AN OPEN LETTER TO MY AIDS CLINIC (SEQUESTRATION & GOVERNMENT SHUTDOWN). OCT 16, 2013

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Young boys doing sex work are finding themselves more and more confronting GHB, Rohypnol, and Ketamine. If the trick isn’t force-feeding this stuff to them, often the pimp is.

Viral load will jump precipitously in infected individuals who use these drugs.

The boys use the term: Date. A “date” is code for a sexual transaction. Date rape is the highly risky and highly toxic use of one, two, or all three of these pharmaceuticals.

I am not here to mouth the words: just say no. It’s a health issue. Not a moral one.

You can’t say no if you have been rendered unconscious.

Tricks who want to fuck a dead body have always been with us. I doubt they will be volunteering to go live on a desert island anytime soon.

I also note that after a “date” involving the boy passing out (overdose is very tricky), the kid can resume consciousness to find his rectum torn and bleeding. Often, he does not know why.

There is a sense of shame that pervades the experience. Combine that with a kid who has HIV and is doing sex work, it’s a lethal combination. 

My own take on it has to do with the relationship of increased Mexican narco smuggling via the same routes sex trafficking follows. You have one, you have the other. Follow the money.

Many pimps are reluctant to have a corpse on their hands. So they simply include the drugs in the price of the transaction with the trick. The trick gets the drugs so the pimp isn’t looking at a murder charge. Tricks can be high-risk-takers, and my own anecdotal assessment is that many of them are clinically depressed. Their willingness to play god is endemic.

Boys doing sex work who have been knocked out by any of these drugs or a combination of them may want to be checked out for internal bleeding. Boys who have HIV as an additional correlation factor may experience risk for internal infections. 

His dick might have fucked you, but his fist may have gotten some play in there, too.

I know this: screaming might just cause the neighbors to close their windows and their eyes.  

 

HIV/AIDS and American Trypanosomiasis

So what is binary fission.

Fifty years ago, Western medicine knew very little about the protozoan parasite, parasite Trypanosoma cruzi. The organism was mainly confined to poor regions of rural Mexico.

Migrant dispora has changed all of that. Sex work and modes of transmission and changing demographics combined with diaspora have created a very complex picture for public health policy-makers to grapple with. Mainly, they have failed.

There are no states who are not reporting cases of Chagas disease.

Chagas disease will kill you but not before you have gone insane. The protozoa can infect the brain. It also gets transmitted to any fetus where the mother is infected.

Combine Chagas with HIV — and poverty — you can kiss your ass goodbye.

Undocumented boys doing sex work have presented the Western medical model with heretofore unknown challenges. The bug has been found in drinking water in the US; extending all the way south to the deserts of Chile. 

T cruzi is a member of the family Trypanosomatidae in the order Kinetoplastida and belongs to a special section called Stercoraria. The infective forms of T cruzi are contained in the shit of the insect vectors and gain entry into its mammalian hosts through contamination. This mechanism of transmission contrasts with that of the two subspecies of African trypanosomes that cause human disease, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense, which are transmitted via the saliva of their vectors, and with the mechanism by which the nonpathogenic trypanosome found in the Americas, Trypanosoma rangeli, is transmitted to its mammalian hosts.

As with other parasites that infect both mammalian and insect hosts, the life cycle of T cruzi is complex. The T cruzi life cycle consists of 3 main developmental forms. Epimastigotes are an extracellular and noninfective form of the parasite found in the midgut of insect vectors, where they multiply by binary fission.

As epimastigotes move to the hindgut, they differentiate into metacyclic trypomastigotes which are nondividing forms resistant to mammalian complement that have the capacity to infect mammalian cells. They then enter local cells through breaks in the skin, mucous membranes, or the conjunctivas and transform into the third morphologic form, amastigotes. Amastigotes multiply intracellularly until the host cell is overwhelmed, at which point they transform into bloodstream trypomastigotes.

Undocumented boys who have done sex work are rarely tested for HIV while in the custody of ICE. Not one of them has ever been tested for Chagas.

Why.

Because no one wants to pay for treatment.

They’re like unwanted fish. Thrown back into the sea as chum.

The potential for immigrant patients in the U.S. to develop severe neurological symptoms related to Chagas is underrecognized but real. Researchers (now furloughed) are sounding alarm bells. Demographics just do not contain disease anymore.

Up to 1 million immigrants living in the U.S. and Canada are estimated to carry latent infection Trypanosoma cruzi, which is endemic in Central and South America and which can reactivate in such individuals who become immunosuppressed.

Because a variety of immunosuppressive agents are commonly used in neurological practice — to treat multiple sclerosis, neuromyelitis optica, and other autoimmune conditions, for example — neurologists should be aware of the risk in patients from Latin America.

Also, clinicians should consider the possibility of Chagas disease in Latino patients presenting with symptoms that appear to be those of toxoplasmosis.

Case reports two Houston-area patients who developed fulminant Chagas disease with brain involvement as a consequence of AIDS. Both were women, one a 38-year-old originally from Honduras and the other, age 50, from Guatemala.

They were found at presentation to have multiple cerebral masses. Toxoplasmosis was initially suspected in both cases and it was actually diagnosed (incorrectly) in the Guatemalan woman. However, the diagnosis was eventually ruled out in the women, via serology in the Honduran patient and through brain biopsy in the Guatemalan woman.

Although the infection proved fatal to the Honduran woman, the other patient survived with antiretroviral and anti-trypanosomal therapy but with persistent mental impairment.

In patients without fully functional immune systems, cerebral manifestations of Chagas disease can be fulminant and lethal.

So. Yeah. For the sake of argument, pretend that you are providing caregiving to young undocumented boys doing sex work in the United States. How would you know a kid might have both HIV and the amebic parasite Trypanosoma cruzi. How would you even suspect it before the kid went mad.

You wouldn’t. You wouldn’t know jack shit about Chagas disease.

Reports have described clusters of reactivated Chagas disease in the context of AIDS, leukemia, and solid organ transplantation.

As a broader range of immunosuppressive agents enters the neurologists’ armamentarium, it is possible that iatrogenically triggered reactivation will be seen in patients.

From 300,000 to 1 million people in the U.S. and Canada, mostly immigrants from nations farther south, are believed to carry the Chagas parasite. Blood donations are now screened for T. cruzi contamination. Donor-blood data from 2010 found that carriers were present in throughout the United States. Chagas disease should be treated with nifurtimox and benznidazole, neither of which is FDA approved. They are available to American physicians only from the CDC.

Which is currently closed.

 

Oct 16, 2013. CDC website message: The lapse in government funding, only web sites supporting excepted functions will be updated unless otherwise funded. As a result, the information on this website may not be up to date, the transactions submitted via the website may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted.

Updates regarding government operating status and resumption of normal operations can be found athttp://www.usa.gov.

http://www.usa.gov/resources/images/Icon_Question.png); color: rgb(45, 91, 138); font-family: Verdana, Geneva, sans-serif; font-size: 16px; font-weight: bolder; background-position: 0px 1px; background-repeat: no-repeat no-repeat; "> What's Affected by a Government Shutdown?

Below, find an overview of some of the government services and operations that will be impacted until Congress passes a budget to fund them again. For detailed information about specific activities at Federal agencies, please see federal government contingency plans.

  • Vital services that ensure seniors and young children have access to healthy food and meals may not have sufficient Federal funds to serve all beneficiaries in an extended lapse.
  • Call centers, hotlines and regional offices that help veterans understand their benefits will close to the public.
  • Veterans’ compensation, pension, education, and other benefits could be cut off in the case of an extended  shutdown.
  • Every one of America’s national parks and monuments, from Yosemite to the Smithsonian to the Statue of Liberty, will be immediately closed.
  • New applications for small business loans and loan guarantees will be immediately halted.
  • Research into life-threatening diseases and other areas will stop, and new patients won’t be accepted into clinical  trials at the National Institutes of Health.
  • Work to protect consumers, ranging from child product safety to financial security to the safety of hazardous waste facilities, will cease. The EPA will halt non-essential inspections of chemical facilities and drinking water systems.
  • Permits and reviews for planned energy and transportations projects will stop, preventing companies from working on these projects. Loans to rural communities will be halted.
  • Hundreds of thousands of Federal employees including many charged with protecting us from terrorist threats, defending our borders, inspecting our food, and keeping our skies safe will work without pay until the shutdown  ends.
  • Hundreds of thousands of additional federal workers will be immediately and indefinitely furloughed without pay.

http://www.usa.gov/resources/images/Icon_Government.png); color: rgb(45, 91, 138); font-family: Verdana, Geneva, sans-serif; font-size: 16px; font-weight: bolder; background-repeat: no-repeat no-repeat; "> Services That Will Continue During the Government Shutdown

  • Social Security beneficiaries will continue receiving checks.
  • The U.S. Postal Service will keep delivering mail.
  • Active military will continue serving.
  • Air traffic controllers, prison guards, and border patrol agents will remain on the job.
  • NASA Mission Control will continue supporting astronauts serving on the Space Station.

 

TIM BARRUS (Creative Director, Real Stories/Smash Street/Show Me Your Life)

An Open Letter to my HIV/AIDS Clinic

Why are HIV/AIDS clinics so punitive. And arrogant. Do they like suffering.

Yes.

I really hate you people. Your definition of medicine is so dated, it’s right out of the 1950s playbook.

Your stupidity is beneath contempt.

It is up to me — it is not up to you — whether I come to your stupid clinic run by stupid people.

Do you really think the people in Africa with HIV are put through the medical gristmill like we are.

I do not include the “me” in that “we.”

I refuse most of your stupid tests.

You may feel free to go fuck yourselves.

Today, AIDS clinics are more concerned with cholesterol than with HIV.

They are so far behind what cutting edge medicine is that there is no dust for them to eat. It’s all settled.

Your ignorance is disgusting.

Don’t touch me unless you have some COMPELLING reason to, and you do not. The paternalism in these places predates the 1950s.

And these are the cheerleading rahrahs who will cheerlead us to an AIDS-free generation. How stupid can a slogan get. Pretty stupid.

In other words…

The requirement to fast before a cholesterol check can be a major pain in the ass.

People who forget to fast may be told to reschedule their appointments. For those who remember, sitting in a doctor’s waiting room with a growling stomach can make for a rough start to the day.

Then, there are people who are not compliant and have no current plans to become compliant.

Now, a large new study shows that cholesterol levels aren’t radically different in people who ate compared to those who fasted before their blood was drawn.

How can this be.

How can the way we have always done something be wrong.

The study, which is published in the Archives of Internal Medicine, suggests that people may not need to fast.

Experts who were not involved in the research called the results an eye-opener.

"This information is actually very, very interesting. It might change how we approach a patient," says Suzanne Steinbaum, DO, a preventive cardiologist at Lenox Hill Hospital in New York City.

Experts in AIDS are experts in procedure. That is all. They question nothing and they do not tolerate being questioned.

I have given up on finding an AIDS clinic that is not a proponent of one size fits all. And you call this medicine. I call this a lawsuit waiting to happen.

Just give me a reason.

For the study, researchers looked at the results of all the cholesterol tests processed at the same lab during a six-month stretch in 2011. Because the lab does all the testing for the entire city of Calgary, Canada, that amounted to test results for more than 200,000 people. Doctors also recorded how long it had been since the patient had last eaten.

When researchers broke down the results by fasting time, they found little change. Overall, total cholesterol and HDL “good” cholesterol varied by less than 2%, depending on when a person had last eaten. Total cholesterol and HDL are important because they are the main measures used to calculate a person’s risk for heart-related events.

LDL or “bad” cholesterol was less than 10% different in people who’d recently eaten compared to those who had been fasting for at least eight hours.

Triglycerides or blood fats, were the most sensitive to food. They varied by no more than 20% between people who had fasted and those who had not.

But everyone must fast (or suffer because they say so) or face the consequences.

They can drop you if they find you noncompliant.

Please, do not write to me about how you are a better person because you are compliant in medical settings.

There are only so many people I can piss on in one day.

"For routine screening, we’re suggesting that a 2% variance probably isn’t going to be significant," says Christopher Naugler, MD, MSc, chief of clinical pathology at the University of Calgary, Canada.

Other experts agree.

"I think we’ve just taken for granted that we should do fasting for lipid testing," says Samia Mora, MD, a preventive cardiologist at Brigham and Women’s Hospital, in Boston.

She says the requirement to fast before a cholesterol test was based on very small studies where researchers fed subjects very high-fat or high-sugar meals.

"Most people aren’t having big fat loads before they get their lipids measured," she says.

Currently, guidelines still recommend that people not eat before a cholesterol test. But Mora says a growing body of evidence suggests that fasting isn’t necessary.

"We’ve had several studies now that have all found the same thing," she says.

Imagine that.

HIV/AIDS clinics always think they know best.

There is little evidence indicating this is even remotely true, and there is a lot of evidence to suggest otherwise.

Fasting is just one example.

Although I have been dealing with eye surgeons, people who know more about eyes than the pompous idiots at the HIV clinic, I had to take their eye test anyway.

I laughed my way through it.

Obamacare will not fix your typical AIDS clinic. There is no excuse for stupidity.

I could cite a thousand examples why AIDS medicine isn’t even medicine.

It’s archeology. But I shall tastefully leave that rant for another time. 



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