Dr. Angeli Achrekar
On January 20, 2021, President Joe Biden appointed Dr. Angeli Achrekar as the new U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, which means she will be leading the President’s Emergency Plan for AIDS Relief (PEPFAR).

Who is Dr. Angeli Achrekar?

Dr. Achrekar is remarkably qualified for her position. She has earned her doctorate from UNC-Chapel Hill, a master’s degree from Yale and her bachelor’s degree from UCLA. In addition to her academic accomplishments, Dr. Achrekar has a career of public service under her belt, involving combating HIV/AIDS around the globe, public health development and women and girls’ health. She originally worked in India and with UNICEF. She then started working with the CDC starting in 2001, where she led the National Initiative to Improve Adolescent Health. This initiative spanned across multiple agencies and consisted of professionals from a variety of disciplines in more than 100 organizations.

Following her leadership of the National Initiative to Improve Adolescent Health, Dr. Achrekar started her work with PEPFAR to fight HIV/AIDS around the world in 2003. In working with PEPFAR, she traveled to South Africa. There, she coordinated with local governments to assess risk patterns that occur through drug use and among sex workers. Dr. Achrekar then became Senior Public Health Manager for the CDC in its Division of Global HIV/AIDS. Lastly, she started in 2011 with the U.S. State Department where she helped come up with and develop the Saving Mothers program, as well as the Giving Life program.

Developments Since Her Appointment

Since her appointment, Dr. Achrekar has already made strides in her position to fight AIDS and other diseases around the world. Notably, under her leadership, PEPFAR has been part of a joint effort with other organizations and agencies including USAID which will bring a new treatment to TB patients in Ghana, Ethiopia, Kenya, Mozambique and Zimbabwe. Rather than patients needing to take a combination of drugs for treatment, the new treatment will combine two drugs so patients will be able to take fewer drugs in total. The new development is a big leap forward and Dr. Achrekar said, “The availability of a shorter, more easily tolerated, and safer regimen for TB prevention that is also affordable is critical for accelerating the fight against TB. The new development is big news as latent tuberculosis is said to affect up to a quarter of the world’s population.”

The Importance of Fighting AIDS in Relation to Global Poverty

PEPFAR’s work to fight AIDS holds much significance to the fight against global poverty because the two interconnect considerably. AIDS disproportionately affects those in poverty. Considering that the prevalence of AIDS has been commonly linked with poverty, a critical component of fighting the disease is fighting poverty. In his article “Is HIV/AIDS Epidemic Outcome of Poverty in Sub-Saharan Africa?” Noel Dzimnenani Mbirimtengerenji wrote, “Unless and until poverty is reduced or alleviated, there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences.”

Sean Kenney
Photo: Wikipedia Commons

HIV/AIDS in South Africa
Since the human immunodeficiency virus (HIV) first evolved into the acquired immunodeficiency syndrome (AIDS) in the early 1980s, the virus has rapidly spread to every corner of the globe. It has infected over 65 million people worldwide. With no cure in sight, over 25 million victims have perished at the hands of the virus to date. HIV/AIDS predominantly plagues regions in Africa, Asia and the Pacific. Though cases have dropped since the epidemic heights of the 1990s, this disease continues to afflict 38 million people today and remains a leading cause of death. Here is a summary of HIV/AIDS in South Africa.

What is HIV/AIDS?

The human immunodeficiency virus (HIV) infiltrates and takes over the cells that protect against infections. As the body’s ability to fight viruses disappears, HIV makes the individual extremely vulnerable to additional infections or diseases. Spread through the transmission of bodily fluids, transmission most commonly occurs during the communal use of drug injection syringes and unprotected sexual activity. When left untreated, HIV can devolve into a lifetime condition called acquired immunodeficiency syndrome (AIDS). No cure exists for HIV or AIDS, but there are preventative measures that an individual can take, as well as treatment, drugs and therapy.

HIV/AIDS in South Africa

In 1982, South Africa was battling the apartheid that had dominated its governance for decades. This landmark transformation created tumultuous political strife that distracted national attention away from the HIV virus that was silently taking root in the gay and impoverished black communities. With drastic changes occurring in the South African government, insufficient measures failed to halt the initial handful of HIV infections from growing by 60% by 1995.

By the time that South African President Nelson Mandela first spoke about the virus, the epidemic had escalated into a public health crisis. South America became the most infected country in the world. Virus deniers and negligent governing officials let the situation further devolve throughout the 1990s and early 2000s. It was not until 2008 and a change in administrations that South Africa treated HIV/AIDS as a public health threat. The new government implemented a plan to distribute medicines and drugs, the largest step South Africa had taken since the virus outbreak 30 years prior.

Currently, efforts to fight HIV/AIDS face infrastructural and monetary difficulties. Public health resources have become sparse as the South African currency lost value. Consequently, HIV/AIDS therapy and antiretroviral treatment declined even while virus rates continue to rise.

In 2019, HIV/AIDS infected an estimated 7.7 million South Africans. That totals 20.4% of the population, with new cases occurring daily. Additionally, more than 72,000 HIV/AIDS-related deaths have occurred in South Africa. Over 70% of South African adults and 41% of minors undergo antiretroviral treatment.

Preventing the Spread

The HIV/AIDS epidemic that continues to plague South Africa may find its match in antiretroviral treatment (ART). This preventative measure is highly popular since the South African government progressed the ART program since the early 2000s. UNAID reported that 70% of South Africans living with HIV/AIDS received ART treatment in 2019, up by 50% since 2010. If an individual tests positive for HIV, they can receive ART to forestall or fully prevent the further devolution of HIV symptoms and the onset of AIDS. South Africans have invested themselves in taking advantage of the free testing. A guaranteed treatment for those testing positive increases the number of South Africans willing to obtain testing.

ART therapy particularly helps mothers with HIV by curbing mother-to-child transmission. This preventative measure has resulted in a strengthening of both mother and child health, and a decrease in birthing mortality and childhood HIV/AIDS infection.

While HIV/AIDS in South Africa remains a massive issue, one can find hope in new and evolving preventative measures. ART treatment offers an avenue to health for many infected individuals. It prevents further spread, curbs symptoms and can make healthy populations resistant to the virus. With South Africa expanding its diagnostic and treatment capabilities, people living with HIV/AIDS may live longer and healthier lives.

– Caroline Largoza
Photo: Flickr

HIV/AIDS in Iran
Iran discovered its first case of HIV/AIDS in 1987. Now, over 30 years later, UNAIDS estimates that more than 59,000 people are living with HIV/AIDS in Iran. While Iran has had success managing its HIV/AIDS epidemic in the past, shifting conditions surrounding the spread of the disease has made prior prevention plans obsolete. Iranian non-governmental organizations (NGOs) are taking a new approach to help tackle the present crisis.

HIV/AIDS in Iran

Avert is an organization working in HIV/AIDS education. According to its reports, the Middle East and North Africa (MENA) region, the area where Iran is located, has the fewest HIV/AIDS infections in the world. However, a concerning aspect of the region’s HIV/AIDS epidemic is that so few people are aware of their infected status. Of the estimated 59,000 people living with HIV (PLHIV) in Iran, UNAIDS estimates that only 22,000, or 37%, know that they are carrying the disease. By comparison, only about 15% of PLHIV in the United States are unaware of their status.

This lack of awareness amongst Iranian PLHIV is concerning both in its implications for the quality of life of those individuals, but also in its potential to increase the spread of the virus. This is part of the reason why Iran continues to see the steady spread of HIV/AIDS. According to UNAIDS, while new infections are down from a spike in 2004, Iran saw more than 4,000 new infections in 2019. The AP reports that this increase could be due to the rising prevalence of sexually transmitted cases of HIV/AIDS in Iran, where infection by contaminated drug injection has traditionally fueled the country’s crisis.

Knowledge and Perceptions of HIV/AIDS in Iran

The unknown status of many Iranian PLHIV results from larger issues surrounding Iran’s attitude towards the virus. Specifically, a lack of education regarding HIV/AIDS and prevailing cultural stigma towards PLHIV impacts how Iranians treat the virus and those living with it.

A 2013 survey showed that public education about HIV/AIDS in Iran is limited. The survey included 4,950 participants, each of whom had to fill out a questionnaire regarding their understanding of and attitudes towards HIV/AIDS.

The results of this survey showed that more than 80% of participants were aware that HIV/AIDS could spread through sexual contact or the sharing of a needle with a person with HIV/AIDS. In addition, 70% of participants knew that the use of a condom decreases the likelihood of contracting the virus during sex. However, despite this understanding, only 21.8% of respondents consistently used a condom during sex. This is particularly concerning given the rising role of sexual transmission in the spread of the disease in Iran.

The survey also revealed high stigmatization of PLHIV by respondents. Among respondents, 43% believed that HIV was a “fair punishment,” for “sins of the past,” and 48.6% said that they would stop interacting with somebody who contracted HIV.

Stigma towards PLHIV in Iran results from numerous factors. Misunderstandings about the spread of HIV/AIDS are part of the equation. Due to cultural norms, the association of HIV/AIDS with drug use, homosexuality and premarital sex have led to the widespread nonacceptance of PLHIV, a sentiment echoed in the aforementioned survey.

A New Approach to HIV/AIDS in Iran

Fortunately, NGOs in Iran exist that are advancing a more compassionate and effective approach to HIV/AIDS. The Tehran Positive Club is one such organization. The club devotes itself to assisting Iranian PLHIV, educating the public about HIV/AIDS and reducing the stigma against PLHIV. It provides services to PLHIV including counseling, group therapy, material support and vocational training.

Based out of Iran’s capital, the Tehran Positive Club has thousands of members and multiple branches throughout the country, including in populous cities like Isfahan, Kermanshah and Qom.

By providing material support, the Tehran Positive Club hopes to alleviate the social and psychological trauma that societal stigmatization causes PLHIV. And by increasing public understanding about the disease, it seeks to eliminate the prevailing cultural stigmata that result from misinformation. Reducing stigmatization creates empathy for PLHIV and raises the likelihood that more Iranians will receive testing for the disease, thereby reducing its spread and increasing the chances of survival for the unwittingly infected.

In 2016, the Tehran Positive Club received the Red Ribbon Award from UNAIDS for its work with the HIV/AIDS epidemic in Iran. Though the organization already has powerful allies at home and abroad, including the Iranian Research Center for HIV/AIDS and the United Nations Development Program, increased foreign aid would undoubtedly help further its mission and turn the tide of Iran’s HIV/AIDS epidemic.

– Joseph Cavanagh
Photo: Creative Commons

HIV/AIDS in The Dominican Republic
HIV/AIDS in the Dominican Republic is on the agenda of the Pan American Health Organization (PAHO) and HIV/AIDS has been the focus of the Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections 2016-2021. The goal of the plan is to end HIV/AIDS in many regions of the Americas, including the Dominican Republic, by 2030.

From 2010 to 2019, HIV cases have reduced to 13 a year and the number of deaths has gone down by 4,000 over the years. Female sex workers are a portion of the population the epidemic affects; they accounted for 37% of new infections in 2019. Less than 30% of individuals do not know they have an infection and about one-third receive a late diagnosis. Over 200,000 were getting antiretroviral treatment in 2019.

HIV Diagnosis Decline

HIV/AIDS in the Dominican Republic has seen an advancement in health through more testing and the option of antiretroviral treatments. The options of PrEP, pre-exposure prophylaxis, and PEP, post-exposure prophylaxis, have contributed to the decline of infections. The COVID-19 pandemic has put a dent in the success of the decline of HIV/AIDS.

The pandemic is changing the social landscape and interaction of people through social distancing measures. Access to medical personnel has also experienced strain because of rising and new COVID-19 infections. When comparing 2019 to the current pandemic, the diagnosis of HIV has reduced by the thousands in the Dominican Republic. According to PAHO, “Self-testing is a key strategy for reaching the U.N. goal of having 90% of people with HIV know their status.”

PrEP and PEP

PrEP and PEP are two types of antiretroviral treatments that people can use to prevent HIV transmission. Individuals can take the antiretroviral treatment PrEP before HIV infection and it is available through two brands. Meanwhile, one can take PEP after an HIV infection and must take more than one medication. The CDC suggests that individuals consult with a doctor for more information. While both treatments are important, PEP offers more because sexual assault victims can use PEP or those who had a workplace accident. Advisories state that one should take PEP within three days of a dire situation and complete treatment within a month. Both treatments are highly effective with PrEP reducing HIV transmission from sex by 90% and PEP reducing risk by 80%.

HIV Self-Testing Market

The HIV self-testing market looks promising on a global scale especially with  HIV/AIDS in the Dominican Republic. Globally, there is a necessity and high demand for rapid diagnosis of HIV in many regions including Latin America. Self-testing is a better alternative because one can do it privately and it is less risky because it will prevent exposure to the COVID-19 pandemic. The self-testing market will grow more between 2020 and 2025. Self-testing will experience a great impact through government investments in healthcare worldwide. The HIV self-testing kit collects samples through blood, saliva and urine. In HIV testing, blood samples provide the most accurate read. According to MarketWatch, “The self-testing market in Latin America is anticipated to reach a value of 51.24 million USD in the year 2025.”

The COVID-19 pandemic has undoubtedly impacted the fight against HIV/AIDS in the Dominican Republic. However, despite HIV/AIDS’ prevalence, antiretroviral treatments and opportunities to self-test should result in improvements.

– Amanda Ortiz
Photo: Flickr

Healthcare in sub-Saharan Africa has a direct impact on poverty in the region. When adults are too ill to work, they and their children can quickly fall into extreme poverty, which leads to hunger and malnutrition. Around 46% of Africa’s population lives on less than $1 a day; an even larger proportion than was the case 15 years ago. Despite these challenges, organizations like Wild4Life are working to expand the reach of healthcare into these underserved communities.

Poverty and Health Care in sub-Saharan Africa

Sub-Saharan Africa is the poorest region in the continent. Close to 60 million children under the age of 17 work instead of attending school in an effort to help their families rise out of poverty. Every fifth child is forced into child labor. This effectively means that when grown, that person will lack education and most likely remain in poverty. This social plight creates a vicious cycle in which chronic malnutrition, growth disorders and physical and mental underdevelopment occur. These health issues further limit an individual’s opportunity to earn a living later in life. In addition, 25 million Africans are infected with HIV, including almost 3 million children — the highest rate of infection in the world. Many of these children have lost one or both parents and are living on the streets.

Government expenditure on healthcare in Africa is very low; typically about $6 per person. This means that medical workers experience huge pressures, operating with little-to-no equipment or means to reach rural populations, Such challenges make healthcare in sub-Saharan Africa difficult to provide.

Good News about Health Care in Rural Communities

The good news is that organizations such as Wild4Life are working to reverse these disturbing healthcare trends. The NGO’s mission is to expand the reach of health services to underserved remote, rural communities in sub-Saharan Africa that have limited or no access to healthcare. To achieve this goal, Wild4Life has developed an incredibly innovative service delivery model. The aim of this model is to reach more people than previously would have been possible. Wild4Life works to establish the basic building blocks of a healthcare system. It believes that a well-functioning system has a lasting effect on a community’s overall health and longevity.

Expansion to Twelve African Countries

The Wild4Life model involves partnering with organizations that are already established in remote locations, and that have put together links with people in the local community. This approach leverages the existing infrastructure, social ties and knowledge bank in cooperation with Wild4Life’s network of health providers. This allows support and treatment to impact some of the hardest-to-reach people and places on earth.

Wild4Life began as an HIV/AIDS program in Zimbabwe, but it has expanded throughout sub-Saharan Africa.  Now operating in twelve countries — Botswana, Cameroon, Ethiopia, Gabon, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe —the organization delivers extremely low-cost healthcare in sub-Saharan Africa and provides interventions that are scalable yet sustainable.

Community Partnerships to Improve Health Care

The goals of the NGO include assessing the needs of rural populations and targeting the health issues that most affect them. It also seeks to build clinics in remote areas; strengthen rural healthcare networks; provide quality healthcare and improve community partnerships so that creative ways to address problems become permanent solutions. For example, Wild4Life trains community leaders to mobilize local demands for healthcare services and advocate for quality care from clinic staff and maintain facilities. This results in significant infrastructure improvements. The NGO also organizes events around such topics as improving healthy behaviors and coming up with strategies for the best way to use clinic funds.

Five Clinics in Zimbabwe

In Zimbabwe alone, Wild4Life has a network of five clinics. These clinics have achieved remarkable results, including hundreds of lives saved by new diagnosis and treatment of HIV as well as other preventable diseases. The organization believes that there is not one single technology or innovation that will create a lasting impact on the health of people living in rural communities. Instead, it partners with all levels of the healthcare system to locate the gaps in the extant setup. By doing this, it hopes to leave behind a resilient, local healthcare system for those who need it most.

During comprehensive clinical mentoring, well-trained, multi-disciplinary teams composed of six specialists comprehensively mentor clinic staffs on primary care conditions. These conditions include HIV, TB, Integrated Management of Childhood Illness and testing for anemia. Such services also aid in labor and delivery. This process also covers monitoring and evaluation of data quality, pharmacy management and clinic management over a two-year period.

Scaling Up to Improve Healthcare in Africa

Wild4Life has significantly scaled up since its inception, through government, nonprofit and for-profit connections. It has gone from delivering care to remote areas, to building healthcare networks in rural populations. As a result of its expansion plan, 70,000 more people will have access to high-quality health services in their communities. By training clinicians and community members in the most up-to-date medical care delivery, the NGO is changing the way that rural healthcare in sub-Saharan Africa is delivered.

Sarah Betuel

Photo: Flickr

Sustainable Development in Chad
Chad, a landlocked country in Sub-Saharan Africa, is one of the poorest countries in the world. With a poverty rate of around 40%, Chad’s life expectancy is only 58.3 years. Only two million of the roughly four million people in dire need of assistance are actually receiving any. Additionally, Chad is surrounded by countries undergoing civil wars, putting further pressure on its infrastructure through refugee flows and inhibiting sustainable development in Chad.

Chad was also hit especially hard by the HIV/AIDS epidemic, with 120,000 people living with HIV in 2018. HIV/AIDS in Chad spread quickly due to a lack of healthcare infrastructure. The country has very few healthcare workers. There are only 3.7 doctors for every 100,000 people throughout the entire country. This is even worse in rural areas, given that healthcare workers are concentrated in just 1 region. In this 1 region, 65% of the entire country of Chad’s doctors practice medicine.

Africare Background

Fortunately, some organizations are stepping in order to try and solve this problem through sustainable development. These organizations believe that the best way to ensure that Chad can grow and reduce poverty is to build business infrastructure locally to create long-term growth. One such organization is Africare. Founded as a partnership between Africans and Americans in 1970, this organization has since grown to span much of the continent. Overall, they have donated approximately $2 billion dollars since 1970 towards developing the economies of 38 African countries.

Africare in Chad

The focus of Africare is on sustainable development, attempting to build enough capacity within countries to make sure the country can sustain itself and reduce poverty in the long term. One notable program in Chad is the Initiative for the Economic Empowerment of Women Entrepreneurs (IEEWEP). The IEEWP, founded in 2008 seeks to uplift communities by providing education, skills training, and economic assistance to women in order to allow them to start businesses. The ultimate goal is to foster sustainable development in Chad.

Success Stories

The IEEWP has been a big success. The projects to develop human capital have already generated returns. Within the first three years of its existence, 1,600 women were trained by the IEEWP, increasing their incomes by 60%. Africare has also encouraged women to become more involved and take more of a leadership role at a local level. One important way they accomplish this is by making sure that 95% of their field staff are women, thus ensuring that women possess a voice within the communities they serve. Putting women at the forefront of the organization, Africare hopes, can help create sustainable development in Chad.

The IEEWP works by partnering with local communities and entrepreneurs in order to support them. In one program, the IEEWP worked with a group of 18 existing entrepreneurs in order to start a restaurant. In 2006, 18 women, calling themselves “Mbailassem” or “God help us”, partnered to produce cassava together on a farm. Seeing their drive, the IEEWP decided to help Mbailassem start a restaurant in Southern Chad.

After initially assisting in running the restaurant, and helping with some financial objectives, the restaurant eventually became economically sustainable and paid their loans back within a year. The women of Mbailassem also succeeded in starting a new location of their restaurant, further improving both their own economic situation and the economic situation of the communities they are working in. Africare hopes that entrepreneurs like Mbailassem can help build sustainable development in Chad, and ultimately all across Africa.

Moving Forward

Overall, Chad is struggling to see long-term growth across the country. However, progress on a smaller scale in individual communities concerning the growth of businesses shows some promise. Applying this same model in various communities across the country could help foster sustainable development in Chad.

Thomas Gill

Photo: Flickr

Russia’s AIDS EpidemicAmid a global pandemic, Russia is fighting a medical war on two fronts; as Russia deals with the spread of COVID-19, Russia’s AIDS epidemic is worsening. As the HIV  infection rate continues to decline in the rest of Europe, the transmission rate of HIV in Russia has been increasing by 10 to 15% yearly. This increase in transmission is comparable to the yearly increase in transmission of HIV in the United States in the 1980s at the height of the AIDS epidemic.

The AIDS Epidemic in Russia

Among other factors, the erosion of effective sexual health education and a rise in the use of opioids has led to a stark increase in the transmission of HIV/AIDS in Russia. The epidemic of AIDS in Russia has received little attention from the Russian Government and the international community, partly because of the nation’s social orthodoxy and the stigma surrounding drug use and HIV/AIDS.

The Silent Spread of HIV

A significant number of Russians infected with HIV are those who inject drugs. Roughly 2.3% (1.8 million) of Russian adults inject drugs, making Russia the nation in Eastern Europe with the highest population of those who inject drugs. Due to the stigma associated with drug use as well as the threat of harsh criminal punishment, few drug users who have been affected by HIV seek treatment. A study from the Society for the Study of Addiction found that in St. Petersburg only one in 10 Russians who inject drugs and are living with HIV currently access treatment.

A large part of the stigma surrounding AIDS in Russia comes from the return of traditionalism to the Russian government following the election of Vladamir Putin in 2012 and the strong connection between the traditionalist Russian Orthodox Church and the Russian Government. The Orthodox Church, in particular, has blocked efforts to instate sex education programs in schools and campaigns to give easier access to safe sex tools like condoms. While methadone is used worldwide to treat opioid addiction to lower the use of drug injection and therefore HIV transmission, the Russian Government has banned methadone. Any person caught supplying methadone faces up to 20 years in prison.

HIV During the COVID-19 Pandemic

Studies conducted during 2020 have shown that Russians living with HIV and AIDS have faced difficulties in accessing treatment. According to UNAIDS, 4% of Russians living with HIV reported missing medical treatment due to the pandemic and roughly 30% of respondents reported that their treatment was somehow impacted by the pandemic.

The same study found that HIV-positive Russians had a positive COVID-19 diagnosis at a rate four times higher than HIV-negative Russians. However, HIV-positive Russians were less likely to seek medical attention for COVID-19 despite the high health risks, such as a weaker immune system that can accompany HIV. More Russians are contracting HIV yearly but the stigma of living with HIV is preventing HIV-positive Russians from seeking medical treatment.

Destigmatizing HIV/AIDs in Russia

With little national attention paid to the epidemic of AIDS in Russia, the movement for change has come from individuals looking to give visibility to and destigmatize HIV/AIDS. In 2015, after television news anchor, Pavel Lobkov, announced on-air that he had been living with AIDS since 2003, Russian doctors including Lobkov’s own doctor, saw a surge in people seeking HIV tests and treatment. In a nation where AIDS is highly stigmatized, a national celebrity showing that one can live a normal life with AIDS brought comfort to many Russians living with HIV/AIDS.

More Russians living with HIV/AIDS have made efforts to shed light on Russia’s HIV epidemic and destigmatize HIV to the public as well as in the medical community. Patients in Control, a nongovernmental organization run by two HIV-positive Russians, Tatiana Vinogradova and Andrey Skvortsov, set up posters around St. Petersburg that read “People with HIV are just like you and me,” and encourage HIV-positive Russians to seek antiretroviral treatment. HIV-positive Russians like Skvortsov and Vinogradova are trying to bring national attention to a health crisis that is seldom discussed, hoping to create a national conversation and put pressure on Russian officials to take action on the worsening epidemic.

A Call for Urgent Action

HIV-positive Russians and AIDS activists like Skvortsov have argued that until the Russian Government puts forth an “urgent, full forced response” to Russia’s AIDS epidemic, the rate of transmission will continue to climb. Many Russians on the ground are making public campaigns to destigmatize and normalize living with HIV, hoping to persuade the government to take action.

In 2018 alone, AIDS took the lives of 37,000 people across Russia. As of May 2020, more than 340,000 Russians have died of AIDS. While the social atmosphere of Russia, influenced by Putin’s government and the Orthodox Church, has created a shroud of secrecy and shame surrounding the AIDS epidemic, many HIV-positive Russians hope that the intensity of the epidemic will force the Russian Government to make a concerted effort to address Russia’s AIDS epidemic.

Kieran Graulich
Photo: Flickr

 Preventing HIV in KenyaA new, injectable antiretroviral drug, cabotegravir (CAB LA), may have significant potential for preventing HIV among sub-Saharan African women. In November 2020, the World Health Organization (WHO) reported trial results of the HIV Prevention Trials Network Study (HPTN 084), testing the use and effectiveness of CAB LA in preventing HIV among more than 3,200 HIV-negative, sexually active women across east and southern Africa. This drug could significantly lower prevalence rates and help in preventing HIV in Kenya, which has one of the largest HIV/AIDS epidemics in the world.

Cabotegravir or CAB LA

CAB LA, a long-acting pre-exposure prophylaxis (PrEP) regimen, requires an injection only every eight weeks and has been shown to be 89% more effective in preventing HIV than taking a daily oral antiretroviral PrEP, a generic pill currently marketed as Truvada.

Kenya’s HIV Epidemic

The first case of HIV in Kenya appeared in 1984. By 1990, HIV was one of the leading causes of illness in the country. At its highest point, more than three million Kenyans lived with AIDS. Since then, the government of Kenya decreased the prevalence of HIV from its 10.5% peak in 1996 to 5.6% in 2012. By 2019, the prevalence rate was 4.5% in adults aged 15-49. However, certain vulnerable populations within Kenya are more at risk of getting HIV, such as women. Males have an estimated prevalence rate of 4.5% while the rate for females is 5.2%. Among youth aged between 15 and 24 years old, boys have a prevalence rate of 1.34% compared to girls at 2.61%.

The only option for preventing HIV in Kenya is a daily PrEP pill called Truvada. The government of Kenya first approved oral PrEP for country-wide distribution in 2015, and since 2017, has scaled up the distribution throughout Kenya. However, of the 1.5 million Kenyans living with HIV, only 26,098 (1.7%) are currently on PrEP.

Though 72% of the population had been tested for HIV, only 70% had been tested more than once. Frequent testing, at least once a year if sexually active or at least every six months if part of a particularly vulnerable population, is vital to giving care and treatment for at-risk groups.

The Potential of CAB LA for Preventing HIV in Kenya

  1. The HPTN study reported that CAB LA is nine times more effective in preventing HIV in Kenya than the Truvada pill, the current form of PrEP. The PrEP pill is only effective if taken daily and is not a standalone prevention method for other STIs or unplanned pregnancies. The new drug also does not require other forms of protection, such as condoms.
  2. This drug gives vulnerable populations more HIV options for preventing HIV in Kenya. Vulnerable populations include sex workers, men who have sex with men, people who inject drugs, youth and women. These vulnerable populations face stigma, which affects their ability to access PrEP pills. Because the injection is needed only once every two months, the increased discretion and ease of the infrequent injection may increase its use and thus increase the protection of those who need it.
  3. Discretion in use of the drug may be able to reach more women specifically. In combination with the stigma attached to HIV, women in Kenya face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships, with women not always able to practice safer sex, even when they know they should. For example, in 2014, 35% of adult women (aged 15-49) who were or had been married had experienced spousal violence and 14% had experienced sexual violence. Women in Kenya find it especially difficult to take a daily pill, which significantly reduces the effectiveness of the medicine. Only 68% of Kenyan women have access to antiretroviral pills.

Though not yet approved by the U.S. Food and Drug Administration (FDA), the developer of the drug, ViiV Healthcare, expects cabotegravir to be ready for the market by early 2021.

– Charlotte Ehlers
Photo: Flickr

Health Concerns During COVID-19COVID-19 has understandably been the main focus around the world. In developed countries, many are new to health epidemics and the disruptions caused by them. But, in some parts of the world, widespread disease is not new at all and COVID-19 is not the only health concern. There are several other global health concerns during COVID-19. Some seem obvious, like malaria or HIV/AIDS. But, some have made less news, like a toxic goldmine in Ethiopia. These health crises also require assistance and aid from the international community.

HIV/AIDS in South Africa

In 2019, it was estimated that more than seven million people in South Africa were living with HIV. Roughly 200,000 of those people were newly diagnosed in 2019, and in that same year, 72,000 people died. Though 70% of people receive antiretroviral therapy (ART), the disease remains incurable. Its prevalence makes it one of the priority health concerns during COVID-19.

Though South Africa has the largest population of people living with HIV in the world, it has made a lot of progress. Data indicates that in 2018, 90% of infected individuals were aware of their status and 87% of people receiving treatment were virally suppressed, meaning they do not transfer the virus. Despite this success, rates continue to increase and it disproportionately affects women and young girls.

In 2016, South Africa made treatment for HIV free to all, where it used to be available only to those with advanced infections. This comes after South Africa made pre-exposure prophylaxis (PrEP) available to all sex workers to prevent HIV contraction in the first place. Though it did take years for South Africa to acknowledge this epidemic, the country is making progress. However, more focus and attention needs to go toward addressing HIV/AIDs in South Africa as it is a significant health crisis.

Malaria in sub-Saharan Africa

COVID-19 severely affected sub-Saharan Africa’s access to insecticide-treated nets (ITN) and malaria treatments. The World Health Organization (WHO) urged nations to resume the distribution of these things, in fear that mortality rates in 2020 would reach 769,000, which is double the rates of 2018.

Preventative treatments, which deliver antimalarial medication to asymptomatic people, aimed at school-aged children, has shown to significantly reduce the risk of contracting malaria. Health officials in sub-Saharan Africa have been urged to take heed of this, but the poverty affecting the region limits progress.

A whole 90% of global malaria deaths happen in sub-Saharan Africa, and of that figure, 78% of victims are children. Malaria is a treatable condition, but those most susceptible to it usually live in a state of poverty, unable to afford treatment. Malaria in sub-Saharan Africa is one of the most pressing global health concerns besides COVID-19.

Toxic Gold Mine in Ethiopia

Gold mining is an important industry in Ethiopia. The export of gold and similar minerals makes up 7-10% of Ethiopia’s export earnings. Hundreds of thousands of people are employed in the mines, both skilled and unskilled.

But, in Ethiopia’s most populous region, Oromia, a gold mine has released harmful contaminants that have severely affected people. Serious deficiencies in mine management have left the soil and water contaminated with dangerous levels of cyanide, arsenic and mercury. This contamination resulted in high rates of miscarriage, stillbirths and infant mortality, birth defects, the destruction of livestock and crops and locals are afflicted with debilitating illnesses. Residents say there was no warning about potential toxins,

The mine was considered so toxic that the situation was deemed a violation of human rights. After pushback from the citizens, it was temporarily shut down, but there was no accountability or treatment for those affected. There remains doubt whether the air and water are now safe and residents anticipate that the mine will be reopened. In August 2020, mineworkers were asked to attend a meeting, cementing this assumption. In collaboration, human rights organizations submitted a document to the Human Rights Committee entailing Ethiopia’s violations of rights in regard to the contaminated mine. It documents Ethiopia’s failures and necessary reparations that should be made to people.

To safeguard the well-being of the Ethiopian people and ensure that aid is provided to the affected people, it is essential for the international community to get involved.

COVID-19 and Other Global Health Concerns

The COVID-19 pandemic has upset the health of nations globally, no matter the resources a country has. But, it has also overshadowed some pressing issues. There are other major health concerns during COVID-19 that need international attention and aid as well.

– Maddey Bussmann
Photo: Flickr

hiv epidemic in the philippinesThe HIV epidemic in the Philippines is the fastest-growing in the Asia and Pacific region. According to UNAIDS data, HIV prevalence in the Philippines increased by 207% from 2010 to 2019. AIDS-related deaths rose by 338% in the same period. In 2019, an estimated 97,000 people were living with HIV in the Philippines. Of those, 73% knew their status and 44% were receiving antiretroviral treatment.

Although these statistics indicate some progress, the Philippines still falls far below the 90-90-90 target set by UNAIDS. Aimed at ending the HIV epidemic by 2020, the program wanted to ensure that 90% of people living with HIV would know their HIV status. It also strove to give 90% of people with a diagnosed HIV antiretroviral therapy and induce viral suppression in 90% of those receiving treatment. Unfortunately, the world is not on track to meet these goals, and new targets are being developed for 2025.

Populations Most Affected

The prevalence rate of HIV in the Philippines among adults ages 15 to 49 was 0.2% in 2019. This national rate, however, masks alarmingly high prevalence rates among specific populations. The groups most affected by the HIV epidemic in the Philippines often face social stigma, isolation and legally sanctioned discrimination. These populations include people who inject drugs (PWID), men who have sex with men (MSM), sex workers and transgender people. However, new technologies, programs and initiatives are working to lessen the burden of disease and stigma on these populations.

People Who Inject Drugs

According to UNAIDS, the HIV prevalence rate among people who inject drugs in the Philippines is 29%. Among PWID, only 26.9% have been tested and are aware of their status. Key factors fueling the HIV epidemic in the Philippines among PWID include hostile public opinion and brutal law enforcement. These constitute major barriers to HIV testing and awareness. While official statistics released in 2018 revealed that over 4,500 drug users were victims of extrajudicial killings, civil society estimated the true toll to be as high as 20,000.

Progress in HIV testing is crucial to reduce HIV prevalence among PWID, who struggle to access services due to their criminalized status. Various alternative testing methods, such as rapid finger-prick testing, can reduce barriers to testing for PWID. In particular, self-testing kits, which allow people to test in private, have attracted a large proportion of first-time testers in Thailand and have achieved impressive success in China.

Men Who Have Sex With Men

The HIV prevalence rate among men who have sex with men is 5%, the second-highest among key affected populations. MSM who fear social stigma and discrimination often do not participate in HIV prevention programs. As a result, the participation rate for these programs is 14.6%, and the majority of MSM lack awareness about HIV. Condom use in this population is also low at 40.1%. However, condom distribution and sex education programs would benefit MSM, many of whom reported not using condoms because they were “not available.” Fighting the HIV epidemic in the Philippines means tailoring help to MSM.

Sex Workers

Female sex workers in the Asia and Pacific region are 29 times more likely to be living with HIV than other adult women of reproductive age. The HIV prevalence rate among sex workers in the Philippines is now 0.6%. This group has the highest rates among affected populations for coverage in prevention programs and condom use, which are 71.8% and 85.3%, respectively. Many important national HIV prevention programs raise awareness about HIV and encourage condom use among sex workers. These programs include the 100% Condom Use Program, the HIV Counseling and Testing Service, and programs led by the Philippine National AIDS Council.

Transgender People

Transgender people are one of the populations most affected by the HIV epidemic in the Philippines, with a prevalence rate of 3.9%. However, there is little information or research about the effects of HIV on the transgender community in the Philippines. A key problem is the lack of transgender visibility due to social exclusion and widespread stigma. This challenges efforts to obtain health data and develop targeted programs to support transgender individuals. To raise awareness about gender identities and transgender acceptance, sexual health education and gender studies programs must be more inclusive. This would help reduce the stigma and barriers to healthcare for transgender people in the Philippines and engage them in HIV prevention and treatment programs.

The Effect of COVID-19

Lockdowns in the Philippines due to COVID-19 have blocked access to essential services for HIV patients, including treatment and testing. Eamonn Murphy, UNAIDS regional director for Asia and the Pacific, stressed that the Philippines needs to do more to convince those in high-risk populations to seek out HIV-related services.

Continued attention to these key affected populations is necessary to reduce HIV prevalence rates and make progress toward HIV eradication. In this way, focused programs can work toward lessening the severity of the HIV epidemic in the Philippines.

– Alice Nguyen
Photo: Flickr