Diseases in Sao Tome and Principe
Sao Tome and Principe is a developing country located on the African west coast. More than two-thirds of the population of this small island state lives on under $3.20 a day and faces the effects of critical disease. However, many organizations are working with the country to fight the war against diseases in Sao Tome and Principe.

Common Diseases in Sao Tome and Principe

Three of the most common diseases in Sao Tome and Principe are tuberculosis (TB), malaria and human immunodeficiency virus (HIV).

TB is an airborne disease caused mainly by air droplets that someone infected with Mycobacterium tuberculosis transmits; it is endemic in Sao Tome and Principe. TB can cause various pulmonary symptoms and affect the lymphatic system, joints and even the central nervous system.

Malaria is a mosquito-borne disease; it is common in the country. Malaria can be very fatal to the victims and cause them to suffer from flu-like symptoms and high fevers.

Finally, HIV is a virus that attacks the immune system and can lead to dangerous acquired immunodeficiency symptoms (AIDS); it is still a significant problem in Sao Tome and Principe.

Key Players in Supporting Sao Tome and Principe

The United Nations Development Programme (UNDP) and the Global Fund have been key players in supporting the fight against diseases in Sao Tome and Principe. Since 2005, the organizations have funded the country in its efforts against HIV, TB and malaria.

Over the years, the organizations have spent $4.5 million for HIV, $3.9 million for TB and $25.4 million for malaria. Through this funding, the UNDP has been able to ally with the National TB Program to develop various treatment and education plans for patients. According to the World Health Organization (WHO), in 2016, there was a 63% decrease in TB mortality since 2000, a 95% detection rate for the disease and a 78% success rate in treating patients.

The UNDP also runs an HIV program; it supports those living with HIV and counsels populations who are at a higher risk for HIV about preventative actions. From 2008 to 2014, the prevalence rate of HIV among 15 to 49-year-olds declined from 1.5% to 0.5%. According to UNDP’s data from 2018, 249,700 people received counseling and HIV testing.

Sao Tome and Principe observed its greatest success in defeating malaria. Mortality rates from malaria have declined from 3.9 to 0.5 cases per 100,000 people. Although the Global Fund is no longer supporting the malaria program, it helped distribute 503,000 bed nets, reaching 100% of the population, and treated 56,800 cases of malaria according to UNDP in 2018. The incidence of malaria morbidity decreased from 65.5 to 11.3 cases per 1,000 people in the time frame between 2012 and 2016. Further, UNDP has granted approximately another $6 million to support the complete eradication of malaria and further control TB and HIV.

Others in the Fight to Eradicate Diseases in Sao Tome and Principe

Although UNDP and the Global Fund have been the major players in supporting the country, there are other groups that have helped toward the goal of eradication of critical diseases in Sao Tome and Principe. In 2015, Brazil spent over $500,000 to build a laboratory that would be focused on diagnosing and treating TB. This laboratory would ensure that the patients would receive quicker lab results and correct diagnoses.

Medical Care Development International, a nonprofit organization, has also taken up a project that will last from 2019-2023. It aims to bolster the ability of the military to provide HIV/AIDs care for its members and population in Gabon and Sao Tome and Principe. The project will increase its capacity to provide care in the military health facilities and laboratories.

A Ray of Hope for Sao Tome and Principe

Despite the dangers of malaria, TB and HIV, the people of Sao Tome and Principe can have hope in the fact that there are many international allies willing to provide support in their fight against these diseases. These common diseases in Sao Tome and Principe may still impose fatal effects on its victims; however, Sao Tome and Principe is not alone in its fight to protect its people.

San Sung Kim
Photo: Flickr

Vaccines in Developing CountriesHow much can the world really rely on vaccines as a cure to disease? For many impoverished communities, the jury is still out; many recent studies show that vaccines in developing countries are more ineffective than those in developed, high-income nations.

However, developing countries are at greater risk for all infectious diseases than developed countries. The World Health Organization (WHO) documented that the “total number of healthy life years lost per capita was 15-times higher in developing countries than in developed countries.” In addition to this imbalance, vaccines in developing countries also threaten these nations with ineffective treatment. Due to the many factors that impact disease, it is difficult to pinpoint specific causes behind vaccine acceptance or denial. However, the health effects of poverty contribute to the reasons why vaccines in developing countries are often ineffective.

How Poverty Increases Sickness

Poverty is a health epidemic. In 2008, PBS aired an original docu-series called “Unnatural Causes” that outlined the ways diseases disproportionately affect poor and marginalized groups. The show posed one overarching, famous question: “Is inequality making us sick?” In the assessment of vaccine effectiveness in rich versus poor countries, the creators of “Unnatural Causes” say the answer is yes.

A functioning immune system is largely responsible for an individual’s ability to make antibodies, the infection-fighting proteins developed via vaccines. Impoverished people often do not have high-functioning immune systems. This means that they cannot produce antibodies as well as their developed-nation counterparts.

Multiple factors contribute to the prevalence of ineffective immune systems in developing countries. The overpopulation and crowding common in low socioeconomic areas increase the risk of disease exposure. Pre-existing health conditions, resulting from vitamin deficiency and little clean water or sanitation, increase individual susceptibility to sickness. Further, unreliable health care places systemic, structural constraints on impoverished communities. In this way, poverty and disease continually reinforce each others’ negative effects.

Comparison Studies: Developed Nations vs. Developing Nations

Water-borne diseases, malaria, tuberculosis and HIV/AIDS continually afflict developing countries. They may be responsible for damaging people’s natural immunity, thus decreasing the likelihood of vaccine acceptance. Indeed, one study found that these diseases “may damage lymph node structures that are crucial to developing immunity after a vaccine.”

This study from the University of Minnesota compared Americans to Ugandans. Researchers discovered all the Ugandans had “significantly higher levels of inflammation in their bodies and a depleted supply of protective T cells.” In addition, the Ugandan’s lymph nodes (which help filter infections and respond to vaccines) were inflamed and scarred. None of the American participants had these issues. After administering a yellow fever vaccine to the Ugandan test subjects, researchers discovered a positive correlation. The more damaged their lymph nodes, the less likely it was for antibodies to form.

Another series of studies in Dhaka, Bangladesh discovered that a poor response to vaccines in developing countries could be correlated to the small intestinal bacteria endemic to low-income countries. Petri’s team surmised that “inflammation [in the intestine] could prevent vaccines from lingering in the gut and could keep the immune system from reacting to them.” The team also identified a similar issue with rotavirus vaccine response. In contrast, 98% of children in the developed world do not have complications after vaccination.

The Future of Vaccines

According to the World Bank, “nearly half of the world lives on less than $5.50 a day.” In addition, only 59 of the 195 countries in the world possess a Human Development Index (HDI) at or above 0.8, making them developed countries. This means that ineffective vaccination responses affect the majority of the world’s nations. Thus, the world needs a systemic change in public health to fix this issue. Studies in Bangladesh and Africa “are testing whether sanitation interventions such as installing hand-washing stations in rural homes” can relieve the gut inflammation thought to be causing poor responses to vaccination.

However, even though vaccines in developing countries are sometimes ineffective, routine vaccination for infants and children may help. Young children are less likely to have the long-term health effects responsible for ineffective responses to vaccines, with the exception of illnesses inherited from a mother’s womb. WHO estimates that approximately 70% of the 9 million deaths from children under five “could be prevented or treated with access to simple, affordable interventions,” including vaccines.

Vaccinating Children in Developing Countries

Still, the complicated relationship to vaccines in the developing world is palpable. One study in India found that there is only a 55% rotavirus vaccine efficacy rate in young children. However, India’s plan to make the rotavirus vaccination routine may “save 27,000 of the 78,000 young lives that infections claim every year.”

Thus, expanding coverage of vaccines in developing countries has proven successful in many cases. Various programs work to extend this success. Since 1990, WHO’s Expanded Programme on Immunization has helped decrease mortality rates among infants and children via vaccination. The Global Vaccine Alliance has also “vaccinated more than half a billion additional children since its founding in 2000,” often in developing countries. While routine vaccination is not a panacea, it helps prevent disease before long-term health issues develop.

Improving World Health

Obviously, this is a hefty challenge. Changing human response to vaccines will take years of improving sanitation and living conditions. In addition, developed countries often receive vaccines first and in larger quantities due to having more money. In the meantime, scientists and doctors are experimenting with speedier methods to the vaccine problem. Take mesalazine, a drug that treats the bowel inflammation preventing antibody response to vaccines. This drug could possibly treat unreliable oral vaccines for stomach illnesses. Recognizing the issue of vaccines in developing countries is the first steps in improving global health.

Grace Ganz
Photo: Flickr

Stigmatization of DiseasePeople often understand diseases as solely biological: an infectious pathogen harms the body and requires medical aid to defeat. However, disease also has social implications. Various social factors can impact not only someone’s likelihood of contracting a disease but also their likelihood of receiving quality medical care. One significant social implication affecting these factors is the stigmatization of disease.

Stigma, as defined by sociologist Erving Goffman, is an “attribute that is deeply discrediting.” Though we normally think of attributes like race, religion, ethnicity, sexuality and gender identity, stigma can also involve disease. The stigmatization of disease refers to the notion that a particular type of person, country or community are the carriers or source of a disease. Like all stigmatization, this involves the process of “othering,” or creating a “them” and an “us.” People attempt to keep the “us” safe by ostracizing the “them.” In the case of the stigmatization of disease, the stigmatized group becomes “them.” Here are four examples of the stigmatization of disease throughout history.

The Stigmatization of Disease: Four Examples

  1. Cholera is a bacterial disease that causes extreme dehydration and diarrhea. It is fatal without immediate treatment. The end of the 1800s saw a global cholera pandemic, with a high prevalence in Europe. This led to the United States quarantining immigrants when they arrived in the U.S., creating a dangerous association between immigrants and cholera. At the time, President Harrison declared that immigrants were “a direct menace to the public health.” This association between immigrants and disease lasted long after the threat of cholera was gone.
  2. Yellow fever is a viral infection carried by a specific species of mosquito. It causes fever, headache, nausea and, in severe cases, fatal heart and liver conditions. By 1850, yellow fever was rampant in southern American states. Cities like Charleston, Mobile and New Orleans faced the brunt of the disease. Because of tensions leading up to the Civil War, the North used the disease to attack the South. Northerners “denounced the South for its unhealthy conditions and people.” This stigmatization helped fuel the separation between “us” and “them” in the North and South. As such, it had lasting impacts on regional divides in the U.S.
  3. HIV/AIDS appeared in the United States in the 1980s. HIV is an aggressive virus that attacks people’s autoimmune system and can eventually lead AIDS. Because early cases affected gay men, doctors named the disease Gay-Related Immune Deficiency or GRID. This initial naming demonized gay men and made them appear to be the source of HIV. Later, the disease was renamed AIDS (Acquired Immunodeficiency Syndrome) when doctors realized that anyone can contract HIV. Despite this renaming, the association of gay men with HIV remains strong. Accordingly, fear and stigma continue to be a barrier to getting treatment in the U.S.
  4. COVID-19 first appeared in China in late 2019. Due to its origin, many people have engaged in racist and xenophobic attacks and discrimination against those of Asian heritage. The use of language such as the “Chinese virus” and “Wuhan virus” in the media and from political leaders has encouraged hate speech and physical attacks. In the U.K., citizens have punched and beaten Asian people. In Australia, two women beat Chinese students while yelling, “Go back to China.” In Texas, a Burmese family was attacked with a knife. This illustrates how the stigmatization of COVID-19 has resulted in extreme discrimination and violence against Asian people around the world.

How Stigma Impacts Care

As indicated above,  stigma creates barriers for stigmatized people to access quality care. Dana McLaughlin, a global health associate at the United Nations Foundation and graduate student at Johns Hopkins, elaborates on how stigma creates barriers to health. She understands stigma as having three components that can dissuade someone from seeking care and reduce the quality of care they receive:

  1. Internalized or Self-Stigma: This occurs when an individual with a disease internalizes the stigma. They may feel shameful about themselves and their condition. They might also fear telling family, friends and their communities about their condition because of possible ostracization. Either way, this internalized fear may prevent someone from seeking medical care.
  2. Public Stigma: This stigma refers to the general population’s opinions  about behaviors associated with people who have a certain disease. In other words, this is a negative cultural context that surrounds a disease. This can vary greatly between countries and cultures, so it’s important to recognize that the public stigma may not be universal.
  3. Structural Stigma: This refers to the social institutions that reflect and reinforce the stigmatization of diseases. For example, structural stigma may manifest as a lack of resources for care, like a limited number of doctors in marginalized communities. One of the most prominent manifestations of structural stigma is the criminalization of certain behaviors associated with specific diseases. With HIV, many countries criminalize sex work and intravenous drug use and stigmatize people who engage in these behaviors. This stigmatization may prevent individuals from receiving care for fear of arrest or punishment. On the other hand, stigmatized individuals may “go underground” and engage in even riskier behaviors, like sharing needles, to avoid police discovery.

Combating Stigma and Providing Care

McLaughlin explains that in the context of global health, it is important to understand the syndemic (occurring simultaneously) nature of stigma and disease. These two aspects are “correlating challenges that the global health community has to be able to respond to.”

For McLaughlin, responding to stigma requires prioritizing the needs and experiences of stigmatized people. This might mean allowing them to speak openly about the daily struggles they face due to stigma. It’s also essential that “the people who are most impacted and know the day-to-day challenges of stigma are at the root of planning.” This ensures that interventions and projects actually meet the needs of stigmatized communities. If people do need to change their behaviors, this message should come from respected community leaders. This will ensure that people trust public health advice, making them more likely to follow it.

Though the stigmatization of disease is a powerful force, viruses don’t pick and choose whom they infect. Association between certain types of people or places, behaviors and disease develop from fear and misinformation. Ultimately, it’s essential to question these associations and dismantle stigma by listening to stigmatized groups.

Paige Wallace
Photo: Flickr

Healthcare Apps in Sub-Saharan Africa
Although sub-Saharan Africa accounts for nearly 11% of the world’s population, it carries approximately 24% of the global disease burden. The region spends less than 1% on global health expenditure and lacks a strong infrastructure to address its citizens’ healthcare necessities.

Advancements in technology may be the solution to this crisis. The mobile industry in sub-Saharan Africa is growing rapidly. In 2012, only 32% of the population had access to a mobile subscription. By 2018, the mobile industry saw a 12% increase in mobile penetration rates. As a result, innovative healthcare apps are being released on the market, allowing individuals to access medical services remotely. This article will focus on three innovative healthcare apps in sub-Saharan Africa that can be accessed through a mobile device.

Hello Doctor: Providing Remote Medical Assistance

Hello Doctor is a mobile healthcare app that was developed in South Africa. It is currently one of the most popular mobile healthcare apps on the market and is available in 10 different countries. The app allows patients to have healthcare that is accessible, affordable and personalized.

The app requires a subscription of $3 per month. It allows a subscriber to “carry a doctor in their pocket.” After filing a request, subscribers are connected with a doctor via text message or phone call. All requests are responded to within an hour. All doctors accessed through the application are registered medical professionals.

The app also has a symptom checker in which patients can note their concerns and are provided with a list of potential diagnoses. It is also updated daily with new content to provide fundamental healthcare advice to patients. This app is most beneficial to citizens who may not be able to easily travel to their nearest healthcare clinic.

Pelebox: Delivering Essential Medication

Communicable diseases such as HIV/AIDs remain a growing problem in sub-Saharan Africa. These chronic diseases must be treated with medication that is picked up from the clinic. However, the limited number of clinics, a shortage of healthcare professionals and a high patient volume create excessive wait times for patients.

Pelebox, a South African app, manages smart lockers that dispense refills of prescriptions to patients. Instead of waiting hours to be seen in the clinic, patients can retrieve their prescriptions within a matter of seconds. Pelebox’s goal is to reduce the burden on hospital staff so that they can focus their attention on patients in critical care.

Here is how the app works. The patient is enrolled in the clinic’s collection program, the prescription is issued and the medication is placed into the locker. Clients will receive a one-time-pin via text message from the system. Patients enter their phone number and PIN at the self-service interface and retrieve their prescriptions from the cubicle. The cubicle is accessible at any time. Through its innovative approach in delivering essential medication, Pelebox has reached approximately 3,000 patients. The company is also planning to set up an additional 30 units in the next five years to continue to expand its reach.

MedAfrica: An All-in-One Healthcare App

MedAfrica, a product of Shimba Mobile, is one of the most popular healthcare apps in sub-Saharan Africa. It was first launched in Kenya in November 2011. By March 2012, it had approximately 70,000 users and was released into several other countries.

The app was created to make healthcare more accessible, affordable and safer. The app is free to use and works on any operating system. It is an all-in-one healthcare app that has various features. It provides users with a directory of qualified doctors and hospitals that are nearby. It also has a symptom checker available to its users so they can decide whether they’d like to pursue further medical advice or treatment. After the diagnosis, they can easily connect with the proper specialist. Users also receive first-aid advice and health updates from local hospitals.

Advancements in Healthcare Through Apps

An underfunded infrastructure, shortage of medical professionals and high patient volumes make for a fragile healthcare system. The surge of healthcare apps in sub-Saharan Africa is a great start to combating these issues. The innovative technologies that are being released for consumer use may be the key to granting much-needed healthcare access to individuals who need it the most.

Jasmine Daniel
Photo: Flickr

civil society response to HIV in South AfricaAccording to the Joint United Nations Program on HIV/AIDS (UNAIDS), South Africa has the largest population of people infected with HIV globally. One of the first countries afflicted with the epidemic in the 1980s, South Africa holds one eighth of the world’s AIDS population. One in nine South Africans and one in four adults are infected. The civil society response to HIV in South Africa has been crucial in addressing the virus and encouraging the government to take action as well.

Government Inaction

South Africa’s HIV statistics are staggering, even in comparison to other countries with large numbers of infected people, like Brazil and India. The problem of HIV in South Africa results from the government’s inadequate response to the epidemic until 2008. Manto Tshabalala-Msimang, the nation’s health minister from 1999 to 2008, refused to promote efficacious treatments such as antiretroviral therapy (ART). He called the antiviral treatments, widely endorsed by the global scientific community, “poison.” Tshabalala-Msimang instead promoted unscientific and largely ineffective treatments such as vitamins, beetroot and garlic. None of these have been shown to protect the health of people who are fighting the effects of the virus.

The year 2002 marked a turning point for the civil society response to HIV in South Africa. AIDS activists and others pushed back against a government policy that attempted to stifle access to effective treatments. In a historic judgment that initiated the fall of Tshabalala-Msimang, the South African courts ruled in favor of the activists. The ruling forced the government to take a more proactive role in fighting the epidemic. Later in 2006, the South African government established a national policy addressing HIV/AIDS following court processes instigated by AIDS activists. This policy broadened the distribution of life-saving drugs such as ART, addressed the shortage of healthcare workers and improved the treatment of HIV in pregnant women.

HIV/AIDS Activism

The South African government’s policies of misinformation and its ill-advised public health approaches to the epidemic worked to downplay the virus as a pressing threat. Because of Tshabalala-Msimang’s respectability and position of power, his rhetoric only fueled AIDS deniers. Still, South African scientists, medical professionals and activists banded together to challenge the government’s deadly inaction with the civil society response to HIV in South Africa.

From the onset of the epidemic, NGOs, CBOs, faith-based groups and activist groups took action to promote the treatment and prevention of HIV/AIDS. This civil society response to HIV in South Africa effectively addressed the acute inadequacy of the government’s response. These groups understood the importance of comprehensive responses to HIV even before international agencies drew connections between the various moving parts associated with the virus. For example, they emphasized the importance of condoms, bringing a wide range of issues into the public eye. Additionally, the groups stressed information, education and communication (IEC) initiatives to stop the spread of HIV/AIDS.

AIDS Foundation South Africa

A large part of the civil society response to HIV in South Africa, AIDS Foundation South Africa (AFSA) was the first registered AIDS NGO in South Africa, and it is currently one of the largest. The organization recognizes the complexity of the virus and the need to address it in a comprehensive way. AFSA focuses on a combination of treatment, prevention, child protection, food security, education and access to basic services. Additionally, AFSA recognizes that different communities have different needs when it comes to AIDS treatment and prevention. As such, the organization serves as a liaison for smaller organizations that might require research, funding, strategies and general aid.

In 2012, for example, AFSA conducted a program in KwaZulu-Natal to engage in work that supported various community programs. These programs included AIDS education and testing, childhood development, community care programs and food security endeavors. The organization is currently on track to meet its 2020 goal of 90% of all people living with HIV to know their status. It also aims to have 90% of all people diagnosed with HIV receiving ART and 90% of people receiving ART having viral suppression, a sign of the treatment’s efficacy.

New Administration

The importance the civil society response to HIV in South Africa is especially clear with the resignation of President Mbeki as well as Tshabalala-Msimang. Elected in 2009 by a large majority, President Jacob Zuma ran on a campaign that acknowledged the urgency of stopping the spread of HIV/AIDS in South Africa. Once elected, Zuma appointed Dr. Aaron Motsoaledi as minister of health. Motsoaledi turned the government’s focus to HIV response.

During Zuma’s term, which ended in 2018, South Africa launched a massive national HIV counseling and testing campaign (HCT), and Zuma himself publicized his HIV test. This campaign also included large-scale medical male circumcision (MMC), which mitigates the spread of the virus in many cases. By the end of 2010, more than half of adults and a third of children eligible for ART were receiving the treatment. Furthermore, the average price of HIV drugs decreased by more than 40% between 2010 and 2014.

Moving Forward

South African society has made monumental strides in addressing HIV/AIDS. However, stigma against several groups particularly afflicted by the disease stands in the way of a truly holistic response. For example, transgender women in South Africa are two times as likely to have HIV than men who have sex with men, but they are routinely excluded from studies and comprehensive care. Additionally, HIV among sex workers is as high as 71.8% in Johannesburg. Because sex work is criminalized in South Africa, AIDS treatment and potentially life-saving health information are less accessible. To more fully address HIV/AIDS, South Africa will have to turn to these issues next.

Kate Ciolkowski-Winters
Photo: Flickr

The Future of Pediatric Aids
The Elizabeth Glaser Pediatric Aids Foundation (EGPAF) strives for a future that prioritizes equal treatment, healthcare and research for children with HIV. It is playing a significant role in shaping the future of pediatric AIDS.

The Story Behind the Organization

In 1981, Elizabeth Glaser gave birth to her first child, Ariel. During labor, she contracted the AIDS virus through a necessary blood transfusion. Unknowingly, she then passed it to her daughter through breast milk and then to her son, Jake, in utero.

Due to the insufficient research-tested pediatric AIDS treatments, Ariel lost her life in 1988. Fearing for her son’s life in the wake of this tragedy, Glaser decided to put her fear and hopes into action. She soon joined her two friends, Susan DeLaurentis and Susie Zeegan, and founded the Pediatric AIDS Foundation. Their central aim has not changed since then: to fund research and provide treatment and care for children suffering from AIDS. These ideals were at the forefront of Glaser’s first visit to Capitol Hill.

At the 1992 Democratic Convention, two years before she lost her own battle with AIDS, Glaser presented a moving speech. Drawing on the loss of her daughter and her own experience with AIDS, Glaser’s speech called for change. More specifically, it called for a stronger response to pediatric AIDS. Glaser remarked that “this is not politics. This is a crisis of caring.” With this statement, she made it clear that this was not only about her life or her children. Rather, she wanted to prepare the nation to help children with HIV and shape the future of pediatric AIDS. Since then, EGPAF has become the leading nonprofit organization fighting against pediatric AIDS globally.

Recent Statistics

According to the World Health Organization (WHO), approximately 1,800,000 children under the age of 14 required treatment in Sub-Saharan Africa in 2011. Roughly 27% of those diagnosed received antiretroviral coverage.

HIV in children has two primary sources: mother-to-child transmission and infections in medical hospitals. Rates are higher in countries with few resources and little healthcare and regulation. Although it is the most common contraction method, mother-to-child transmission is preventable. If the mother has access to antiretroviral therapy, the chances of her passing the virus to her child via breastfeeding or delivery, or in utero, greatly decrease. As Glaser’s experience demonstrates, healthcare malpractice can also result in the transmission of the virus. In order to prevent this, healthcare workers must strictly regulate sanitation practices and blood transfusions.

By recognizing and addressing these means of contraction, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other organizations like EGPAF increased treatment to cover 70% of the affected population in Africa by the end of 2019.

The Impact

The steady advancements in global pediatric AIDS treatment are by no means a signal to slow down. At least for EGPAF, an organization committed to eliminating childhood HIV and AIDS completely, this is only a part of the journey. Focusing on countries in Sub-Saharan Africa, EGPAF treated 96,716 HIV-positive pregnant women to reduce the risk of mother-to-child transmission in 2019. By improving access to HIV services, it also tested over 8,000,000 individuals and facilitated treatment to approximately 86,537 children.

EGPAF’s in-house research division has also performed extensive work in the clinical and operational fields, strategizing and altering treatments. For example, The Kabeho Study was one of the first studies that assessed the implementation of lifelong antiretroviral therapy in pregnant women. Its findings suggested a decline in mother-to-child transmission when mothers receive proper treatment. Project Acclaim also showed that engaging community leaders led to the greater prioritization of newborn and child health.

From early congressional meetings and calls for change, EGPAF’s impact has grown immensely. As the organization continues to advocate for the cause and raise awareness, it simultaneously provides healthcare for children without the financial means – not only in the United States but also overseas.

Samantha Acevedo-Hernandez
Photo: Flickr

reducing STD transmission
India, officially known as the Republic of India, is a country in Southern Asia. It is the second-most populous country in the world, after China. Around 6% of the adult population in India are diagnosed with sexually transmitted diseases (STDs) and reproductive tract infections (RTIs) each year. With a population size as great as India’s — a 6% rate of infection amounts to more than 30 million infected people. These figures demonstrate why reducing STD transmission rates in India is such a large undertaking.

STD Rates and Poverty

In Jharkhand, an Indian state, over 1.5 million women are at risk of sexually transmitted diseases. In impoverished areas, male and female sex workers are most at risk of sexually transmitted diseases. In a screening of 336 female sex workers, 9.7% were positive for N. gonorrhoeae, 23.2% were chlamydia-positive and 5.9% had trichomoniasis. In another screening for men, of 150 participants, around 46% tested positive for HIV.

HIV and AIDS

India has the third-largest rate of HIV contraction in the world. As of 2017, around 2.1 million citizens in India received the diagnosis of HIV. Statistics show that HIV prevalence was higher in men (0.25%) than women (0.19%) in 2017. The main reason for this is because of men having sex with other men. They are more prone to HIV since most men reportedly do not use protection during intercourse. However, the percentage of citizens with HIV has dropped drastically since 2001. The spread of sexually transmitted diseases has been slowing down since the last decade. From 2010 to 2017, new infections decreased by 27% and AIDS-related deaths decreased by around 56%. By 2017, 79% of those living with HIV were aware of it, and about 71% were on antiretroviral treatment.

Chlamydia and Syphilis

Chlamydia is a sexually transmitted infection (STI) caused by a bacterium called chlamydia trachomatis. Every year in India, there are more than 1 million cases of chlamydia reported. Typically, people cannot feel any symptoms and it can be quickly treated with antibiotics. However, if it is not treated timely — it may lead to serious health problems. This STI may affect female fertility or cause ectopic pregnancies.

Syphilis is an STD that starts as a painless sore and spreads through contact via genitals, rectum or mouth. In 2014, around 16,797 men and 16,105 women reportedly contracted syphilis in India. Yet in 2015, around 16,128 men and 13,878 women were reportedly infected with the STD. This promising trend in statistics shows a roughly 9% decrease in cases in just the last decade.

India’s Solutions to Reducing STD Transmission

To start, the country’s main strategy involves a counseling and multidisciplinary approach. Almost 25% of those diagnosed with an STD are unaware of it. India is making the availability of counseling more prevalent within communities. Counseling will have a positive impact because professionals will help citizens become aware of their health situation by explaining the treatment options, along with the consequences.

Testing and Antiviral Therapy (ART) are further initiatives that India promotes for reducing STD transmission. Every five years, India provides universal HIV testing to the general population. The country also gives an annual screening for high-risk individuals. This system helps detect individuals who have contracted HIV at an early stage. ART is available readily to citizens. This program enhances the outcomes for those with HIV and decreases transmission rates within the community.

Hope for the Continued Trend

Overall, although India still has large numbers of citizens living with an STD, the government is creating initiatives to resolve this problem. There has been much progress, as shown by the major decrease in HIV transmissions within the last decade. As the government implements more counseling and ART programs, more individuals will become aware of their situation and the rate of transmission will hopefully continue to decrease.

Megan Ha
Photo: Flickr

Nepal Youth Foundation
Despite the country’s growing GDP, Nepal ranks the poorest among countries in South Asia and the 12th poorest in the world. One quarter of the 28.09 million population lives below the poverty line. Nepal’s poverty is even more evident in the country’s young population, as more than 60% of children lack at least one basic necessity. With children under the age of 18 making up 40% of Nepal’s population, investments in youth are integral to the nation’s continued improvement. Nepal Youth Foundation (NYF) is a nonprofit organization that works to empower Nepali youth through educational programs, health services and girls’ empowerment.

The Problem: Education in Nepal

Although Nepal’s education system improved in the past decade, gender disparities and segregation of disabled children prevail. Secondary school completion rates remain low, as only 30% of males and 15% of females have completed secondary school. Poorer areas pose additional challenges to female education, as the female literacy rate in rural areas is 74% compared to 89% in urban areas.

However, Nepal’s education system fails vulnerable, disabled children the most. More than 30% of children with disabilities do not attend school, as most public schools refuse to enroll them. When they do attend school, children with disabilities are placed in segregated classrooms, resulting in social isolation and an education of lower quality. It is estimated that more than 200,000 children in Nepal have disabilities.

3 Solutions from Nepal Youth Foundation

  1. Educational Scholarships: Nepal Youth Foundation provides educational scholarships for vulnerable youth, which include disabled, orphaned and homeless children. These scholarships pay for clothing, health services, living costs and counseling, in addition to educational expenses.
  2. Day School Scholarship: Nepal Youth Foundation’s Day School Scholarship program purchases school supplies and covers school fees for 165 children living in Kathmandu’s slums.
  3. Supporting Higher Education: The organization supports impoverished, high-performing students in college, prioritizing girls and other vulnerable groups. Nepal Youth Foundation contributes to the education of more than 300 students in Nepali universities. By prioritizing education for girls and vulnerable groups, Nepal Youth Foundation provides specific solutions for Nepal’s impoverished and vulnerable young people.

The Problem: Malnutrition and HIV/AIDS in Nepal

Both malnutrition and HIV/AIDS pose significant challenges to Nepal’s impoverished youth, who are most likely to lack basic needs and contract diseases. Of every five Nepali children, two are malnourished. Although the nation produces greens and sprouted vegetables that could solve malnutrition, these nutritional foods are most commonly fed to livestock, in accordance with rural traditions in Nepal. As a result, most rural Nepali people eat white rice for the majority of their meals. Healthcare providers’ lack of awareness of the connection between diet and malnutrition exacerbates Nepal’s staggering malnutrition rate, as hospitals fail to address the root causes of malnutrition and offer temporary remedies instead.

Although HIV/AIDS is considered a concentrated epidemic in Nepal isolated to at-risk groups, stigma around the disease has detrimental effects on those diagnosed. Children diagnosed with HIV/AIDS are neglected by society, denied healthcare, refused school enrollment and socially isolated by their peers.

3 NYF Solutions

  1. Nutrition Rehabilitation Homes: Nepal Youth Foundation’s 17 Nutrition Rehabilitation Homes exclusively treat malnourished children. Since 1998, these homes have replenished the health of more than 15,000 children. Malnourished children stay in Nutrition Rehabilitation Homes for three to four weeks and are fed diets catered to their specific needs. Additionally, these homes teach caregivers and mothers about cooking healthy foods with cheap, available produce to ensure the long-term health of children and families.
  2. Nutritional Outreach Camps: NYF’s Nutritional Outreach Camps provide further prevention and intervention services for malnourished children. To treat malnourished children, NYF provides medical check ups and medicine and distributes a nutritional flour called Lito. The organization’s prevention techniques include nutrition and hygiene education for local communities. Each short camp serves between 500-800 children and their families.
  3. New Life Center: The organization’s New Life Center serves children with HIV/AIDS with a team of doctors, nutritionists and specialists that provide healthy diets, counseling, treatment and fun activities. Nepal Youth Foundation also ensures that adults are trained in proper hygiene practices. Nepal Youth Foundation’s commitment to finding solutions to malnutrition and reducing the stigma against children with HIV/AIDS has lasting effects on the communities it serves.

The Problem: Indentured Servitude of Kamlari Girls

Kamlari is a rural Nepali tradition of indentured servitude, through which girls from impoverished families are sold as domestic slaves for a yearly monetary price.  These girls, often sold at very young ages, are not legally protected by a contract and are almost always denied the food, bed and education they are promised. Additionally, many are subjected to violence, food deprivation and rape. Although many girls have been rescued as a result of NYF and government efforts, more than 300 girls remain in child slavery.

Nepal Youth Foundation Solutions

The organization’s Empowering Freed Kamlaris program provides management and business training, vocational career counseling and emotional support for former Kamlari girls. NYF also collaborates with local governments to locate and rescue enslaved Kamlari girls. The organization’s Freed Kamlari Development Forum has contributed to the rescue of more than 12,000 girls. Kamlari girls support each other in building businesses through the Freed Kamlari Development Forum, which has more than 2600 members in 37 business collectives. Many former Kamlari girls in the program are trained in specialized skills to run a business and secure a stable source of income. By rescuing and training former Kamlari girls in self sufficiency and economic freedom, Nepal Youth Foundation empowers girls and strengthens the communities in which they build their businesses.

The Nepali government should follow the example of Nepal Youth Foundation and continue to implement programs that support the country’s future generation in education, employment, access to healthcare and gender equality. It is by empowering young people that developing nations progress.

Melina Stavropoulos
Photo: Unsplash

Women Are Disproportionately Affected by HIV

Young women between the ages of 15 and 24 make up approximately 9.8% of sub-Saharan Africa’s total population, but they account for 20% of the region’s confirmed cases of HIV. While part of the reason why HIV affects women the most is due to basic biology and the fact that women are more likely to contract HIV, it also has to do with economic, cultural and legal factors present in sub-Saharan Africa.

Poverty and the Spread of HIV

The good news is that poverty is declining globally. The bad news is that extreme poverty is becoming ever more prevalent in sub-Saharan Africa, where experts believe that 90% of impoverished people will live by 2030. A struggling economy warrants little room for government expenditures on healthcare and education, so not only are many poor people in sub-Saharan Africa not able to access affordable methods of HIV prevention and treatment, but they also do not receive substantial education on how to prevent its spread. Specifically, in this region, 70% of young women have not learned about the risks, treatments and preventions of HIV.

Without promising futures, it is not uncommon for young women to resort to transactional sex or early marriage for support. Both customs are associated with less condom use, sexual violence and multiple partners. Both transactional sex and child marriage often result in a significant age gap between partners. Evidence shows that HIV in men becomes more prevalent with age, so higher age gaps cause HIV to affect young women.

Cultural and Political Barriers

Gender norms that accompany older man/younger woman relationships also add how HIV disproportionately affects women. In order to feel masculine, men tend to assert their dominance by having many partners, refusing to get tested for sexually transmitted infections and not wearing a condom during sex. These practices reinforce ideals that perpetuate sexual health as a woman’s responsibility and are some of the reasons for why HIV affects women so significantly.

Culturally, there is much stigma surrounding premarital sex, having multiple partners and being a woman with HIV. There are many reports of unsupportive healthcare professionals, denial of service and miscommunication about results concerning HIV status. Coupled with the fear of horror stories of forced sterilization, forced abortions and forced virginity examinations, there are high barriers discouraging women from accessing the care they need.

Restrictive policies also make it difficult for young women to access information about their sexual health. In a study that received results from 110 countries, over half of the responding African countries required parental or spousal consent for women under 18 to receive HIV testing. Although these laws may be to protect children, it actually prevents young women from accessing sexual and reproductive medical care. For places that do offer HIV services, many are exclusively for married women with children, so most young women do not fit the criteria to obtain testing. Additionally, nearly half of the responding African countries reported having age restrictions for buying condoms.

Action Plan

The statistics look grim, but the World Health Organization’s five-year plan to reduce the number of HIV infections and deaths is in full swing. Its goals include increasing testing, eliminating discriminatory laws and creating larger global access to testing for sexually transmitted infections.

The plan includes five specific tactics the WHO intends to use, which cover assessing the situation, deciding which services to provide, how to provide these services, financing the efforts and implementing structural change. In the end, the WHO aims to end the AIDS epidemic by prioritizing preventative measures like wearing condoms and education about injection safety, allocate more resources towards ending gender-based violence and discrimination, introducing a harm-reduction intervention package and much more.

If WHO carries out this plan correctly, it will reach hundreds of thousands of people, many of whom are young women residing in sub-Saharan Africa. It should also equitably deliver HIV services to those who are most in need.

– Rebecca Blanke
Photo: Wikipedia Commons

HIV in the Central African Republic

The Human Immunodeficiency Virus (HIV) has affected millions of people around the world for many decades. If left untreated, HIV can slowly develop into Acquired Immunodeficiency Syndrome (AIDS) and leave those infected with a compromised immune system. Thousands of individuals have suffered from the disease or lost their life to it since the first reported case in the Central African Republic in 1984. The country has mobilized numerous efforts to combat the disease but still requires assistance to ensure that the citizens have adequate testing and access to medicine. Here are five important facts to know about HIV in the Central African Republic.

5 Facts About HIV in the Central African Republic

  1. Around 5,000 citizens die each year from HIV/AIDS in the Central African Republic. In 2018, more than 5,000 individuals died from AIDS-related causes and an estimated 110,000 citizens were living with illness. Though the infection rate still remains high, the efforts being made to stop the spread of HIV have been effective. In 2010, the prevalence of HIV in the Central African Republic was 5% and according to recent data acquired in 2018, the rate has decreased, with only 3.6% of the population living with the disease.
  2. HIV in the Central African Republic primarily affects homosexual men and sex workers. In the Central African Republic, the number of HIV infections are extremely high in the sex worker population, with a prevalence of 9.2%. Similarly, gay men are also at an increased risk for contracting the virus, with a prevalence of 25.4%. Though these two demographics make up a smaller portion of the nation’s population, the lack of testing and awareness affects every citizen in the Central African Republic. With the help of funding from other countries and organizations, the Central African Republic can begin to provide more medicine and diagnostic centers for individuals.
  3. ART can treat HIV yet is seldom available in every community. While there is no cure for the virus, there is a well-known therapy for slowing it down. The treatment for HIV is a multi-drug regime known as antiretroviral therapy (ART). ART can alleviate the severity of HIV if a person begins treatment after diagnosis. While ART does not kill the virus, it stops the virus from creating DNA in the fourth phase of cell formation and slows the spread of HIV in the body. However, in remote cities like Zemio, medicine and supplies are hard to find. The prevalence of HIV is more than 12% higher in remote regions than it is in the rest of the Central African Republic. The HIV-positive residents in these areas seek comfort and support in Community Antiretroviral therapy Groups (CAGs). Some preemptive strategies for HIV-prevention include condom use, using new needles and premature testing. It is imperative that the citizens, especially those already diagnosed with HIV in the Central African Republic, have suitable access to new condoms and needles.
  4. Due to the political turmoil in the Central African Republic, testing and medicine have become inaccessible to some regions. Because of the conflict arising in the country and other surrounding areas in 2013, ransacking or closing of medical centers weakened the already struggling healthcare system. The political unrest and violence that ensued also resulted in individuals with HIV to avoid seeking treatment or to stop taking their medication. With an increase in displacement, poverty levels and closing of healthcare facilities, individuals in the Central African Republic are in dire need of trained medical staff, consistent medical treatment and more testing sites. It is imperative for the citizens living with HIV in the Central African Republic that other nations continue to increase funding for testing locations, training and medicine.
  5. Other countries and organizations are helping in numerous ways. The Central African Republic depends heavily on funding from other countries to provide treatment for its citizens, with more than 90% of the money spent on individuals with HIV coming from international sources. After the political instability faced by the country in 2013, The United Nations Refugee Agency, also known as the UNHCR, assisted the healthcare facilities in rebuilding their database and providing immediate treatment for refugees and asylum-seekers. UNICEF, another global organization, also provides technical services and financial aid for the Central African Republic. With the help of UNICEF, the country can provide more testing, ARV treatment and care for pregnant women with HIV.

HIV has been prevalent in the Central African Republic since the first case was reported in 1984. While the virus impacts many people, weakening their immune systems, organizations are stepping in to help. Outside funding and support from agencies like UNHCR and UNICEF are helping reduce the prevalence of HIV in the country. 

Danielle Kuzel
Photo: Flickr