Myron S. Cohen

Bio: Myron S. Cohen is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Population & Acquired immunodeficiency syndrome (AIDS). The author has an hindex of 103, co-authored 549 publications receiving 46021 citations. Previous affiliations of Myron S. Cohen include University of Massachusetts Medical School & Scripps Health.

HIV and sexual behavior among young people: the South African paradox.

Abstract: South Africa is one of the countries hardest hit by the HIV and it is estimated that there are more people living with HIV/AIDS in South Africa than in any other country in the world. We have documented high levels of HIV infection in young people in South Africa: young South African women are infected at 2 to 3 times the rate of young men and by the time a woman reaches age 21 she has a 1 in 3 chance of being HIV infected. Despite declines observed in other countries in sub-Saharan Africa including Uganda and more recently in Kenya and Zimbabwe South Africa has failed to see a significant decline in the HIV epidemic nationally. However it should be noted that there are some indications from the 2006 Antenatal Clinic (ANC) survey that HIV prevalence is at least stabilizing and may be declining in young women aged 15 to 24 years. In this issue of STD Katz and Low-Beer assess the sexual behaviors of young people from numerous sexual behavior surveys conducted in South Africa during the past 10 years including our national youth survey. They compare these behaviors to those of young people in Uganda at similar stages of the epidemic in an attempt to explore the role of sexual behaviors in the South African youth epidemic. Surprisingly the data reviewed show that young people in South Africa reported less sexual activity fewer lifetime sex partners and more condom use during the "stabilization" of the South African epidemic than did Ugandan youth during the decline of the Ugandan epidemic. Likewise we have reported that young people in the United States (where <1 in 1000 youth are infected) report far more "high risk" sexual behaviors than their South African counterparts when examining traditional measures of sexual behavior. The results described are entirely based on self-reported sexual behaviors and are therefore dependent on memory and likely reflect "social desirability" bias. However surveys conducted with different youth samples and by different organizations have been consistent in the levels of behaviors found among South African youth. Although sexual exposure is an essential element for HIV transmission the data suggest that the behaviors of South African youth are not sufficiently different than Ugandan youth (or youth in other parts of the world) to explain the magnitude of the epidemic in the South African population. This issue is truly critical because the results help to shape global HIV prevention strategies that have increasingly been subjected to critical review. If high-risk sexual behavior alone does not explain the South African HIV epidemic then other social and biologic forces must play a critical role. First the epidemiology of the epidemic deserves attention. Because 16% of all South Africans are HIV infected the probability of coming into contact with an HIV-infected sexual partner is high. Sexual encounters traditionally deemed "low risk" lead to the possibility of HIV acquisition. Second the traditional belief that HIV is difficult to acquire through heterosexual intercourse is simply not correct. The efficiency of HIV transmission is dramatically increased by cofactors that raise the genital tract viral burden such as early (acute) and late HIV disease and sexually transmitted infections. The HIV types in Africa (and especially clade C) may be more contagious. South Africans may also be more susceptible to HIV because of genetic factors a low innate barrier to HIV (perhaps related to vaginal flora) pregnancy sexually transmitted infections and lack of male circumcision. Consistent with this idea we reported high probabilities of HIV acquisition among young women in South Africa; approaching close to 100% per partnership. These ideas affect prevention strategies. Greater emphasis must be placed on increasing awareness with regard to the high risk of HIV transmission and chance of having a partner who is HIV infected (1 in 3 in many sub-Saharan African countries). The majority of youth in South Africa-even those found to be HIV-positive-believe that they are at low risk for HIV acquisition. Prevention messages must emphasize the great risk(s) of concurrent sexual relationships an intervention just as important as overall reduction in partner number. Programs should also consider providing information to young women on the increased risk of HIV infection posed by even slightly older male partners. Continuing to emphasize the role of significantly older "sugar daddies" in the spread of HIV confuses the greater risk of mixing with men who are only a few years older and yet have the highest prevalence of infection. There is a political dimension to HIV prevention in South Africa as well. It is widely believed that some of the success in Uganda in controlling HIV (regardless of the precise mechanism) can be ascribed to concomitant HIV prevention from all levels and sectors in the country. The South African government has failed to provide optimal leadership around HIV prevention and care which might partially account for sustained differences in the epidemic(s) reported by Katz and Low-Beer. The HIV pandemic will not simply go away and no single prevention "magic bullet" (e.g. a vaccine) is on the horizon. The magnitude and scope of the problem do not allow us the luxury of simply observing the spread of the virus; we have no option but to work tirelessly to develop better HIV prevention strategies. But development of better strategies requires a complete and total knowledge of "the enemy." Although it is perhaps easy to focus on sexual behavior(s) the actual data nicely summarized by Katz and Low-Beer lead to a far more complex and nuanced picture. Unraveling this puzzle is critical to successful HIV prevention. (full text)

Toward an endgame: finding and engaging people unaware of their HIV-1 infection in treatment and prevention.

Abstract: Epidemic modeling suggests that a major scale-up in HIV treatment could have a dramatic impact on HIV incidence. This has led both researchers and policymakers to set a goal of an “AIDS-Free Generation.” One of the greatest obstacles to achieving this objective is the number of people with undiagnosed HIV infection. Despite recent innovations, new research strategies are needed to identify, engage, and successfully treat people who are unaware of their infection.

Public Health Education in India and China:History, Opportunities, and Challenges

Abstract: Public health education in China and India has a long history that has been both deeply responsive to the unique needs and medical traditions of each country, and sensitive to global influences. The history of public health education in China reaches back several centuries, with substantial input from American and European organizations during the Republican Era, 1911–1949. In India, centuries-old health care traditions were influenced during the colonial period by the British Empire prior to independence in 1947. Political upheaval in both countries during the 1940s further impacted the public health systems as well as public health education. The primary goal of this review is to outline public health education in India and Mainland China, with a focus on describing the historical systems and structures that have promoted the development of formalized public health education. We examine current challenges, and analyze opportunities for improvement. Health reforms in China and India need to consider new and modern models for public health education, perhaps in independent faculties of public health, to reinvigorate public health education and strengthen the position of public health in addressing the health challenges of the 21st century.

Prevention of HIV-1 Infection with Early Antiretroviral Therapy

Abstract: Background Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. Methods In nine countries, we...

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Abstract: Lionel A. Mandell, Richard G. Wunderink, Antonio Anzueto, John G. Bartlett, G. Douglas Campbell, Nathan C. Dean, Scott F. Dowell, Thomas M. File, Jr. Daniel M. Musher, Michael S. Niederman, Antonio Torres, and Cynthia G. Whitney McMaster University Medical School, Hamilton, Ontario, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, and Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; Division of Pulmonary and Critical Care Medicine, LDS Hospital, and University of Utah, Salt Lake City, Utah; Centers for Disease Control and Prevention, Atlanta, Georgia; Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio; State University of New York at Stony Brook, Stony Brook, and Department of Medicine, Winthrop University Hospital, Mineola, New York; and Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clinic del Torax, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain.

Role of free radicals and catalytic metal ions in human disease: an overview.

Abstract: Publisher Summary This chapter discusses the role of free radicals and catalytic metal ions in human disease. The importance of transition metal ions in mediating oxidant damage naturally leads to the question as to what forms of such ions might be available to catalyze radical reactions in vivo . The chapter discusses the metabolism of transition metals, such as iron and copper. It also discusses the chelation therapy that is an approach to site-specific antioxidant protection. The detection and measurement of lipid peroxidation is the evidence most frequently cited to support the involvement of free radical reactions in toxicology and in human disease. A wide range of techniques is available to measure the rate of this process, but none is applicable to all circumstances. The two most popular are the measurement of diene conjugation and the thiobarbituric acid (TBA) test, but they are both subject to pitfalls, especially when applied to human samples. The chapter also discusses the essential principles of the peroxidation process. When discussing lipid peroxidation, it is essential to use clear terminology for the sequence of events involved; an imprecise use of terms such as initiation has caused considerable confusion in the literature. In a completely peroxide-free lipid system, first chain initiation of a peroxidation sequence in a membrane or polyunsaturated fatty acid refers to the attack of any species that has sufficient reactivity to abstract a hydrogen atom from a methylene group.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

Abstract: 1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Sexually transmitted diseases treatment guidelines.

Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.