The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Suppression of the Hepatitis C viral load by Phyllanthus niruri extracts

Gemstone Team ANTIDOTE

The vague, the viral, the parasitic: Piranesi's metropolis

In mid-18th century Giovanni Battista Piranesi’s etchings systematically document the old and new monuments, decrepit buildings and broken down infrastructures of a Rome that continues to inhabit and reinvent its past. His views of Rome offer a devastating account of the blurring of distinctions and articulations that time, use and neglect have imposed on the old differentiations of the urban and the rural, the public and the private, the monumental and the domestic in the 18th century city. Rome becomes for Piranesi the laboratory for a questioning of architecture that places his work well beyond the debate on style and on the origin that dominated the architectural discourse of his time. This paper suggests that Piranesi’s images anticipate the dispersion and sprawl of the city of today, in which the ‘vague’, the ‘viral’ and the ‘parasitic’ become modes of inhabitation and of transient negotiated definition. In the Antichità di Roma, ancient buildings are represented not only in their large scale and magnificence, but also in their decay and reversal to a state of naturalness. These works, together with the acute observations of the Vedute di Roma, provide the materials that are then dislocated, manipulated, cloned and endlessly mutated by Piranesi in the synthesis of the Campo Marzio dell’Antica Roma, in which the historical city is almost entirely dissolved and replaced by an extraordinary congestion of fragments. When they are re-examined on the grounds of contemporary architectural and urban theory, the sites of Piranesi's views reveal anticipations of phenomena that affect the metropolis of today. Political, social and economic conditions have changed dramatically, but the questions asked of architecture in and by these sites challenge the definition of an architecture of style, forms and boundaries - in the 18th century as well as in the 21st -in favour of an architecture of change.