Archive for category: Health

Information and stories on health topics.

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Russian Healthcare Declines

In the winter of 2013-14, residents of Russia’s Pskov region were left waiting in the cold at their train stations due to alleged obstructions on the tracks. Oddly, neither snow nor ice had blocked paths of the trains; rather along the tracks lay the shivering bodies of numerous Russians in need of medical attention.

A lack of accessible health service or transportation options had compelled these ill residents to prostrate themselves on the cold steel in hopes of hitching a ride to metropolitan centers with hospitals.

Even in city centers like Moscow and St. Petersburg, the situation has become dire. Hunger strikes aimed at preventing the healthcare cuts have occurred in the past two years in both of these major metropolises.

Stories like these call attention to the increasingly desperate state of Russia’s healthcare system, which has experienced significant consolidation and downgrading. In response, many Russians, as these incidents indicate, are quite literally willing to die for better healthcare.

The fierce will for state-sponsored, universal healthcare coverage has persisted since the Soviet era, while the quality of Russian healthcare has not. According to The Moscow Times, “from 2005 to 2013 the number of health facilities in rural areas fell by 75 percent, from 8,249 to 2,085. That number includes a 95 percent drop in the number of district hospitals, from 2,631 to only 124, and a 65 percent decline in the number of local health clinics, from 7,404 to 2,561.” In March of 2015 leaked government reports claimed that over 10,000 medical professionals in the capital had been laid off after the closure of 28 clinics and hospitals. The reports outlined 14,000 further firings leading up to 2017.

Between the years of 2013-14, 90,000 medical workers lost their jobs despite reports of significant shortages of personnel across the country. That same year, The Audit Chamber, a government agency, had attributed the 3.7 percent spike in hospital deaths to spending cuts. In total, 18,000 Russians needlessly lost their lives.

This is all a part of the Russian Government’s recent ‘optimization’ which aims to eliminate inefficiency by consolidating healthcare resources in larger hospitals. Consequentially, it entails the closure of smaller more local treatment centers.

Putin and his administration are determined in their efforts. They seem to have ignored funding and personnel issues and have instead lauded the healthcare system during a meeting in April 2015. Contrary to their own government reports, they claimed an alleged increase in rural medical coverage and a $4 billion expansion of healthcare funding.

For the doctors that have survived ‘optimization’, life in the workplace has become chaotic. Bloomberg News reported on a female family doctor who had to increase her workday from eight hours to 12 hours. On top of this, she admitted to working three weekend shifts per month for the past year.

One clinic has restricted the average appointment time between the doctor and patient to a mere 12 minutes. This gives the doctor just enough time to fill out paperwork.

Those unwilling to compromise effective treatment will defy these strict time limits. This comes at a cost, however, as many doctors have been forced to regularly work overtime in order to provide adequate care.

For patients, this entails excessive waiting times for treatment. With so few staff, they can expect to wait hours just to meet with a specialist. Those in need of ultrasounds often get put on a six week waiting list. Last year one could expect an ultrasound in a matter of days.

Tired of waiting, many Russians have sought better medical care by taking to the streets in protest. Several demonstrations challenging recent healthcare developments took place in Moscow during the fall and winter of last year.

With approval ratings for the country’s healthcare system under 20 percent according to a recent poll, Putin has also displayed some hesitation. During a conference in the fall of last year, he admitted that his administration had not yet considered everything. If protests continue it is perhaps possible even the notoriously headstrong Putin will alter the course of Russia’s healthcare.

– Andrew Logan

Sources: Bloomberg, The Moscow Times, Radio Free Europe/ Radio Liberty, The Washington Post

Photo: Bloomberg Business

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Can the Infectious Disease Yaws Be Eradicated?

Can the Infectious Disease, Yaws, be Eradicated SoonYaws is a relatively unknown disease in the developed world, but in poor tropical areas of Africa, Asia, Latin America and the Western Pacific, it is common and can lead to disfigurement and disability.

Yaws is the most common endemic treponematoses, a group of bacterial infections that also includes nonvenereal syphilis and pinta. All of these infections are transmitted through non-sexual contact with an infected person. They can cause skin lesions, bone pain, bone lesions, nose deformities and the thickening or cracking of a person’s hands and soles of the feet. The World Health Organization (WHO) estimates that 75% of infected people are under 15 years of age, with most cases seen in children aged 6 to 10. Gender is not a determining factor of infection.

Yaws is spread through skin-to-skin contact, usually after a small injury occurs, something common when children play. Yet, WHO states that “overcrowding, poor hygiene and socioeconomic conditions facilitate the spread of the yaws.”

The disease is not life-threatening, which is likely why it became a neglected disease in the scope of global disease work. But if left untreated, a person can become permanently disfigured and disabled. Such a diagnosis is bad for anyone infected with the disease, but since mostly children suffer from yaws, it becomes a life-long issue if not resolved quickly. When a child contracts yaws, their ability to go to school is jeopardized. If left untreated, absenteeism rises among children and their future employment, especially feeding their families through farming, is impacted.

It has long since been thought that yaws could be a disease that can have complete eradication since humans are the only carriers of the disease. Previously, initiatives to eradicate yaws were undertaken with almost complete success. But the mass effort was prematurely lifted and the disease returned, though not quite on the same scale as before.

Recently, the idea of complete eradication has come back up. The two most effective antibiotics to treat yaws are azithromycin and benzathine penicillin, both of which can be given with relative ease. Even though no vaccine is available for yaws, if early diagnosis is achieved, treatment with the antibiotics can occur and sanitation can be improved to help stop the spread of the disease. With the steps, the end of yaws is in sight.

There have already been cases of previously endemic countries achieving complete eradication, including India. The Yaws Eradication Programme (YEP) was launched in India in 1996 with the goal to have complete eradication in the country. In 1997, 735 cases of yaws were reported; in 2004, the country was considered to have achieved “Zero Case.” Because not all cases of yaws are reported, only time will tell if complete eradication can be sustained, but right now all signs are pointing to success.

With great things already happening in India and a plan in place to achieve more success globally, yaws should be eradicated from remaining endemic countries by 2020.

– Megan Ivy

Sources: PubMed.gov, WHO 1, WHO 2
Photo: Chacha

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Poverty and Engagement in Arts, Culture and Leisure

artsLast year, the U.K. Department of Culture, Arts and Leisure published a literature review that summarized research regarding poverty and its impact on people’s engagement with culture, arts and leisure. While it drew some fairly obvious conclusions, other findings were insightful and thought-provoking.

The first object of research was measuring how much poverty impacts people’s participation in sports. It found that adults who lived under the poverty line played fewer sports for far less time. These findings replicated those in similar studies in Canada and Australia. The lack of involvement in sports is believed to increase health risks such as obesity that are already present in lower income groups.

Some people blamed the lack of sports facilities provided in their neighborhoods. Financial and logistical barriers are a constraint. Sports equipment and transportation to and from facilities may cost extra money that the family cannot afford to spend. Moreover, parents who work more than one job find it difficult to take the time out to supervise their children, especially if their neighborhood is perceived as unsafe.

Another reason for poorer people’s reluctance to take part in sports is that they are simply not interested in them, as a study in Ireland concluded. Research in Australia demonstrated that even with ease of access to facilities and training, lower income children and adults were still less likely to play sports than their middle and upper income counterparts.

The second objective of the research was to determine how poverty impacts people’s engagement with arts, libraries and museums. Unsurprisingly, people living under the poverty line were less likely to be interested in or involved in their community’s culture. Even libraries, which are free and open to the public, see lower levels of engagement from poorer people. Children living in poverty are more likely to use the computer or TV for entertainment.

In addition to the obvious barriers of transportation costs and time constraints (for adults), poorer people frequently voiced the view that arts were for “other people and not for them.” They reported feeling out of place and uninterested. In their daily lives, art was perceived as being completely irrelevant.

To fight the main barriers to engagement in sports and culture — a dearth of facilities, extra costs and a lack of interest — the literature review recommends a few solutions: community-based solutions, personal and trusting relationships between mentors and participants, and lower costs.

– Radhika Singh

Sources: UK Department of Culture, Arts and Leisure, Art Council of Wales
Photo: PxHere

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Improving Vaccine Shelf Life

Vaccine-Shelf-LifeIt is hard enough to find vaccines for the world’s deadliest diseases, but scientists also grapple with another concern: shelf life.

In order for vaccines to remain potent, they must be kept within a range of suitable temperatures. For instance, they are rendered useless in excessive heat.

The effects of such temperature fluctuations can be substantial. According to the global health nonprofit PATH, the cholera vaccine Dukoral has a shelf life of 36 months when stored at temperatures between 2-8 degrees Celsius. If stored at 27 degrees Celsius, the vaccine will only last 14 days.

This poses a problem for those performing vaccinations in the developing world; in countries near the equator, the heat can be stifling. That means vaccines could expire when they are needed most.

Compounding the problem is the lack of electricity in certain regions. With high temperatures and no reliable way of keeping supplies cold, many vaccines go to waste.

At Intellectual Ventures Lab, scientists are developing a new device to keep vaccines at the ideal temperature, as part of their Global Good program. The Arktek, a passive vaccine storage device, is able to keep vaccines cold for a month with no electricity. It uses the same techniques to remain protected from extreme temperatures as employed by spacecrafts.

The device was put to the test during the recent Ebola outbreak. When health care workers started to test Ebola vaccine candidates, they needed a way to keep them cold during transport and storage.

The vaccines were required to be kept between -60 and -80 degrees Celsius, well below the usual temperature range of the Arktek device. However, with some quick modifications and carefully conducted tests, the container was modified to support such low temperatures.

That meant scientists could prolong the shelf life of experimental Ebola vaccines, if only for a few days longer.

– Kevin McLaughlin

Sources: Intellectual Ventures Lab, PATH, World Health Organization
Photo: Science Museum

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Sexual Health of Adolescents in the Developing World

sexual_health
There are more than 1 billion teenagers worldwide. Seventy percent of them live in developing countries. According to the Demographic and Health Surveys and the AIDS Indicators Survey, the average age that young people in impoverished countries have their first sexual encounter is, at the lowest, age 16 or younger, and, at the highest, 19.6.

Just like in developed nations, with sexual activity comes the risk of sexually transmitted diseases and unwanted pregnancies. Unlike wealthier nations, these impoverished countries lack adequate healthcare. In places such as Sub-Saharan Africa, AIDs is an epidemic. Two-thirds of those infected are adolescents.

Adolescent girls run the greatest risk for sexual and reproductive health threats. A young girl that becomes pregnant who lacks access to healthcare faces many serious health risks. Pregnancies, child-birth and abortions are all perilous. The likelihood that a 15-year-old girl in a developed nation could ultimately die of maternal complications is 1/3800. Compare this to just 1/150 in the developed world.

Meet Reem: she is a 15-year-old girl living as a refugee in a camp. Her two-month-old baby is underweight because it was born prematurely and because Reem was never taught how to breastfeed. She has no one to help her, her husband was killed before the baby was born, and her mother was separated from her in the national conflict.

In other instances, girls marry older men. Hibo is a 13-year-old girl living in a Somalian refugee camp. The oldest of five children, she is responsible for helping her mother care for the family. Her parents are planning to marry Hibo to a wealthy landowner that will bring the family much-needed money and honor. She has been told that it is her duty to marry, serve her husband, and bear him children.

Married women like Hibo are encouraged to have children as soon as possible. Their social status and identity are associated with raising children. Being childless is frowned upon. Unfortunately, wedding older men who have had previous partners bring the potential for STDs.

Young people also face the danger of sexual violence. A national survey in Swaziland revealed that one-third of girls aged 13-24 suffered sexual abuse before the age of 18. Boys face abuse as well but are reported as being less likely to reach out for help from healthcare providers.

Although young people are getting married at an older age, the amount of premarital intercourse is increasing. At the same time, contraceptive use for all teens is low. In Sub-Saharan Africa, contraceptives are used by a low of 3% of sexually active adolescents in Rwanda and a high 46% in Burkina Faso.

Due to the U.N.’s Millennium Development Goals, more youth have greater access to formal education. Health officials decided that school-based sexual/reproductive health programs were the perfect way to educate adolescents. Yet, a survey of these programs and their effects have produced varied results. Not all adolescents attend school, and the funding for these programs is not always there.

The Save the Children organization understands that if there are no programs that specifically reach young people with sexual health programs and education, they will never access the care and knowledge they need. The organization has set up teen-accessible places to teach them about safe sex and offer health services.

Their methods and the continuation of school-based programs have been yielding promising results in places like Mexico, Nigeria and the Dominican Republic. Young people are taking more measures to prevent STDs and unwanted pregnancies.

– Lillian Sickler

Sources: Guttmacher Institute, Women and Children First (UK), Alliance for International Youth Development
Photo: The Times

The AIDS Crisis in Lesotho

AIDS_Crisis
Surrounded on all sides by its neighbor South Africa, the little country of Lesotho is the largest enclave in the world; larger than its only rivals Monaco, San Marino and Vatican City.

Essentially a landlocked island amidst African highlands, Lesotho also features the lowest point of any country in the world, measured at 1400 meters or 4,953 feet. However, it has another, less fortunate distinction; it places third on the list of countries with the highest HIV/AIDS prevalence.

In total, nearly one-quarter of the population lives with HIV, which accounts for 360,000 people. Close to 26,000 new HIV infections and 14,000 AIDS deaths were recorded in 2011. Of these infections, 40,000 are in children while around 60 percent of adults with HIV are women. On top of these harrowing figures, 42 percent who need treatment cannot access it.

Lesotho’s first reported incidence of HIV occurred in 1986 and accelerated rapidly into a national epidemic. While the government made attempts to monitor and treat the illness, the proved insufficient due to poor finances and infrastructure. Just six years later, in 1992, 3.2 percent of pregnant women between the ages of 20 and 24 had HIV. By 1996, the figures had exploded; in just four years, a quarter of the same demographic was living with HIV.

The sheer extent of this illness has had a detrimental impact on the development of Lesotho. The most productive age group in the country is also the most infected. This has compromised their ability to work and sustain themselves and their families.

For the Basotho people, family is vital. For centuries, extended relatives have supported one another through any hardship. However, AIDS/HIV has eroded this support system by orphaning 220,000 children. This has left children as the head of families in which the working generations are debilitated or have died.

One can notice the extent of the AIDS epidemic by looking at the data. It has significantly shortened the life span of the average Basotho to just 48.3 years from nearly 60 years in 1990.

Moreover, the two main statistics most indicative of development, GDP and the Under Five Mortality Rate have worsened. Since 1990, the Under Five Mortality rate has risen from 85 in 1000 to 100 in 1000. While from 1970 to 1990 the average annual growth rate of Lesotho stood at 3 percent, it fallen to 2.6 from 1990 to 2012.

With such a widespread influence throughout Lesotho, the nation’s government, along with international aid groups has made efforts to tackle the AIDS crisis. The first step was to provide universal testing for the entire country. Beginning in 2004, the program called “Know Your Status” involved training thousands of health care workers to perform swift HIV testing. However, the government has only trained one-quarter of the required workers, failing to meet its objective of universal coverage.

Besides testing, the government has implemented a variety of campaigns to confront the epidemic, but with mixed results. It introduced HIV/AIDS awareness to the curriculums of both primary and secondary schools. A ‘road show’ was also planned to inform communities about AIDS/HIV while providing both entertainment and HIV testing. Despite the efforts, only 29 percent of 15 to 24-year-old males and 29 percent of females from the same demographic had an understanding of HIV prevention.

Unlike awareness efforts, the distribution of cheap condoms has also served as an effective mainstay of HIV intervention in Lesotho. In 2001 affordable condoms began selling throughout communities. The sales spiked, with the number of distributors tripling and the number of condoms bought doubling.

In order to help those already infected with AIDS, the government has worked to provide better access to antiretroviral treatments. Since 2004 the government of Lesotho has sought to make antiretroviral treatment free to those in need. With only 89 trained medical professionals in the whole country, the program lagged behind at first. But since expansion in 2008 coverage has expanded to around 86,000 people, or close to 60 percent of those needing treatment. Still, only a quarter of children in need receive antiretroviral treatment.

While Lesotho has become closer to controlling its AIDS epidemic it has come at the cost of the nation’s development. Despite its aspirations, the country’s inadequate infrastructure, health care and budget have hindered its efforts. With more foreign assistance, Lesotho has the capacity to get back on its feet.

– Andrew Logan

Sources: Avert, CIA, PEPFAR, UNDP, UNICEF 1, UNICEF 2
Photo: NY Times

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Breeding Superbugs

SuperbugsResearchers have been tracking the increase of the global spread of antimicrobial-resistant infections, also known as superbugs. But the reason for this increase surprised the researchers — drug co-pays seem to have increased superbugs.

Superbugs are defined as “strains of bacteria that have changed (or mutated) after coming into contact with an antibiotic. Once this happens, these bacteria are ‘resistant’ to the antibiotic to which they have been exposed, which means the antibiotic can’t kill the bacteria or stop them from multiplying.”

Many individuals may suggest going back to a doctor and receiving a new prescription for a different antibiotic. But in the developing world, many individuals cannot afford the co-pays for multiple doctor visits, let alone the cost of multiple antibiotic prescriptions.

With the rising costs of prescriptions, many individuals are turning to informal or black markets for their prescriptions. The pills that they buy from black markets may be lower quality, prescribed inappropriately or dosed incorrectly. All of these factors can lead to the spread of superbugs.

According to an analysis of data from 47 countries published in the Lancet Infectious Disease Journal, the amount people spend out-of-pocket on healthcare has turned out to be a better predictor of antibiotic resistance than poverty, sanitation or livestock production.

In the first major report last year, the World Health Organization (WHO) has called antibiotic resistance “a growing public health threat.” This report, which tallied the level of antibiotic resistance in each country, warned that “many of the available treatment options for common infections in some settings are becoming ineffective.”

According to the Centers for Disease Control, each year superbugs cause 2 million people in the United States to become sick, killing 23,000. With the advanced healthcare available in the United States, what effects do superbugs have on the developing world?

With the WHO report in mind, researchers from Stanford University in California and Gandhi Medical College & Hospital in India set out to determine whether the levels of resistance in low and middle income countries were linked to the direct healthcare costs that patients pay.

The researchers found that in countries where patients paid a higher share of healthcare costs, there was a higher level of antibiotic resistance. But this was also only evident in countries that charge co-payments for prescriptions.

While this data does not prove that higher prescription costs cause greater antibiotic resistance, it does show that the two are linked.

Co-payments are usually used to discourage people from seeking unnecessary healthcare but are currently having the opposite effect. With higher co-payments, patients that cannot afford the cost must look elsewhere for their prescriptions: the black market.

Not only are patients endangering themselves with unknown prescriptions and doses, but they are also enabling antibiotic resistance. There needs to be a change so that patients are able to receive needed antibiotics at a reasonable price. If not, antibiotic resistance will become a major problem in the future.

– Kerri Szulak

Sources: ABC Health & Wellbeing, Bloomberg Business
Photo: Live Science

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The Silver Standard for Eradicating Malaria

eradicating_malariaEvery minute, a child dies from malaria. 90 percent of the deaths from malaria occur in the poorest African countries. Malaria is a preventable, treatable disease, yet more than half of the world’s population continues to be at risk.

Malaria has long been established as a poverty-related disease. Poverty is both a cause and effect of this potentially lethal disease: poorer people can often not afford preventive measures, and the contraction of disease leads to further economic loss. Consequentially, a substantial investment of time and resources into finding a solution is necessary to interrupt this vicious cycle.

The most successful method to combat the problem has been vector control- that is, to eradicate the mosquito transfer agent. Traditionally, the efforts have been to implement better preventative measures, primarily through insecticides, which are both expensive as well as environmentally harmful.

A more modern approach to the problem is to employ biotechnology to eliminate the mosquito vector more economically and effectively. This encompasses targeting the mosquito at a subcellular level by using a cytotoxic agent- that is a chemical that disrupts the mosquito’s cellular machinery.

Of these methods, the use of silver nanoparticles is becoming increasingly popular as nanotechnology advances. Silver nanoparticles are miniscule, nanoscale pieces of silver, which is highly toxic at cellular levels. This toxicity is being explored in its usages as antimicrobial and pesticidal agent.

Silver nanoparticles are traditionally synthesized using laboratory-grade reagents, which tend to be expensive and not readily available. Many researchers are now looking to phytosynthesis as an answer. The process of phyto-synthesis manipulates the ability of plants to carry out reactions to use in chemical synthesis. For instance, the phytosynthesis reaction of plants can be alternatively used to reduce silver ions to silver atoms.

Recent endeavors to utilize the phytosynthesis capabilities of plants have centered on the use of plant waste products to maximize productivity and minimize cost. In a recent study, researchers used the husk of coconut plant- abundant in the tropical regions plagued by malaria. They used the husk of coconut, which is a waste product from the fruit, to synthesize silver nanoparticles from silver nitrate. The synthesis eliminated the use of a synthetic reagent, and achieved successful results.

The nanoparticles produced were then used by the researchers to treat larval Culex quinquefasciatus, a species of mosquitos found in sub-tropical regions which is similar to the malaria mosquito in its transmission mechanism. The nanoparticles were observed to have significant larvicidal effect on the mosquito.

The study indicates the great potential of phytosynthetic methods to produce cheap and effective insecticides. By using plants indigenous to the tropical areas where malaria is most prevalent, the insecticidal measures of prevention can be made more accessible to the people. The use of waste products of coconut in the process is considerably cost-effective and eco-friendly.

Although the implementation of these innovative techniques may be some way in the future, ingenuity in research offers promising new horizons for a better, healthier world. To borrow Einstein’s words, it is time our technology caught up with our humanity.

– Atifah Safi

Sources: WHO 1, WHO 2, Science Direct
Photo: Flickr

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How World Rowing Is Changing Poverty

How World Rowing Is Changing Poverty

Clean water is a very important part of people’s lives. However, for many poorer nations and communities around the world, access to clean water is limited. Some people have to travel for several miles just to find drinkable water. Many individual people and organizations have tackled this problem, but there is no singular solution to having clean water.

In 2011, World Rowing, the international organization, for rowing began a project with the World Wildlife Fund (WWF) to give to disadvantaged people the vital thing that makes the sport of rowing possible: water. The alliance began as a way to educate people about the importance of clean, fresh water, not just for humans but also for the environment.

WWF and World Rowing further developed this movement to find an area where water was endangered the most by various threats to water security. Some such threats include the effects of pollution, industry, agriculture, flooding, damming, hydropower, other ecosystems and human consumption. The resulting location was the lower water basin of the Kafue River in Zambia. This basin is a key area for economic resources, but it is also an important home to wetland wildlife and the main source of clean water for locals.

The issue at hand is how to reconcile the importance of the water basin with the harmful environmental effects. If people were to stop using it for industrial and agricultural purposes, the area would lose a large portion of its economic support, which could throw more people into poverty. However, if industry pollution and pesticides continue to contaminate the water, then there will be no safe drinking water.

The project has two goals that, if reached, can help end water insecurity and poverty. The first is to create a world-class water research center at the Kafue River Center. The center will team up with universities and researchers from around the world. Here they can study the effects of pollution, various ways to clean water, the balance of industry and wildlife and much more. The results found here will be open to the public, so that all water sources can benefit from the research.

The center’s second task is to provide a meeting place for all the people involved with this water project and other similar projects around the world.

While the project will do work to clean up the water in the Kafue Basin and provide cleaner water for the people, the research done at this center will help the world. It is a local project with a potentially global impact that can help solve the issue of water resources and poverty by finding a balance for all of the uses of water. The research here will hopefully solve the problems of water usage and water access, problems that keep people in poverty. It will be a balance that can provide sustainability and allow people to bring themselves out of poverty.

– Katherine Hewitt

Sources: World Rowing, World News
Photo: International Water Security Network

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The AIDS Crisis in Thailand

The_AIDS_Crisis_in _Thailand
When many think of places most devastated by the AIDS crisis, usually Sub-Saharan Africa first comes to mind. However, the disease also has spread to parts of South and Southeast Asia, where it is perhaps not as destructive, but still a major public health concern. Countries such as Indonesia, Laos, the Philippines and Sri Lanka all have rising rates of HIV/AIDS deaths. Thailand is particularly afflicted by this auto-immune disease. In total, nearly 500,000 people live with HIV/AIDs.

Mechai Viravaidya, the former politician and activist who first began the campaign to fight AIDS two decades ago, has become vocal once again. He claimed that “The government has fallen asleep at the wheel” and that HIV has become a health crisis in Thailand.

The figures seem to confirm his decree. HIV/AIDS remains the number one cause for premature death in Thailand and HIV infections are now rising. Since 2011, the number of AIDS-related deaths has also been rising.

The burden of the epidemic has fallen heavily on certain high risk groups. One such group is young people; those aged between 15 and 24 accounted for around 70% of the annual sexually transmitted HIV cases.

Among young people, certain minority and marginalized demographics are even more likely to contract HIV. In Thailand’s capital, Bangkok, the percentage of gay men with HIV has risen drastically. While in 2003 an already shocking 17% of homosexuals living in the city had HIV, by 2011 those figures had risen to nearly 30%.

Two more marginalized groups, intravenous drug users and migrant sex workers, are also vulnerable. Unlike their counterparts in brothels, informal, migrant sex workers do not receive information or health services that would help them to avoid contracting HIV. Those who inject drugs are likely to receive inadequate government support for their addictions; the Thai government will only provide addicts with 11 sets of clean needles a year compared to the 88 needles deemed necessary.

Yet, as bad as the crisis is now, it was once far worse. From 1991 to 2003, Thailand experienced a 90% decline in the number of HIV infections. This trend, until recently, had continued; while in 2005 the annual total of new infections was around 15,000, in 2013 it fell nearly in half to only 8,000. Much of this dramatic decline can be contributed to comprehensive awareness campaigns and the widespread dissemination of condoms throughout the sex industry.

So, then, why has this progress stagnated in recent years?

The answer lies in generational changes that have taken place over the past 20 years. The advent of smart phones and the expansion of social media on the Internet have allowed people to connect and have sex without having to meet in public places such as bars, where many of the awareness campaigns took place. This shows in the data; according to a UNAIDS report, “There is no clear sign of improvement in knowledge, condom use and STI among general population and youths on the national scale.”

AIDS was once the number one cause of death in Thailand when the epidemic was at its peak. Today AIDS is the fifth leading cause of death. With renewed efforts, hopefully it can fall even lower on that list.

– Andrew Logan

Sources: Bangkok Post, Trust, UNICEF, UNAIDS, Voice of America
Photo: Flickr