Edward Braun, M.D., a gay, lesbian, bisexual and transgender constituency delegate from Tampa, Fla., explains why he co-authored a resolution that calls for training family physicians about administering pre-exposure prophylaxis for individuals at high risk for HIV infection.
During the 2015 National Conference of Constituency Leaders held here April 30-May 2, AAFP members from the five constituency groups -- women, minorities, new physicians, international medical graduates (IMGs), and gay, lesbian, bisexual and transgender (GLBT) physicians and those supportive of GLBT issues -- acted on resolutions considered by the Reference Committee on Health of the Public and Science.
One substitute resolution delegates adopted during the May 2 business session addressed training family physicians in the implementation and use of pre-exposure prophylaxis (PrEP) for individuals at high risk for HIV infection.
Randy Gelow II, M.D., a GLBT delegate from Scottsdale, Ariz., and PrEP resolution co-author, explained during the May 1 reference committee hearing that PrEP is an HIV-prevention practice in which people who are not infected with HIV, but who are at high risk for the disease, take antiviral medications to lower the chance of becoming infected.
"This method of preventing HIV transmission has been shown to be more than 90 percent effective if used appropriately -- taken every day by high-risk individuals," he said. "Some studies have shown PrEP to be 100 percent effective in men who have sex with men, particularly.
- Delegates to the 2015 National Conference of Constituency Leaders adopted, among other things, a resolution recommending that family physicians be trained in the implementation and use of pre-exposure prophylaxis for individuals at high risk for HIV infection.
- Another substitute resolution addressed inconsistent application of policing and law enforcement standards as a social determinant of health.
- A third resolution called for the AAFP to support and endorse the recently issued World Health Organization recommendation on sugar intake and also to update its current educational resources to reflect that recommendation.
"We need family physicians to be educated on this treatment to help their patients."
Resolution co-author David Hoelting, M.D., a GLBT delegate from Pender, Neb., agreed. "We are on the forefront of trying to prevent the disease in the first place," he said. "As the people seeing these patients, it is very important that we are versed in the drugs necessary for this and where they should be implemented."
"I've had patients come to me out of desperation because infectious disease doctors don't see these patients because they don't have infectious disease," added a third co-author, Edward Braun, M.D., a GLBT delegate from Tampa, Fla. "This is preventive health care. It is perfectly appropriate to be given at a primary care level in a family physician's office."
Angela Sparks, M.D., a new physician delegate from Olympia, Wash., explained that she works for a large multispecialty group that has instituted PrEP training for its primary care physicians. "It was very helpful," Sparks said. "So know that there's good training out there that is starting to be used by larger health care organizations."
Even Application of Law Enforcement Standards
Another substitute resolution addressed inconsistent application of policing and law enforcement standards as a social determinant of health. Adopted during the business session May 2, it called for the AAFP to
- review the recommendations from the president's newly created Task Force on 21st Century Policing,(www.cops.usdoj.gov) and find concordance with existing AAFP policy;
- assign Academy representatives to collaborate in developing and implementing recommendations from the president's task force;
- draft a letter to Surgeon General Vivek Murthy, M.D., M.B.A., and Attorney General Loretta Lynch, J.D., citing the AAFP's current policy, "Violence as a Public Health Concern," and position paper on violence as they relate to inconsistent application of policing and law enforcement standards in different communities; and
- introduce a similar resolution during the 2015 annual meeting of the AMA House of Delegates and seek support and co-authorship from other delegations and constituencies.
Rachel Franklin, M.D., a women's delegate from Oklahoma City, discusses a resolution she co-authored that addresses inconsistent application of policing and law enforcement standards as a social determinant of health.
Co-author Rachel Franklin, M.D., a women's delegate from Oklahoma City, pointed to the recent death of Freddie Gray while in police custody and subsequent unrest in Baltimore as inspiring the resolution.
"The Academy is not being asked to say that police officers are doing a bad job," Franklin said. "Most people in law enforcement have their hearts in the right place and are trying to do the best job they can. We are just trying to point out that there is a pattern of violence in particular communities, and the AAFP has already declared that violence is a social determinant of health."
GLBT delegate Bernard Richard, M.D., of Greenfield, Ind., also addressed the issue during the hearing, telling an anecdote about staying after work one night and talking with the office manager of his practice in the parking lot. A police car pulled up to them, and Richard -- who is African American -- said his instinct was that the two needed to leave. But one officer simply said, "We will be closing soon and we wanted to make sure you are safe and OK to leave soon."
Richard explained to the reference committee that he had become used to being harassed by police officers while he was growing up. This incident, he said, was the first time he realized that other peoples' experiences with law enforcement might be vastly different from his own.
Kevin Bernstein, M.D., M.S., U.S.N., a new physician delegate currently stationed in Okinawa, Japan, reinforced the importance of being at the table with the president's task force to help shape this discussion.
Kevin Bernstein, M.D., M.M.S., U.S.N., a new physician delegate currently stationed in Okinawa, Japan, talks about a resolution he co-authored that asks the AAFP to support and endorse the recently issued World Health Organization recommendation on sugar intake.
WHO Guidance on Sugar Intake
Bernstein co-authored another resolution delegates adopted that called for the AAFP to support and endorse the 2015 World Health Organization (WHO) recommendation on sugar intake(who.int) and also to update its current educational resources to reflect the WHO recommendation.
The WHO released its guidelines for sugar intake for children and adults in March, recommending that sugar comprise less than 10 percent of daily caloric intake and further noting that best evidence indicated that less than 5 percent of daily caloric intake would be optimal.
"As simple sugars increase in the diet, they can lead to obesity, diabetes and negative health outcomes," Bernstein said. "This isn't just a civilian problem -- we've seen increases in obesity trends in the military, as well."
Resolution co-authors cited research from a 2010 study(cdn.missionreadiness.org) that found obesity had tripled in the past 30 years and rendered 27 percent of young adults too overweight to serve in the military, which they called a national security issue.
Among other measures considered by the reference committee, NCCL delegates adopted recommendations that asked the Academy to
- advocate that hospitals establish accommodations for family medicine residents who wish to breastfeed; and
- support a policy stating that long-acting reversible contraceptives methods be a recommended option for postpartum women before hospital discharge, as well as support insurance coverage for these devices.
Finally, delegates referred to the AAFP Board resolutions calling for the Academy to
- review available data on needle exchange programs and consider developing an evidence-based position paper on the topic to decrease transmission of HIV, hepatitis B and C infection, and other illnesses; and
- seek further evidence to support the performance of annual anal pap smears to detect HIV and HPV.
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