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PBS NewsHour

How a Caribbean island became prime source of U.S. Zika cases

An edes aegypti mosquito is seen inside a test tube as part of a research on preventing the spread of the Zika virus
         and other mosquito-borne diseases at a control and prevention center in Guadalupe, neighbouring Monterrey, Mexico, March 8,
         2016. REUTERS/Daniel Becerril/File Photo - RTX2DV6U

An edes aegypti mosquito is seen inside a test tube as part of a research on preventing the spread of the Zika virus and other mosquito-borne diseases at a control and prevention center in Guadalupe, neighboring Monterrey, Mexico, March 8, 2016. Photo by Daniel Becerril/File Photo/Reuters

More than 1,400 Americans contracted Zika while traveling outside the U.S. this year and a Caribbean-island nation is one of the top destinations where they caught the virus.

Visitors to the Dominican Republic account for more than a fifth of the confirmed Zika cases in the U.S. through mid-July, according to data from state health departments. New York, Florida and California alone tally 304 cases linked to the country, the data show.

As Florida officials investigate what may be the first non-travel-associated cases of Zika infection in the U.S., Kaiser Health News looked more deeply into the origins of the 1,404 travel-related cases reported by all states to the Centers for Disease Control and Prevention.

For most people, Zika causes flu-like symptoms. Pregnant women are considered especially at risk of the threat because Zika can cause severe birth defects, such as microcephaly.

The CDC does not break out the cases it tracks by country of origin — only by the infected person’s state of residency. It said in June that 48 percent of the travel-associated cases for all of 2015 and through May of this year originated in the Caribbean, 26 percent in Central America and 23 percent in South America. The cases numbered 591 at that time.

Data from the four health departments that have reported more than half of the national case total — New York state, New York City, Florida and California — provide additional detail.

More people who visited the Dominican Republic in 2016 returned with Zika than did U.S. residents who traveled to Puerto Rico, Colombia, Jamaica, El Salvador, Haiti, Guyana and Venezuela combined, the four departments’ figures show.

[Watch Video]

What’s the explanation? In part, it reflects travel patterns between people living in the U.S. with family members in the Caribbean nation, public health officials say.

“It’s not really tourists going back and forth,” said Chris Barker, a researcher in the School of Veterinary Medicine’s Department of Pathology, Microbiology and Immunology at the University of California, Davis.

Dominican Republic immigrants are the fifth-largest Hispanic group in the United States, numbering 960,000 in 2012, according to the Migration Policy Institute. Their highest population concentrations are in New York, New Jersey and Florida. Dominicans comprise New York City’s largest Hispanic group and “have a significant travel exchange with the Dominican Republic,” according to the city’s health department.

It counts 207 travel-associated cases linked to the republic, followed by 27 to Puerto Rico and 20 to Jamaica.

“Dominicans, Puerto Ricans and Guyanese do not have a higher risk of transmission for Zika infection,” the department said in a statement. “The data we have released simply reflects New York City’s demographics and travel patterns.”

People who travel outside the U.S. to visit family tend to make longer visits and often stay in residential locations, instead of “more sanitized areas made for tourists,” and that may increase their chances of getting bitten by a Zika-infected mosquito, Barker said.

Travel-related Zika cases are a function of both travel volume and how active the virus is in countries being visited, according to Barker. “When there is a high level of both, that is where you have the most cases,” he said.

Knowing which countries account for the most Zika travel cases helps drive public education efforts, said Vicki Kramer, chief of the vector-borne disease section at the California Department of Public Health.

As in New York City and Florida, California’s Zika statistics are also linked to immigrant populations there. Of California’s 77 cases, the greatest numbers resulted from travel to El Salvador, Honduras and Guatemala, all countries where state residents go to see family and often make extended visits, Kramer said.

New York City’s Health Department said it has done “extensive outreach” to local communities with strong ties to countries where Zika is active.

“These data could mean that Dominican New Yorkers are paying attention and testing more than other groups, which, in a way, is encouraging for us,” a statement from the department said.

With a population of about 10 million, the Dominican Republic shares the island of Hispaniola with Haiti.

Comparing U.S. data with a dataset from an international public health group indicates many more American visitors to the Dominican Republic have contracted Zika than residents of the island. The Pan American Health Organization reports 101 locally acquired cases there.

Brazil’s cases — 64,311 in total — account for almost 80 percent of the Zika infections in the Western Hemisphere through July 14, according to the organization. The country is so vast that infections are more spread out than in other areas of Central and Latin America, Barker said.

Public health sources for Zika statistics for the same country can vary. Puerto Rico’s tally is 2,162 on the Pan American Health Organization’s site. The CDC reports 2,843 locally acquired cases.

But among American travelers to both Brazil and Puerto Rico, the numbers appear to be far smaller, according to KHN’s analysis.

Those figures show 80 travel-related cases linked to Puerto Rico and six to Brazil. Colombia was at 46 and El Salvador at 31.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post How a Caribbean island became prime source of U.S. Zika cases appeared first on PBS NewsHour.

Black pain gone viral: racism, graphic videos can create PTSD-like trauma

A protestor is detained by NYPD officers as people protest the killing of Alton Sterling and Philando Castile during a march in New York City. Photo by Eduardo Munoz/Reuters.

When video of the Baton Rouge shooting death of Alton Sterling first surfaced on July 5, social media networks became immediately populated with Sterling’s final moments. The following day, the shooting death of Philando Castile was streamed live by his girlfriend on Facebook. The video, which shows Castile gasping for air after being shot four times by a Minnesota police officer, has since been shared on Facebook more than 5 million times.

Now, outrage is peaking again after cell phone footage captured a North Miami police officer shoot an unarmed caretaker as he lay on the ground with his hands up. Charles Kinsey, a behavioral therapist, was aiding an autistic patient who wandered away from his assisted living facility.

Escaping the imagery can be nearly impossible, especially as online users post commentary and news updates. For some, it can merely be a nuisance. But research suggests that for people of color, frequent exposure to the shootings of black people can have long-term mental health effects. According to Monnica Williams, clinical psychologist and director of the Center for Mental Health Disparities at the University of Louisville, graphic videos (which she calls vicarious trauma) combined with lived experiences of racism, can create severe psychological problems reminiscent of post-traumatic stress syndrome.

“There’s a heightened sense of fear and anxiety when you feel like you can’t trust the people who’ve been put in charge to keep you safe. Instead, you see them killing people who look like you,” she says. “Combined with the everyday instances of racism, like microaggressions and discrimination, that contributes to a sense of alienation and isolation. It’s race-based trauma.”

While research on the psychological impact of racism has only emerged within the last 15 years, Williams says it’s “now starting to get the attention that it deserves” and experts are “seeing very strong, robust and repeated negative impacts of discrimination.”

A 2012 study found that black Americans reported experiencing discrimination at significantly higher rates than any other ethnic minority. The study, which surveyed thousands of African-Americans, Hispanics and Asian-Americans, also found that blacks who perceived discrimination the most, were more likely to report symptoms of PTSD. Although African-Americans have a lower risk for many anxiety disorders, the study reported a PTSD prevalence rate of 9.1 percent in blacks, compared to 6.8 percent in whites, 5.9 percent in Hispanics, and 1.8 percent in Asians.

Social media and viral videos can worsen the effects. During the week of Sterling’s and Castile’s deaths, a scroll through timelines of black social media users could uncover subtle expressions of mental and psychological anguish, from pleas for others not the share these videos, to declarations of a social media hiatus. Williams says that’s not unusual. These expressions of anger, sadness and grief can hint at something much more serious.

“It’s upsetting and stressful for people of color to see these events unfolding,” she says. “It can lead to depression, substance abuse and, in some cases, psychosis. Very often, it can contribute to health problems that are already common among African-Americans such as high blood pressure.”

That stress is the reason why April Reign refuses to share the graphic final moments of Alton Sterling and Philando Castile. In a column for the Washington Post, the former attorney and now managing editor for Broadway Black — which reports on African-Americans in the performing arts — calls the need to share viral footage of police shootings “a sick sort of voyeurism.”

“We’re witnessing mentally and emotionally traumatizing videos and pictures. It’s enough, it’s just enough. It’s just so overwhelming all the time,” she told The NewsHour. “There are people who are having trouble sleeping, who are having trouble eating. There are people who are having those symptoms of PTSD in the truest sense.”

Reign says opponents have pointed out that it sometimes takes the graphic videos going viral before issues of police brutality and racial bias are given any attention. Both Sterling and Castile’s deaths sparked national and international protests after first being shared among black users of platforms like Facebook and Twitter. While Reign agrees, she calls decisions to shield certain footage “selective censorship,” often influenced subconsciously by racial bias.

She points to last August as an example, when many national media outlets opted not to air the graphic footage of news reporters in Virginia as they were shot and killed by a former coworker on live television. Many news organizations cited respect for the victims and their families as the basis of their decision. Reign says that sense of humanity isn’t typically given to victims of color, especially black-Americans. Instead, their gruesome final movements are replayed again and again for all to see.

“It is a dehumanization of black people, and we don’t see that with any other race. It’s ingrained in us from our history,” she says. “White people used to have picnics at hangings and at lynchings, bringing their children to watch black bodies suffer and die. We are not far removed from that, it’s just being played out through technology now. And it hurts.” 

“White people used to have picnics at hangings and at lynchings, bringing their children to watch black bodies suffer and die. We are not far removed from that, it’s just being played out through technology now. And it hurts.”

Dr. Williams says that history of racism, passed down through generations of storytelling, can become crippling when combined with personal experiences, including daily microaggressions — subtle, racially-insensitive comments or acts such as a person of color being followed in a store, or having their name mocked or mispronounced by peers.

The physical impact is something Black Lives Matter activist Brittany Packnett knows all too well. “Racism is not real to a lot of people, period,” she says, “But what people also don’t seem to get is how [black people] internalize that racism and manifest that suffering because, for so long, we’ve been conditioned to hide it. But’s real. It marks us everyday.”

Packnett can recall every time she learned of a new person of color killed by law enforcement. In each instance, she struggled with whether to watch the video, and can recount the emotional reaction when she did.

“I hadn’t had nightmares about Ferguson and tear gas or protests for a long time, but they came back when I saw those videos,” Packnett says referencing the shootings of Sterling and Castile. Avoiding them wasn’t an option. Both, she says, were set to automatically play on her Facebook timeline. 

“I hadn’t had nightmares about Ferguson and tear gas or protests for a long time, but they came back when I saw those videos.”

“I saw the Tamir Rice video while sitting in the parking lot next to the park where he was killed. In hindsight, did I need to feel that pain watching the video in order to fully absorb what clearly was a tragedy? No. So why did I? Pressure.”

Packnett said that activists also feel an expectation to speak authoritatively on these subjects immediately after. “We’re supposed to be able to provide language for people’s grief that is informed. And in order for it to be informed, there’s this unspoken obligation to consume the images, to watch the videos. It’s easy to forget that activists are affected too.”

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Amid the protests and pressure associated with being a public figure, Packnett finds herself still needing to take a break and unplug from the rest of the world. “I finally learned when to genuinely disconnect.  Yes, I know I’ll be coming back to tragedy and sadness, but at least when I do I’ll be coming back on a full tank instead of nearly empty.”

Williams acknowledges that even the most experienced therapists can lack the cultural understanding necessary to treat minorities who exhibit symptoms of race-based trauma. The key, she says, is seeking help from culturally competent professionals or even loved ones. The Association of Black Psychologists have released guidelines for African-Americans experiencing cultural trauma from recent coverage of racial tension in the media and online.

April Reign says the first step is simply recognizing when racism and the deaths of minorities played out publicly is becoming overwhelming.

“Recognize that if you’re numb, that means something. If you’re breaking down in tears, that means something,” she says. “It affects you more than you know, and there is nothing wrong with saying that this pains you. Understand it, and actively move toward healing yourself.”

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Diabetes linked to risk of mental health hospitalization in young adults

A person receives a test for diabetes at a free medical clinic in Los Angeles, California. Photo by Mario Anzuoni /Reuters

A person receives a test for diabetes at a free medical clinic in Los Angeles, California. Photo by Mario Anzuoni /Reuters

Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease, according to a recent study that shines a harsh light on the psychological toll the disease can take on this group.

For every 1,000 young adults aged 19 through 25 who had diabetes, 37 were hospitalized for mental health/substance use, compared to nine young adults without diabetes. The study by researchers at the Health Care Cost Institute also found the incidence of such hospitalizations is on the rise for these patients. The 2014 rate was 68 percent higher than two years earlier, when the rate of mental health/substance use hospitalizations per 1,000 for that group was 22.

“It was definitely not something that we were expecting,” said Amanda Frost, a senior researcher at HCCI, who worked on the recently published study. HCCI researchers will examine the trend more closely in future work, she said.

The study analyzed the insurance claims of more than 40 million people younger than age 65 from 2012 through 2014 with work-place provided coverage from three major health insurers. No other age group showed such high rates of hospitalization for mental health or substance use, according to the study. The rate for children up to age 18 with diabetes was second highest, at 21 per 1,000 in 2014.

One possible contributor to the rise in hospitalizations may be the health law, which permitted young people to stay on their parents’ health insurance until they turn 26, said Frost.

In 2014, “we saw a big jump in employer-sponsored insurance coverage for those young folks,” she said. In addition, “we could see an increase in young adults’ mental health hospital admissions at that time.”

Depression is two to three times more common among young people with diabetes than those that don’t have the disease, said Tina Drossos, a clinical psychologist at the University of Chicago Medicine Kovler Diabetes Center.

Managing the disease is tough at any age, but young people may find it particularly challenging. “It’s a 24/7 disease,” she said, requiring kids to continually test their blood, monitor their carbohydrates, and take more insulin if their blood sugar gets too high. In contrast, some other chronic conditions require someone to take a pill once a day, nothing more.

Young people may feel their condition sets them apart. “Everybody wants to fit in, and this is something that doesn’t fit in,” she said, noting that young people with diabetes can be subject to bullying and teasing.

But that doesn’t explain the increase in hospitalizations for mental health issues, she said. Typically, young people would be hospitalized if they tried to commit suicide or had seriously entertained the idea of suicide and formed a plan to carry it out.

“Most people who are depressed don’t commit suicide,” she noted.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

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How South Africa, the nation hardest-hit by HIV, plans to ‘end AIDS’


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HARI SREENIVASAN: Next, our series “The End of AIDS” wraps up in South Africa, where, this week, many of the world’s top scientists, researchers and advocates are meeting in Durban.

Among the topics: Is the end of AIDS really a possibility?

Perhaps no nation has paid as steep a toll from AIDS as South Africa has.

But, as correspondent William Brangham and producer Jason Kane report, few other nations are doing as much to push back against the virus.

This is the final report in our series, which has been supported by the Pulitzer Center on Crisis Reporting.

WILLIAM BRANGHAM: As the world races to end the HIV/AIDS epidemic, many are looking to South Africa, which has more ground to cover than anywhere else.

They’re sending out fleets of bike messengers to deliver lifesaving drugs. They’re testing as many people as they can. Educating others. Running some of the world’s top state-of-the-art research labs. They’re even trying this: surfing lessons as HIV prevention.

South Africa has more people infected with HIV than any nation on Earth. Over six million people here have the virus. Only half of those are being treated, so South Africa also has one of the greatest challenges.

SALIM ABDOOL KARIM, CAPRISA: One out of every five people living with HIV in the world lives right here, in South Africa.

WILLIAM BRANGHAM: Salim Abdool Karim is one of the leaders of South Africa’s fight against HIV/AIDS. He runs CAPRISA, a major research lab in Durban.

SALIM ABDOOL KARIM: We estimate that there are about 1,000 new HIV infections in South Africa each day.

WILLIAM BRANGHAM: Every single day?

SALIM ABDOOL KARIM: Every single day. And what’s critical in that: It’s not just that there’s all this HIV, but that young women are a key factor in the highest-incidence populations.

WILLIAM BRANGHAM: This is the Desmond Tutu HIV Foundation Youth Center in Masiphumelele Township in Cape Town. This is the place that uses surfing, among other things, to keep kids engaged in its HIV program.

Here, Linda-Gail Bekker is trying to prevent young women from ever getting HIV in the first place. Some studies indicate that up to 8 percent of teenage girls will become infected every year in parts of South Africa before they reach their mid-20s.

LINDA-GAIL BEKKER, Desmond Tutu HIV Foundation: These are unprecedented around the world. We have to do something about this.

WILLIAM BRANGHAM: Bekker’s center is trying something few other places in the world are trying. They’re offering uninfected teenage girls PrEP. It stands for pre-exposure prophylaxis. And as we have reported in this series, it’s a once-a-day pill which greatly lowers your risk of becoming infected if you’re exposed to HIV.

WOMAN: You need to take your pill every day so that you can stay protected by the pill.

WILLIAM BRANGHAM: Bekker says, this isn’t just crucial HIV prevention for these young women. It’s also empowerment. Too often, she says, young girls here have very little say in their own sexual lives and sexual health.

WOMAN: By not taking your pill every day, you might be in risk of getting HIV.

LINDA-GAIL BEKKER: For the first time, we have something that works if people take it, but it works for them. It’s in their hands. So, a young woman can swallow a pill a day. She is in control. She decides whether she swallows that pill or not, and she doesn’t have to have a conversation with her male partner about what he does and doesn’t do under the circumstance.

WILLIAM BRANGHAM: Of course, these innovations come after a very dark history that drove the spread of HIV in South Africa. For years, apartheid-era laws created a system where black men were forced to travel long distances from their rural homes to find work, often in the nation’s mines.

Many slept with HIV-positive sex workers, and then brought the virus home to different regions. But even after the end of apartheid, and as the HIV epidemic deepened, former President Thabo Mbeki questioned whether HIV even caused AIDS.

THABO MBEKI, Former South African President: How does a virus cause a syndrome?

WILLIAM BRANGHAM: Mbeki was widely criticized for hindering South Africa’s response to the epidemic. One study estimates his policies led to the deaths of over 300,000 South Africans.

Mbeki was president when Mpumi Mevana was diagnosed with HIV.

MPUMI MEVANA, HIV Patient: I was diagnosed in the corridor by the doctor in Johannesburg Hospital. “No, my dear, we can’t help you in this situation, because you’re HIV-positive.”

So, I went home that day, thinking that this is the end of the story for me. I’m waiting for the day I’m going to die.

WILLIAM BRANGHAM: This 37-year-old single mother from Soweto is almost completely blind, because of a virus that can strike HIV-positive people who aren’t getting treatment.

But in a sign of the times, Mevana is now being treated in one of the most innovative clinics in Johannesburg. The Right to Care clinics treat more people with HIV in South Africa than anyone else.

It’s 9:30 in the morning, and they have already seen 300 patients so far. They see 12,000 to 15,000 a month.

Ian Sanne is the founding director and CEO.

DR. IAN SANNE, Founding Director and CEO, Right to Care: This clinic happens to be the most efficient clinic in South Africa. It’s probably one of the largest.

WILLIAM BRANGHAM: Sanne’s goal is to bring the most modern technologies to bear on HIV treatment in South Africa. They have built a robotic pharmacy to speed drug dispensing.

WOMAN: First, you insert your card in there.

WILLIAM BRANGHAM: They have built this prototype ATM-like machine to dispense HIV drugs far away from clinics. They use electronic medical records and bar coding throughout the system.

And wait times in many South African clinics can be more than half-a-day, but here, Sanne says, they average less than an hour. He says, remember, South Africa has over three million people more people who aren’t being treated today, so every facility nationwide has to scale up.

DR. IAN SANNE: In my view, we don’t have a choice. We actually have to make this work.

DR. AARON MOTSOALEDI, South African Minister of Health: How do we successfully run this world’s biggest treatment program?

WILLIAM BRANGHAM: Dr. Aaron Motsoaledi is South Africa’s minister of health. He points out that South Africa has made huge gains in recent years.

In 2004, only 400,000 were being treated for HIV. Today, 3.4 million are. In 2004, 70,000 babies a year were born HIV-positive, but treatment has brought that down to less than 6,000 a year. But Motsoaledi says achieving these advances in so short a period of time has stretched the country’s resources thin.

DR. AARON MOTSOALEDI: There’s no way on earth you could increase the number of doctors proportionately within a decade.

WILLIAM BRANGHAM: So, for now, the burden of South Africa’s expanded HIV care falls the hardest on its health care workers.

Nobuhle Ndlela is a nurse in a rural part of KwaZulu-Natal in eastern South Africa. Her day starts early, getting her girls off to school before she drives to the HIV clinic where she works.

KwaZulu-Natal is one of the most HIV-infected regions on the planet. At the local hospital, people routinely show up with advanced AIDS. They’re often also infected with tuberculosis, another epidemic that’s plaguing South Africa.

T.B. is the leading cause of death for HIV-positive people here. It’s estimated that in many pockets of KwaZulu-Natal, one out of every three adults is infected with HIV.

At the clinic where Ndlela works, she says the stream of patients coming through her door is overwhelming.

NOBUHLE NDLELA, Nurse: Too much. I used to see 260 usually per day. But on the fourth of this month, April, there were 305.

WILLIAM BRANGHAM: Three hundred and five?

NOBUHLE NDLELA: Yes, because…



So — and it became even difficult for me to observe the patient properly.

WILLIAM BRANGHAM: This woman with her back to us just received her diagnosis a few days ago. She asked that we not show her face or use her name.

She’s told us she stares at the sheet of paper with her positive result on it for hours, in disbelief.

WOMAN: I didn’t expect it to be like that. I was so shocked and surprised, so disappointed. I don’t know how to explain it.

WILLIAM BRANGHAM: She says she was infected by her boyfriend, who didn’t know or didn’t tell her about his own status. She hasn’t yet told her two young sons the news.


WOMAN: I’m not ready to tell them. Even my family, I never said anything to them. So, it’s not easy.

WILLIAM BRANGHAM: What are you worried their reaction is going to be? There’s a lot of people in this community that have it. It’s — there’s no shame in having this disease.


WOMAN: They will think I’m going to die. They will not feel comfortable about it.

WILLIAM BRANGHAM: It obviously doesn’t feel this way to her, but she’s one of the lucky ones. Consistent HIV medication, which she will now get, can prolong her life for decades. She can still work, still be a mom.

This is the challenge for so much of South Africa today: Find the people who are infected with HIV, but don’t know it, persuade them to start treatment, and sustain that treatment for the rest of their lives.

SALIM ABDOOL KARIM: It’s not that we don’t know what to do. It’s a challenge of trying to do what we know works, and to do it at a scale where it can really make a difference.

WILLIAM BRANGHAM: After a long day treating hundreds of HIV patients, Nobuhle Ndlela is tired, but not defeated.

NOBUHLE NDLELA: God knows every step I take.

WILLIAM BRANGHAM: She has a few hours with her daughters to pray and to sing and to rest, before she starts again, wrestling against an epidemic.

For the “PBS NewsHour,” I’m William Brangham in KwaZulu-Natal, South Africa.

HARI SREENIVASAN: You can explore the entire series “The End of AIDS” on our website,

The post How South Africa, the nation hardest-hit by HIV, plans to ‘end AIDS’ appeared first on PBS NewsHour.