By Neil Gupta
In the past decade, sub-Saharan Africa, the world’s poorest region, has made enormous strides in the fight against HIV. There are now more than 7.5 million people receiving antiretroviral therapy, 150 times as many as a decade ago. Medications have become more effective and easier to take, and they are now combined so that many patients take as little as one pill a day. HIV testing has become more widely available, and we are detecting the virus at earlier stages before too much damage is done.
With World AIDS Day upon us, however, it is important to keep in mind that the needs in this part of the world are still grim. The U.N. estimates that only 45 percent of pregnant women are tested for HIV and only 35 percent of infants born to mothers with HIV are tested for the virus on time. Treatment for children and adolescents lags dramatically behind that of adults. Around the world, 1.7 million people die of the disease every year. Unfortunately, the UNAIDS goal of 15 million people on treatment by 2015 seems a long way off, and HIV vaccines and “cures” remain in early investigatory phases.
Yet in Rwanda, where just 20 years ago a genocide claimed approximately 1 million lives, the government has transformed HIV care for the poor by redefining the standards for successful treatment. More than three decades into the epidemic, many national and international agencies are still counting the basics—how many people get infected, how many people receive medication, how many patients die. Success in Rwanda, meanwhile, is measured not in the number remaining alive, but rather in how many are actually able to take their medications as directed and suppress the virus in their bodies to a level where it is essentially non-existent. In Rwanda, success is achieved when people living with HIV can earn a living, support their family, raise their children, and care for their community no differently than their peers.
As a physician working for Partners in Health in Rwanda, I have witnessed the impact of this relentless approach to HIV care and treatment, and the stabilizing and uplifting impact it has had on the lives of Rwandans. Patients who would have previously been hospitalized with severe and end-stage complications of HIV are now coming for regular, preventive care. Families and communities previously devastated by the dual impact of insecurity and HIV are now thriving hubs for HIV prevention and treatment. I’ve come to realize that this tiny East African country may have large lessons to share with the global HIV movement.
There’s long been a rivalry between China’s two best-known cities, Shanghai and Beijing, ranging from political cliques to business interests. A few areas where Shanghai supposedly had the lead were air quality and quality of life.
Then this happened: Yesterday and today, Shanghai experienced some of the highest levels of air pollution ever recorded in China. The US Consulate in Shanghai reported levels were “beyond index”—i.e., off the charts.
Shanghai authorities had to warn the elderly and children to stay indoors as air pollution reached levels 10 times what the World Health Organization deems safe to breathe. Even South Korea and Japan are complaining (paywall) about the pollution that’s floating over to them.
This isn’t just a health hazard. It’s also potentially a blow to the economy of Shanghai, which is trying to position itself as the region’s new financial and commercial hub with a new free-trade zone. Bad pollution could make it less likely that businesses and financial professionals from Hong Kong or elsewhere will relocate there.
How did Shanghai, a city that visitors often say is among China’s most charming for its winding alleys, art scene, and proximity to the sea get so polluted? There’s automobile traffic, of course, but the worst offenders are Shanghai’s many coal-fired boilers for electricity production and industrial use. The city wants to get rid of more than 2,500 of them by 2015, replacing the power generation component with natural gas-fired plants and electricity bought from further afield. It plans to replace some of the industrial applications with electric boilers.
Shanghai is also going to enact anti-pollution measures that are much tougher than Beijing’s (paywall). Those include stopping industrial production, shutting down coal-fired power plants and banning trucks carrying dust-causing payloads when the air pollution index hits 300. Beijing’s anti-pollution measures don’t kick in until the air pollution index hits 500—or about where it was in Shanghai on Dec. 6, when the pictures in this piece were snapped.
Next year football fans in Brazil will have more to worry about than tiebreakers and bad calls.
Dengue fever will be near its peak threat when games of the 20th FIFA World Cup are played in three host cities, Simon Hay said in the journal Nature.
Also known as “breakbone fever,” dengue is a nasty virus that causes a high fever, severe headache and pain in joints and muscles. It is transmitted by city-loving mosquito Aedes mosquitoes and thus, is a probably in dense, urban areas.
"Dengue is a persistent threat to Brazilians, as it is to billions of people throughout the tropics," Hay wrote. "It is much less familiar to others, such as Europeans" — and Americans.
To access the risk of dengue at the World Cup next year, Hay and his colleagues analyzed epidemiological records and distribution maps for the virus in Brazil since 2001.
For nine of the cities hosting the World Cup, the records suggest that the main dengue season will have passed before matches start in June and July. But for three cities along the northeast coast — Fortaleza, Natal and Salvador — the risk for the virus is typically still high during these months.
To keep dengue out of the 2014 World Cup, Hay says that Brazilian health officials need to stop the mosquitoes in early spring. “They can target adult Aedes mosquitoes through fogging (the use of aerosol formulations of insecticides that disperse efficiently) and can interrupt breeding by clearing sites at which the mosquitoes lay their eggs.”
The map shows the 12 cities in Brazil hosting the 20th FIFA World Cup football games in June and July 2014.
The background color of the map shows the probability of dengue occurrence scaled between 0 and 1. The scale moves from green (zero probability of occurrence) to red (100 percent probability of occurrence).
The three cities along the northeast coast — Fortaleza, Natal and Salvador — are predicted to still be in the thick of their dengue season when the football games start.
Map from Hay 2013, Nature.
The programming tool provides evidence-summaries for 16 programming approaches for preventing and responding to violence against women in the context of the HIV epidemic.
A key feature of this tool is an inter-active programming wheel that summarizes the 16 ideas and the core values that must guide all programming on violence against women.
The 2013 theme for World AIDS Day is “Shared Responsibility: Strengthening Results for an AIDS-Free Generation.”
Malaria deaths are down (and research spending on malaria is rising)
New HIV infections and AIDS-related deaths are down.
Infant mortality is down.
Also down is maternal mortality.
Download posters, flyers and information resources for World AIDS day
By the World Health Organization’s official tally, the 2009 flu pandemic killed 18,449 people around the world. Those are deaths of people who had laboratory-confirmed cases of the so-called swine flu.
But a fresh analysis says the real toll was 10 times higher — up to 203,000 deaths. And maybe it was twice that, if you count people who died of things like heart attacks precipitated by the flu.
The most important insight from the analysis is that the H1N1 swine flu was hugely variable in how it affected different parts of the world. “The take-home message is that you can have such heterogeneity in a pandemic,” says epidemiologist Lone Simonsen, who led the study. “It was really, truly twentyfold worse in some countries than in others.”
Another message that comes through clearly in the current study is the unusual burden that fell on previously healthy children, teenagers and young adults, especially pregnant women.
"The thing that sets this pandemic apart is not the absolute number of deaths, but the fact that those deaths occurred in a much younger group of people than one normally sees during a typical flu season," Dr. Anthony Mounts of the WHO’s Global Influenza Program writes in an email to Shots. “Therefore, if one thinks in terms of years-of-life-lost, the 2009 pandemic had a much greater impact than a typical influenza season.”
The map shows estimates of death rates from swine flu in 2009-10. The value is deaths per 100,000 for each country. From Simonsen et al., PLOS Medicine, 2013.
Christina Asima seems tired for a 13-year-old. I meet the shy-mannered girl in the remote farming village of Chitera, in the southern African nation of Malawi. She wears a bright pink zip-up shirt and a blue print cloth wrapped up to her chest. Snuggled in that, hugging her side, is a chubby-cheeked baby boy.
My gut assumption is that the infant must be Christina’s little brother. I know 8-month-old Praise is actually her son. Still, it’s startling when, as we speak, she shifts him around front to nurse.
"I was 12 years old when I got married to my husband," she explains softly. "My mom had run away, so I was forced to get married to help my other siblings."
Despite decades of international and local efforts to curb child marriage, it’s estimated that 1 in 3 girls still marries before age 18 in developing countries; 1 in 9 marries before age 15. And the numbers are even worse in Malawi.
In fact, pregnancy and childbirth are the leading causes of death worldwide for girls ages 15 to 19.
Malawi law permits marriage at 15 with parental consent and merely “discourages” it at younger ages. But last summer Chitera passed its own legal age of marriage — 21 — with the ambitious goal that every girl attend college.
Parents in the village now face a steep penalty if parents marry off a daughter before age 21.
"They have to give five goats to the chief," says another local official, Roben Ndrama, "and eight chickens to the village headmen."
In a more humiliating measure, some parents have been made to scrub clean the local health center. Ndrama laughs when I ask if parents get mad about that.
"It’s worked!" he says. "This year there’ve been no early marriages."
Photograph: Christina Asima says she had no choice but to marry last year at age 12 to help care for younger siblings after her mother abandoned the family. But she says her husband was abusive, so she left him, and now must look after her 8-month-old son, Praise, alone. (Jennifer Ludden/NPR)
Female workers administering polio vaccine in Afghanistan.