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Julia Marcus, PhD, MPH Profile picture
@JuliaLMarcus
Sep 18, 2020 • 5 tweets • 4 min read • Read on X
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In contrast to #COVID19, there are powerful pharmaceutical interventions that can prevent HIV transmission: #PrEP is ~99% effective and #UequalsU is 100% effective.

So why has HIV incidence essentially flatlined in the U.S., and what does this mean for COVID19?

THREAD.
Structural inequities ensure that HIV prevention strategies are used least by those most in need. That's why incidence is *increasing* in young Black gay and bi men while stable or declining in other groups.

The result: highly effective interventions, limited population impact.
We can't just put interventions out in the world and hope for the best — we have to address people's barriers to using them.

Unstable housing is a key barrier for HIV. So what happens when we provide housing assistance? HIV outcomes improve. ajph.aphapublications.org/doi/10.2105/AJ…
Shutdowns, distancing, masks, test/trace/isolate —population impact of these interventions on #COVID19 will be limited unless we address the inequities that drive transmission.

We can't wait till the virus is under control to address equity. Equity IS how it gets under control.
Like HIV, #COVID19 risk is heterogeneous and our response needs to reflect that. cmaj.ca/content/192/25…

Equity means doing more for those who need more: UBI, paid sick leave, health insurance, housing, safe isolation spaces, etc.

More complex? Yes. More impactful? Also yes.

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More from @JuliaLMarcus

Julia Marcus, PhD, MPH Profile picture
Apr 7, 2021
For decades, the @WHO has defined health as more than just the absence of disease. But epidemiologic research typically focuses on disease and risk factors, not health and health assets.

New paper, short thread. 🧵
Take sexual health. Researchers and clinicians tend to focus on preventing unwanted outcomes, like STIs. But this picture of health is incomplete: people with STIs can have robust sexual health, while people who don’t have STIs can lack sexual well-being. 2/
PrEP research has centered on HIV, STIs, or "risky" sexual behavior, obscuring other ways that PrEP can affect health. New from me, @WhitneyCSewell, @khmayer1, and @douglaskrakower: we found that PrEP use was associated with greater sexual satisfaction. 3/ pubmed.ncbi.nlm.nih.gov/33657578/
Read 6 tweets
Julia Marcus, PhD, MPH Profile picture
Dec 9, 2020
I wrote about our collective underestimation of people's drive to see loved ones, the limits of lecturing, and how all I want for Christmas is a new public health strategy. theatlantic.com/ideas/archive/…
People are lonely, scared, exhausted, grieving. Our leaders have abandoned us, so of course we're turning on each other. But shaming doesn't deter risky behavior—it just perpetuates stigma, which is counterproductive to containing the pandemic. theatlantic.com/ideas/archive/…
Officials have blamed this surge on private social gatherings (even as they have their own!). Yes, they're risky. But here's the message: indoor dining is safe, but you're selfish and reckless if you have a holiday gathering that doesn't generate revenue. theatlantic.com/ideas/archive/…
Read 7 tweets
Julia Marcus, PhD, MPH Profile picture
Nov 13, 2020
What is #covid19 stigma, why is it toxic to public health, and what can we do about it?

A short thread. 🧵
Without federal support, it feels like "personal responsibility" is what will save us—so of course people are trying to shame each other into healthier behavior. But shame and blame perpetuate stigma, which can have the *opposite* of the intended effect. theatlantic.com/ideas/archive/…
People are called "selfish" and "reckless," even criminalized, for not wearing masks, not distancing. They're told to just "do the right thing," be "responsible." So it's no surprise when those who get #covid19 are seen—& see themselves—as bad, careless, deserving of punishment.
Read 7 tweets
Julia Marcus, PhD, MPH Profile picture
Sep 13, 2020
As @BillHanage has written, hybrid schooling may be the worst of all worlds. I'd like to walk you through a week in the life of my first grader to illustrate why. washingtonpost.com/outlook/2020/0…
For context, my city has very low community spread: test positivity is 0.16%. Public high schools are fully remote, middle schools will be remote until at least November, and elementary schools are using a hybrid approach. (Many private schools are opening full-time in person.)
On Mondays and Tuesdays, my 6-year-old will be learning remotely while cohort A attends school in person. He can't handle remote learning on his own and both parents work, so he'll probably be with a paid sitter, likely one that's shared with at least one other family.
Read 8 tweets
Julia Marcus, PhD, MPH Profile picture
Aug 15, 2020
🚨NEW: I wrote this piece for @TheAtlantic about the latest weapon being unleashed in the war against #COVID19: the cops. Crowded indoor parties need to be avoided during a pandemic, but policing people’s behavior will be toxic to public health efforts. 1/ theatlantic.com/ideas/archive/…
Enforcement may be ramping up now, but let's be real: we’ve already spent months policing each other. People have been widely shamed for enjoying themselves—even when their fun is low-risk. The message is clear: pleasure is not essential in a pandemic. 2/ theatlantic.com/ideas/archive/…
The instinct to yell at people for being careless and selfish is perfectly understandable. But public health is a service industry, and it can't serve customers without first trying to understand them. Let’s start by asking *why* people are partying. 3/ theatlantic.com/ideas/archive/…
Read 7 tweets
Julia Marcus, PhD, MPH Profile picture
Jul 24, 2020
Many people have seen this new @CDCgov statement on the importance of opening schools, which is watered down and likely politically driven. But there was also some useful guidance that was posted today.

I'll try to link each item in this thread. cdc.gov/coronavirus/20…
Here's the guidance for K-12 administrators on preparing to open schools, including considerations related to community spread and best practices for prevention. cdc.gov/coronavirus/20…
Here's the guidance on the use of cloth face coverings for schools, including scenarios where they're recommended and strategies to support students of various ages in wearing masks. cdc.gov/coronavirus/20…
Read 8 tweets

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