Weekly News and Notes From the Duke Global Health Institute
Greetings!
Greetings! Starting today, DGHI Weekly News and Notes is going on its summer schedule. You will receive the next newsletter on June 9. We'll publish twice a month until August 18 when we'll resume the weekly schedule. In the meantime, look for exciting new features and improved navigation on the DGHI website and links to student fieldwork blogs.
As always, we welcome your news stories, calendar items and funding opportunities. Send them to me any time at gseaford@duke.edu
Until next time,
Geelea Seaford and Everyone at DGHI |
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Research Spotlight Optimizing Adherence in Adult Survivors of Childhood Sexual Abuse
reprinted from amfAR In the Lab, May 2009
 By Jeffrey Laurence, M.D. Cocktails of anti-HIV drugs known as HAART have dramatically raised the life expectancy of people with HIV/AIDS. But they can only help if a person knows his or her HIV status, has affordable access to appropriate medications under the care of a knowledgeable physician, and faithfully takes those medications as prescribed. Many federal and local programs address the first two issues, but the problem of HIV medication adherence is just as complex, if not more so.
amfAR fellow (and DGHI Faculty Member) Dr. Christina Meade, working initially at Harvard Medical School and now at the Global Health Institute at Duke University, explored whether childhood sexual abuse interferes with treatment utilization.
One-third to one-half of all HIV-positive adults in the U.S. are survivors of child sexual abuse, according to estimates. Writing in the April issue of AIDS Patient Care and STDs, Dr. Meade and colleagues at Yale and Duke investigated HAART utilization, mental health, substance abuse, and other psychosocial factors among a group of HIV-positive men and women with a history of such abuse who were participating in a coping intervention trial in New York City.
Childhood sexual abuse is known to be closely tied to psychological trauma, substance abuse, and poor social support, and is also a predictor of poor treatment utilization. However it is unclear how or why such trauma interferes with adherence to medical treatments. Dr. Meade sought to identify relevant factors that might be modified through social and behavioral interventions.
She found that while nearly all study participants-99 percent-had access to medical care, one-quarter were not compliant with their medications. Poor adherence, she discovered, was associated with severity of sexual abuse trauma symptoms, including hopelessness, mistrust, flashbacks, hyperarousal, intrusive images, and having few links to networks of friends or family.
In striking contrast, the presence of either a general psychiatric disorder, depressive symptoms, or perceived stress did not impact HAART use. In other words, the traumatic stresses and interpersonal difficulties classically experienced by survivors of child sexual abuse were much more important predictors of low adherence to HIV treatment, and thus poorer long-term outcomes, than a frank psychiatric diagnosis.
Dr. Meade concluded that better case management utilizing a care team, coupled with mental health treatment for trauma, could be the key to optimizing the medical care of people with HIV/AIDS who have a history of childhood sexual abuse.
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News and Announcements
Duke Committee Removes Mexico from Restricted Regions List; Decision opens way for undergraduate travel to country
 Duke's International Travel Oversight Committee (ITOC) voted unanimously Friday to remove Mexico from the list of Restricted Regions, clearing the way for Duke undergraduates to travel there.
Following the lead of federal health officials and others, Duke placed Mexico on its Restricted Regions list in April, at the height of concerns about the H1N1 flu there. Undergraduates are prohibited from traveling to countries on the Restricted Regions list in university-sponsored programs. The policy also recommends against travel to countries on the list by Duke graduate students, faculty and staff using funding from Duke accounts.
The committee removed Mexico from the list after considering the latest information on the H1N1 influenza outbreak from federal agencies and other public health authorities. The committee concluded the H1N1 flu strain is less severe than previously feared; the number of new cases in Mexico is declining; and the number of new cases in the United States is rising.
After instituting the undergraduate travel ban, campus officials relocated Duke's Study Abroad in Mexico program to Durham, with a focus on the Hispanic community in the region. As a practical measure, they say it is now too late to relocate the program back to Mexico. Of the 19 students who signed up for the Mexico program, five have decided to participate in the Durham project, two have transferred to other Study Abroad programs and the rest are pursuing other summer plans.
The updated policy will allow this summer's DukeEngage in Tucson program to revive its original plans for students to make brief visits into Mexico to pursue service work.
Watch a short Q&A with Mike Merson about the flu epidemics here.
Job Opportunity:
Director of Triangle Global Health Consortium
The Triangle Global Health Consortium is seeking a Director. The Director will be responsible for coordinating and directing a consortium dedicated to promoting collaborative research, integrating scientific programs across institutions, inspiring and mentoring future researchers and teachers, and establishing service projects. View the full job description. * * *
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Funding Opportunities
The NIH National Center on Minority Health and Health Disparities (NCMHD) has designated up to $7 million for Community-Based Participatory Research (CBPR) planning grants to support community participation in health disparities intervention research.
Active Living Research: Investigating Policies and Environments to Support Active Communities Deadline: July 29, 2009
Active Living Research is a national program of the Robert Wood Johnson Foundation (RWJF) that supports research to identify promising policy and environmental strategies for increasing physical activity, decreasing sedentary behaviors and preventing obesity among children and adolescents. This funding opportunity from RWJF for New Connections research or publication grants through the Active Living Research program is for new investigators from historically disadvantaged and underrepresented communities. Two types of grants will be funded under this call for proposals: research grants and publication grants.
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May 23 - 25 » 11th Annual Conference of Association for India's Development USA, Love Auditorium, Duke
June 9 » 5:30-7 pm, Duke Gardens, Global Health in the Gardens: Medical Student/ Faculty Mixer sponsored by Global Health Interest Group
June 11 » 7 pm Durham Arts Council,120 Morris St., Durham Not Yet Rain - A Film Exploring Abortion in Ethiopia
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