Julia L. Marcus

Last updated
Julia Lenore Marcus
Alma mater University of California, Berkeley (PhD)
Scientific career
Institutions Harvard Medical School
Thesis Maximizing Effectiveness of HIV Preexposure Prophylaxis Among Men Who Have Sex with Men  (2013)

Julia Lenore Marcus is an American public health researcher and infectious disease epidemiologist at Harvard Medical School. Her research focuses on improving the implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Marcus is also a popular science communicator, and has contributed to The Atlantic .

Contents

Early life and education

Marcus attended Wesleyan University, where she earned a bachelor's degree in sociology and women's studies. [1] [2] Her undergraduate thesis considered the criminalisation of sexual deviance. [1] She moved to the University of California, Berkeley for her graduate studies, where she worked toward a master's in public health. She was appointed as an epidemiologist for the sexually transmitted disease section at the San Francisco Department of Public Health. She eventually completed her doctoral degree in epidemiology at the University of California, Berkeley, where she studied the effectiveness of Pre-Exposure Prophylaxis (PrEP) in men who have sex with men in the United States. [3] After earning her doctoral degree, Marcus moved to the research branch of Kaiser Permanente. [4] There she studied the life expectancy of people living with HIV, finding a dramatic increase in survival over time but a persistent gap compared to people without HIV. [3] [5] Her research on hepatitis C treatment among Black patients at Kaiser Permanente led to the elimination of race-based treatment guidelines for hepatitis C infection by the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases. [6] [7] She also studied the implementation of PrEP at Kaiser Permanente, including studies that are now cited by the Centers for Disease Control and Prevention as evidence of the effectiveness of PrEP. [8] [9] [10]

Research and career

In 2016, Marcus was appointed to the faculty in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. [11] Her research focuses on optimising the implementation of PrEP, including the use of electronic health records and predictive analytics to improve PrEP prescribing. [9] [11] In 2020, she received the Office of Disease Prevention's Early-Stage Investigator Lecture award [12] from the National Institutes of Health. The award [13] recognizes early-career prevention scientists who have not successfully competed for a substantial NIH-supported research project, but who have already made outstanding research contributions to their respective fields and are poised to become future leaders in prevention research.

During the COVID-19 pandemic, Marcus has written about public health communication related to coronavirus disease, including what lessons could be learned from the HIV epidemic. [14] She took part in a CNN town hall on the pandemic, where she advocated for a harm reduction approach rather than “abstinence-only messaging.” [15] In the early years of the AIDS epidemic, HIV prevention campaigns often used moralistic and fear-based messaging, which tended to perpetuate stigma and drive people away from public health efforts. [16] Likewise, Marcus believed that shaming or policing people who were engaging in behaviors that were high risk for coronavirus transmission, including not wearing face coverings or having large gatherings, would be counterproductive. [17] [18] She argued that public health messaging and policy related to coronavirus prevention, including face masks, should be compassionate rather than punitive and support people in overcoming their barriers to adopting preventive behaviors, similar to the approaches used by effective public health efforts to promote safer sex for HIV prevention. [19]

Selected publications

Related Research Articles

<span class="mw-page-title-main">Safe sex</span> Ways to reduce the risk of acquiring STIs

Safe sex is sexual activity using methods or contraceptive devices to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.

Men who have sex with men (MSM) refers to all men who engage in sexual activity with other men, regardless of sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay or bisexual, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. An alternative term, males who have sex with males is sometimes considered more accurate in cases where those described may not be legal adults.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

<span class="mw-page-title-main">Emtricitabine/tenofovir</span> Drug combination for HIV/AIDS prophylaxis and treatment

Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoproxil. For treatment, it must be used in combination with other antiretroviral medications. For prevention before exposure, in those who are at high risk, it is recommended along with safer sex practices. It does not cure HIV/AIDS. Emtricitabine/tenofovir is taken by mouth.

<span class="mw-page-title-main">Pre-exposure prophylaxis</span> HIV prevention strategy using preventative medication for HIV-negative individuals

Pre-exposure prophylaxis (PrEP) is the use of medications to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. The term typically refers to the use of antiviral drugs as a strategy for the prevention of HIV/AIDS. PrEP is one of a number of HIV prevention strategies for people who are HIV negative but who have a higher risk of acquiring HIV, including sexually active adults at increased risk of contracting HIV, people who engage in intravenous drug use, and serodiscordant sexually active couples.

<span class="mw-page-title-main">HIV Prevention Trials Network</span>

The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that brings together investigators, ethicists, community and other partners to develop and test the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. HPTN studies evaluate new HIV prevention interventions and strategies in populations and geographical regions that bear a disproportionate burden of infection. The HPTN is committed to the highest ethical standards for its clinical trials and recognizes the importance of community engagement in all phases of the research process.

HIV/AIDS was first diagnosed in 1981. As of year-end 2018, 160,493 people have been diagnosed with HIV in the United Kingdom and an estimated 7,500 people are living undiagnosed with HIV. New diagnoses are highest in gay/bisexual men, with an estimated 51% of new diagnosis reporting male same-sex sexual activity as the probable route of infection. Between 2009 and 2018 there was a 32% reduction in new HIV diagnosis, attributed by Public Health England (PHE) to better surveillance and education. PHE has described an "outbreak" in Glasgow amongst people who inject drugs, and has campaigns targeting men who have sex with men in London and other major cities. London was the first city in the world to reach the World Health Organization target for HIV, set at 90% of those with HIV diagnosed, 90% of those diagnosed on HAART and 90% of those on HAART undetectable. The UK as a whole later achieved the same target. Under the Equality Act 2010, it is illegal to discriminate against someone based on their HIV status in the UK.

The history of HIV/AIDS in Australia is distinctive, as Australian government bodies recognised and responded to the AIDS pandemic relatively swiftly, with the implementation of effective disease prevention and public health programs, such as needle and syringe programs (NSPs). As a result, despite significant numbers of at-risk group members contracting the virus in the early period following its discovery, Australia achieved and has maintained a low rate of HIV infection in comparison to the rest of the world.

iPrEx

iPrEx was a phase III clinical trial to determine whether the antiretroviral medication emtricitabine/tenofovir could safely and effectively prevent HIV acquisition through sex in men who have sex with men and transgender women. iPrEx was the first human study of an HIV prevention strategy known as pre-exposure prophylaxis, or PrEP.

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

CONRAD is a non-profit organization scientific research organization that works to improve the reproductive health of women, especially in developing countries. CONRAD was established in 1986 under a cooperative agreement between Eastern Virginia Medical School (EVMS) and the United States Agency for International Development(USAID). CONRAD’s products are developed primarily for women in low-resource settings, in that they are designed to be safe, affordable and user-friendly. CONRAD is led by Scientific and Executive Director Gustavo Doncel, M.D., Ph.D. Primary funding for CONRAD comes from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), with additional funding from The Bill & Melinda Gates Foundation and the National Institutes of Health (NIH).

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

Infectious diseases within American correctional settings are a concern within the public health sector. The corrections population is susceptible to infectious diseases through exposure to blood and other bodily fluids, drug injection, poor health care, prison overcrowding, demographics, security issues, lack of community support for rehabilitation programs, and high-risk behaviors. The spread of infectious diseases, such as HIV and other sexually transmitted diseases, hepatitis C (HCV), hepatitis B (HBV), and tuberculosis, result largely from needle-sharing, drug use, and consensual and non-consensual sex among prisoners. HIV and hepatitis C need specific attention because of the specific public health concerns and issues they raise.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

<span class="mw-page-title-main">Elioda Tumwesigye</span> Ugandan politician

Elioda Tumwesigye is a Ugandan politician, physician, and epidemiologist who has served as minister of science, technology and innovation in the cabinet of Uganda since June 2016. From March 2015 until June 2016, he served as the minister of health.

HPTN 083 is a 2016 clinical trial which compares cabotegravir injections with oral use of Emtricitabine/tenofovir as pre-exposure prophylaxis ("PrEP") for prevention of HIV/AIDS.

Elizabeth Anne Bukusi FAAS is a research professor working within the field of obstetrics and gynaecology, and global health. Bukusi's main areas of research focus around sexually transmitted infections, women's health, reproductive health, and HIV care, prevention and treatment. Bukusi is the Chief Research Officer at the Kenya Medical Research Institute (KEMRI) and led a "landmark" study on the use of PrEP in Kenya.

In January 2018, the provincial government of British Columbia (BC) began providing individuals at high risk of HIV infection with pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at no cost. High risk individuals include men and trans women who have sex with men, people who inject drugs, and people who have sex with people living with HIV. One year following this policy change, which is delivered as part of the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE)'s Drug Treatment Program, almost 3,300 people have been prescribed with PrEP or PEP.

<span class="mw-page-title-main">Oni Blackstock</span> American physician and academic

Oni Blackstock is a primary care and HIV physician, researcher, and founder of Health Justice, a racial and health equity consulting practice. She previously served as assistant commissioner for the Bureau of HIV for the New York City Department of Health, where she led the city's response to the HIV epidemic. Her research considers the experiences of women and people of color in healthcare. During the COVID-19 pandemic Blackstock shared advice on how people in New York City could maintain sexual health and slow the spread of COVID-19 as well as guidance for people with HIV and HIV care providers about the intersection of HIV and COVID-19.

Nelly Mugo is a Kenyan obstetrician, gynaecologist and scientist involved in HIV and cervical cancer prevention research. She is a Research Associate Professor, Global Health in the University of Washington and the Center for Clinical Research, Kenya Medical Research Institute. She is also a member of the African Academy of Sciences. In 2021, Mugo became the inaugural recipient of the Gita Ramjee Prize.

References

  1. 1 2 "Theses, Feminist, Gender, and Sexuality Studies - Wesleyan University". www.wesleyan.edu. Retrieved 2020-07-18.
  2. ↑ "C*** Crazy". City Journal. 2015-12-23. Retrieved 2020-07-18.
  3. 1 2 Marcus, Julia Lenore (2013). Maximizing Effectiveness of HIV Preexposure Prophylaxis Among Men Who Have Sex with Men (PDF). Berkeley, CA. OCLC   904238184.{{cite book}}: CS1 maint: location missing publisher (link)
  4. ↑ "Life Expectancy Gap Has Decreased But Still Persists for Individuals with HIV". Kaiser Permanente Division of Research. Retrieved 2020-07-18.
  5. ↑ "Narrowing the Gap in Life Expectancy for HIV+ Compared With HIV- Individuals". CROI Conference. 16 February 2016. Retrieved 2020-07-18.
  6. ↑ "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C". HCV Guidelines. Retrieved 2020-08-17.
  7. ↑ Marcus, Julia L.; Hurley, Leo B.; Chamberland, S.; Champsi, J.H.; Gittleman, L.C.; Korn, D.G.; Lai, J.B.; Lam, J.O.; Pauly, M.P.; Quesenberry, C.P.; Ready, J.; Saxena, V.; Seo, S.I.; Witt, D.J.; Silverberg, M.J. (2018-03-11). "No Difference in Effectiveness of 8 vs 12 Weeks of Ledipasvir and Sofosbuvir for Treatment of Hepatitis C in Black Patients". Clin Gastroenterol Hepatol. 16 (6): 927–35. doi: 10.1016/j.cgh.2018.03.003 . PMC   5962408 . PMID   29535057.
  8. ↑ "Effective HIV Prevention Strategies | HIV Risk and Prevention Estimates | HIV Risk and Prevention | HIV/AIDS | CDC". www.cdc.gov. 2019-11-12. Retrieved 2020-07-31.
  9. 1 2 Marcus, Julia L.; Hurley, Leo B.; Krakower, Douglas S.; Alexeeff, Stacey; Silverberg, Michael J.; Volk, Jonathan E. (2019-10-01). "Use of electronic health record data and machine learning to identify candidates for HIV pre-exposure prophylaxis: a modelling study". The Lancet HIV. 6 (10): e688–e695. doi:10.1016/S2352-3018(19)30137-7. ISSN   2352-3018. PMC   7152802 . PMID   31285183.
  10. ↑ Venter, Willem D.F. (2016). "What does preexposure prophylaxis mean for treatment; what does treatment mean for preexposure prophylaxis?". Current Opinion in HIV and AIDS. 11 (1): 35–40. doi:10.1097/coh.0000000000000208. ISSN   1746-630X. PMID   26545265. S2CID   1682479.
  11. 1 2 "Department of Population Medicine". populationmedicine.org. Retrieved 2020-09-04.
  12. ↑ "2020 Awardee". Office of Disease Prevention. Retrieved 2020-10-19.
  13. ↑ "Nomination and Selection Process". Office of Disease Prevention.
  14. ↑ "Julia Marcus, PhD, MPH, Author at Harvard Health Blog". Harvard Health Blog. Retrieved 2020-07-18.
  15. ↑ "Epidemiologist Warns 'All-Or-Nothing' Messaging On Coronavirus Can Backfire". huffpost.com. 22 May 2020. Retrieved 2020-09-04.
  16. ↑ Katwala, Amit (2020-06-27). "The rise of mask shaming reveals the tricky science of social change". Wired UK. ISSN   1357-0978 . Retrieved 2020-07-18.
  17. ↑ Krasnoff, Barbara (2020-06-25). "How do you deal with people who refuse to wear a mask?". The Verge. Retrieved 2020-07-18.
  18. ↑ "Mask-Shaming Won't Work. Try These 5 Things Instead". Yes! Magazine. Retrieved 2020-07-18.
  19. ↑ "Why we need to market masks like condoms". CityNews Edmonton. 2020-07-03. Retrieved 2020-07-18.
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