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OBJECTIVE: There have been significant successes in the fight against HIV/AIDS due to the access to rapid HIV testing, interventions to reduce the mother-to-child transmission (MTCT) risk, potent and effective antiviral medications, and other biomedical prevention strategies. The purpose of this work is to demonstrate that Puerto Rico eliminated Mother-to-Child Transmission of HIV (MTCT) following the 2017 World Health Organization (WHO) criteria for validating the elimination of MTCT and Syphilis. METHODS: Existing epidemiological data from Puerto Rico was used to document the elimination of MTCT and Syphilis. Data to calculate the indicators was obtained from the various divisions of the Puerto Rico Department of Health, including vital statistics, surveillance data, and programmatic outcomes. RESULTS: Puerto Rico eliminated MTCT and syphilis, according to the WHO indicators, earlier than other countries. We can trace the outcomes to 1994 using the incidence rate of perinatally-acquired HIV of <50/100,000; to 2007 using HIV perinatal transmission rates for non-breastfeeding countries (<2%), to 2008 using 90% of women receiving ART at delivery, and to 2005 using the incidence rate of congenital syphilis of <50/100,000. CONCLUSION: Not only have we eliminated the MTCT of HIV and syphilis, but the efforts have been sustained since 2000. The elimination of transmission of infectious diseases requires the intersection of scientific feasibility, coordinated interventions, and political will, successfully attained in Puerto Rico.

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Objective. To assess the self-reported impact of hurricane Maria on the perceived academic performance of student pharmacists at Nova Southeastern University's (NSU) Puerto Rico Regional Campus. Methods. A 37-item electronic instrument, the Hurricane Impact Survey, was created and sent by email to all student pharmacists ≥21 years old enrolled at NSU-COP Puerto Rico Campus during the fall 2017 semester. The electronic survey was available through Redcap platform for four weeks. Descriptive statistics, bivariate analysis, and logistic regression were used to analyze students' responses. Qualitative analysis was used to identify emerging themes in the open-ended comments. Results. A total of 150 student pharmacists completed the survey for a response rate of 69% (150/215). More than 70% of student pharmacists perceived that their academic performance was affected after the hurricane. About one third of students reported not being able to function mentally at the same level as they had prior to the storm (n=53, 35%) and reported having difficulty sleeping (n=54, 36%). Female student pharmacists were more likely than male student pharmacists to report not being able to function at the same level mentally as they had before the hurricane (41% vs 17%). In the multivariate analysis, first- and second-year student pharmacists were more likely to perceive a negative impact on their academic performance compared to third- and fourth-year student pharmacists. Lack of preparedness, gratefulness, and campus management were the themes that emerged from the qualitative analysis. Conclusion. Hurricane Maria had a significant impact on the lives of student pharmacists in Puerto Rico. This led to a perception of diminished academic performance, especially among first- and second-year students. The results can be used to guide preparedness and response to natural disasters in academic settings.

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On February 1, 2016, the World Health Organization (WHO) declared the ZIKV virus outbreak a Public Health Emergency of International Concern (PHEIC). Pregnant women and their infants, are vulnerable to the impact of this vector-borne illness (mosquito) and sexually transmitted viral infection. The uncertainty surrounding the possibility of congenital anomalies due to ZIKV infection during pregnancy bring a renewed debate about the rights of women to control their reproductive decisions. Current strategies, resources and services aimed at prevention priorities fall short of responding to a clear framework regarding sexual reproductive health, rights and justice. A comprehensive approach to reproduction, in times of Zika, needs to empower women of reproductive age and their families to make decisions and to act on those decisions. This paper highlights the contributions of the Maternal-Infant Studies Center (CEMI-Spanish Acronym) in close collaboration with the Department of Obstetrics and Gynecology of the University of the Puerto Rico School of Medicine and the University Hospital in providing comprehensive health care to pregnant women with ZIKV or at risk of ZIKV, at the very onset of the epidemic. CEMI approaches the care of pregnant women from a reproductive justice perspective, integrating clinical services, education, research, and advocacy. Transformación Prenatal (Centering Group Prenatal Care, GPC) currently implemented at the Puerto Rico University Hospital High Risk Clinics has been pivotal to achieve this aim. Based on the health professionals' experiences and women's testimonies, we articulate a set of principles and key actions that would benefit women, their family and children.

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The world has encountered a new and serious epidemic which has disproportionately affected fetuses and infants. What makes the Zika virus (ZIKV) epidemic such a threat in our times, is that a whole generation can be affected by birth defects caused by a seemingly innocuous maternal infection, which in most cases go unnoticed and undiagnosed. Spreading to over 80 countries and affecting millions, it is associated with severe birth defects known as congenital Zika syndrome (CZS), which include fetal brain development abnormalities (microcephaly and brain calcifications), retinal abnormalities, and contractures and hypertonia of the extremities. Testing strategies are challenging because of the lack of symptoms and cross reactivity with other viral infections. Obstetrical complications include fetal loss and the need for an emergency cesarean delivery. The rate of CZS has been described as ranging from 5 to 6% among cohorts in the US, reaching 11% for 1st trimester exposure. Prolonged viremia during pregnancy has been documented in a few cases, reaching 89 days after the onset of symptoms in one case and 109 days after such onset in another. If the ZIKV can infect, multiply in, and persist in diverse placental cells, then movement across the placenta, the fetal brain, and the maternal peripheral blood is possible. There is a sense of urgency, and we need safe and effective vaccines and treatments, particularly for pregnant women. If we do not expand testing and develop methods for early diagnosis and treatment, thousands of infants will be exposed to a neurotropic virus that causes severe birth defects and that could also affect the lives of those who form the next generation.

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OBJECTIVES: To evaluate the impact of group prenatal care (Centering Pregnancy) on the rate of Preterm Birth (PTB) and low birth weight. Women were enrolled into Centering Pregnancy (Transformación Prenatal) if they fell in the category of poverty, and had at least one risk for PTB according to known risk factors for low birth weight or PTB. METHODS: Mother's age, parity, risk factors, prenatal/delivery complications, infants' Gestational Age (GA), birth weight, Apgar scores, delivery route, indications for delivery, and use of Neonatal Intensive Care Unit (NICU) were abstracted from charts of mothers who received group or traditional care at the University Hospital in San Juan, PR. RESULTS: More infants were born at term if the mothers received Centering Pregnancy. The mean birth weight and gestational age of the infants were higher (6.59 vs. 6.33 lbs. and 37.8 vs. 36.8 weeks) than for those in traditional care. Centering Pregnancy also had lower rates of preterm birth (27.7% vs. 34.1%) and births earlier than 31 weeks (2.8% vs. 9.9%). All were statistically significant (P<0.05). CONCLUSIONS: We successfully implemented group prenatal care (Centering Pregnancy) for the first time in PR in a complex environment: tertiary care hospital with a high-risk prenatal clinic. Despite having known risk factors for preterm birth, the mothers in Centering Pregnancy had better outcomes. In an environment of adverse determinants of health, the program was effective in reducing the odds for adverse infant outcomes early in life and demonstrating that innovative models of health care can improve such outcomes.

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OBJECTIVE: To examine the impact of the HIV normalization discourse on the life of a group of perinatally HIV-infected (pHIV-I) youth in Puerto Rico. METHODS: A qualitative research study was conducted to explore the life experiences of pHIV-I youth in Puerto Rico. Twenty in-depth interviews were carried out among 12 women and eight men aged 18 to 30 years. Questions focused primarily on their life experiences and the meaning they ascribe to HIV. Interviews were analyzed and interrelationships, connections and patterns were assessed. FINDINGS: Normalization messages were present in most of the participants' narratives. The majority considered their HIV diagnosis like "any other health condition" and most of them had a positive attitude towards life. When study participants positioned themselves from a social perspective, contradictions of normalization messages emerged. Some participants reported that because HIV is highly stigmatized, their rejections, discrimination and stigma experiences are different from those of patients with other chronic conditions. Those with HIV also face unique and difficult situations such as losing family members, dealing with a potentially fatal illness, and maintaining secrecy about their health conditions. CONCLUSION: While the normalization discourse is very common in the medical field, it does not necessarily translate into the personal and social spheres of HIV-positive youth. Interventions to assist patients in dealing with the social implications of the HIV condition are still needed.

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This essay discusses the educational evolution of the University of Puerto Rico-School of Tropical Medicine (UPR-STM) under the auspices of Columbia University. It takes a closer look to what was taught, who taught it and who were the students benefitting from the educational, learning and advanced research activities. It highlights some characteristics of the educational environment that aimed to harvest a well-trained group of scientists, academicians, and practitioners. It examines the characteristics of the faculty and graduates and their role in the teaching and dissemination of knowledge in tropical medicine and closely related fields. The curricula was characterized for its flexibility to accommodate the students' clinical and research interests. With the advent of the 1940s the School started offering public health professionals degrees in addition to the former research-based training. This brought tensions associated to professionalization, the diversification of purposes, the expansion without sufficient resources, and the opening to different levels of students. Maintaining a cadre of well-trained prestigious faculty was always a struggle. Strategies such as visiting professors and joint and ad-honorem appointments were used. Agreements with universities around the world, philanthropic institutions, professional associations, and with different branches of the local and federal government supplemented the resources of the School. In return, the School offered an environment committed to educational standards, networking and a wealth of data for study and discovery.

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This essay introduces a series of five historical articles on the scientific and educational contributions of the University of Puerto Rico School of Tropical Medicine (STM), under the auspices of Columbia University (1926-1949), to the fields of tropical medicine and public health. The articles will appear in several consecutive issues, and will address various themes as follows: 1) historical antecedents of the STM, particularly institutional precedents; 2) the educational legacy of the STM; 3) a history of the STM scientific journal ("The Puerto Rico Journal of Public Health and Tropical Medicine"); 4) the scientific practices and representations that prevailed at the institution; and, 5) a brief sociocultural history of malaria in Puerto Rico, mainly from the perspective of the STM's scientific and public health activities. The authors have systematically and comprehensively studied a wide variety of documents from different sources based on multiple archives in Puerto Rico, the United States and England. The authors treat the fluid meanings of the examined historical encounters from a research perspective that privilege complex reciprocal interactions, multiple adaptations and elaborate sociocultural constructs present in a collaborative exemplar of the modernity of medical science in a neocolonial tropical context.

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This article deals with the historical antecedents of the University of Puerto Rico (UPR) School of Tropical Medicine (STM) under the auspices of Columbia University. It presents a general view of the social, institutional and conceptual factors that were correlated with the establishment of the STM. The authors start by examining the historical continuities and discontinuities present during the imperial transitions between Spanish colonial and U.S. military medicine at the turn of the 20th century. The clarification of these changes is important for the proper understanding of the emergence of tropical medicine in Puerto Rico, marked by the identification of the biological determinant of the so called "peasants' anemia." The essay focuses on two institutional precursor events: the Puerto Rico Anemia Commissions (1904-1908) and the Institute of Tropical Medicine and Hygiene (1912-1914). Their nature and work paved the way for the establishment of the STM. The notions of tropical medicine and diseases are considered as historical concepts. The support of the Rockefeller Foundation to several significant public health activities in Puerto Rico is also examined. Finally, the social and health conditions which prevailed at the time of the creation of the STM have been summarized. In general, the article provides a sense of historical context deemed essential to understand the emergence and evolution of the STM.

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On February 1, 2016, the World Health Organization (WHO) declared the Zika virus outbreak a Public Health Emergency of International Concern (PHEIC). Because Zika virus is a relatively new infection with several transmission routes that include mosquito bites, sexual and possibly blood-related, we present the case for a parallel between the Zika epidemic and the AIDS epidemic for issues that relate particularly to pregnancy and epidemic response. We will discuss the many similarities between both epidemics while acknowledging that the viruses are different and the pathophysiology and disease manifestation are also different. What can we learn of the three decades of awareness campaigns, community involvement, clinical, behavior and prevention research, activism and policy-making related to HIV/AIDS? How can the lessons and experience of dealing with the HIV epidemic can help us deal with the ongoing Zika epidemic? Is there a roadmap that we can follow? Our position is that we can and we should. Parallels between the Zika and HIV/AIDS epidemics particularly in relation to pregnancy can be established. Lessons and successes from the HIV/AIDS epidemic control efforts can guide us towards comprehensive approaches to improve the health of women and infants at risk for Zika.