousin moved to California after being diagnosed with an unknown illness and died a lonely death. HIV/AIDS was once thought to be a problem for gay white men only and was defined as the Gay Related Immunodefeciency Disease or GRID. However, ten days after being admitted to the hospital with pneumonia, a common complication of AIDS, Eazy E was dead. The HIV/AIDS epidemic was real and one of gangsta raps pioneers fell prey.

Today, African Americans are facing its greatest health challenge and the numbers reported by the Centers for Disease Control are staggering: African Americans make up only 13% of the United States population, yet we represent 50% of the cases of HIV/AIDS in this country; African American women are the fastest growing population of HIV positive people in the United States; and of the 1.2 million people in the US believed to be infected with HIV, 200-300,000 are unaware they are infected. In the month of October I personally diagnosed eight African American women of child bearing age with HIV- all but one, 25 years old or younger, was incarcerated. This unfortunately comes as no surprise when individuals like Elidor Kersaint (club promoter in Miami), Nikko Briteramos (former college basketball player), and Nushawn Williams (former drug dealer from Brooklyn) have knowingly spread the disease to women.

What was considered a gay white man’s disease has now become one of black and brown brothers and sisters. Debates continue on the origins of the HIV and the emphasis focuses on treatment, not prevention, immunization, or a cure. The bottom line is that the HIV, which is spread by blood and body fluids, is here!

Abstinence, wearing condoms, getting tested, dispelling the myths and educating ourselves about HIV are the only cure. Intravenous drug use (IVDA), promiscuity, men having sex with men (MSM), is the primary modes of infection among African Americans. The southern states have been hit the hardest and my hometown of Baton Rouge ranked number 6 in the country in AIDS cases followed by New Orleans. In 2005, Miami had the highest rates of new AIDS diagnoses in this country. Hip-hop has made several attempts to raise and help eradicate this illness from our communities. When hip-hop was “founded” in the early 1970’s, it was the result of crime and violence that brought about the movement to positively change things. “Coochie Bang” by Queen Latifah and “Go See the Doctor” by Kool Moo Dee, although not specifically addressing HIV, did address condom usage and sexually transmitted diseases. But as you know, the culture has evolved, the game has changed, and the call to do things not necessarily hip-hop is upon us. Rappers, MC’s, and DJ’s have been summoned to speak on politics, injustice, and health. "Hip-hop as a culture is getting a lot of backlash right now for its lyrics, for its public image, and the people are crying out for more responsibility," said KRS-One at the 2007 BET Hip Hop Awards. I applaud Common and Ludacris in their recent efforts to bring more awareness to the issue of HIV/AIDS. We need more of a collaborative effort, however, and I support KRS One for pulling MC’s together to “stop the violence”, but we need some love on the medical battlefield. The messages must be consistent and reinforced on and off the stage. The use of hip-hop as a tool for empowerment has been proven. Lets us use it to educate about health issues as well.

For more information on HIV visit http://www.blackaids.org/. (c) 2007 Rani Whitfield. This article was published October 2007 at http://allhiphop.com.

Is HIV/AIDS a terminal illness?

This is a very good question and would have been a lot easier to answer in the late 1980s and early 90s. Before I answer, let me first define “terminal illness”. There are many definitions for a terminal illness, but the most accepted definition is an illness that is incurable and will result in death in a certain time period. This definition is commonly used by hospice agencies and helps to determine the patient’s eligibility for services. In the case of an HIV infected person in the 80s and 90s, treatment options where limited and many died from complications of AIDS. Since the introduction of Highly Active Antiretroviral Therapy (HAART), which is the use of multiple medications to treat HIV/AIDS, this disease has evolved from a terminal illness to a chronic illness and individuals are living longer lives.

With that being said, HIV/AIDS is a terminal illness if one does not have access to care and/or is non compliant with his or her medical therapy. HIV/AIDS patients who do receive adequate treatment and have access to care can live a normal lifespan. (c) 2007 Rani Whitfield. This article was published July 2007 at http://aolblackvoices.com

HIV/AIDS

African Americans are well represented in many areas these days. We are leaders in business and education, have ownership in both the private and public sector, dominate sports (now with head coaches and franchise owners), have lead roles in cinema, and only comprise 13% of the United States population. Even in small numbers we have found a way to make our presence known and have a positive impact on society. So how is it that we make up only 13% of the US population, yet we account for approximately half of the more than one million people estimated to be living with the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)? Since the “discovery” of HIV/AIDS in the early 1980’s, 40% of all deaths among people with HIV/AIDS in the US have been among African Americans. Highly active antiretroviral therapy (HAART), an intricate, sometimes difficult, but effective treatment regimen is expensive, but has expanded the lifespan of people infected with the virus. This has also created the environment for HIV transmission as some individuals still continue to participate in unsafe practices despite known infection.

Let us look at the numbers collected by the Centers For Disease Control and Prevention (CDC) over the last 4 years (2001-2005). This data is based on information from 33 states with long-term, confidential name-based HIV reporting. African American women are the fastest growing population of HIV-positive people in the US, however, African American men continue to bear the greatest burden of HIV infection. In 2005, the rate of HIV diagnosis among African American men was seven times higher than that of Caucasian men, and more than twice that of African American women. Infection rates among African American women were more than 20 times that of white women. In our young African American brothers and sister, defined by the CDC as ages 13-24, we accounted for 61% of the HIV/AIDS diagnoses. Another shocking statistic is that there are 200-300,000 people in this country who are HIV positive and have not been tested. They are unaware of their infection, and for one reason or another have yet to be tested. Barriers to testing include poverty, lack of education and awareness, denial, and the social stigma placed on individuals that are diagnosed. Once considered a gay-white man’s disease, HIV/AIDS has become the greatest crisis facing African American men, women and young people today!

Transmission of HIV has been clearly identified and the major modes of infection are by unprotected sex, sharing needles with someone who is infected, blood transfusions (very rare now), and babies born to HIV infected mom’s during birth or through breast feeding after birth. I include substance abuse as a major risk factor because when someone is under the influence, the chance for him or her to indulge in risky behaviors increases. Health care workers and sometimes the patients are at risk of transmission and thus universal precautions and safety are a must in the hospitals and physician offices. HIV cannot be spread by casual contact (i.e. hugging, casual kissing, shaking hands). Dispelling these myths will decrease some of the negative attitudes and stigmata placed on individuals who are HIV positive.

There is some good news however. Even in the storm of rising HIV disease, there is no indication that the overall rate of infections in African Americans is increasing. Mother to child transmission has been significantly reduced, and there also has been increase use of condoms among young people and a decrease in risky sexual behavior.

In my opinion, there is nothing “positive” about being HIV positive. Once this diagnosis is handed to someone, his or her entire life changes. Negative attitudes, beliefs, and actions are directed at those living with HIV/AIDS despite the mode of transmission. Consider the 1980’s when blood transfusions where a major route of transmission. Now we have the unsuspecting mother/girlfriend/lover whose partner brings the virus into what was believed to be a monogamous relationship; or the unborn child who is infected by an HIV positive mom. Men having sex with men (MSM- the undercover brother or the down low brother) is getting more attention than the other common means of infection among African American men which are IV drug abuse and having unprotected sex with a woman who is HIV positive. For women, the most common ways of getting infected include having unprotected sex with an infected male and IV drug abuse. If you are unaware of your partner’s risk factors, have a sexual transmitted disease (STD), live below the poverty level, or have been incarcerated, your risk of HIV is higher.

Max Robinson, Eric “Easy E” Wright, and Arthur Ashe are not here anymore to be celebrity leaders, advocates, and spokes persons’ against this disease. All died from the complications of AIDS, but did live long enough to speak out against HIV. Magic Johnson is carrying the torch by himself in this celebrity role, but there are other organizations and individuals stepping up and speaking out. On December 1st of 2006, World AIDS Day, author/editor Gil Robertson, IV released his book Not In My Family: AIDS in the African American Community. This collection of powerful polemics, essays, and personal stories speaks to the lack of discussion and the denial in our community when it comes to addressing HIV/AIDS. You can read the words of Rev. Calvin Butts, Hill Harper, Jesse Jackson, Jr., Patti LaBelle, Mo’Nique, Sheryl Lee Randolph, and Dr. Jocelyn Elders, Rev. Al Sharpton, and Omar Tyree just to name a few. The CDC has several programs that are addressing HIV/AIDS across the nation including programs specifically targeting incarcerated men, gay and bisexual men, emergency rooms, and labor and delivery departments. The AIDS Drug Assistance Program (ADAP) spoke before congress in March of this year to address the lack of prescription coverage for the uninsured and underinsured. Individuals have died because they could not get/afford their medication. Whitney Breaux, sophomore at Louisiana State University and Miss Teen Louisiana has made over 100 hundred appearances educating teens and young adults on the ills of HIV. Phil Wilson, Executive Director of the Black AIDS Institute has an educational website that is constantly updated and addresses all realms of the disease. Phil is also a contributor to Not In My Family. I have personally seen the effects of HIV/AIDS on the south as southern states have been hit the hardest. Baton Rouge, my birth place and home suffers from the sixth highest AIDS case rate in the nation. Many HIV/AIDS residents, primarily African American, displaced by hurricane Katrina, have attempted to return to New Orleans or surrounding areas to find the necessities of housing, employment, and healthcare stable and fragmented. It was a “no brainier” when asked by Gil to contribute to his book.

More must be done to effectively address the impact of HIV/AIDS among African Americans men, women, and young people. Although prevention efforts have grown substantially over time and important progress has been made, major unmet needs remain. If this disease is killing “US”, then “US” needs to fight. ADAP, the CDC, Not In My Family, The Black AIDS Institute, and Whitney Breaux cannot fight this battle alone. It will take a nation wide effort.

© 2007 Rani Whitfield.