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UM Launches State’s First Needle Exchange Program

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UM Launches State’s First Needle Exchange Program


syringesFor years, while a student at the University of Miami Miller School of Medicine, Hansel Tookes fought the Florida legislature to pass the first law in the state that would allow drug users to exchange used needles for clean ones in an effort to combat HIV transmission among at-risk groups.

On Thursday, after four years of fighting and on a day that coincides with World AIDS Day, the pilot needle exchange program begins in Miami-Dade.

“Syringe exchange is one of the most evidence-based interventions we have to prevent HIV,” said Tookes, M.D., M.P.H. “As the heroin epidemic in South Florida flourishes, we now have the proper tools to keep this population healthy. Harm reduction works and now Miami will join other progressive U.S. cities to better service our citizens.”

The pilot program, the IDEA Exchange named after the Infectious Disease Elimination Act, is just one area where University of Miami health officials have been working to find a cure and stop the spread of HIV/AIDS.

“The HIV statistics in Miami are sobering and now it’s become a personal mission to stay working on HIV until it’s vanquished,” said Mario Stevenson, Ph.D., the Miller School of Medicine’s chief of infectious diseases and Director of the AIDS Institute.

As Stevenson notes, the HIV epidemic in Miami-Dade – which has the nation’s highest rate of incidence – extends beyond basic science.

“Much of the challenge is really dealing with societal issues in terms of how HIV thrives on substance abuse and lifestyles,” he said. “Those are the effects that we have to deal with to fight this epidemic.”

Miami has been a battleground for the HIV and AIDS epidemic since the early 1980s when the then-mysterious, immune-attacking virus first surfaced. The emergence of HIV and AIDS quickly propelled University of Miami physicians to the front lines of one of the deadliest and complex epidemics in modern times.

Seeing a swell of symptomatic women and dying infants, doctors at the School of Medicine were among the first to sound the alarm about the disease. Miami’s close proximity to endemic countries in Latin America and the Caribbean, rising substance abuse, homelessness and mental health are just some of the unique factors that have made Miami-Dade County the HIV epicenter, having both the highest rate and incidence of HIV and the largest and most diverse infected population. Broward County also consistently ranks among the nation’s top HIV-plagued counties.

Over the past three and a half decades, University of Miami Health System infectious disease physicians along with public health experts, psychologists and a team of world-renowned scientists have implemented a unique comprehensive care model and devised tailored population outreach strategies that range from rapid testing, strong community alliances and aggressive adolescent outreach, among other innovative initiatives. The pioneering work of UM pediatricians has nearly erased mother-to-child transmission in Miami. UM’s wide-ranging research has led to groundbreaking HIV drug discoveries and has served to inform top U.S. research institutes on what approaches are effective, especially among minority women. Across the University, scientists in high-tech infectious disease labs busily work toward a cure, vaccine and new therapies.

Stevenson, a renowned scientist, is one of three top infectious disease scientists who relocated their labs to Miami in recent years for greater access to Miami’s diverse patient population. UM’s HIV research arm has allowed thousands of patients to be enrolled in clinical trials that give them access to new therapies and help improve their overall health.

Stopping the Spread

Adding to its arsenal of outreach strategies is UM’s pilot needle exchange program, along with ramped up efforts to reach at-risk communities with the highly-critical pre-exposure prophylaxis (PrEP) drug that blocks the transmission so effectively that it has been likened to a vaccine. These measures may represent a turning point for Miami, as they were key to reducing HIV in other U.S. cities such as San Francisco.

The University of Miami Health System is collaborating with the Miami-Dade County Health Department to start a PrEP clinic that will allow enhanced access to PrEP for Miami-Dade County residents. “New strategies such as PrEP have revolutionized the way we think about HIV prevention,” said Susanne Doblecki-Lewis, M.D., associate professor of clinical medicine, and a PrEP expert leading the effort. “Our work now is to make these very effective interventions available to everyone in Miami who could benefit from them.”

In another innovative research project involving PrEP, renowned UM infectious disease physician Margaret Fischl, M.D., professor of medicine, Director of the Miami AIDS Clinical Research Unit and Co-Director of the Miami Center for AIDS Research, will be targeting transgender women with longer term inter-muscular injections of the drug. Transgender women, she said, tend to have higher rates of drug use and risky sexual behaviors.

“As part of our work, we continue to identify vulnerable populations and employ different modalities to prevent transmission, improve adherence and in turn stop the disease from replicating in those who are infected,” said Fischl, whose early pioneering research was instrumental in gaining FDA approval of AZT, the world’s first antiretroviral drug treatment for AIDS that would later be widely used to prevent transmission of HIV. “Longer term injections of PREP will greatly boost adherence, which has been one of the greatest obstacles in stemming HIV.”

Needle exchange is another new promising initiative. Florida was one of just 15 states that lacked a needle exchange program despite Miami-Dade having the highest rate of HIV and skyrocketing heroin use. Hansel Tookes, M.D., M.P.H., a Miller School-trained resident with a background in public health fought four years for passage of the state needle exchange bill, which was passed in April 2016 and authorized the Miller School of Medicine to conduct a five-year exchange program on a pilot basis within Miami-Dade County.

In addition to receiving clean needles, participants will be educated on safe injection techniques and offered immunizations, as well as viral hepatitis and HIV testing. The program will also link drug users into treatment programs and link those who test positive for HIV or hepatitis to health care – with the goal of reducing the spread of these diseases.

“Syringe exchange is one of the most evidence-based interventions we have to prevent HIV,” said Tookes. “As the heroin epidemic in South Florida flourishes, we now have the proper tools to keep this population healthy. Harm reduction works and now Miami will join other progressive U.S. cities to better service our citizens.”

Changing Behavior, Changing Outcomes

Given the psychological burdens and barriers associated with HIV, behavioral health has long been a crucial component to UM’s role in connecting people to care and stemming transmission.  Since the 1990s, psychologists and behavioral health specialists in the Department of Psychology on UM’s main Coral Gables campus and the Department of Psychiatry and Behavioral Health Sciences on the Miller School campus have rigorously studied risky sexual behaviors, mental health patterns and barriers that contribute to HIV. Addressing the epidemic from a behavioral and mental health perspective allowed UM psychologists to create effective interventions and group therapy sessions that have helped HIV-infected minority women overcome the stigma and obstacles to care. The behavioral research also found that most infected women continue to be sexually active (often times unprotected) and go on to have children, which prompted UM behavioral health experts to collaborate with physicians to devise and implement interventions that provide pre-conception counseling. The project educates young HIV-positive women and teens on safe sex practices, including adherence and the role of PREP, preventing mother-to-child-transmission and overcoming barriers to disclosing their HIV status to their partners.

UM professor of psychology Steven Safren, Ph.D., and other UM collaborators, recently published a study in The Lancet HIV journal that linked depression to lower HIV drug adherence and also showed that integrating cognitive behavioral therapy with specialized counseling helps boost adherence.

“While HIV medications and drug prevention mechanisms have greatly improved, it can still be difficult for some to benefit from those drugs due to mental health issues that worsen adherence,” said Safren. “Evidence-based mental health interventions help patients overcome the psychological burdens of the disease which in turn helps boost their adherence and their overall health outcomes.”

UM has also made significant strides in HIV research, testing, outreach and care in the following areas

Street Testing

A project led by Sonjia Kenya, Ed.D., M.S., M.A., Director of Community Health Programs at Sylvester Comprehensive Cancer Center’s Jay Weiss Institute for Health Equity, conducts rapid street testing in African-American and black Caribbean neighborhoods. Funded by the Elton John AIDS Foundation, the project aims to increase knowledge of HIV transmission and treatment among African-American and Caribbean black adults in Miami, and reduce risky behaviors among program participants. The program builds on Kenya’s previous studythat showed the use of community-based health workers along with rapid, home-based HIV testing is an effective strategy for getting more high-risk African American residents tested and connected to health services and treatment.

Innovative Lab Research

Adding to existing clinical research and lab studies, the University became an HIV research hub with the addition of Stevenson and two other world-renowned infectious disease scientists, David Watkins, Ph.D., professor and Vice Chair for Research in the Department of Pathology, and Ronald Desrosiers, Ph.D., professor of pathology. In 2015, Desrosiers and his Harvard University collaborators identified an antibody-like molecule that provides long-term protection against HIV/AIDS infection. Researchers engineered molecules which blocked two key receptors that the HIV virus uses to gain entry to the body’s CD4 white blood cells. The study showed that 100 percent of HIV-1 strains were neutralized by this new molecule inhibitor, which is the first time that this level of protection has been accomplished.

Women’s Interagency HIV Study

As minority women are disproportionately affected and represent the majority of new HIV cases, the University became a site for the national Women’s Interagency HIV Study. Funded by an $8.5 million National Institutes of Health grant, the five-year study has a broad focus including epidemiology, social and behavioral issues, substance abuse, long-term impact of HIV medication, prevalence of co-infection with other opportunistic diseases, such as hepatitis B and C, early onset of menopause, vaginal health and other scientific insight. In a recent and significant finding, Fischl and her collaborators found that vaginal douching increases the risk for women to contract HIV and transmit it to their partners. Douching, researchers found, breaks down the vaginal cell structure and causes bacterial vaginosis, which leaves women more vulnerable. For HIV-positive women, it causes increased amounts of the virus to form in the vagina, particularly around the cervix, which increases chances for transmitting the virus to their partners.

Comprehensive Care

Partnering with Jackson Memorial Hospital, University of Miami Health System doctors created a comprehensive HIV clinic designed to be a one-stop-shop clinic for all the patients’ needs, especially those of low socioeconomic status. The unique center provides a range of medical and advocacy services and, partnered with the UM School of Law, provides a legal clinic at the site.

Adolescent Outreach

The teen and adolescent population (13-24) has become a primary target for UM’s local outreach efforts. Many are unaware of their status, or if positive, are unable to disclose to family members. Miller School outreach workers in the Division of Adolescent Medicine have become the foot soldiers of outreach and have mounted creative tactics to reach youngsters—from setting up mobile testing clinics to staffing health fairs outside of alternative night clubs and high school sporting events. The clinic itself and the group sessions for those newly diagnosed have become a safe haven for youth who can get comprehensive care, interact and confide in others like themselves.

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Researchers to Study Cancer Stress

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Researchers to Study Cancer Stress


UM research examines biological and psychological health mechanisms in cancer patients and their caregiving partners. 

By Deserae E. del Campo
Special to UM News

kim-cancer-stress

Youngmee Kim, associate professor in the College of Arts and Sciences’ Psychology Department, is leading the study.

Cancer affects not only individuals suffering from the disease but their family members as well.

With the assistance of a five-year, $2.5 million grant from the National Institutes of Health, University of Miami researchers hope to gain an understanding of the connection between cancer patients and their caregiver’s health in relation to mutual stress regulatory patterns.

“The research will study and find answers to why cancer patients and their family members’ health deteriorates both psychologically and biologically,” said Youngmee Kim, associate professor in the College of Arts and Sciences’ Psychology Department and lead researcher of the study. “Currently, research is fragmented focusing on how the patient handles stress and how it affects their recovery. Yet, cancer caregivers also report high levels of anxiety and depression, sometimes at higher levels than the cancer patient, and their health is compromised by their elevated stress.”

UM researchers will study the stress regulation patterns between cancer patients and their caregivers, including coregulation (regulating the stress to mutually calm each other’s stress reactions and reduce negative affect and physiological arousal) and coagitation (mutual regulation increasing such reactions).

The coregulation and coagitation will be quantified by evaluating cardiovascular (heart rate variability), neuroendocrine (saliva), and self-reported affective reactivity and regulation in response to a stress situation that is relevant both to health and to close relationships; testing also includes how daily health, such as sleep and mood, as well as longer-term health, such as depression and cardiovascular health of both the cancer patient and caregiver, are affected.

“Findings of this project will help develop novel interventions pertaining to effective and mutual management of stress in daily life and dyadic influences on health promotion,” added Kim.

During a three-year period, UM researchers plan to gather data from 172 heterosexual colorectal cancer patients (86 female, 86 male) and their caregiving partners. Kim hopes to recruit patients living in South Florida.

“Colorectal cancer affects both genders, so we hope to investigate the role of gender in mutual stress regulatory patterns and their health outcomes by studying colorectal cancer patients and their heterosexual partners,” said Kim.

With the results, researchers hope to develop interventions to help cancer patients and caregivers find ways to curb adverse effects of stress and promote better health by using positive coregulation mechanisms. The interdisciplinary study will bring together Charles Carver and Barry Hurwitz, professors from the psychology department; Armando Mendez and Laurence Sands, from the University of Miami Leonard M. Miller School of Medicine; and David Spiegel and Jamie Zeitzer, from Stanford University School of Medicine.

 

 

 

 

 

 

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Survive Cancer? Join the Sylvester Singers Survivor Choir


The music therapy program at Sylvester Comprehensive Cancer Center invites cancer survivors of all ages, abilities, and experience levels to join the Sylvester Singers Survivor Choir. Enjoy free lessons with no commitment and the physical and mental benefits of social singing. All styles of vocal music are welcome.

Rehearsals begin in January and will be held on Mondays from 2:30 to 4 p.m. in the Support Services Building, 1430 NW 11th Avenue, Miami. Parking fees will be covered. For more information, email SCCC music therapist Marlen Rodriguez-Wolfe, a graduate of the Frost School of Music, at marlenr@med.miami.edu.

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Felicia Knaul Participates at 2016 APEC CEO Summit


apec-peru

From left are UM’s Felicia Knaul, Peru Vice President Mercedes Aráoz, and   Merck CEO of Healthcare Belén Garijo.

UM News

CORAL GABLES, Fla. (November 25, 2016)The University of Miami had a key presence in the recently held 2016 Asia-Pacific Economic Cooperation (APEC) CEO Summit in Lima, Peru. Dr. Felicia Marie Knaul, director of the University of Miami Institute for the Americas and professor at the Miller School of Medicine, participated in multiple sessions. Peruvian Vice President Mercedes Aráoz, a UM alumna, and Minister of Health Patricia Garcia hosted and led many aspects of this global landmark two-day event.

A forum of 21 economies in the Asia-Pacific region, APEC seeks to achieve prosperity among member economies. This year’s CEO Summit highlighted the importance of “Quality Growth and Human Development” as well as the key role of women in healthy economies.

During a discussion on “Driving Sustainable Health Systems to Achieve Quality Growth and Human Development,” Knaul focused on the often-ignored roles women play in both the economy and health care.

“Women are the motors of economic growth who also produce the majority of both paid and unpaid health care. Yet, health systems are disabling instead of enabling women,” Knaul said at the Executive Health Dinner held in conjunction with the CEO Summit.

Knaul’s participation was part of ongoing collaboration with Belén Garijo, member of the executive board and the CEO of Healthcare at Merck, who has been spearheading work at APEC on examining the relationship between healthy women and healthy economies. This work builds on her research published in The Lancet on women and health.

While at the summit, Knaul also met with Peruvian Vice President Aráoz, a leading voice and defender of women’s empowerment who graduated from UM’s School of Business Administration. She has accepted an invitation to speak at UM and share her thoughts on women as leaders. In meetings with Garcia, the Peruvian minister of health who graduated from the Miller School of Medicine’s William J. Harrington Fellowship Program, Knaul advanced collaborative work aimed at closing the global divide in access to care for women, particularly cervical cancer screening and treatment, with the Peruvian Ministry of Health, the U.S. National Cancer Institute, and the University of Miami.

In addition, Knaul participated in the Women in Parliaments’ APEC Women Leaders Breakfast, which featured Chilean President Michelle Bachelet, who encouraged ongoing work in which UM is deeply committed on women, health, and the economy. An ongoing series, the breakfast strengthens connections between women in leadership roles in politics, business, and social development initiatives across the Asia Pacific and serves as a network for building dialogue around issues impacting the region.

 

 

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Family Matriarch Sue Miller Passes Away

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Family Matriarch Sue Miller Passes Away


sue-miller-may-2010-001Susan “Sue” Miller, the matriarch of a family whose business and philanthropic enterprise has left an indelible mark on South Florida and, in particular, improved medical care, student life, and the study of Judaism at the University of Miami, died Thursday after a battle with cancer. She was 81.

“Sue Miller was an inspirational force in our community,” said UM President Julio Frenk. “Her tireless and passionate advocacy for educational opportunities helped lift and shape young minds. Her legacy, in particular through the Leonard M. Miller School of Medicine, will endure in the many lives touched by her generosity. The University of Miami family mourns her loss, and our hearts go out to her children Stuart, Leslie, Jeffrey, and the entire Miller family.”

Flags on the University of Miami campuses were lowered to half-staff Thursday to honor the legacy of Sue Miller.

The widow of the late Leonard M. Miller, former chair of UM’s Board of Trustees who built a prominent homebuilding company with an investment of his own capital, Sue Miller had become the torch bearer of her family’s boundless generosity after her husband passed away in 2002.

At the 2004 ceremony where the Millers announced their landmark $100 million gift to UM’s medical school, it was Sue Miller, in a moving speech, who paid tribute to her husband, recognized the many physicians, caretakers, and researchers for their commitment to humanity and the value they place on life, and urged the youngest members of her family to continue its tradition of philanthropy.

“We in this family know that the measure of one’s success is not the wealth accumulated,” she said. “It has nothing to do with shrines erected, nor records broken; it is the inner strength we build each day through hard work, through integrity, and the respect for our fellow man.”

The landmark gift, which renamed the school in Leonard Miller’s honor and was the largest ever to the University at the time, transformed Florida’s oldest medical school, helping it to achieve unprecedented levels of excellence in clinical care, biomedical research, and medical education.

“It would be hard to overstate the impact Sue Miller had on this campus and in this community,” said Laurence B. Gardner, M.D., MACP, interim dean of the Miller School of Medicine. “She was a wonderful friend of the Miller School, as was Leonard, and we are forever grateful for their support. Their efforts will resound for generations to come through our students, as well as the thousands of patients who come to the University of Miami for care.”

Steven M. Altschuler, M.D., senior vice president for health affairs at the University of Miami and chief executive officer of UHealth – the University of Miami Health System, described her as “a matriarch of her family.”

“Sue Miller provided a shining example of service and commitment to our community, and she instilled that into everyone around her,” Altschuler said. “She will be deeply missed.”

In 1998, Sue Miller and her husband donated $5 million to establish the Sue and Leonard Miller Center for Contemporary Judaic Studies. Located on the Coral Gables campus, it is the first academic and research center in the United States that focuses on the issues that have affected the Jewish people in the 20th century and the challenges they face in the future.

At the 2003 dedication ceremony for the center’s new home in UM’s Merrick Building, Sue Miller called the center a vital component of UM’s campus tapestry. “Students must be armed intellectually against the backdrop of Holocaust denial, racists, bigots, and neo-Nazis,” she said. “We must keep our young students informed so they can help build an uplifting society.”

Longtime South Florida residents, the Millers came to Miami in 1954 as newlyweds following Leonard Miller’s graduation from Harvard. Both had grown up in Massachusetts. Soon after the young couple arrived in Miami, Leonard invested $10,000 into a small construction company that ultimately became Lennar Corporation, one of the nation’s leading homebuilders and providers of residential financial services.

Over more than four decades, Sue and Leonard Miller built a distinctive style of philanthropy, inspiring many others to join them in making powerful commitments to improve the community. One of their most passionate causes was the South Florida Annenberg Challenge, now known as the Council for Educational Change, which works to raise the level of student achievement in public schools. Sue Miller served as a trustee of the council and chaired its Educational Advancement Committee.

A dedicated community advocate, she had always believed in fostering the spirit of giving, chairing the Miami Beach Community Campaign to benefit the United Way in her early days as a volunteer for the nonprofit charitable organization. Over time, she played an instrumental role in shaping the United Way of Miami-Dade’s leadership giving program. She was a founding member of the Tocqueville Society, established in 1991 to honor individuals who give $10,000 or more annually.

Sue Miller also founded United Way of Miami-Dade’s Women’s Leadership program, which has raised millions of dollars since its inception while mentoring young women as community leaders. Her work in the women’s leadership arena carried over to the national and international levels, as she once spearheaded and sponsored a leadership exchange between United Way of Miami-Dade and United Way of Jamaica. Her work on the education front, and specifically early education with United Way of Miami-Dade, took her to Washington, D.C. to advocate for increased funding for quality early education.

But it is Sue Miller and her family’s generosity toward UM that is arguably the hallmark of their philanthropic efforts. Among her family’s other notable gifts to the institution: In 2014, The Lennar Foundation, the Lennar Corporation’s charitable arm established by Sue Miller and her husband, gave a lead gift of $50 million to name The Lennar Foundation Medical Center, a state-of-the-art facility that brings the University of Miami Health System to UM’s Coral Gables campus. It will open in December.

The donation was one of the signature gifts of UM’s Momentum2 campaign. Last year, the Miller family propelled UM past the campaign’s $1.6 billion fundraising goal with a $55 million gift, the bulk of which—$50 million—is being used to build the new Miller School of Medicine Center for Medical Education. A ceremonial groundbreaking for the state-of-the-art facility was held earlier this year during a pre-inaugural ceremony for Frenk. During that event, her son, Stuart Miller, lauded his mother as a “primary driver of philanthropy” in his family.

“Both my mother and my father were extraordinary examples of how important it is to give, so a community can build,” he said.

The remaining $5 million of that $55 million gift was donated to the University’s Phillip and Patricia Frost School of Music.

The Miller family’s generosity during the Momentum2 campaign also included a naming gift for the Braman Miller Center for Jewish Student Life for UM Hillel.

In all, Sue Miller and her family have given more than $200 million to the University, primarily to the Miller School of Medicine, the Miller Center for Contemporary Judaic Studies, the School of Law, the Frost School of Music, and the Intercollegiate Athletics Program.

Sue Miller is survived by her three children—Stuart Miller (J.D. ’82), who followed in his father’s footsteps as chair of the UM Board of Trustees; Jeffrey Miller; and Leslie Miller Saiontz—11 grandchildren, and five great-grandchildren.

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