GYNECOLOGICAL CARE FOR ADOLESCENTS pdf

JUICE JUICE is a SMART, INC. NEWSLETTER (Sisterhood Mobilized for AIDS/HIV Research & Treatment) There is not a defined age at which a female needs to see a gynecologist (GYN provider). The basic rule is a girl should make an appointment before she becomes sexually active or be seen by age 21. This almost never happens in real li fe. Care for HIV+ Adolescent Girls However, HIV+ perinatally (at birth) infected girls may have an advantage if they are enrolled in a comprehensive clinic (a one-stop-shopping unit where many services are offered at the same site such as dentistry, gynecological care, mental health services, and so on) where as they “age out” (or get older) they can “transition up” to GYN (gynecological or women’s) services in the same place. A newly diagnosed HIV positive teen should look for a clinic specializing in adolescent health that offers comprehensive services. The clinic should be responsive to the needs of adolescents such as offering flexible “walk-in” hours for medical and case management services. At those sites, the pediatrician, pediatric nurse practitioner (PNP) or physician’s assistant (PA) can make an appointment or introduce the girl to the GYN clinician. That way, if a problem arises, it can make the visit less traumatic, if she already knows the provider. An introductory visit can include issues relating to the girl’s periods or cramps. Later, issues such as douching, shaving, abnormal vaginal discharge, safer sex practices, sexually transmitted infections and avoiding unplanned pregnancies, which are further discussed in this article, can be explored. (Continued on page 2) GYNECOLOGICAL CARE FOR ADOLESCENTS Virginia Graham, NP, MPH “The clinic should be responsive to the needs of adolescents such as offering flexible ‘walk-in’ hours for medical and case management services.” INSIDE THIS ISSUE Gynecological Care for Adolescents 1 SMART Youth Rocks! 1 Meet Jonathan Bee and Carrie Panzer 3 Teens & Health Care: Getting It, Keeping It Private 5 Youth Resources: Health Care Providers, Conferences, Trainings and Programs 5 & 6 Lost in Transition: Adolescents Transitioning into Adult Care 7 SMART Youth Halloween Party: Get Your Fright On! (Pictures and Story) 8 SMART Body: Healthy Living and Eating — SMART Treats 9 SMART Voices: Computer & Creative Writing Classes 10 SMART University Schedule of Classes 11 The Scoop on Microbicides 12 Health and Treatment Updates: Microbicides and HPV Vaccine 13 More Halloween Party Pictures! 14 Acknowledgements 15 SMART Youth is a program started this past fall by a group of teens who are living with, affected by or at-risk for HIV/AIDS under the guidance of Jonathan Bee (details about him on page 3). The teens decided to launch the program with a Halloween/Teen Party (“GET YOUR FRIGHT ON!”) in order to reach out to other teens. The successful and fun event was held on October 29th at the HOT dance club "HOME" in Chelsea. It ended with a trip upstairs to the scary haunted house attraction, “Blood Manor.” Over 200 teens from agencies around New York City that serve teens/families affected by HIV/AIDS showed up for the event. SMART Youth planned this event over several weeks with Jonathan. Go to pages 8 and 14 to see the results of their hard work, including a story about the party with pictures. Vol. II, Issue 8 Fall 2005 Fall 2005 Teens on HOME’s dance floor GETTING THEIR FRIGHT ON SMART YOUTH ROCKS! SMART YOUTH ROCKS! JUICE VOL. II, ISSUE 8 antiprostiglandin medicines, also know as NSAIDS (nonsteroidal anti- inflammatory drugs) are sold over the counter as ibuprofen (Motrin, Advil, Aleve). They also come in prescription strength but a doctor has to prescribe them. Unfortunately, the side effects, such as GI (stomach) bleeding, upset stomach, etc. may make it difficult for some girls to use them. If their clinician states it is okay to take, then ibuprofen should be tried. Since every menstrual cycle is different, do not give up if it does not work for that period. Vitamins B, E, C, calcium and magnesium also help some women with their cramps, as does exercise. The birth control pill will limit blood flow and cut down on cramping, if the girl can tolerate taking another pill. Many times this is not an option. Adolescence is a time of hormonal highs and lows, a time of vulnerability. During times of experimentation, with or without alcohol or street drugs, girls are at high risk for unplanned or unwanted pregnancies or sexually transmitted infections. We are limited in our power to stop our kids from making mistakes, but we can arm them with tools to help them make their own good decisions. Teaching a girl not only about condoms and how to use them but negotiating and communication skills is vital. Adolescent girls are at higher risk for STIs (sexually transmitted infections) for several reasons: • During the heterosexual sex act, boys ejaculate their semen inside the vagina. The semen stays there for hours to days until it is absorbed, leaving the girl exposed to it during that time frame. There is a much greater surface area of mucus membrane in the vagina. The penis is only exposed to the vagina during the sex act itself. Thus, it is more difficult for a man to pick up STIs from a woman than vice-versa. • During intercourse, tiny tears or micro abrasions occur in the vaginal walls, making an open pathway for organisms to enter the woman’s blood stream. • Using spermicides (such as nonoxynol 9), gels and douching can dry or thin the vaginal walls or lining, again causing tiny tears making the female more vulnerable to organisms which can cause infection. • The cervix (opening to the uterus) of the adolescent girl (as well as a girl taking oral contraceptives or pregnant) is much more open and porous than that of a mature female. Again, this leaves her more vulnerable to infections caused by viruses and bacteria carried by her male partner. Girls have to depend upon boys to put and keep the condom on. Most girls do not know they have a sexually transmitted infection unless their partner tells them because the female is less likely to have symptoms than the man whose penis is outside of their body and in full view. If boys have a discharge, they can see it. Most infections burn when the male urinates. Most male partners are older and more “experienced.” Therefore, they are exposed to more viruses and bacteria and can pass them on to their younger partner. Some young women practice anal sex to preserve her virginity and avoid pregnancy. The anal canal is very susceptible to tears, making a female more vulnerable to viruses such as hepatitis B and C, HPV (human papilloma virus) and bacterial infections. HPV Vaccines The good news is there are vaccines (more on page 13) currently being developed which can offer protection against different strains of the human (Continued on page 4) GYN CARE FOR ADOLESCENTS (continued from front page) Choose your words wisely… A word of caution about the menstrual cycle (or periods): Moms/grandmothers/ aunts/guardians should try not to make girls feel “dirty” or “unclean” by making them take excessive baths, washing or introducing douches, sprays, or suppositories during this cycle. Yes, they should be aware that the blood carries more HIV virus than normal vaginal fluid, but try not to make her feel “soiled” during this time. Douching is unnecessary and can be harmful. All young women feel self-conscious the first few years after “menarche” (first period). They need to know that the period is a normal cleansing process and that the internal body cleans itself. It is not necessary to douche or spray. In fact, douching can cause problems by sending bacteria, normally found in the vagina, up into the uterus, which does not harbor bacteria, leading to serious infection. The vagina will replace the bacteria lost after cleansing. If yeast (normally present in the vaginal flora) grows back first, she can give herself a yeast infection. Cleanliness is a state of mind. If a female thinks the period is something dirty, she will feel dirty and self- conscious. She shouldn’t let advertisers for a product make her feel the need to be psychologically “fresh” (because that’s what it is doing, making the brain think the vagina is fresh like delicate flowers). If you want daisies, go to a florist, not your drug store. Vaginal discharge is often normal. At different times during the month female hormones rise and fall making the vaginal fluids thick, thin or clumpy, and at times heavy or light. When a woman is ovulating (or passing an egg-a time when she can get pregnant) she wil l have long sticky, stringy, clear discharge which can look like it comes from the nose. This is normal. Some girls think that something is wrong with them. As long as the discharge is not yellow, green or colorful when she wipes herself (most discharge turns yellow on the panties), does not have a foul odor (we all have an odor, but this is a foul-smelling, different smell) or is not very itchy (you can’t think of anything else to do but scratch) then it is probably normal vaginal fluids. Pubic hair is there for a reason and that is to fight infection. It is our first line of defense against bacteria and other organisms. When a woman shaves her pubic area, she can make small cuts which can easily get infected. If a woman is sexually active, broken skin is an easy entrance for bacteria and viruses. There is probably no way of stopping a young woman from shaving, but trimming the hairs instead of total baldness should be encouraged. Menstrual Cramps and Remedies Normally the first year after menarche, a girl does not experience cramps and the period is light. If they have excessive cramping or bleeding there may be measures that can be taken to relieve them. Every month the uterus (or womb) builds up a soft, blood filled lining in anticipation of a pregnancy. If not pregnant, the woman looses the lining of the uterus in the form of a period. During the monthly menses the uterus releases a hormone called prostaglandin. We now know that prostaglandins cause cramps or pains during the period (dysmenorrhea). Scientists have developed medicines called “antiprostiglandins” which, if taken early enough, can take the edge off of menstrual cramps. Some “ the period is a normal cleansing process the internal body cleans itself… douching can cause problems… leading to serious infection.” PAGE 2 JUICE VOL. II, ISSUE 8 MEET JONATHAN BEE: SMART YOUTH PROGRAM COORDINATOR & SPECIAL EVENTS I met Susan Rodriguez (SMART’s President) and her children over 3 years ago at an ice skating event that I was involved in organizing. As we metaphorically and physically learned how to glide on the ice and not fall on our butts, Susan told me about SMART and the exceptional women she had the opportunity to work with. I was blown away by her energy to take things into her own hands and fight loudly for services that were not being offered for women living with HIV/AIDS. That’s what impressed me most about Susan and SMART. It was a moment I will never forget because I saw a clear understanding of the needs that were not being met in the community and a visionary trying to represent the voice of so many silent women. The other thing I loved about Susan and Petra Berrios (SMART’s Executive Vice President) and all the other women I met was that they made things happen. No politics, just a desire to meet needs quickly, efficiently and compassionately. I was happy and honored to help as a volunteer for SMART. Sometimes the piece fits and that’s what helping SMART was like. I was asked to consider being on SMART’s Board. I said “yes” immediately for the opportunity to be a part of SMART in a deeper way. During my time on the Board, I saw great changes in the agency: From a small program that was run out of different agencies, we finally struggled to get our own “piece of the rock.” With the security of having our own permanent space, we are now able to start spreading our wings and expand our programming. One idea that was talked about was a teen program for youth living with, affected by and at-risk for HIV/AIDS. I had worked with youth before and understood that there is a large population of children that are aging into adolescents and young adults who lack the support system to cope with the many challenges of transitioning. As a Board member, I was very interested in this work and was glad that the women felt the need for such services. When the Board agreed to expand our mission statement to include youth initiatives, we needed someone to run the program. The Board asked if I would take on the role. This was a very exciting opportunity for me but at the same time, it was bittersweet because I knew I would have to step down from the Board to accept the position. I am inspired by youth — the eagerness to absorb everything and the confusion as they process the world around them. If this program can take all the richness and opportunity that this city has to offer and inspire them to follow a positive course, then we are making our mark on our future. I could not think of anything greater than this. On this note, I would just like to say “thanks” and “welcome.” MEET CARRIE PANZER, SMART’S NEW INTERN Hello SMART Ladies! My name is Carrie and I am SMART’s first student intern. I moved across the country to New York City in mid-August to study social work at Columbia University. I was born and raised in Northern California near the San Francisco Bay Area. I followed in my parents’ footsteps and studied at U.C. Berkeley and a spirit of activism has always been alive in my family. I am so excited to be here in New York given all of the wonderful learning opportunities (New York City is really a classroom in itself), although I have to admit I am a little worried about the cold East Coast winter to come. Prior to moving here, I volunteered a lot for an agency dedicated to the prevention of domestic violence and child abuse. For a couple of months I was a student in the agency’s volunteer training program so I could work on their Community Crisis Help-Line. It was very rewarding for me to serve as a peer educator / counselor in my community. I was also a Chairwoman for the agency’s annual fundraiser that raises money to fund domestic violence treatment programs. In addition, I worked as an Independent Living Services Instructor for a non-profit that educates and empowers developmentally disabled adults. A few years ago I also participated in the Avon Breast Cancer 3-Day Walk. I personally helped raise money for breast cancer research and I trained for over 3 months to be able to finish the 60-mile course in 3 days. All of these experiences inspired me to study social work and earn a professional degree in the human services field. During my time at SMART, I have been helping Yolanda with the day-to- day details of SMART’s different courses. I have really enjoyed getting to know all of you wonderful women through SMART University and your participation in SMART Voices and SMART Body. These last few months I have been helping the course instructors of SMART Voices and SMART Body. These smaller class settings are exciting because they allow people to open up and really get involved in their own learning. The SMART Voices writing program, for example, has grown into a creative writing course that really allows women to freely put their life experiences on paper. Cooking is also one of my favorite hobbies (it’s a stress reducer for me) so I have enjoyed learning about nutrition and the value of eating certain food items through the SMART Body program. In the coming months we will be reviving the SMART Voices Book Club – so please come and talk to me if you are interested. I also have to say that I love working with Yolanda – she makes me laugh at least 10 times a day! It is also exciting to work with Jonathan as he is launching SMART’s new teen program. Please come talk to me anytime about the different courses at SMART. I value your input and I am always open to discussing SMART programs or anything that is currently going on in your life. It is an honor to be here and I look forward to getting to know you all better in the coming months! PAGE 3 papilloma virus or HPV which can plague women for years and cause cervical cancer. Unfortunately, the vaccine will not help those women already exposed to HPV. It should be available in 2006. Although some bacterial sexually transmitted infections (STIs) are becoming resistant to standard antibiotics (gonorrhea), and we do not have a cure for the viral STIs (HPV, herpes simplex virus 1&2 (HSV), hepatitis B&C), most STIs can be managed but only if the adolescent is seen by a clinician in clinic. There are severe short and long term consequences for ignoring or avoiding treatment of STIs such as infertility (unable to become pregnant), future ectopic (tubal) pregnancies, cervical and hepatic (liver) cancer, and also death. In addition to STIs, unprotected sex can result in unplanned and/or unwanted pregnancy. As stated earlier, a girl should be seen by a GYN provider before she decides to become sexually active. That way, she can discuss with her provider and decide on a suitable method of contraception. However, with HIV positive adolescents, particularly those infected perinatally, the methods available are limited. The effectiveness of hormonal contraceptives can be decreased with many of the PIs (protease inhibitors). Oral contraceptives add a daily pill to an already over burdened pill regimen. Long acting progestogen only injectable contraception (depot medroxyprogesterone acetate “Depo Provera”) is given every 12 weeks which is a major advantage. Also, one side effect, amenorrhea (no period) may be ideal for a young girl suffering with anemia. However, some girls develop vaginal spotting/staining/heavy bleeding causing them to stop the method. If their partner is HIV negative, the constant bleeding can put him at risk. There are reports of “bone thinning” while on the contraceptive. We can send a man to the moon, but there is no ideal birth control method. For newly diagnosed girls, not on HIV medications, low dose oral contraceptives are a good method as they can control acne and menstrual cycles in addition to avoiding a pregnancy. However, they only protect against pregnancy if taken at the same time every day. A male or female condom still must be used for STI blockage. Every sexually active or planning-to-be adolescent girl should not leave the clinic without condoms (both male and female) and a prescription for “emergency contraception” or the “morning after pill” (levonorgestrel or “Plan B”). Instructions on how to take (within 72 hours of a condom failure) as well as warnings that it does not work if one is already pregnant should be supplied. Microbicides (gels, creams or other substances applied to the vagina before sex to stop the passage of sperm, viruses, bacteria and other unwanted things) are still being researched (more on pages 12 &13). There are some promising products but they are not yet available. A clinician should never assume anything about an adolescent. A sexual health history should be assessed at the first pelvic exam without making assumptions about her sexual orientation. A history of sexual abuse, rape or domestic violence needs to be assessed. There are so many issues which affect any adolescent. However, education along with skills to employ that knowledge can help a teen move on. Using all the resources a clinic/community has to offer such as mental health services, Gyn Care…. (Continued from page 2) JUICE VOL. II, ISSUE 8 alternative therapies, case management, nutrition appointments and education classes can contribute to helping an adolescent through this difficult and challenging time in their lives. Virginia Graham, NP, MPH is a Women's Health Care Nurse Practitioner currently working at the Center for Comprehensive Care, located at St Luke's-Roosevelt Hospital Center in NYC. She has worked with women affected/infected with HIV since 1986. She can be reached at vgraham@chpnet.org . “Every sexually active or planning-to-be adolescent girl should not leave the clinic without condoms and a prescription for ‘emergency contraception’ or the ‘morning after pill’ ‘Plan B’.” Report Details F.D.A. Rejection of Next-Day Pill [EXCERPT] By GARDINER HARRIS Copyright 2005 The New York Times Company November 15, 2005 WASHINGTON, Nov. 14 - Top federal drug officials decided to reject an application to allow over-the-counter sales of the morning-after pill months before a government scientific review of the application was completed, according to accounts given to Congressional investigators. The Government Accountability Office, a nonpartisan investigative arm of Congress, concluded in a report released Monday that the Food and Drug Administration's May 2004 rejection of the morning-after pill, or emergency contraceptive, application was unusual in several respects. Top agency officials were deeply involved in the decision, which was "very, very rare," a top F.D.A. review official told investigators. The officials' decision to ignore the recommendation of an independent advisory committee as well as the agency's own scientific review staff was unprecedented, the report found. And a top official's "novel" rationale for rejecting the application contradicted past agency practices, it concluded. The pill, called Plan B, is a flashpoint in the debate over abortion, in part because some abortion opponents consider the pill tantamount to ending a pregnancy. In scientific reviews, the F.D.A. has concluded that it is a contraceptive. The report suggested that it quickly became apparent that the agency was not going to follow its usual path when it came to the pill. "For example," it said, "F.D.A. review staff told us that they were told early in the review process that the decision would be made by high-level management." Top agency officials denied many of the report's findings, including its conclusion that the top officials' involvement was unusual and that they had decided to reject the application before the agency's own scientific review was concluded. Julie Zawisza, an F.D.A. spokeswoman, said the agency stood by its rejection of the morning-after pill application. "We question the integrity of the investigative process that results in such partial conclusions by the G.A.O.," Ms. Zawisza said. Earlier this month, after Senator Patty Murray, Democrat of Washington, denounced the agency's decisions on the pill, Health and Human Services Secretary Michael O. Leavitt also said the agency had acted appropriately. But on Monday, Dr. Susan F. Wood, former director of the agency's office of women's health, said that what she described as the F.D.A.'s willingness to ignore science in the service of abortion politics has "only gotten worse" since the events that were the focus of the G.A.O. investigation. Dr. Wood resigned in August after the agency decided to delay its decision on the morning-after pill once again. Planned Parenthood Federation of America, the nation's largest provider of abortion services, issued a statement saying, "The G.A.O. report confirms the F.D.A. has been playing politics with women's health all along." Plan B is manufactured by Barr Laboratories and is now available only with a prescription. Plan B was originally manufactured by Women's Capital Corporation, which won approval from the F.D.A. in 1999 to sell the drug by prescription. The pill contains high doses of the medicines present in birth control pills. If taken within 72 hours of unprotected sex, Plan B generally prevents pregnancy. But it is most effective taken soon after sex, prompting the efforts to make it available quickly and without a prescription. JUICE NOTE: Despite the FDA's inaction, seven states already make Plan B available without a prescription (Massachusetts was the eighth state to pass this legislation is September, overriding Gov. Romney's veto). Governor George Pataki vetoed similar legislation passed by the New York State Legislature last session despite the fact that New York ranks 14th in teen pregnancies, nationwide. It is estimated that 78% of teen pregnancies are unwanted. Imagine the potential impact on these young women's lives if they could have PREVENTED an unwanted pregnancy because of Plan B over-the-counter availability? Consider the potential to reduce abortion rates. Mr. Pataki, what was the motivation behind a veto that could adversely affect so many young women in your State? J. Falkenberg PAGE 4 JUICE VOL. II, ISSUE 8 PAGE 5 JUICE VOL. II, ISSUE 8 TEENS & HEALTH CARE: GETTING IT, KEEPING IT PRIVATE Catherine Hanssens, Esq., Executive Director Center for HIV Law and Policy PAGE 5 Let’s suppose that you’re 16 and you just tested HIV positive. You are completely freaked out, and you know you should follow up with a doctor to see if you should start medications to keep the virus under control. You wonder if you should see a gynecologist about a sore that won’t go away and maybe to get more information on birth control. But maybe you’re also worried that your mother will find out that you’re positive before you’ve figured out how you feel about it or how you’re going to tell her when she doesn’t even know you’re having sex! You wonder: Is it possible to get the treatment you need without your mother finding out from the doctor or from the insurance or benefit forms that will come later? And what about people at school? Do you need to tell your teacher or the principal? Will they find out anyway? These are big issues that are easier to deal with if you have someone to help you along. Hopefully you will be able to talk to the adults in your life and get their support. But if you’re not ready to talk, or not sure how those adults will take the news, it’s helpful to know what you can do on your own, or where to find people outside your family to help you out. Here in New York, minors (anyone under the age of 18) who can understand the risks and benefits of a particular health decision can get certain kinds of health care, such as birth control and testing and treatment for sexually transmitted diseases (STDs), without their parents’ knowledge or consent. This means that you can go see that gynecologist – whether it’s a doctor in a private office or one at Planned Parenthood or another type of clinic – about your possible STD treatment and birth control needs without having to get parental permission. Information related to your HIV status can be disclosed to a parent without your permission only if: • Your doctor concludes that you are unable to consent to your own care; and • Your doctor believes that telling your parents is necessary in order to get you the care you need in a timely fashion; and • The doctor has already talked with you about the need to tell your parents and given you the opportunity to do this on your own but you refuse; and • The doctor believes that telling your parents is truly in your best interest; and • You are not married, a parent yourself, pregnant or otherwise self-supporting and therefore otherwise legally able to make decisions about your health care on your own. The law in New York is a little less clear on whether HIV treatment is considered the type of care you can consent to without your parents’ involvement. However, doctors who specialize in adolescent HIV care may allow you to consent on your own if getting a parent involved is not possible or actually could cause you harm – like getting you thrown out of the house or worse. A federal law called HIPAA, passed by Congress to give people more control over their medical records, may help you to keep your HIV status and care private. Under HIPAA, it’s possible to get your doctor and health insurer to restrict parent access to your records of HIV care. However, it’s a harder to make sure bills, claim forms, and notices about benefits don’t go to your home; the law lets you ask that your records stay private and that doctors and insurance companies deal directly with you about your benefits (e.g., by email) ONLY IF you can make it clear that disclosures to your parents will put you in danger. And the law doesn’t absolutely require that doctors and insurers do what you ask. The bottom line: Do your best to find an adolescent HIV doctor whom you can trust, someone who will treat you with respect and take a leading role in working with health plan people and others to keep your business private until you’re ready to tell parents and other family members. As for people at school, you have no obligation to tell anyone, including the principal or your teacher. If you need to take meds or see a doctor, and leave the classroom, you can tell them as much as you want to; a doctor’s note doesn’t have to provide a diagnosis. If you need help finding a good doctor who specializes in adolescent HIV health care, or other information related to your health or your rights, you always can call SMART (212-564-3282) or the Center for HIV Law and Policy (212-564-4738). RESOURCE LIST OF SOME ADOLESCENT HEALTH CARE CENTERS IN NEW YORK THAT PROVIDE FREE /LOW-COST CONFIDENTIAL CARE : PROJECT S.T.A.Y. — Clinic: 21 Audubon Ave, Manhattan (646) 284-9732; email: jop9026@nyp.org THE DOOR — 555 Broome St., Manhattan (212) 453-0222 HEAT—Kings County Hospital, 451 Clarkson Avenue, U-Bldg, 4th Fl., Rm 441, Brooklyn (718) 245-3490 COMMUNITY HEALTHCARE NETWORK — Brooklyn Teens PACT, 260 Broadway, 3rd Fl (718) 387-7341; Harlem Teens PACT, 81 W. 115th St. (212) 426-0088 ext. 201 THE CHILDREN’S AID SOCIETY — Milbank Medical Group, 14-32 W. 118th St (212) 369-8339; Bronx Family Center, 1515 Southern Blvd. (718) 860-8595 HOTT PROGRAM — Callen Lorde Community Health Center, 356 W. 18th Street, Manhattan (212) 271-7212 —More resources for adolescents on the next page— JUICE VOL. II, ISSUE 8 YOUTH-RELATED CONFERENCES, TRAININGS AND PROGRAMS FIERCE! (Fabulous Independent Educated Radicals for Community Empowerment) — A community organizing project for Transgender, Lesbian, Gay, Bisexual, Two-Spirit, Queer, and Questioning (TLGBTSQQ) youth of color in New York City. FIERCE! organizes regular political education and organizing skills-building workshops open to all of our constituency. FIERCE! continues its efforts to raise the level of political and social consciousness of TLGBTSQQ youth as a means to strengthen our organizing efforts. Our skills- building trainings include topics such as campaign development, direct action tactics, practical skil ls for community organizing and media advocacy. Our political education training topics have included histories of social change movements, policing in the queer community, as well as a series of know-your- rights trainings. For more information, please contact: Bran Fenner at (646) 336-6789 ext. 107 bran@fiercenyc.org 13 Annual Ryan White National Youth Conference on HIV &AIDS February 18-20, 2006 Positive Youth Institute February 17, 2006 Loews Philadelphia Hotel, Philadelphia, PA www.napwa.org SAFE SPACE 24 West 30th Street, 2nd Floor, Manhattan (212) 481-8062 Case management, referrals, counseling, life skills recreation, presentations, trainings. Access to: food, shower, toiletries, Metrocard THE ADOLESCENT INITIATIVE PROJECT (AIP) is a program of the Partnership for Family Health. We work with youth and AIDS Service Organizations across New York City to link youth ages 13 — 24 to social, medical and HIV-related services in northern Manhattan. AIP is especially focused on seeking out youth who are not connected to care and engaging them in services. AIP also produces a monthly announcement page which reaches 350 agencies across New York. HIP HOP 4 HEALTH 511 Ave of Americas, #179, NY 10011 This organization partners with health industry professionals and youth social service organizations to educate tweens (8-12) and teens (13-17) on important mental, emotional and physical health issues and through interactive forums and seminars. With Hip Hop culture having such a large influence on tweens and teens, Hip Hop 4 Health incorporates artists, celebrities and athletes, along with a fun and inviting atmosphere. For information about workshops and events, contact Tamekia Flowers (646) 235-0200, email : info@hiphop4health.com VOICES UNBROKEN PO Box 342, Bronx, NY 10461 Voices UnBroken is a community-based organization dedicated to providing under-heard members of the community with the tools and opportunity for self- expression. Through creative writing workshops in jails, prisons, group homes, residential treatment facilities and various other transitional and alternative settings, Voices UnBroken nurtures the inherent need in all people to tell their stories. It is our belief that through this telling of stories and sharing of dreams community growth is possible. For more information on current or future Voices UnBroken programm ing, becoming a member of the Voices Network, making donations or to schedule a workshop in your community contact: Victoria Sammartino, Founder & Director (718) 239-0281 Email : voicesunbroken@yahoo.com www.voicesunbroken.org SISTAS ON THE RISE 835 Dawson Ave, Bronx, NY 10459 Sistas on the Rise is a space for young women of color ages 13-21 to take ownership and power over their lives and create a healthy community. We provide free workshops, activities and trips that develop leadership skills and teach our young women to be critical and active members in the community. One of our goals is to build sisterhood among young women who have children and those who do not. We provide childcare to make sure that teen moms can participate in our programs. Our staff is a combination of both adult and young women who are dedicated and passionate about their work. For more information, call: (718) 991-6003; email: info@sistasontherise.org www.sistasontherise.org HARLEM LIVE 301 W. 125 St, 3rd Floor (212) 222-4681 Harlem Live is recruiting new reporters, writers, photographers, video producers and webmasters. Be a part of this dynamic group that publishes an award- winning Internet magazine seen around the globe. THEO (Teens Helping Each Other) Adolescent Education Program, STAR Program @ SUNY Downstate, 450 Clarkson Avenue, Box 1240, Brooklyn (718) 270-3992 Hip Hop Theater Presentations; Street Outreach/Education; Teen Conferences; Youth Development Activities; HIV Counseling & Testing; Adolescent Education Workshops CHILDREN’S AID SOCIETY: YOUTH DEVELOPMENT SERVICES Dunlevy Milbank Center, 14-32 West 118th Street, Manhattan Contact: Casper Lassiter 212-996-1716 Educational Programs (College Prep, Computer, SAT Prep), Character Development (Keystone Club, Sisternet, Hoop Brothers), Career Readiness (Job Ready, Corporate Workplace and LEAP (Leadership in Employment & Academics Program), Cultural Enrichment (African Dance, Video Production, Hip Hop Dance) FLUSHING YMCA YOUTH BUILD 138-46 Northern Blvd, Flushing, Queens, (718) 961-6880 ext. 142 or 143 Program for unemployed young men and women ages 17-24 who have not completed high school and who come from low-income families to enable them to serve their communities by building affordable housing and assist them in transforming their own lives and roles in society. FRIENDS OF ISLAND ACADEMY 330 W. 38th Street, 3rd Floor, Manhattan, (212) 760-0755 Services include education programs inside Rikers Island for youth. After Rikers, Case Management, Education (Literacy, Basic Ed, Pre-GED & GED), Employment and Job Training, Counseling Services and Recreation Activities On Friday, November 5, youth from all over the city attended the Uptown Youth Conference and REMIX party afterwards held in Alfred Lerner Hall at Columbia University. The conference was organized and implemented for youth by youth and its major sponsor was the Adolescent Initiative Project (AIP) Other co-sponsors were S.T.A.Y., NYC Mission Society, HAPPI and CFS. It was hosted by Raqiyah of HOT 97. SMART Youth showed up in full force, tabled, networked, went to workshops, got tons of information and had a great time! PAGE 6 JUICE JUICE VOL. II, ISSUE 8 ADOLESCENTS TRANSITIONING INTO ADULT CARE: WHAT DOES THAT MEAN? Jonathan Bee, SMART Youth Program Coordinator A host of issues are arising and we need to mobilize once again to meet the needs of our youth. Isolation and exposure to a negative social environment are holes laid out in the front of so many young adults working their way through this world. At SMART Youth, we are creating a bridge over these gaps and teaching the youth how to fill in the holes by inspiring them to think about their future in a fun and exciting way. We listen and create. That is the goal of this new initiative for Youth Living With, Affected By and Youth-At-Risk for HIV/AIDS to come together to create a safe place to make friends and learn from experience the limitless opportunities that lay in front of them. There are issues and problems relating to these youth and we want to be the solution. We are not a hospital, we do not do case management and we are not a research program. We are a social recreational program driven by youth. If you are struggling to motivate your adolescents, this may be the perfect place for them to discover their own voice. We encourage you to let them know that we are around and always welcoming. * * * ROUNDTABLE DISCUSSION: YOUTH TRANSITIONING INTO ADULT CARE By Susan Rodriguez, SMART President with John Falkenberg, RN Some of the issues facing adolescents living with and affected by HIV/AIDS were discussed at an informal roundtable meeting on July 26, 2005 at the office of SMART, Inc., organized by SMART’s new Executive Director, Maya Iwata. In attendance were: Dr. Stephen Arpadi (St. Luke’s-Roosevelt Hospital), Dr. Jeffrey Birnbaum (Kings County Hospital/HEAT), Dr. Lisa Orban (NYU School of Medicine/ Bellevue), Catherine Hanssens, Esq. (Center for HIV Law and Policy), John Falkenberg, RN (SMART Advisory Board), Maya Iwata, LMSW (SMART Executive Director) , Jonathan Bee (SMART Board) and Susan Rodriguez (SMART Board) As a woman living with HIV and mother of 3, one of whom is an HIV+ teenager, I was very interested in the topic and extremely grateful to Maya for arranging this forum. I also appreciate all the attendees taking the time out of their busy schedules to discuss this important issue that will have significant impact on the future for our youth living with HIV. PAGE 7 LOST IN TRANSITION: ADOLESCENTS TRANSITIONING INTO ADULT CARE A few of the major points and problems that were identified for youth transitioning into adult care were: • Currently, there is no systematic incentive for adult physicians to become providers for this small population. • Children infected perinatally (from birth) have more medical complications — similar to older HIVers who have developed drug resistance. • There is often a breakdown of services during this transition and a difficult adjustment to adult clinical settings where services on which the youth have depended are no longer available. When John Falkenberg asked Dr. Arpadi, Dr. Birnbaum and Ms. Orban what are the differences between perinatally infected children living with HIV/AIDS and other children with chronic illnesses (i.e., diabetes) transitioning into adult care, some of the answers were quite simple but nonetheless devastating to hear: • Most have lost one or both parents and many have been raised by a foster parent or grandparent. Children with other chronic illnesses usually have both parents and have not suffered parental loss. • Most of these caregivers did not expect these children to live and many were not prepared for them growing up. Unlike other children, these kids were often not taught basic life strategies which would serve them as adults. Examples include autonomy, assertiveness, time management and emotional modulation. • Due to loss of family there is a loss of independence — many of the kids growing up in the clinics feel like the clinic is their second family — it is hard for them to leave their providers that they’ve known and trusted for many years. This often results in "separation trauma". • As youth get older, they tend to slip through the cracks and fall of out care. Some have dropped out of school due to il lness and never finish high school. Many experience hopelessness. • Youth behaviorally-infected may experience homelessness and /or are rejected by their fami lies. The group discussed solutions that could engage these youth as they grow into adulthood. It was agreed that programs outside of the hospitals and clinics that provided social support could build a network among this population to assist them in their journey toward a healthier and productive life. SMART Youth, led by Jonathan and driven by its youth, is just such a program — social events that unite youth and develop community among each other is its mission as it provides life strategies, social skills and most importantly, HOPE, through field trips, workshops, event planning, and cooking classes. Catherine Hanssens, John Falkenberg, Dr. Jeff Birnbaum and Dr. Stephen Arpadi Maya Iwata, Dr. Lisa Orban and Jonathan Bee SMART YOUTH: Left to right: Samantha, Kodu, Sadé, Melanie, Eileen, Jahleese, Adriana, Yahaira, Zachaye, Denise planning the Halloween Party at SMART’s office Here’s what some of SMART Youth teens had to say about the Halloween Party they planned and hosted for over 200 teens from different programs around the City at the club, HOME, ending with a trip to the haunted house , BLOOD MANOR: “On Saturday, October 29, I attended a Halloween party hosted by SMART Youth and I had a great time! I really enjoyed helping out whenever I could as well as getting my make-up done by M.A.C. I also enjoyed , believe it or not, the door check-in. I enjoyed checking people in at the door because I got to meet new people and learn about the organizations that they were a part of. I think the best part of the party was the haunted house at the end. I loved the haunted house because it scared me more than I expected. Overall, I thought the whole party was great.” Zachaye B., Age 17 “I liked that despite the different people that were there and the fact that people didn’t know each other, things went smoothly. No one was forced to do anything. No one was forced to dance if they didn’t want to. People were comfortable.” Adriana L., Age 17 “I really enjoyed the party. It was my first time being in a club and the music was loud. I really enjoyed the food and the haunted house! It was nice because it was a cool place to lounge but there was still a dance floor where they can ‘get their fright on’ HAHAHA!” Jahleese L. , Age 17 “On Saturday, October 29, I had a great time. I really was happy with the difference in music. My favorite part of the party was the M.A.C. make-up artists. The club also was very nice, too. The atmosphere and the decorations went well together. The haunted house was great! I almost peed on myself I was so scared and from laughing too. I can’t wait for the next party!” Melanie C., Age 17 “The party was great! Awesome and great energy. It turned out really well and it was really fun! I met a new girl my age and I went through the haunted house with her. She wasn’t scared at first but later on I kind of heard her scream. I was too scared to scream!” Christina R., Age 13 SMART Youth Halloween Party: GET YOUR FRIGHT ON! JUICE VOL. II, ISSUE 8 ▲Entrance to Blood Manor ▲SMART YOUTH Jahleese, Samantha and Volunteer, Alex Rodriguez ▲SMART YOUTH chilling at HOME ▲M·A·C· artists, led by Mar, working their magic MORE PICTURES ON PAGE 14! WHAT’S SMART YOUTH ABOUT? Here’s what some of the teens in SMART Youth have to say about it: “SMART Youth is to unite youth — to help people become more social and comfortable with people from different places. We want to have fun events and give youth time to enjoy and get more out of life.” “SMART Youth is a free youth program created by and for teens. We want to empower each other and be exposed to opportunities that we wouldn’t normally get. We want to meet new people, try new things, and go places we’ve only dreamed of going. We have big plans in store for this program and hope that others want to join us and make them happen. We are looking for teens ages 13- 21 and we hope to see you soon!” WHAT DO YOU WANT IT TO BE ABOUT? COME JOIN US! SMART Youth meets Thursday afternoons from 3-5PM at SMART’s office: 306-308 W. 38th St., 6th Fl. A Metrocard and light snack are provided. Call Jonathan at 212-564-3282 for more information. PAGE 8 PAGE 9 JUICE VOL. II, ISSUE 8 SMART TREATS By Rosa Donohue, MS, RD, CDN It’s getting colder as fall turns into winter — the perfect time for holiday treats. Listed on the right are a few treats to make at home: Cinnamon Apples, Pumpkin-Apple pie, Citrus-Apple Fizz. The recipes are easy to prepare, so have fun making them! GROWING UP WITH HEALTH AND FITNESS The American Heart Association has recently updated the Dietary Guidelines for Children. This was based on national surveys, studies and research that link the risk of heart disease among children to their current food intake, cigarette smoking and lack of physical activity among other factors. The hardening of the arteries process, heart disease, begins in youth. The visible complications may not be seen until they are in their 30’s, or 40’s, but the problem starts early in life. Heart disease can be prevented by starting NOW. Some of the new guidelines are briefly summarized here. To promote growing up healthily, try to follow as many of the recommendations as possible. You can start by one or two at a time. See how many you are already practicing now and how many you will by the end of the year. Here the ‘tricks’ and the ‘treats’ are at the end: 1. Eat several servings of fruits and vegetables every day. Ideally, at least 3 servings of fruit and 5 or more servings of vegetables would be wonderful. A serving size is about ½ cup. 100% fruit juice counts as a fruit serving. Choose brightly colored fruits and vegetables for added vitamins and minerals. 2. Have low-fat dairy products, skim milk would be best but 1% milk is acceptable. Eat less cheese, but when you do, try to eat hard cheeses rather than soft cheeses which have more fat (ie, cream cheese, American, Muenster and cheese spreads). 3. Eat more whole grains: whole wheat breads and cereals and other grains like rye, buckwheat, barley, oats, brown rice, etc. 4. Eat more legumes: black, red, pink and other beans; chickpeas, lentils, dry peas. 5. Avoid saturated fats: fried foods, greasy snacks, anything made with “hydrogenated oils” – read the ingredients on the labels. Before eating, remove all visible fat from meats, skin from chicken. 6. Eat the “good fats” which include olive oil, canola oil, avocado, walnuts, almonds, sunflower seeds, etc. 7. Eat fish at least once a week, i.e., salmon, tuna, sardines. 8. Eat less sugar, avoid sweetened juices and sodas. Each can of soda may contain up to 12 teaspoons of sugar, plus caffeine and no nutrients. Drink only 100% fruit juice, no sugar added. Better yet, eat the fruit and drink water. Juices will not have the fiber found in fruits. 9. Increase your daily physical activity. Go out daily to exercise if possible, or do some at home while watching TV, just keep moving. 60 minutes a day of exercise is recommended. 10. Avoid overeating to maintain a healthy weight. CINNAMON APPLES 1.Wash 2 apples. Cut the top off, about ½ inch or less and save. With a spoon, remove the seeds from the center, making a small cavity in the middle of the apple. Make sure the hole doesn’t go through the bottom of the apple. 2.Mix 2 level tablespoons of sugar with 1/2 teaspoon of cinnamon powder and a dash of nutmeg powder if you have some. 3.Divide the sugar mix in two parts and fill the center of the apples with it. Put a dot of butter or margarine on top of the sugar mix, and cover with the tops of the apple you cut off. MICROWAVE:Put in a baking dish or bowl and microwave for 4 minutes. If the apples are still hard, return to the microwave for another 2-3 minutes. The timing depends on size of apples and the power of your microwave. - OR - OVEN: You can also bake them in the oven, putting about ½ inch water at the bottom of the pan, and bake at 375 degrees for 15-20 minutes. The apples will be very HOT when ready, wait at least 10 minutes after done before you eat them. PUMPKIN-APPLE PIE Buy a frozen 9” pie crust. Pre-heat oven to 375 degrees. For the filling: ⅓ cup brown sugar 1 tablespoon cornstarch, 1 teaspoon cinnamon powder — divide in two parts. 1 teaspoon vanilla extract ⅓ cup water 1 tablespoon canola oil 3 Granny Smith apples, or any other firm apples, peeled and sliced to ⅛ inch thick ¾ cup canned pumpkin (plain cooked pumpkin, no spices or sugar) ¾ cup low-fat milk, or soymilk, or ricemilk ⅓ cup sugar 1 egg, beaten In a big skillet: Combine brown sugar, cornstarch, ½ teaspoon cinnamon, vanilla, water, and oil. Bring to a boil, stirring constantly. When mixture starts to thicken, turn heat to medium and add apples. Cook 4 more minutes, always stirring. Pour into the unbaked pie crust. Be careful, the mixture will be very hot! Mix the rest of ingredients in a bowl, the pumpkin, milk, sugar, egg, and remaining cinnamon. Pour over the apple mixture and bake at 375 degrees for about 50 minutes. When you insert a knife or a toothpick, it should come out clean when pie is ready. If the crust is browning too much, you may cover it with aluminum foil, be careful not to burn yourself, everything will be very hot in the oven. Cool at least 30 minutes before cutting. Refrigerate any leftovers. CITRUS-APPLE FIZZ Ingredients: 1 cup apple juice, 1 cup orange juice or grapefruit juice, 2 squeezed limes – use juice only, 1 can (12 oz) ginger ale, ice cubes Have all ingredients in the refrigerator, they need to be cold. Put 2 or 3 ice cubes in each glass. Mix the juices, then add the ginger ale and stir gently. Serve immediately over the ice cubes. SMART BODY: HEALTHY LIVING AND EATING JUICE VOL. II, ISSUE 8 SMART VOICES: COMPUTER CLASS Aaron Bauman, Instructor Computers are everywhere. It has been said a million times, but it is an increasingly relevant statement. Our children and grandchildren will continue to log on for access to communication, entertainment, research, finances, communities, news, and everything in between. With our new Computer Class, SMART University hopes to provide SMART women the opportunity to develop their own “tech-savvy.” The class will move quickly through the basics to help students navigate their way to computer literacy. Women will complete fun and challenging tasks to learn web surfing, search engines, and email. Keep in touch with friends and family without running up the phone bill; find pictures, information, and resources; and share your experiences with online communities. Students will also bolster their employability through office software training, including typing, word processing, and spreadsheets. Many employers these days will not even consider candidates without computer experience. Learn valuable skills from creating a resume and cover letter to sending a thank you email; from typing a memo to tabulating an expense report. No computer course would be complete without addressing security concerns: learn to spot the difference between an email from a friend and an email from a fraud; help stop email spam by recognizing scams and protecting your email address; and make online purchases while keeping your personal information safe. Finally, when the class is over, there's no reason to stop surfing. Learn about computer software and hardware to be able to make an informed decision about your next personal computer purchase. SMART Voices Computer instructor, Aaron Bauman, was born and raised in Athens, Ohio, home of the Ohio University Bobcats. He has a B.S. in computer science from the Fu Foundation School of Engineering and Applied Science at Columbia University. This is Aaron's first class at SMART, though he has taught similar classes for two years through Community Impact, a community service organization at Columbia. Aaron works full time as Web Developer for the Lesbian, Gay, Bisexual & Transgender Community Center. SMART Voices Writing Class is a 12-week creative writing course that invites the ladies of SMART University to come and share their personal stories on paper. We will all write about a topic then read and discuss it with the entire class. We all write on different topics. So far, the women of SMART have written and discussed topics such as family relationships, sexual identity, HIV/AIDS in older people, caring for a loved one living with HIV, quilting and traveling to Italy. We help each other edit and improve our writing by talking about what we like about each other’s pieces and what we would like to know more about. We have an editor’s sheet with symbols of different grammar and punctuation issues. The instructors explain errors in punctuation, spelling and grammar and each of us will also give input. We will then rewrite our pieces, type it up and reread it again. We all enjoy the classes. SMART Voices Writing Class brings out a lot of emotions. We share some deep feelings and wipe each other’s tears and comfort those who need comforting by words and extending the warmth of our arms. We also share homemade food, laughter, and amazing stories. Our goal is exciting: we will put our writings together and create a book of them in time for our graduation. One woman said: “The SMART Voices Writing Class has given me the freedom to express myself in writing.” SMART VOICES: WRITING CLASS By: All of the Women in the Writing Class SMART’s Office Manager, Yolanda Diaz and Computer Instructor, Aaron Bauman. Women in his class rave about how patient he is and love him as their teacher. The women had little or no computer experience prior to taking his class. They all quickly learned to surf the internet, send emails to friends and family and felt comfortable using the computer in no time at all! If you are a participant in SMART University, you are eligible for this class. Please contact Yolanda at (212) 564-3282 for more information. PAGE 10 Women in the SMART Voices Writing Class are at all different levels of writing but share the common goal of wanting to improve their skills. The women discuss and write about their experiences, life and interests in a safe, supportive and confidential environment. Tap into your creative writing talents and express yourself! If you are interested in joining the SMART Voices Writing Class, please contact Yolanda at (212) 564-3282. [...]... “Understanding Your Labs” Please visit our website for updates on classes — http://www smartuniversity.org Contact Yolanda Diaz at (212) 564-3282 for information and to register for the Winter 2006 session Dr Michael DeLorenzo talking about how to improve your smile (whitening, implants, etc.) as well as proper dental hygiene and treatment in “Dental Care and HIV” PAGE 12 JUICE VOL II, ISSUE 8 THE SCOOP... By: Ford Foundation Good Neighbor Committee Ms Foundation for Women Broadway Cares/Equity Fights AIDS Community Resource Exchange Bailey House Benjamin Moore & Co Union Square Awards Program Individual Donors In-Kind Donations: Home Depot/Team Depot Ricky’s Materials for the Arts, NYCDOCA/NYCDOS/NYCDOE Alpha Workshops Children’s Hope Foundation We also especially thank all of our Volunteers! Thanks for. .. THE FOLLOWING INFORMATION (ALL INFORMATION IS KEPT CONFIDENTIAL AND WE DO NOT SHARE OUR RECORDS): Name _ Address _ City State _ Zip Code OPTIONAL INFORMATION FOR SMART’S RECORDS: Phone: ( ) _Email Address: _ SEND THIS FORM TO: SMART, Inc... (Global Campaign for Microbicides and Alliance for Microbicide Development), David Gilden (GMHC Treatment Issues), PRNewswire, The NY Times, SMART Youth and all the women in SMART Voices Writing Class Thanks Ian Haram for the photos in our previous newsletter and showing us how to use our digital camera! PAGE 16 JUICE The Primary Mission of SMART is to: Provide treatment education and support for women living... Inc 306-308 West 38th Street, 6th Floor New York, NY 10018 THANK YOU FOR YOUR SUPPORT! Thank you for your donation and/or interest SMART, Inc is a 501(c)(3) non-profit organization and your contribution is taxdeductible to the extent allowed by law Your gift will be wholly used to support the mission and programs of SMART For further information, please contact Maya Iwata, Executive Director or Susan... found that persistent infection with varieties such as 16 and 18 are a necessary precondition for the development of precancerous lesions Those who clear the virus are out of danger Although there is no treatment for chronic HPV infection, control of the associated anal and cervical cancers is fairly straightforward Even so, there are about 5,000 U.S deaths a year from such cancers and HPV infections... trials of new vaccines against HPV Merck expects to file for FDA marketing approval in the fall of 2005 and GSK in early 2006 Because of the ubiquity of the virus and the deadly consequence of infection in some people, a preventative vaccine for HPV could have signif icant public health benefits Since active HPV infection may also increase the risk for acquiring HIV there has also been much speculation... the next decade will take more than just good science, it will take significant investment and political support from right here at home Why should you care about microbicides? HIV-positive women are some of the most vocal advocates for microbicides for many reasons Microbicides could help protect women from sexually transmitted and vaginal infections other than HIV, which can pose an even larger danger... different needs for, and responses to, various microbicide products, we need to make sure that positive women are involved in the testing of microbicides So what can you do? Microbicide research depends on government funding, because big pharmaceuticals are not investing in this research Right now, barely 2% of the US budget for HIV/AIDS research – only two cents of every dollar is spent on efforts to find... enable women living with HIV/AIDS to become informed participants in their treatment decision-making process so that they can be advocates for themselves, other women and their communities VOL II, ISSUE 8 SMART, Inc 306-308 West 38th Street, 6th Floor JUICE IS A New York, NY 10018 PHONE: 212-564-3282 SMART, INC NEWSL ETTER FAX: 212-564-4365 E-MAIL: MOBIL I ZED FOR (SISTERHOODSMARTUNIV@AOL.COM A IDS/HI . (Continued on page 2) GYNECOLOGICAL CARE FOR ADOLESCENTS Virginia Graham, NP, MPH “The clinic should be responsive to the needs of adolescents such as. offering flexible ‘walk-in’ hours for medical and case management services.” INSIDE THIS ISSUE Gynecological Care for Adolescents 1 SMART Youth Rocks!