Turf Wars, Part I

Before I get to the substance of this series (covered in the much-anticipated Part II), I think that some background information is needed. If any of you were wondering what I'm up to in D.C., this will give you a much clearer picture. If you have no interest in what I'm up to these day, don't read this entry! You will be reduced to snores... Here goes.

I work for Food & Friends, a D.C.-based organization that provides free freshly-prepared meals and groceries to individuals with serious illnesses. Food & Friends was originally founded in the early 1990s, before aggressive highly-active anti-retroviral therapy (HAART) for HIV/AIDS existed. Due to the stigma associated with AIDS (read about Ryan White if you have any doubt) and the lack of effective medical therapy, people with HIV/AIDS were basically up the creek. Some noble-minded and compassionate people, many from the LGBT community, founded nutritional organizations to help preserve the health and dignity of people who were literally starving because they were too sick to work, shop, and cook for themselves. And thus, Food & Friends was born -- in a church basement.

Since HAART came into practice in about 1996, people with HIV/AIDS have been able to live much more mainstream lives. Although nutritional inadequacies still existed for people with HIV/AIDS, the increased stability in medical treatment allowed Food & Friends to begin focusing individuals with other life-challenging illnesses such as cancer. (We've also moved out of the basement -- thank goodness. By "we," I mean Food & Friends because I currenly do live in a basement.) And thus, my organization currently provides free meals and groceries to individuals with various forms of serious health conditions and an inability to prepare nutritious meals for themselves. Our services are provided on a need-blind basis, and eligibility is only based on medical status.

As HAART changed the way that AIDS impacted society, it also changed the face of Food & Friends' clients. Unexpectedly, the new antiretroviral treatment transformed AIDS from a disease characterized by wasting syndrome to one that could be associated with insulin resistance and obesity. Protease inhibitors, a key element of HAART, have been shown to increase insulin resistance, which in turn can cause hyperglycemia and diabetes. In fact, one study estimated that individuals with HIV/AIDS were more than 3 times as likely to develop diabetes than the general population.

In addition, cancer -- the other primary focus of Food & Friends -- is also linked to diabetes in several ways. First, diabetes has been shown to increase the risk of developing several types of cancer; in fact, both impaired glucose tolerance and diabetes have been shown in separate studies to be independent predictors of cancer mortality. Second, certain cancer treatments such as androgen deprivation for prostate cancer have been shown to increase the risk of developing diabetes. Finally, diabetes has been shown to decrease survival after cancer diagnosis through its extremely serious implications on vascular health.

And for this reason, my work at Food & Friends focuses on co-morbid diabetes. So far, this topic has not been featured in much literature, so the other Emerson Fellow and I are really starting from the ground up. Also, Food & Friends has never systematically looked out our diabetic client population, so we're all essentially waiting to be surprised. My job involves a quantitative and qualitative study of (1) the needs of our comorbidly diabetic clients and (2) the effectiveness of our current (and extremely, extremely limited) services for diabetics. At the present, the only option for diabetic clients is to receive less dessert each week; instead of 6, they receive 1. While this is one method of carb control, many would argue that it is extremely limited in its focus and potential benefits. For instance, if the only food that you're eating comes from Food & Friends, you may find that our carb-rich portions of rice and pasta are too large to eat in one serving. However, since all of it is packged in one meal, I can imagine some of our clients' eating all of the carbs and then experiencing a large blood sugar spike. This is obviously not ok!

So here comes clueless Swiss Beats to walk it out and save the day. I will be running focus groups with diabetics who also have HIV/AIDS or cancer. I will be asking them for their opinions on what we're doing now and what we can do better (which seems like a lot!). I will also be visiting individuals' homes to conduct some in-home assessments that will explore similar themes (while collecting some quantitative data that will be used for statistical analysis). All of the data collection, analysis, and writing has to be completed before February (no pressure!), so I definitely have my work cut out for me.

So that's a big bit of what I'm doing in D.C. I'm going to shut up now because I'm boring even myself. To find out what turf has anything to do with it, you'll have to wait for Part II. (I'll give you one spoiler; no cheesy indoor sports are involved.)