Why Women Still Don’t Know They’re at Risk for HIV, part 3

[00:00:46] Natalie Wilson: We would like to eliminate all new infections by the year 2030 because we have this technology and we have the ability to get these medications to most people. [00:01:00] I think we’re making some headway.

[00:01:04] Ellen Scanlon: Welcome to How To Do The Pot, A podcast helping you feel confident about cannabis. I’m your host, Ellen Scanlon.

[00:01:17] You just heard from Natalie Wilson, a California based assistant professor at the University of California San Francisco. We have reached the third episode in our three part series, honoring Pride. In the series, we’ve explored how the AIDS crisis led to the birth of medical cannabis and sparked a national legalization movement.

[00:01:41] I. Last week we heard from Dr. Donald Abrams, who was on the front lines of the crisis in San Francisco. Dr. Abrams shared how losing his partner to the virus inspired his years long mission to secure the first government grant to study cannabis from medical use in AIDS [00:02:00] patients. We’ll hear more from him this week too.

[00:02:03] In episode one of the series, you heard the story of me voles, the woman who ran the largest cannabis operation in San Francisco in the 1970s and eighties, selling pop brownies in the largely gay neighborhood of the Castro. She found herself as the source of cannabis to help dying patients relieve symptoms related to aids.

[00:02:26] If you haven’t listened to those episodes yet, please check them out. In today’s show, we’re celebrating how far we’ve come with managing the disease. I’m happy to tell you that HIV is now considered a chronic condition. We are very far from the days when it was a death sentence. I. People who are at risk can take pre-exposure prophylaxis, also known as prep to prevent the disease if it is contracted.

[00:02:58] There are antiviral [00:03:00] drugs that help manage the virus with early diagnosis and treatment. HIV is able to go into a state that’s called U equals you. It is both undetectable in the body and untransmittable to others. It’s even possible for an HIV positive mother not to pass the virus onto her child during pregnancy.

[00:03:22] These are miracles of modern medicine that deserve celebration, and yet the virus is still around. Currently one in four people living with HIV in the US are women. Of those patients are disproportionately women of color. For example, black women account for more than half of new HIV infections in US women, and they make up less than 15% of the total female population.

[00:03:54] And structural racism within the healthcare industry makes women of color [00:04:00] less likely to receive adequate care. Just like in the early days of aids, cannabis helps people manage symptoms and the side effects of medications, including low appetite, anxiety, pain, and sleep. 40 years later, we continue to await cannabis rescheduling to a Schedule three substance, which means it would be worthy of research and use in the medical community.

[00:04:32] Natalie Wilson, who you heard from at the beginning of the episode, was first exposed to HIV patients when she was running a clinic for the homeless. She went on to get master’s degrees in nursing and in public health and a PhD in nursing. Eliminating new infections has become her mission. I asked Natalie how patients with HIV are doing today.

[00:04:58] I.

[00:04:58] Natalie Wilson: There are people who are [00:05:00] living with HIV that never go to a diagnosis of aids, and I think the field has done a really great job at starting medications really early to suppress the virus so that people’s immune systems can maintain the integrity. To protect the person from infections or these disorders that people have.

[00:05:24] So the prognosis is really good. If we can catch somebody early in a diagnosis and start medications, they have a very long life that is not going to impact them like the old days. And this is just a plug that everyone should have an HIV test in their life, at least one. If you’ve been sexually active one time.

[00:05:48] Then you should have a HIV test at least once.

[00:05:51] Ellen Scanlon: I hope listening to this series helps to normalize testing for HIV testing, helps stop the spread of the [00:06:00] disease and paves the way for a much higher quality of life for the individual. If you listen to last week’s episode, you’ll recognize Dr. Donald Abrams.

[00:06:12] He reminds us what the difference is between HIV and aids.

[00:06:17] Dr Donald Abrams: So HIV is the virus that causes the infection and AIDS is acquired. Immunodeficiency syndrome, which is what people get, who have had longstanding HIV infection that’s not treated so that their immune system has been destroyed. Uh, by the virus aids was the term that we use to define the malignancies and the opportunistic infections.

[00:06:41] And then we used it to also say that people whose immune systems were impaired to the point where they had less than 200 of these so-called T lymphocytes, that they would qualify for having an AIDS diagnosis as well. And that allowed patients who didn’t necessarily [00:07:00] have one of the cancers or infections to benefit from the services and support that was available to patients with, as we call it, full-blown aids.

[00:07:09] Ellen Scanlon: Even with a managed condition, a person still has an incurable virus that takes a toll on their health and wellbeing.

[00:07:18] Natalie Wilson: It impacts their life because now they’re gonna be taking a medication to save their life every day. Of course, we are getting into long acting injectable treatment, but your life has changed and.

[00:07:30] Physiologically living with HIV, the virus impacts the immune system and so there is some low level immune activation and inflammation which can impact your overall health and can actually AIDS you faster.

[00:07:51] Ellen Scanlon: Natalie thinks a lot about who is most at risk today.

[00:07:55] Natalie Wilson: There are people that are at risk are, are generally those people [00:08:00] who have difficulty accessing care.

[00:08:03] When you think about the overall social determinants of health, there are people who to maybe work during the daytime. It can’t take time off and get to a doctor’s appointment or have to live in a partnership dynamic where they may not have a lot of power. In their sexuality or when they have sex or how they have sex.

[00:08:28] And so these people are generally at risk for HIV women are particularly at risk, mostly because of the power dynamic. I. People aren’t empowered in their their sexuality. We do have medications to prevent HIV. Those are even oral form or long-acting injectable prep or pre-exposure prophylaxis. Those are some ways you can prevent HIV.

[00:08:54] And then we have, if people are exposed to HIV or possibly exposed, we have [00:09:00] post-exposure prophylaxis medications that can prevent HIV. But when you’re of color. You are dealing with structural barriers that are racially based. Black women in particularly, have difficulties in protecting themselves and their sexual health, and seeing how our easy our reproductive rights have been stripped from women will consider being black.

[00:09:29] In America, you have even more structural barriers. It’s more difficult for you to cross state lines or to take time off when you’re working to keep a roof over your head or feed your children or are a primary caregiver. So those are some of the things I think that really put women at risk. I think also physiologically or.

[00:09:52] The vaginal tissue can be very friable when having sex, so it’s very easy to get micro tears, which is an [00:10:00] access for HIV. Or women can be prone to yeast infections or bacterial vaginosis, which are not necessarily sexually transmitted yet, can cause some friability of the vaginal tissue. And so when men may have sex with.

[00:10:19] Women, they can tear that tissue. And if they have the virus present and they’re not aware that they are HIV positive or they are not on medications to suppress the virus, they’re gonna transmit that virus to the woman. And that woman may think she’s in a monogamous relationship. That’s one of the misconceptions we have that.

[00:10:40] Women have multiple partners? Well, not necessarily many of the women that I’ve diagnosed with HIV or seen in practice actually, were in monogamous relationships.

[00:10:53] Ellen Scanlon: Natalie explains why women are at risk of contracting. HIV

[00:10:57] Natalie Wilson: women are at a smaller risk, but black women [00:11:00] out of the women who are at smaller risk are highly impacted.

[00:11:04] So we still continue to get HIV and because we’re not a priority population, there is no one coming to save us. And so women continue to get HIV because they are not even told that they’re at risk for HIV. Imagine you’re heterosexual, you’re with a man who does not consider himself gay, but he may be bisexual or he may consider himself straight, but has sex with.

[00:11:35] Transgender women. You know, I had a couple I saw one time. The reason they got to me was because she was having symptoms ’cause we’re more likely to have the symptoms and need to deal with it. You know, as a result of treating her, I said, we should also test your partner. And of course I run a full sexual health panel.

[00:11:56] He was HIV positive. She was HIV [00:12:00] negative, but she had chlamydia and gonorrhea, and of course he did too. Come to find out he goes to parties where men are and they have sex, and one, he did know that after exposure he could access post-exposure prophylaxis and he was having sex. With a woman partner who was his main partner and they were having unprotected sex and she was young and in college and also they were living in out of her car.

[00:12:33] These are situations, even if you’re not living outside of your car, you, you could be living in a multimillion dollar house and still think, Hey, I’m in this one relationship. And this isn’t to put mistrust in, in relationships, you know, having. A discussion with your partner and to say, Hey, you know, if you’re gonna do this, I need to protect myself.

[00:12:59] Or having [00:13:00] honest conversations really, and I think that’s why women are at risk and why women so easily get HIV and. If I had not gotten that woman on post-exposure prophylaxis and then followed up with prep, she might have gotten HIV as well. I.

[00:13:24] Ellen Scanlon: One of the incredible medical advances related to HIV is that if you are pregnant and HIV positive, you can prevent your child from being born with HIV.

[00:13:36] It’s why testing pregnant women is so important, even if it feels scary.

[00:13:42] Natalie Wilson: I’m hearing rumors that people have kind of relaxed off of testing mothers in pregnancy and therefore there has been an increase in children being born with HIV. People need to pick that back up [00:14:00] and get tested. I mean, we have protocols to prevent mother to child transmission, and so those need to be implemented.

[00:16:01] The underfunded state of women’s health is finally starting to get some attention. Natalie outlined some of the issues that women in particular face.

[00:16:11] Natalie Wilson: We need to empower patients in education not only on how to care for themselves. But also how to advocate for themselves. One of the things that has really struck in me in the past couple of years, including with my own health.

[00:16:29] Is that with some providers, they’re serving as gatekeepers to health and their own bias is actually informing their clinical practice. I say this because I’ve heard so many black women who have been denied pre-exposure prophylaxis prep because they’re not at risk because they’re a woman. I’ve heard a woman being denied pain medications post-surgery [00:17:00] because the provider said that they were okay with them being managed at a level five, and that there’s an opioid epidemic and.

[00:17:10] Even just in, you know, my own menopausal symptoms, I’ve. Been denied certain requests to help manage some of my symptoms for menopause, and I just start to see this overall. So I think one, there needs to be a system change in how we provide person-centered care and partner with patients, but I also feel like patients need to start advocating for themselves and figuring out how we can bridge the gap between the two so that we can.

[00:17:46] Truly have person-centered care and partnership, but also improve outcomes and reduce health disparities, racial health disparities. I’m still in the, probably the [00:18:00] frustration phase of this, but I think we’ve gotta do a better job at really improving health in America overall.

[00:18:09] Ellen Scanlon: One of the benefits of changing cannabis from a Schedule one substance to Schedule three could be that doctors may be able to prescribe it.

[00:18:19] There would also be many more opportunities for medical research. This could reduce the challenges that HIV patients face in accessing cannabis to manage their symptoms. Dr. Abrams remembers clearly how cannabis was helping AIDS patients in the 1980s.

[00:18:36] Dr Donald Abrams: Prior to the availability of highly active antiretroviral drugs, many of these men with advanced HIV infection just wasted away with diarrhea, fevers, and incredible weight loss.

[00:18:49] I mean, I remember walking around the Castro in the early nineties and. You looked like you were in a concentration camp looking at the people walking on the streets with their canes and their [00:19:00] bones poking out from their clothing. So the wasting syndrome, we thought, well, gee, maybe cannabis, which increases appetite would be useful, and cannabis, it does increase appetite, and it was useful for those patients.

[00:19:14] Nausea was also a problem, particularly with some of the antiretroviral drugs that we use. And some of these patients were actually only able to tolerate their antiretroviral therapies because they were using marijuana Pain, I think is the whole reason that we have a system of cannabinoid receptors and we make our own endogenous cannabinoids to help us facilitate our response and our reaction to pain.

[00:19:41] So many AIDS patients had pain from a number of different issues. And then, as you know, sleep, people sleep better sometimes if they tolerate cannabis. And cannabis is also useful for anxiety and depression. So for all those different symptoms, AIDS patients [00:20:00] benefited from the use of cannabis.

[00:20:02] Ellen Scanlon: Natalie sees how cannabis helps patients today with symptoms of HIV

[00:20:08] Natalie Wilson: as a result of the inflammation and the immune activation.

[00:20:11] People experience symptoms such as fatigue, loss of energy, difficulty sleeping, falling asleep, or staying asleep. There’s definitely pain. Whether in muscle aches, just generalized joint pain or this peripheral neuropathy that people get or this pain and numbness and tingling in their hands and feet.

[00:20:35] Also, HIV impacts the gut brain access, so it’s impacting the gut and therefore shifting the gut microbiome. Which therefore communicates with the brain, and there’s inflammation in the central nervous system or the brain, and people can end up feeling down, depressed, [00:21:00] feeling anxious, and so about 60% of people or a little more experience.

[00:21:09] Depression and anxiety and pain and difficulty falling asleep. Now, all of these can be impacted by cannabis or alleviated by cannabis. Cannabis actually interacts with our own endocannabinoid system, so we have our own kind of cannabis within our bodies and over time and with inflammation and stress.

[00:21:34] That can be impacted and we can have a deficit of our endocannabinoids. The cannabinoids in cannabis can bind to those receptors and actually decrease. Pain, decrease inflammation, decrease immune activation, decrease depression, anxiety, and even help people fall asleep [00:22:00] and stay asleep. Even help with fatigue, not just from your sleep, but ev actually give you a boost.

[00:22:05] I can consider cannabis like a superfood almost. There are plenty of strains that you can use or combinations or hybrids that you can get that can support. A person living with HIV in the symptoms that they’re having. And if one strain doesn’t work, don’t think, oh, cannabis doesn’t work for me. You just gotta find a different strain.

[00:22:28] Ellen Scanlon: Natalie shares the guidance she gives to patients who are figuring out what type of cannabis works best for them. She has a tip that I also give to a lot of people. You don’t have to get high to get the benefits of cannabis. I.

[00:22:42] Natalie Wilson: Remember, this is your body. It’s not the same for everybody, and the cannabis is actually interacting with your own endocannabinoid system, the receptors in your system.

[00:22:56] So a small dose may be all you [00:23:00] need. If you’re Snoop Dogg, you need a higher dose. ’cause you have way more receptors that you can interact with. I could not come close to what he would take and he would not probably get an impact from a dose that I could take. You don’t have to get high, you don’t have to get stoned.

[00:23:22] You just have to figure out what’s your right dose. Before you have the impact that you need. And so I tell people to start really slow and that’s what I would want people to walk away with and remember to do their research on the strains.

[00:23:40] Ellen Scanlon: If you wanna learn more about strains, check out how to do the Pots Essential Strains series.

[00:23:47] We have a whole bunch of episodes that will help guide you to the go-to strains that work best for you. Our goal is to help you figure out which strains will consistently help you feel the way [00:24:00] you want. I’ll add a link to the series in the show notes. Natalie has been able to manage her own chronic pain with cannabis.

[00:24:08] I.

[00:24:09] Natalie Wilson: I can actually speak to impersonal experience with this. I could say I used to have chronic pain. I don’t have chronic pain as much anymore. I don’t use the cannabis necessarily to get high, like one or two puffs would just be able to knock out the pain. I. And I’m active. I think they call it now microdosing.

[00:24:28] Just microdose, and that will help you just fine. You do not have to get high nor get stoned to get the impact that you need on symptoms.

[00:24:39] Ellen Scanlon: Natalie explains why despite positive patient experiences with cannabis, doing research on the plant is complicated. Changing cannabis to Schedule three could help simplify some of these challenges.

[00:24:54] So

[00:24:54] Natalie Wilson: we have a traditional way of doing research and people like that traditional way. [00:25:00] And you know, you’ve gotta have a randomized controlled trial with a placebo cohort because cannabis impacts an each individual human being differently because of the makeup of that human being. It is difficult to say, okay, I’m gonna start with this dose.

[00:25:22] And then this dose, and then this dose, and then be able to make a recommendation that’s generalizable to everyone. Like you can only take this much. You can’t do that in a clinical trial that way. Second thing is you’ve gotta be able to measure how do you measure the pharmacokinetic of the cannabis for that particular person, and then in a person who is not taking cannabis.

[00:25:52] Understand their makeup to be able to dose that person. It’s a botanical that is, [00:26:00] it’s a super food if you look at it like this. But what we wanna do is, because it’s impacting symptoms and a health, we wanna pull it into the pharmaceutical world because that’s a context that we’ve had cannabis as a controlled substance as opposed to having it as a food.

[00:26:22] I think now plant medicine and as we are expanding cultural knowledge, we’re starting to understand other cultural methods of medicine, how we can use plants formally known as psychedelics or drugs that I’ve had a negative connotation. How we can use them to impact conditions that we deal with here in the United States.

[00:26:52] I think we’re, we’re just kind of getting into that and once we start to [00:27:00] acknowledge that there is some benefit and the government acknowledges there may be some benefit, then I think we can actually make some headway. Because in order to do research, you need funding and you need support from the government to be able to do that in this country.

[00:27:19] Ellen Scanlon: Natalie is doing all she can to eliminate new infections of HIV. She explains what it’s gonna take to make that happen.

[00:27:29] Natalie Wilson: We have made some progress. Some of the campaigns that we have with undetectable equals untransmittable, which means that people who have been diagnosed with HIV can. Immediately start treatment and get to undetectable such that they will not transmit HIV to a partner.

[00:27:52] So that’s treatment as prevention for those people living with HIV and then for those people who are, are [00:28:00] not living with HIV or HIV negative. We have prevention strategies with pre-exposure prophylaxis or prep, and also post-exposure prophylaxis for if you’ve been exposed to HIV, I think everyone needs to know their status.

[00:28:18] We continue to have people who are testing late with an AIDS diagnosis, and this is why everyone should have at least one HIV test and that way we would all know if you’re negative or positive. And then you could get treatment or prevention if you’re at risk or would benefit from prep, and you would know if you were exposed what to do within 72 hours of the exposure, which is to get.

[00:28:46] On pep. I think that because we have this technology and we have the ability to get these medications to most people, I think we’re making some headway. We would like to [00:29:00] eliminate all new infections by the year 2030. We’re not that close. We have some work to do, but I think that there are people that are making the efforts to expand access to care, to marginalized populations.

[00:29:19] And you know, that’s some of the work that I’ve been working to do.

[00:29:23] Ellen Scanlon: Thank you for listening to this three-part series celebrating Pride. I hope you’ve been inspired by the courage it took to persevere through the AIDS crisis and that you feel the love that led to the legalization of cannabis that many of us enjoy today.

[00:29:42] Volz talked about wanting to write her book, home Baked to Pay a Debt of Remembrance. I’ve tried to do the same with this series, and I hope you’ve enjoyed learning about this piece of cannabis history. Thank you to all our guests who were so generous with their [00:30:00] stories and their knowledge and happy pride.

[00:30:05] If you liked this episode, please share it with a friend. We love new listeners and are here to help everyone feel confident about cannabis.

[00:30:19] Thank you for listening to this episode of How to Do The Pot. For lots more information and past episodes, visit do the pot.com. That’s also where you can sign up for how to Do the POTS newsletter. If you like how to do the Pot, please rate and review us on Apple Podcasts. It really helps more people find the show.

[00:30:41] Thank you to writer Joanna Silver. And producers Maddie Fair and Nick Patri. I’m Ellen Scanlan and stay tuned for more of how to do the pot.