Conversations with CEI

Cultural humility in healthcare, especially for those involved in kink, requires going beyond basic competence. Clinicians must provide respectful care, acknowledging patients' diverse backgrounds and beliefs about kink as part of their identity. This necessitates self-reflection, ongoing learning, and awareness of the doctor-patient power dynamic. Healthcare professionals still hold unfounded biases, highlighting the need for further education and combating the stigma surrounding healthy expressions of sexuality. Related Content: https://ceitraining.org/

In this episode, Dr. Marguerite Urban and Dr. Daniela DiMarco pick up from the November 2023 episode of Conversations with CEI, where they talked about Doxy-PEP for the prevention of sexually transmitted infections (STIs) covering updates on doxy-PEP since the last episode, and delving deeper into some unique aspects. Drs. Urban and DiMarco are infectious disease faculty members at the University of Rochester, specializing in sexual health care. They were part of the team who authored the recently released New York State (NYS) Department of Health (DOH) AIDS Institute’s guidelines regarding Doxy-PEP. This episode is a “part two” of Doxy-PEP. Drs. Urban and DiMarco review the results of a recently published trial from Kenya, and discuss common questions related to Doxy-PEP. Related Content: https://www.nejm.org/doi/full/10.1056/NEJMoa2304007?query=featured_homehttps://www.hivguidelines.org/guideline/sti-doxy-pep/?mycollection=sexual-healthhttps://www.cdc.gov/nchhstp/newsroom/2022/Doxy-PEP-clinical-data-presented-at-2022-AIDS-Conference.htmlhttps://ceitraining.org/

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. It is also a movement for social justice build on a belief in, and respect for, the rights of people who use drugs. With its introduction as a U.S. Federal Drug Policy Priority in 2022, harm reduction has been in the news a lot lately. This episode will build on the momentum by discussing action steps that clinicians can take to address stigma and promote compassionate, non-judgmental interactions with people who use drugs. Dr. Linda Wang will use a clinical vignette to describe the impact of stigma on access to and engagement in healthcare services. She will continue by outlining commonly-used stigmatizing language associated with drug use, and providing practical replacements that promote engagement and trust. Related Content: https://harmreduction.org/https://oasas.ny.gov/harm-reductionhttps://doi.org/10.1186/s12954-017-0196-4https://doi.org/10.1186/s13011-020-00288-0https://doi.org/10.1002%2Fjclp.20669https://doi.org/10.1016/j.lana.2022.100271https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-main-highlights.pdfhttps://doi.org/10.1016/j.drugpo.2009.10.010https://ceitraining.org/

RSV vaccine for adults has recently become available and can protect against severe disease or death from one of the main causes of upper respiratory infections. HIV patients are asking if they should receive the vaccine. This question is discussed by Dr. Steven Fine. Related Content: https://doi.org/10.1016/j.jinf.2017.06.007https://www.hivguidelines.org/guideline/hiv-immunizations/?mycollection=hiv-carehttps://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html#:~:text=CDC%20recommends%20a%20single%20dose,most%20of%20the%20United%20Stateshttps://www.cdc.gov/rsv/high-risk/older-adults.htmlhttps://www.cdc.gov/vaccines/schedules/hcp/imz/adult.htmlhttps://ceitraining.org/

Compared with the general population, transgender and gender diverse people are more likely to experience poor health outcomes, such as chronic health conditions, HIV, substance use, and mental illness. We know these disparities are due structural factors, such as political and economic policies, and interpersonal factors, such as discrimination, stigma, and violence. Transgender people are also more likely to encounter barriers to accessing health insurance and health care. When transgender people do access health care, nearly half report being mistreated by medical providers. In this episode, Dr. Antonio E. Urbina, Medical Director of CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Dr. Joshua D. Safer, Executive Director of Mount Sinai’s Center for Transgender Medicine (CTMS) and Professor at the Icahn School of Medicine. While gender wellness clinics like CTMS are so important, there is a need to expand the health care workforce of providers treating transgender patients. For example, transgender patients report barriers to accessing inclusive primary care providers and specialists who can treat them outside of their gender-affirming interventions. Drs. Urbina and Safer unpack common misconceptions and discuss how providers can improve access to inclusive care for transgender and gender diverse patients. Related Content: https://www.mountsinai.org/locations/center-transgender-medicine-surgeryhttps://www.wpath.org/https://ceitraining.org/

In this episode, Dr. Marguerite Urban and Dr. Daniela DiMarco discuss Doxy-PEP, a new tool for the prevention of bacterial STIs. Drs. Urban and DiMarco are infectious disease faculty members at the University of Rochester, specializing in sexual health care. They were part of the team who authored the recently released New York State (NYS) Department of Health (DOH) AIDS Institute’s guidelines regarding Doxy-PEP. This episode is an introduction to the use of doxycycline as post exposure prophylaxis for bacterial STIs. The hosts will briefly review results from recent clinical trials as well as discuss concerns about risks and side effects. They will also present how guidelines for implementation (who, when and how) of Doxy-PEP have varied thus far and review the current recommendations of the NYS DOH guidelines. Related Content: Quick Survey: https://93dsff4pt87.typeform.com/to/ECrf0DTYhttps://www.hivguidelines.org/guideline/sti-doxy-pep/?mycollection=sexual-healthhttps://www.nejm.org/doi/full/10.1056/NEJMoa2211934https://www.health.ny.gov/statistics/diseases/communicable/std/docs/sti_surveillance_report_2021.pdfhttps://www.cdc.gov/std/statistics/2021/default.htmhttps://ceitraining.org/

The United States is in the midst of an overdose crisis that’s been exacerbated by the COVID-19 pandemic and increased toxicity of the drug supply, largely a result of adulterants like fentanyl and other synthetic opioids. In 2021, the number of deaths in New York State alone surged to more than 5,800 individuals – an average of nearly 16 people every day. Scaling up harm reduction interventions has helped avert thousands of overdose-related deaths, but the persistent predominance of fentanyl continues to fuel mortality. To complement existing interventions, colleagues in Canada and elsewhere around the globe have pointed to providing “safer supply,” or an alternative to the unregulated, toxic drug supply as a potential solution to prevent overdose-related deaths and address the needs of people for whom current treatment models do not work or are not a good fit. Although not intended as a standalone treatment for substance use disorder, this novel approach is showing promise in addressing the growing morbidity and mortality surrounding the current drug supply. This episode will introduce safer supply as a harm reduction approach to support and engage people who use drugs. Disclaimer: Safer supply is not legal or authorized in the United States under current FDA and DEA regulations. Related Content: https://oasas.ny.gov/harm-reductionhttps://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.htmlhttps://www.bccsu.ca/opioid-use-disorder/https://harmreduction.org/https://profiles.mountsinai.org/eric-kutscherhttps://ceitraining.org/

HIV patients are known to have up to a two-fold increase in heart-related events, compared with the general population. Could treatment with statins reduce this risk? Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester, reviews the recently published results of the REPRIEVE trial. The big picture is a 35% reduction in heart-related events. Dr. Fine digs into the details and statistics of the trial, and the encouraging results of statin treatment, even in those deemed to be at lower risk. Related Content: The Reprieve TrialThe Results in NE Journal of Medicinehttps://ceitraining.org/

The clinical innovation of antiretroviral treatment for HIV is a major public health victory that has transformed the shape of the epidemic. Healthcare professionals must remain committed to reaching every person with HIV, which means not only developing new clinical technologies, but also the strategies to implement them equitably. Long-acting injectable antiretroviral treatment (LAI-ART) is the newest clinical tool for ending the epidemic. How can we make sure that it reaches the people living with HIV who are not virally suppressed? In today’s episode, I speak with Dr. Monica Gandhi about her research increasing access to LAI-ART among vulnerable populations. Related Content: https://www.acpjournals.org/doi/10.7326/M23-0788https://profiles.ucsf.edu/monica.gandhihttps://www.hivguidelines.org/antiretroviral-therapy/art-injectable/https://ceitraining.org/

In this episode, Dr. Marguerite Urban chats with Drs. Rachel Hart-Malloy and Wilson Miranda from the New York State Department of Health AIDS Institute Office of Sexual Health and Epidemiology (OSHE) to discuss how clinicians and the Department of Health can collaborate to tackle the significant increases in cases of syphilis and congenital syphilis reported in New York State. What is the Office of Sexual Health and Epidemiology? Are we bending the curve in reducing syphilis? What are the trends in syphilis rates? What is the Department of Health and the Clinical Education Initiative doing to help reduce and prevent syphilis and congenital syphilis? Listen to this new episode to find out and learn more about what you can do to help! Related Content: https://www.health.ny.gov/diseases/aids/general/about/sexual_health_epi.htmhttps://www.health.ny.gov/statistics/diseases/communicable/std/docs/sti_surveillance_report_2021.pdfhttps://ceitraining.org/

Hepatitis C virus (HCV) infection is a major public health problem responsible for substantial morbidity, including cirrhosis and liver cancer, and mortality. In 2021, over 6,500 new cases were reported in New York State, many of which occurred in younger people as a result of injection drug use. Although we have highly effective treatments available for HCV, many people face numerous barriers to accessing them. With the ongoing opioid epidemic fueling new cases, innovative ways of reaching people who inject drugs to ensure they have access to treatment are more essential than ever. Furthermore, people who use drugs and substance use disorder treatment programs were identified in the New York State HCV Elimination Plan as priority populations and settings to focus HCV elimination efforts. Opioid Treatment Programs, or OTPs for short, are uniquely poised to engage people who inject drugs and integrate HCV treatment into their services and help expand access to those most in need. This episode, featuring Dr. Sara Lorenz Taki from New York City’s Greenwich House, will discuss evidence for and best practices to integrate hepatitis C treatment into an OTP setting. Related Content: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hepatitis_c_elimination_plan.pdfhttps://hcvdashboardny.org/https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/providers/index.htmhttps://www.hcvguidelines.org/https://doi.org/10.1002/cld.921https://empireliverfoundation.org/wp-content/uploads/2020/10/Building-Capacity-for-Hepatitis-C-Treatment-at-Opiod-Treatment-Programs-On-site-and-via-Telemedicine-in-New-York_slides.pdfhttps://attcnetwork.org/sites/default/files/2020-07/Guide%20to%20Integrating%20HCV%20Services%20into%20Opioid%20Treatment%20-%20July%2024-1.pdfhttps://www.greenwichhouse.org/https://ceitraining.org/

In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center explains the pros and cons behind the newly approved Lenacapavir (Sunlenca) injectable for HIV. Dr. Fine receives a lot of questions about the medication in his practice. Many patients have heard good things about the new treatment for HIV that is given as a subcutaneous injection once every 6 months. Dr. Fine discusses the current indication in combination with other agents for “treatment-experienced” HIV patients and possible future uses. You’ll hear about Lenacapavir, the data that led to approval, and how it may be used in the future - including possibly for Pre-Exposure Prophylaxis (PrEP). Related Content: The Capella Trial for Lenocapavir CROI 2023FDA Approves New HIV Drug for Adults with Limited Treatment OptionsVisit us at https://ceitraining.org/

One recent study shows that only 4% of trans youth with supportive parents attempted suicide, while 57% with unsupportive parents committed suicide… In the current political landscape, transgender healthcare and rights have been used to stoke political divisiveness, creating confusion and perpetuating misinformation. As healthcare providers, it is important to focus on the facts and how to provide inclusive care and support the health and well-being of the transgender community, especially during these tumultuous times. In this episode, Dr. Tony Urbina, Professor of Medicine from Mt. Sinai Health System and Medical Director of the New York State CEI HIV Primary Care and Prevention Center of Excellence, speaks with Carolyn Wolf-Gould, MD, founder of the Gender Wellness Center in Susquehanna, New York. Dr. Wolf-Gould began practicing transgender medicine in 2007, when her first trans patient begged her to get educated on transgender care so she could provide treatment. She is a member of the World Professional Association for Transgender Health (WPATH), and trains healthcare professionals on how to include transgender health services within a primary care setting. Dr. Wolf-Gould and The Gender Wellness Center clinicians provide a broad range of patient care services- from medical and mental health care to research and legal advocacy. They provide care for all who consider themselves “under the transgender umbrella,” including individuals who identify as transgender, gender-expansive, or non-binary. Related Content: The Gender Wellness CenterArticle about Dr. Wolf-Gould and the Gender Wellness CenterDr. Antonio Urbina LinkedInhttps://ceitraining.org/

In this episode host Melinda Godfrey, a Nurse Practitioner at the University of Rochester, and Program Manager of the Congenital Syphilis Prevention Project, (part of the NYS CEI Sexual Health Center of Excellence) speaks with special guest Dr. Geoffrey Weinberg, Professor of Pediatrics at the University of Rochester School of Medicine and Dentistry. Dr. Weinberg is the Clinical Director of the Pediatric Infectious Diseases and Pediatric HIV Program. He is the co-attending at the Pediatric Primary Immune Deficiency Disorders Clinic at the University of Rochester Golisano Children’s Hospital, and consults with the NYSDOH AIDS Institute. Dr. Weinberg gives us a brief history of syphilis (“The Great Pox”) all the way back to the 1400s. Through the years, medicine began to understand how the disease was transmitted, and in the 1940s, with the advent of penicillin, syphilis was all but eliminated. The disease resurfaced in the 1980s with other STDs and chronic drug use. Again, it was all but eliminated by the year 2000. Alarmingly, in 2021 there were 2700 known cases in newborns, and this has led to today’s discussion about what clinicians can do to help reduce the number of babies born with syphilis today, and preventing transmission in the future. Related Content: CDC - syphilis InformaionClinical Education Initiative; Sexual Health Learning Pathways - Mastering syphilishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/https://ceitraining.org/

In this episode host Lauren Walker, Program Director for the Hep C and Drug User Health Center of Excellence at CEI, speaks with special guests Dr. Sharon Stancliff and NYSDOH’s Lisa Skill about the increasing health threat posed by Xylazine. Dr. Stancliff is Associate Medical Director of Harm Reduction in Healthcare and Medical Director of Harm Reduction in Healthcare, AIDS Institute, NYSDOH. She has been working with people who use drugs since 1990, and currently focuses on opioid overdose prevention. Lisa Skill is a Health Program Coordinator at the NYSDOH AIDS Institute Office of Drug User Health. Xylazine, often called “tranq” or “tranq dope” on the street, is being used to amplify and extend the effects of other drugs such as stimulants, opioids, and other sedatives. The drug was designed for veterinary use in animals as a sedative and muscle relaxant and is not approved for human consumption. Human use of Xylazine was first noted in Puerto Rico in the early 2000s, and has since spread across the U.S. into local drug supplies. In November 2022, the FDA issued a national warning to healthcare professionals to be cautious of the potential for xylazine inclusion in fentanyl, heroin and other illicit drug overdoses. This episode will describe xylazine trends and use over time, and provide clinicians with an understanding of the physiologic effects of xylazine intoxication. Dr. Sharon Stancliff and Lisa Skill will also share their clinical and harm reduction recommendations for xylazine intoxication, overdose and withdrawal. Related Content: NYSDOH Naloxone Availability without a prescriptionSafer Consumption Spaces - End Overdose NY Kariisa M, Patel P, Smith H, Bitting J. Notes from the field: Xylazine detection and involvement in drug overdose deaths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021, 70(37):1300-1302. doi: 10.15585/mmwr.mm7037a4 National Institute of Drug Abuse. Xylazine.United States Department of Justice, Drug Enforcement Administration. Xylazine. November 2022United States Food and Drug Administration. FDA alerts health care professionals of risks to patients exposed to xylazine in illicit drugs. November 2022.https://ceitraining.org/

This podcast is about a long term follow up to the START trial which originally showed that starting antiretroviral therapy even at high CD4 counts (above 500) was better than waiting until CD4 counts drop to

Preventing perinatal HIV transmission is an important strategy for eliminating HIV. Historically, rates of perinatal HIV transmission were 25-40% without interventions, but advances in HIV research, prevention, and treatment have made it possible to reduce that risk to less than 1%. Despite this progress, many myths and misconceptions about HIV and pregnancy remain. In this episode, Dr. Antonio E. Urbina, Medical Director of CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Dr. Andrés Ramírez Zamudio, Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Medicine, Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai. Drs. Urbina and Ramírez Zamudio discuss strategies for preventing perinatal HIV transmission more broadly. As well, they unpack some of the common myths and misconceptions to help destigmatize HIV in pregnancy. Related Content: https://www.thewellproject.org/https://virology.eventsair.com/international-workshop-on-hiv-women-2023/registration/Site/Registerhttps://www.idsog.org/https://www.hivguidelines.org/perinatal-hiv-care/https://ceitraining.org/

Reproductive healthcare is a critical part of healthcare overall. Yet components of this care, including abortion, are becoming more and more inaccessible to certain parts of the population, worsened by the overturning of Roe vs. Wade. The implications of this decision on access to care, marginalization and inequity are already being seen and causing substantial concern within the medical community. In this episode, Dr. Erica Bostick chats with Dr. Rachael Phelps, a nationally recognized family planning expert, about the impact of this decision on New York State clinicians and patients. Dr. Phelps offers her expertise and insights into what encompasses reproductive healthcare, and how clinicians can “take the next step” in offering comprehensive, preventative reproductive health services to patients of all ages. Related Content: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.htmlhttps://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdfhttps://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.htmlhttps://www.cdc.gov/reproductivehealth/contraception/contraception-app.htmlbedsider.orghttps://societyfp.org/https://abortionpillcme.teachtraining.org/https://www.ansirh.org/research/ongoing/turnaway-studyhttps://www.heyjane.co/home-bhttps://www.plancpills.org/https://ceitraining.org/

Hepatitis C is the most commonly reported blood-borne infection in the US, responsible for more deaths than all 60 reportable infectious diseases combined. Once most prevalent among “Baby Boomers” or those born between 1945 and 1965, the current hepatitis C burden disproportionately affects young adults who inject drugs, including women of childbearing age. Because of this epidemiological shift, perinatal transmission – which happens when a pregnant person living with hepatitis C passes it to their baby either within the uterus or during labor – is also on the rise. Approximately 6% of infants born to people with hepatitis C will become infected. Given the increased prevalence of hepatitis C among women of childbearing age, more people with hepatitis C will become pregnant and for many of them, obstetric care will be their primary encounter with the health system. Hepatitis C screening during pregnancy presents an opportunity for early identification as well as dialogue between pregnant people and their clinicians about transmission and risk. In a sense, pregnancy presents an ideal opportunity to diagnose hepatitis C among pregnant people, link them to care and refer them to treatment. Tackling hepatitis C among women, and during pregnancy in particular, is critical to achieving the New York State Hepatitis C Elimination Plan’s goal to eliminate hepatitis C as a public health problem in the state by 2030. Related Content: https://www.hivguidelines.org/hepatitis-care/treatment-with-daa/#tab_4https://www.hivguidelines.org/substance-use/sud-treatment-pregnancy/https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/05/routine-hepatitis-c-virus-screening-in-pregnant-individualshttps://ceitraining.org/

HIV and Hepatitis B share similar routes of transmission. In United States, a large cohort study of patients with HIV showed that over 10 % of men who had sex with men, over 8% of those who injected drugs and over 5% of heterosexual individuals with risk factors tested positive for HBsAg or detectable HBV DNA. Because of the shared transmission routes, there is an increased risk of HIV and HBV co-infection. Despite the advancement of ART, that has a very efficient suppression rate of the HIV and HBV replication, morbidity and mortality rates are still higher in patients with HIV-HBV co-infection. In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center, speaks about the management of Hepatitis B in patients with HIV. Related Content: https://ceitraining.org/courses/https://www.hivguidelines.org/hiv-care/hbv-hiv/#tab_0https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virushiv-coinfectionhttps://www.cdc.gov/hepatitis/populations/hiv.htmhttps://ceitraining.org/