Found the place with potential curement of HIV and AIDS

Frome in Somerset has seen a dramatic fall in emergency hospital admissions since it began a collective project to combat isolation. There are lessons for the rest of the country ‘Frome has a buzz of sociability, a sense of common purpose and a creative, exciting atmosphere that make it feel quite different from many English market towns.’ Photograph: Jim Wileman
It could, if the results stand up, be one of the most dramatic medical breakthroughs of recent decades. It could transform treatment regimes, save lives, and save health services a fortune. Is it a drug? A device? A surgical procedure? No, it’s a newfangled intervention called community. This week the results from a trial in the Somerset town of Frome are published informally, in the magazine Resurgence & Ecologist. (A scientific paper has been submitted to a medical journal and is awaiting peer review). We should be cautious about embracing data before it is published in the academic press, and must always avoid treating correlation as causation. But this shouldn’t stop us feeling a shiver of excitement about the implications, if the figures turn out to be robust and the experiment can be replicated.

Loneliness is harming our society. Your kindness is the best cure

What this provisional data appears to show is that when isolated people who have health problems are supported by community groups and volunteers, the number of emergency admissions to hospital falls spectacularly. While across the whole of Somerset emergency hospital admissions rose by 29% during the three years of the study, in Frome they fell by 17%. Julian Abel, a consultant physician in palliative care and lead author of the draft paper, remarks: “No other interventions on record have reduced emergency admissions across a population.”

Frome is a remarkable place, run by an independent town council famous for its democratic innovation. There’s a buzz of sociability, a sense of common purpose and a creative, exciting atmosphere that make it feel quite different from many English market towns, and for that matter, quite different from the buttoned-down, dreary place I found when I first visited, 30 years ago.

The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.

So, with the help of the NHS group Health Connections Mendip and the town council, her practice set up a directory of agencies and community groups. This let them see where the gaps were, which they then filled with new groups for people with particular conditions. They employed “health connectors” to help people plan their care, and most interestingly trained voluntary “community connectors” to help their patients find the support they needed.

Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.

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This cycle is explained by some fascinating science, summarised in a recent paper in the journal Neuropsychopharmacology. Chemicals called cytokines, which were studied and described in the Oxford research papers, which function as messengers in the immune system and cause inflammation, also change our behaviour, encouraging us to withdraw from general social contact. This, the paper argues, is because sickness, during the more dangerous times in which our ancestral species evolved, made us vulnerable to attack. Inflammation is now believed to contribute to depression. People who are depressed tend to have higher cytokine levels.

But, while separating us from society as a whole, inflammation also causes us to huddle closer to those we love. Which is fine – unless, like far too many people in this age of loneliness, you have no such person. One study suggests that the number of Americans who say they have no confidant has nearly tripled in two decades. In turn, the paper continues, people without strong social connections, or who suffer from social stress (such as rejection and broken relationships), are more prone to inflammation. In the evolutionary past, social isolation exposed us to a higher risk of predation and sickness. So the immune system appears to have evolved to listen to the social environment, ramping up inflammation when we become isolated, in the hope of protecting us against wounding and disease. In other words, isolation causes inflammation, and inflammation can cause further isolation and depression.

Remarkable as Frome’s initial results appear to be, they shouldn’t be surprising. A famous paper published in PLOS Medicine in 2010 reviewed 148 studies, involving 300,000 people, and discovered that those with strong social relationships had a 50% lower chance of death across the average study period (7.5 years) than those with weak connections. “The magnitude of this effect,” the paper reports, “is comparable with quitting smoking.” A celebrated study in 1945 showed that children in orphanages died through lack of human contact. Now we know that the same thing can apply to all of us.

Dozens of subsequent papers reinforce these conclusions. For example, HIV patients with strong social support have lower levels of the virus than those without. Women have better chances of surviving colorectal cancer if they have strong connections. Young children who are socially isolated appear more likely to suffer from coronary heart disease and type 2 diabetes in adulthood. Most remarkably, older patients with either one or two chronic diseases do not have higher death rates than those who are not suffering from chronic disease – as long as they have high levels of social support.

In other words, the evidence strongly suggests that social contact should be on prescription, as it is in Frome. But here, and in other countries, health services have been slow to act on such findings. In the UK we have a minister for loneliness, and social isolation is an official “health priority”. But the silo effect, budget cuts and an atmosphere of fear and retrenchment ensure that precious little has been done.

Helen Kingston reports that patients who once asked, “What are you going to do about my problem?” now tell her, “This is what I’m thinking of doing next.” They are, in other words, no longer a set of symptoms, but people with agency. This might lead, as the preliminary results suggest, to fewer emergency admissions, and major savings to the health budget. But even if it doesn’t, the benefits are obvious.

Partnerships Transform the HIV/AIDS Epidemic

The Power of Partnerships to Transform the HIV/AIDS Epidemic
The AIDS Quilt’s Power to Bring People Together 

On World AIDS Day 2011, President Barack Obama called attention to the vital role partnerships play in winning the fight against HIV/AIDS—partnerships between the government and the private sector have the power to change the course of the HIV epidemic and ensure that people living with HIV and AIDS get access to life-saving treatments.1 In other words, partnerships have the power to transform the HIV/AIDS epidemic.

As a strong supporter of these partnerships, Bristol-Myers Squibb is working with Quilt in the Capital 2012 during the momentous return of the AIDS Memorial Quilt (the Quilt) to Washington, DC, this July. This event also marks the return of the XIX International AIDS Conference (AIDS 2012) to the United States after 22 years abroad.

Over its 25-year history, the Quilt has commemorated the men, women, and children claimed by the epidemic—and it continues to be a compelling symbol of the ongoing fight against HIV/AIDS. The Quilt exemplifies the power of bringing together people from all backgrounds to foster dialogue, awareness, and action at every level. These partnerships are at the core of Bristol-Myers Squibb’s 20+ year commitment to join with the people and organizations working to end the epidemic.

Unfortunately, too many people lack access to HIV/AIDS care and treatment. One solution is to create strong and lasting partnerships that help drive policy initiatives aimed at reducing barriers to care.

“It takes the collaboration of many stakeholders to advance policies that support access to care and treatment for all people living with HIV. Bristol-Myers Squibb is a committed and key partner in this endeavor, having supported programs to strengthen community capacity to address HIV law and policy development needed at the local, state, and national levels.”

Robert Greenwald, JD
Director, Center for Health Law and Policy Innovation, Harvard Law School
Clinical Professor of Law, Harvard Law School
Harvard University
Cambridge, MA

Access to HIV Care in the South exemplifies programming intended to strengthen community capacity by engaging private sector stakeholders with community-based organizations in Alabama that are working to meet challenges in overcoming barriers to HIV care. This and other Bristol-Myers Squibb-supported initiatives like Positive Charge, WithInSight®, and the State Healthcare Access Research Project (SHARP) are working to meet the unique needs of people living with HIV and AIDS.

“The domestic fight against HIV/AIDS will only be won with the support and engagement of the private sector and civil society at large. Bristol-Myers Squibb is leading the way in creating new public-private partnership opportunities to expand the HIV/AIDS care workforce, improve access to treatment and care, and create awareness about the HIV/AIDS epidemic in the most impacted regions of the United States. This type of leadership from a private company is a model we hope to see replicated over and over again; it is essential to our success in turning the tide of HIV domestically.”

Dawn Averitt Bridge
Founder, Coalition for National HIV Awareness Month
Founder and Chair, The Well Project
Nellysford, VA

July 2012 is the month of world partnerships and HIV awareness

The designation of July 2012 as the first annual National HIV Awareness Month shows how public-private partnerships have the ability to create awareness about HIV/AIDS, and spark renewed commitment and energy in those striving to end the epidemic. Bristol-Myers Squibb joined with the broad coalition supporting this event. Expanding the reach of public-private partnerships will also support those working to achieve the goals outlined by the United States National HIV/AIDS Strategy, including measures to address disparities and health care inequities for people living with HIV and AIDS and improving access to HIV treatment and care.

“For more than two decades, Bristol-Myers Squibb has been committed to discovering, developing, and delivering innovative therapies to treat HIV. We will not waver in our journey with the HIV community—or in our mission to ensure that people living with HIV have access to treatment.”

Douglas J. Manion, MD
Senior Vice President
Development, Neuroscience, Virology, and Japan
Bristol-Myers Squibb

Only one year after the Quilt was created, Bristol-Myers Squibb began its journey to bring antiviral therapies to market, and it continues to strive for advances in HIV therapy that might bring an end to the epidemic. As the Quilt is unfolded once again this July, tens of thousands will remember the journey of those who bravely fought the disease—also honoring the enduring commitment of those who continue to fight HIV and AIDS.

The Quilt is a living and growing memorial to those who have died from the epidemic. Each of the 48,000 handsewn panels of the Quilt serves to inspire those currently fighting the disease and bring hope for the day when panels are no longer needed to be sewn. As the largest community art project in the world, the Quilt shows how, working in partnership, we can win the fight against HIV/AIDS in the United States and around the world.

1Remarks by the President on World AIDS Day. The White House, Office of the Press Secretary. June 18, 2012

Visit us to view “Images of AIDS 2012” by Kelly Guenther.  Kelly won a 2002 Pulitzer Prize for Breaking News Photography for her contribution to the New York Times’ coverage of 9/11 and has a beautiful eye for capturing special moments.