You’ve got the flu or want to avoid getting it:

Here’s what you do – HIV Positive people, especially, need to take extra precautions

When U.S. Vice President Joe Biden said that people should avoid subways and other confined spaces because of the swine flu sweeping the nation, the country recorded its first swine flu death – a toddler in Houston, TX – which led to the decision by state and federal health officials to ratchet up their alert level, and which prompted the Word Health Organization (WHO) to up their grade to Phase 5, a status just below declaring a full pandemic, has come as a jolt to everyone. This drastic and seemingly draconian action by national and internationally health related agencies should come as no surprise, since many of them were severely criticized for their lack of preparedness and response to two major flu outbreaks in recent memory, Sars and the Avian Flu, both which emphasized the global nature of the spread of any infection and threatened to overwhelm countries’ health infrastructure, revealing how unprepared many were.

But while there are numerous suggestions on what to do, to protect against contracting or passing the virus on, many of those tips in the local media have not included enough detail for adequate protection.

A person could be infected and spread the flu up to a full day before he or she feels symptoms and up to seven days after they are sick.

Many HIV positive people, especially, need to take extra precautions, as someone once said, the general perception is that most people are afraid of contracting HIV from an HIV-positive person, but really, it is the HIV positive person, who with a compromised immune system, is most vulnerable and at risk from the general population. Consequently, a HIV-positive person needs to observe the rules for the general population and take additional precautions, such as staying away from crowded or heavily populated areas, like night clubs, sex clubs, parties, public transport conveyances, and should contact their doctor to enquire as to the best medication. Those with the HIV virus should be aware of the signs of an illness coming on, the beginning scratchiness or dryness in the throat, the feeling of lethargy or extreme tiredness, or headaches. HIV positive people should make it their duty to pay attention to their bodies, as with a compromised immune system, assumption should not be entertained and nothing taken for granted.

According to William Shay, M.D., a Chelsea-based general internist who specializes in HIV treatment, an HIV-positive person who has a fever of 101-degrees or higher and has a cough with any other symptoms, should see their doctor.

So, while waiting for a vaccine, which the U.S. Centers for Disease Control and Prevention (CDC) optimistically suggest could take six months to be produced and some reports state that even if there is a vaccine there won’t be enough for everyone, and it would be ineffective, because this flu strain is likely to have mutated or people would develop a resistance to it.  These five critical tips, widely agreed upon by the WHO, the CDC, and other health experts, are what a person could do to avoid getting sick and, importantly, avoid infecting others.

• Washing hands:
  The best thing anyone could do right now to avoid swine flu, experts say, is to wash their hands. It sounds like a stupidly simple response to an overwhelming situation, but almost compulsive hand-washing helps prevent the spread of this respiratory infection. It’s the droplets from coughing and sneezing, which coat surfaces and which people touch that spread the infection. The virus gets on hands, and then everything touched is infected.

  While washing the hands seems simple, how it is done is important:

• Use warm or hot water if you can;
• Lather up with soap and rub not just your fingers and palms but also under the fingernails, around the wrists and between the fingers for as long as it takes to sing the “Happy Birthday” song twice; and
• Rinse well.

While it is important to wash hands thoroughly with soap and water before eating and after using the bathroom, for whatever the bodily function, it is also important after using a tissue or covering the mouth as with a sneeze or a cough, sick or not, or as with seasonal allergies, which could present similar symptoms to the flu.

A person should think of how often he or she would wash their hands if they worked in a hospital’s emergency or operating room; hands should be washed that often and that thoroughly.

2. Covering the mouth when coughing or sneezing.

“The way you spread influenza is with droplets that come out of your mouth or nose,” said Dr. George T. DiFerdinando Jr., a physician, epidemiologist and professor at the University of Medicine and Dentistry of New Jersey-School of Public Health. He recommends the classic shoulder or crook-of-the elbow sneeze.

“It’s a whole lot better for those [droplets] to be on blouse or sleeve than spraying onto surfaces or other people,” he said, after which, wash the hands.

While wearing surgical face masks are an option for containing the droplets, they don’t keep a person’s hands clean and there is no consensus in the healthcare community on whether or not face masks are advisable for everyday use.

“If the swine flu virus is spreading throughout the community, it would not surprise me if people use face masks to good effect,” DiFerdinando said.

1. Staying home.

Someone who is sick should stay home, DiFerdinando said. Try to muster the energy to wash the hands after every tissue use so as not to avoid re-infecting everything touched afterward. This helps to reduce the presence of the virus in the immediate environment, with recovery, and protects household and loved ones.

1. Not touching the face.

While very few people succeed at restraint and control, more people are urged to try to keep their hands away from their face and areas where there are mucous membranes, such as around or close to the eyes, inside the nostrils and mouth, which are direct routes to the bloodstream and which allows the virus to bypass the protective barrier of the skin.

“That’s just human nature,” DiFerdinando said. “It’s not something to moan about. In this circumstance you’ve got a very strong motivator to keep your hands clean. If you keep washing your hands, you decrease the dose [of flu virus] that you get when you put your hands in your mouth.”

5. Avoid sick people

It’s a good idea to avoid close contact with other people who are sick, DiFerdinando said, adding: “We won’t even see air kisses.” The flu virus tends not to float in the air. Instead, once dispersed, the liquid droplets tend to settle on objects that doctors call fomites – things that people touch that can pick up a virus. Examples include coins, hand rails, door knobs, common household and office objects. Smooth objects transmit microbes more than rough or porous ones. So, for instance, coins would allow one to pick up more virus than paper money.

Not surprising to Dr. James Koopman, professor of epidemiology at the University of Michigan’s School of Public Health, is the number of cases concentrated in one geographic area.

“There is a lot of direct contact and touching of common things when children are in school,” Koopman said. “They are in general more susceptible to these things.”

Koopman and his colleagues are trying to pin down the relative importance of different routes of transmission, whether by the air or by hand touching, fomite.

“Our work is indicating there can be big differences between something like airborne virus – you may take a small amount in with every breath, but when you get a big goober of someone’s cough on your finger and it touches your mucosal membrane – your eye, nose, mouth or somewhere where it can gain access – that could be a much higher dose,” Koopman said.

It takes time for a new virus – and the swine flu outbreak is based on a new strain of an H1N1 virus – to adapt to a human’s immune system and survive there long enough to find another organism to infect, Koopman said.

At first, the immune system can handle small doses of virus, such as with airborne transmission, he said. In that case, “maybe the hand-fomite touching spread would be more important than the airborne,” he said.

Maybe later, the virus evolves to survive and transmit successfully in smaller doses, or via different routes, he said.

“I personally think this virus has been circulating a bit longer than is recognized at this time,” Koopman said.

The CDC photograph, below, captured a sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth. The flu virus can spread in this manner and survive long enough on a doorknob or countertop to infect another person. It dramatically illustrates the reason you should cover your mouth when sneezing or coughing to protect others from germ exposure, health officials say. It’s also why you need to wash your hands a lot, on the assumptions others don’t always cover their sneezes.

Photo of man's sneeze - droplet plume

LGBT and Homeless in NYC: What to do if LGBT and Homeless?

(New York, NY) Sitting opposite me in a subway car as the A train rolled through a tunnel in Brooklyn was a light skinned Black young man, seemingly between 17 or 19-year-old, dressed in New York’s black uniform: black sweater, black jacket, and black cargo pants, with black boots.

It was Thanksgiving night about 11:30 p.m., and the temperature outside was close to freezing. Feeling satisfied and thinking of sleep, I was returning home from celebrating the holiday with my family when I was roused from my near sleeping state by the sound of conversation cutting into the hypnotic clickity-clack humming of the subway’s wheels on the rails. The young man who was seated in a side facing seat had asked another young man in a forward facing seat, for a dollar. The young man looked over in my direction asking me if I spoke Spanish. Replying that I did, he asked me again what was it that the young man in black was asking, I enquired and translating from Spanish to English and English to Spanish, that the other young man didn’t have any money. At which point the young man in black proceeded to shared with me his night’s misfortune. He said he had recently moved to New York from Philadelphia to take a job which didn’t work out, and had been asked to leave the place where he was staying. With no family and no place to go, he was trying to understand and to stitch something together for himself, if only for that night.

Listening to the young man and remembering I had recently written two articles about homeless LGBT youth in NYC, I asked myself, where would someone who is young, LGBT, and who is suddenly rendered homeless, go for shelter? Who to call? I was stumped, so I suggested the young man in black call the city’s 311-service to see what help or direction he would receive. It dawned on me to ask the heads of non-profit agencies and others, what they would say should they encounter someone suddenly rendered homeless.

According to Charles Jones, LCSW-R, there is an organization in the Bronx that is the Bronx’s “answer” to the Center in Manhattan – The Bronx Community Pride Center.  It is located on 149th Street, one block east of Third Avenue, where he could be referred for services. There is Safe Horizon’s Streetworks Program, currently housed at 165 West 131st Street, 3rd Floor, New York, NY 10027.  The Streetworks program works with homeless and marginally homeless youths up to 24-years old.  However, while Streetworks is not LGBT-focused, they are aware of the issues facing the population.

Jones suggests that while Covenant House may be a first recommendation, it might be less likely a place to which he would refer someone who is new to New York.  He stated that over the years, Covenant House has become somewhat notorious for breeding predators within their gates, streetwise kids who prey on NYC neophytes without mercy.  While he admits that, things may have changed at Covenant House, he doubts it very seriously. Another organization he suggests is the Salvation Army, and says that for inasmuch as they offer programs and services for youths, mainly in the foster care system which, in turn means this kid may need to enter the ACS system to access care, he would not entrust anyone to their care.  Their houses seem to be filled with the same types as Covenant House: drug dealers, nascent pimps, prostitutes, and other such characters.

“They all need help, but I am not confident the line staff of either of the two agencies are equipped to handle this fragile population, let alone that segment of LGBT youth with their additional dynamics,” says Jones.

Additionally, Jones raises questions into the young man’s background, family relationships back in Philadelphia which would be more applicable for an evaluation and acknowledges that he would not get “whole” answers initially, as the young man is likely to and has every reason to be suspect of anyone he meets, he may be “running game” himself.

Steve Welch, LCSW-R, with Harlem United, suggests the young man contact the Ali Forney Center (AFC) or the LGBT Community Center on West 13^th Street. But Colleen Jackson, executive director of the West End Intergenerational Residence, recommends contacting the Department of Homeless Services (DHS) at their Website, http://www.nyc.gov/html/dhs/html/homeless/homeless_now.shtml, which has instructions and locations of drop-in and intake centers for homeless individuals.

“We are the only crisis facility equipped to handle this population of homeless LGBT Youth in NYC. We are the first and last stop for the youth. When they go to Ali Forney Center and find that they have a waiting list for a bed, AFC sends them to us. If they are on the street and ask another youth, they send them to us. If they show up here anytime of the night and have never been here before, even if we are overfull, we will give them a place to stay,” says Lucky Michaels, director, Metropolitan Community Church, New York (MCCNY) homeless shelter program, Sylvia’s Place.

Michaels said that of the available facilities, typically many of the city’s homeless LGBT youth begin at Sylvia’s Place or wait on the street until a bed becomes available at AFC or a cot opens up at Trinity, where if they get into those places, they usually either get discharged or kicked out and come to us next, or if they make it through AFC and can get a job or get into school and a bed opens at Green Chimneys, based in Brewster, NY with locations in the five boroughs, then they move on to a transitional living program. But most of these young people can’t do this and so they hope they can get on some sort of financial assistance and get an apartment, but usually many return to Sylvia’s Place more than once.

All of the organizations are doing great work, says Michaels, and doing the best they can to serve this population. On any given night there are 3,500 to 5,000 homeless youth on the streets of NYC, where 40 -50 percent identify as LGBT, and there are only 75 beds for LGBT youth including Sylvia’s Place, AFC, Green Chimneys, and Trinity; for all of the young people to share and which all the organizations in a juggling act to provide for as many as they can and to work with each other to better serve the youth.

Many of the agencies, Michaels says, have programs with psychological and medical components to them, providing care for many of the young people regardless of documentation or status, so undocumented immigrants and those who are HIV positive, are represented, receive care and case management. Case workers, he adds, at the agencies work to get the homeless young people appropriate health care and legal services, including documents to begin legalization, or just to get their identification, change identification if needed as with the transgender clients and work on name and gender changes with all the proper government agencies.

“We are doing the best we can to serve the high-risk, crisis population that otherwise would be waiting for space at the other facilities, but believe me we work together as soon as we can get one youth on to the next place,” says Michaels, admitting that Sylvia’s Place is not as nice as AFC or Green Chimneys.

Sylvia’s Place was featured in an Apr 17, 2008 NY Times article, which mentioned that it is open to people from ages 16 to 23 and has expanded to accommodate 26 clients at a time, up from six when it opened. The original emergency shelter now has several satellite programs: Sylvia’s East, an intermediate shelter in the East Village for up to six youths under 21 who are enrolled in school or working, and Sylvia’s Sugar Hill, a six-bed shelter at the Church of the Intercession, an Episcopalian parish on West 155th Street, that is intended to help “chronically homeless” youth become independent, and the Marsha P. Johnson Center, a drop-in crisis center for homeless youth, at 151 West 127th Street, between Lenox Avenue and Adam Clayton Powell Boulevard in Harlem.

Resources for Homeless LGBT Youth:

Safe Horizon Street Works Program for Homeless youth:

• Streetwork Harlem Drop-In Center
  165 W. 131st. St., 2nd Fl.
  New York, NY 10027
  Phone: 212-695-2220

Hours of Operation: Monday through Sunday (9:00 am – 9:00 pm)
Transportation services: Monday Through Sunday (1:00 pm – 9:00 pm)
Linkages are conducted each day

• Lower East Side Drop-In Center
  33 Essex St
  New York, NY 10002
  Phone: 646-602-6404

Hours of Operation: Monday, Tuesday, Thursday, Friday (2:00PM-7:00PM)
Evening groups are also offered.
Intakes are conducted each day.
Syringe exchange available each day.

• Residential Programs
  Streetwork has a Residential Program with a total of 24 beds for short-term emergency housing. Referrals to the Residential Programs can be made by calling the Streetwork Drop-In Centers.

Ali Forney Center (Manhattan/Brooklyn)
Phone: 212-206-0574
Contact: Eric Hartman (Program Director Day Center)

Green Chimneys (Runaway & Homeless Youth Programs) (Manhattan)
Phone: 212-491-5911
Contact: Miguel Caraballo

Sylvia’s Place (Manhattan)
Phone: 212- 629-7440 Ext. 226

446 West 36^th Street

Contact: Kate Barnhardt

Sylvia’s Place has an emergency night shelter for self identified Gay, Lesbian, Bi-sexual, trans-gendered, trans-sexual and questioning youth from 16 to 23 years of age. Its primary focus is to provide a safe space, a good meal, bathroom facilities and toiletries, a cot for the night and breakfast in the morning. Care Workers provide a listening ear, affirmation, and a friendly voice of encouragement. It is open 365 days/year from 8pm-8am. Curfew is at 12am, and provides hot meals (dinner and breakfast); clothing; showers; case management; physical and mental health medical services; and court advocacy. Sylvia’s Place accepts clients on a walk-in basis after 6pm daily as long as there is room. Call before coming to make sure there is space available (212) 629-7440 Ext. 226. No paperwork is necessary. Drop-in services at Sylvia’s Place are 6-10:30pm, Monday/Tuesday and Thursday/Friday.

The Door (Manhattan)
Phone: 212-941-9090 x3331; TDD/TYY: 1-800-662-1220

Contact: Miriam Hernandez

Department of Homeless Services (DHS):

In partnership with non-profit organizations, DHS sponsors nine Drop-In Centers located throughout the City. Drop-Ins provide hot meals, showers, laundry facilities, clothing, medical care, recreational space, employment referrals, and other social services. Staff can also help you find a safe and secure place to sleep. All Drop-Ins operate 24/7 – so please come by.

The DHS operates the most comprehensive shelter services system for single adults in the world – with programs to assist individuals in addressing and overcoming their homelessness to securing and sustaining permanent housing. To enter a shelter, you must first visit an intake center. As noted below, there is one intake center for men and three for women.

Dial 311 to contact any Drop-In Center, receive directions, or other information. Drop-In Centers are located at:

MANHATTAN
Mainchance
120 East 32nd Street
NY, NY 10017
(Subway: 6 to 33rd St.)

John Heuss House
42 Beaver Street
NY, NY 10004
(Subway: J/M/Z to Broad St.,

4/5 to Bowling Green, N/R to Whitehall St.)

Olivieri Center for Women
257 West 30th Street
NY, NY 10001
(Subway: A/C/E to 34th St.)

The Open Door
402 West 41st Street
NY, NY 10036
(Subway: 1/2/3/A/C/E to Port Authority)

Peter’s Place
123 West 23rd Street
NY, NY 10011
(Subway: 1 to 23rd St.)

BRONX
The Living Room
890 Garrison Avenue
Bronx, NY 10011
(Subway: 6 to Hunt’s Point)

BROOKLYN
The Gathering Place
2402 Atlantic Avenue
Brooklyn, NY 11233
(Subway: A to Broadway Junction)

STATEN ISLAND
Project Hospitality Drop-In Center
25 Central Avenue
Staten Island, NY 10036
(Subway: No subway service)

Dial 311 to receive directions and other information on the following intake centers:

30th Street Intake (Men)
400-430 East 30th Street (near 1st Avenue)
NY, NY 10016
(Subway: 6 to 28th St.)

Brooklyn Women’s Shelter (Women)
116 Williams Avenue,

Brooklyn, NY 11217
(Subway: C to Liberty Ave.)

Franklin Shelter (Women)
1122 Franklin Avenue
Bronx, NY 10456
(Subway: 2 to 149th St., then #55 bus to 166th St and 3rd Ave.)

Innovative prostate cancer technology

by Antoine Craigwell

HIFU, high intensity focused ultrasound, is prostate cancer technology used to eliminate cancerous cells in the prostate, with comparably lesser side effects, cost and a quicker return to normalcy than other commonly used treatment methods currently available in the U.S.
The American Cancer Society (ACS) 2007 Cancer Facts and Figures says that while incidence rates of prostate cancer are significantly higher in Blacks than in white men and although prostate cancer death rates have been declining nationwide since the early 1990s, mortality among African-Americans still remains more than twice as high as those of white men.
The ACS 2007 Surveillance Research estimates 26,730 new prostate cancer cases in African-Americans in the New York tri-state region and 8.5 percent or 2,270 deaths. The ACS says that though common among men in North America and southern Europe, statistics show that Afro-Caribbean men have the highest prostate cancer incidence rates in the world and advises men with a strong family history to begin screening for it as early as age 45.
As a treatment method, HIFU goes back to the early 1940s through to the 60s when it was used extensively for the treatment of various cancers in women. It is an alternative to already established treatment methods, including: cryotherapy, freezing cancerous cells; radical prostatectomy, prostate removal; external beam radiation, radiation through healthy tissue for six to eight weeks; and internal radiation seeds, permanent implantation of 80 to 100 radioactive seeds in the prostate — all of which have periods of hospitalization, extended recovery, varying percentages of impotence and incontinence (insufficient bladder control), pain and other lower abdominal abnormalities. While avoiding nerves and blood vessels, HIFU focuses a large pulse of high-energy ultrasonic waves on a single location, raising the temperature of cancerous cells to 100 degrees Celsius, and causing the lipids of cell membranes to melt and the proteins in them to denature.
John Rewcastle, Ph.D., of the Radiology Department at the University of Calgary, Alberta, Canada, in a comparative review paper says this treatment method is minimally invasive, without any incision— a probe into the rectum— the recovery is less than one week, the impotency rate is 28 percent, and the incontinence rate is lower that other methods. Other forms of prostate cancer treatment leave radiation failures and prostatectomy residuals — rectal injury, blood loss, and cancer cells. After receiving the HIFU treatment, lasting up to three hours, patients are able to return to their regular lives almost immediately, with only two follow-up treatments for about two hours each.
While acknowledging its effectiveness, Brian Stone, M.D., assistant professor of urology at Columbia University Medical Center, cautions, “It is experimental because there are still questions about it.”
Though accepted and practiced in Europe, Canada, South Korea, Australia, the Dominican Republic, Mexico, and Brazil, HIFU is in the U.S. Food and Drug Administration Phase III clinical trials, which examines equipment safety and efficacy, and has not been approved for use in the U.S. Current insurance payouts for approved prostatectomy or radiation procedures range between $100,000 to $150,000; a HIFU treatment costs $25,000 when there is a low prostate specific antigen (PSA), the level of antigen found in the blood, and the tumor is localized in the prostate, and $30,000 if the tumor has traveled and has compromised the seminal vesicles, and the PSA is higher than seven. It is not a treatment option for those people whose cancer has metastasized beyond the prostate.
But, Abraham Woods, III, M.D., one of three African-American urological specialists in the country who work with HIFU, says an alternative prostate treatment is predicated on preventing the certain death men face with undiagnosed prostate problems.
“For those who have had conventional forms of treatment and are living lives with impotence and wearing pads against incontinence, the result is psychological damage to their masculinity,” he says