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Marburg Virus Outbreak in Rwanda: The Progress

Marburg Virus Outbreak in RwandaRwanda is fighting its first outbreak of the Marburg virus and experiencing its third-largest outbreak. As of October 2024, there were 63 cases, with 15 cases resulting in death. The Marburg virus is very contagious but only contracted through bodily fluids and scientists believe the Rwanda outbreak began with contact with contaminated animals.

Animal Contagion

The Marburg outbreak in Rwanda was announced on September 27, 2024, according to Nature. Surrounding countries reported their outbreaks years before, with Tanzania and Equatorial Guinea having their outbreak just last year. At first, the virus’s origins were uncertain; researchers thought it came from an animal but had no proof. Rwanda started contract tracing and an epidemiological investigation to identify the first patients and to determine how they contracted the virus.

According to the World Health Organization (WHO), the animal of contact was possibly a Rousettus bat, a fruit bat found in mines or caves, because they carry the Marburg virus. “Initially, human Marburg virus infection results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies,” said eMedicine Health.

Progress of the Marburg vaccine

The Marburg virus is a relative of the Ebola virus, both being part of the Filoviridae family. Both viruses have similar symptoms and transmission. According to eMedicineHealth, the Ebola virus has a higher fatality rate of 25%-90% compared to the Marburg virus fatality rate of 24%-88%. Ebola is more virulent but has two licensed vaccines, while the Marburg virus has none.

As of October 2024, the only vaccine for the Marburg virus is experimental. The scientists had the first trial of the experimental vaccine to fight the Marburg virus outbreak in early October. The Sabin Vaccine Institute sent out 700 vaccine doses to health care workers because they are the most at risk. The vaccine is currently in Phase 2, which means it is still undergoing testing. The Sabin Vaccine Institute still monitors people with previous outbreaks in surrounding countries.

“Interim results are expected next year, and Sabin also plans to launch a similar Phase 2 trial in the U.S. next year,” said the Sabin Vaccine Institute.

Outside Help

The people of Rwanda are not combating the Marburg virus outbreak alone. They have the support of many, some of which are WHO, Africa CDC and the United States, using a “governmental approach.” The CDC and WHO worked with Rwanda to begin a response to the outbreak and identify the public health needs. Rwanda’s supporters also sent scientists and researchers to help with the epidemiologic investigation and distribution of the vaccine.

The Marburg virus outbreak in Rwanda has reached level two for travelling which states “Practice Enhanced Precautions.” The WHO and the CDC have released statements about the outbreak and the risks people take if they travel to Rwanda. The supporters of Rwanda during the outbreak have helped create a response plan/program to assist in the public health of the people in Rwanda.

Conclusion

Since the announcement of the Marburg virus outbreak in Rwanda, the country has worked effortlessly to stop the virus. Many have come to Rwanda’s aid in their time of need. Their supporters have provided vaccines and plans to help support the public and the health officials/workers. Coming to Rwanda’s aid has allowed the progress of attaining an official and approved vaccine for the Marburg Virus that could prevent any more severe outbreaks in the future.

– Ashley Diaz

Ashley is based in Homestead, FL, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Monkeypox Outbreak in Africa

monkeypox outbreakCOVID-19 was a difficult time for everyone. Not only did we see extreme drawbacks in the economy, but drawbacks socially and personally as well. The world has worked hard to move on from a time of social isolation, and face masks, but a new problem has begun to arise that threatens the world’s plans for global stability. Monkeypox, now known as Mpox is a rare disease that leads to a rash and flu-like symptoms. There are two strains that affect a multitude of people at different rates and are contracted in various ways. Infected are commonly found in central African countries like the Democratic Republic of Congo (DRC), Uganda, and Rwanda. These countries are now facing high rates of spreading, stirring tensions and concerns of another global crisis and potential monkeypox outbreak.

Countries at Risk

Mpox is causing major outbreak fears in the DRC, Uganda and Kenya as people are starting to experience an increase in cases. Mpox in the DRC has reached over 15,000 reported cases, as of August 2024, making it the largest concentration of infected on the continent, and surrounding countries are at risk. Kenya, Uganda, and Rwanda have now reported their first cases of monkeypox, and have begun taking necessary precautions to isolate the problem before more are infected.

The DRC and other countries are working hard to contain the threat; a mixture of existing economic setbacks and Mpox would be detrimental to the progress and stability Africa has worked hard to achieve. Mpox in the DRC is close to a total outbreak in the eastern provinces of South and North Kivu where millions of displaced people are living in overcrowded conditions, inevitably causing an immediate rise in cases.

Kwazulu Natal reported nine cases of Mpox and two confirmed deaths already in July 2024. Men between the ages of 17 through 43 were among the first groups to contract the disease in July 2024. Exposure can occur through contact with contaminated materials, infected animals or infected people, most notably through sexual contact. South Africa fears of growing community transmission in areas with high concentrations of vulnerable groups.

Monkeypox Outbreak: Solutions

Government organizations like UNICEF, WHO and the African CDC are working in partnerships to provide vaccines, services and information, and health kits to healthcare facilities across Africa. A collaboration with Gavi, the vaccine alliance has led to the approval of several projects aimed at containing and stopping Mpox in the DRC and other African countries.

Beginning in 2026, Gavi will start stockpiling vaccines, but progress will rely on funding, prequalification of a recommended vaccine and the availability of WHO Emergency Use Listing. Gavi will support outbreak response in DRC and surrounding countries in the meantime. The organization will invest in the learning agenda which aims to help inform and improve future vaccination efforts.

In 2022 the CDC Foundation activated the Emergency Response Fund, previously used to bolster support to communities and organizations when Ebola, Zika, and most recently COVID-19 threatened the world. Appealing with government and private entities the CDC aims to raise as much support as possible, the first of many donations coming from the Robert Wood Johnson Foundation.

Going through the COVID-19 pandemic, the world gained an experience. Support in awareness and advocacy of the problem that the monkeypox outbreak poses is necessary for low-income countries to receive help. The world has the chance to stop another pandemic from taking shape.

– Immanuel Wiggins

Immanuel is based in Jackson, MS, US and focuses on Global Health for The Borgen Project.

Photo: Flickr

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HIV in India: Working Towards Improving the Health Care

hiv in indiaMore than two decades ago, Bill and Melinda Gates learned about the contagious Rotavirus, present in several countries. The more they learned, the more devoted they became to helping. Higher-income countries could treat rotavirus with ease, but lower-income countries struggled with it, leading to many casualties. Hearing this, the Bill and Melinda Gates Foundation started working in India in 2003. The foundation launched the Avahan Program, which targeted HIV prevention. Avahan was incredibly successful in its endeavors, eliminating nearly 600,000 infections.

The Bill and Melinda Gates Foundation also partnered with others to help the Indian government in defacing polio. These efforts were not easy; nearly 2.3 million volunteers helped with vaccination efforts, and their labors were fruitful. The efforts helped provide vaccines to 170 million children finally eradicating polio in India in 2014, according to the foundation’s website.

CDC in India

In 2001, the Centers for Disease Control and Prevention (CDC) established its first Indian office in New Delhi. Establishing this office was one of the first steps to their end goal: eliminating any presence of HIV in India by 2030.

The CDC, partnering with National AIDS Control Organization (NACO) began advancing HIV treatment in India. They improved accessibility to antiretroviral therapy (ART) and viral load (VL) testing. With CDC, NACO created 740 ART centers in India, all providing specialized care, disease management and ART, according to a 2024 CDC report.

Regarding their laboratories, the CDC has worked on reaching remote areas through community-led testing, and access to PLHIV. Additionally, the CDC is collaborating with the Indian Government to create systems within their laboratories, dedicated to the early detection and management of HIV, along with continued care regarding cervical cancer, according to the same report.

The CDC and the Indian Government have partnered together regarding testing, targeting districts with a high HIV prevalence, including Mumbai, Mizoram, Manipur, Nagaland, and Andhra Pradesh, according to the CDC. This partnership has led to an increased awareness and understanding regarding HIV.

USAID Project

Additionally, USAID and the Johns Hopkins University School of Medicine started a project to make HIV treatment available in socially remote areas. This program has opened several centers that help with treatment. There are centers dedicated to teenagers, where they have access to “sports, music, and life-skills programs, while also accessing counselling, social services and peer support on their HIV journey.”

This mix of services allows them to navigate life and challenges as they live with HIV. There are also centers for transgender people, that provide specialized treatment for HIV along with general healthcare services as well. In these specific centers, they provide stigma-free care, allowing for a more accepting, safe atmosphere for patients. There are also online platforms such as SafeZindagi.in, which can often be a faster or easier option for patients. It provides confidential care and counselling for those living with HIV.

HIV in India: The Future

Having centers like these available to the general public is a game-changer. Factors that may inhibit people from seeking care include stigma, transportation accessibility, cost, lack of awareness, and more. Programs like these, along with the work from the CDC and Indian government, are slowly tackling these issues and working towards a healthier India.

Now, around 2.5 million people are living with HIV in India, compared to the 39.9 million people living globally with HIV. Thanks to the efforts from the CDC, the Indian Government and USAID, HIV prevention in India is advancing in an upward trajectory.

– Lakshya Anand

Lakshya is based in Bellevue, WA, USA and focuses on Global Health for The Borgen Project.

Photo: Unsplash

State of Health care in Vietnam

Health care in VietnamVietnam’s public health system has faced significant challenges in recent years, from diseases including tuberculosis, HIV/AIDS and COVID-19. With the help of organizations including USAID and the CDC, however, Vietnam has also achieved a great deal of success in addressing these issues. Here are some important things to know about health care in Vietnam, and how foreign aid programs have contributed to its development.

The Centers for Disease Control and Prevention (CDC)

The CDC’s partnership with the Vietnamese government celebrates its 25th anniversary in 2023. Since 1998, the CDC has supported Vietnam in establishing programs to improve the treatment of diseases including TB, HIV and influenza. The number of HIV sentinel surveillance sites, for instance, which help Vietnam detect and monitor patterns of infection have doubled since 2003. Furthermore, a clinical trial for a new TB treatment conducted by the CDC in Vietnam reduced the length of treatment from six months to only four; it was the first new treatment regimen, in any country, for the disease in three decades. The CDC has also aided in the creation of five emergency operations centers to support the country’s health care system in times of crisis, such as the COVID-19 pandemic.

The World Bank

In 2013, the World Bank funded a $126 million project to protect and improve the public hospital system in 13 provinces in North Vietnam. The North East and Red River Delta Regional Health System Support Project aimed to solve the overcrowding problem that many Vietnamese hospitals were experiencing. It was a success — nearly half of the 74 hospitals included in the program were awarded the Vietnamese Ministry of Health’s upper hospital classification, and patient satisfaction rates experienced a marked increase, reaching 88.5% at the district level. Almost 5,000 local doctors received training from Vietnam’s top medical specialists, learning around 3,000 new techniques to use in their own communities.

USAID

In an effort to ensure an effective response to the COVID-19 pandemic, USAID provided Vietnam with $12 million in aid in 2020. This included $4.7 million in funding for laboratory systems, public health screenings, infection prevention in health care settings and 100 ventilators. USAID also provided $5 million in support of the country’s economic recovery.

Other programs financed by USAID that support health care in Vietnam include Erase TB. This initiative has improved the country’s ability to detect and treat tuberculosis, contributing to a decline in cases of the disease in Hanoi and Ho Chi Minh City. Additionally, USAID’s Local Assistance to Develop and Deliver Excellence, Resilience and Sustainability in Vietnam (LADDERS) program helps high-risk people living with HIV, often living in remote areas, to access testing and treatment services.

The World Health Organization (WHO)

The WHO has supported Vietnam with the goals set out at the ninth Global Conference on Health Promotion, held in 2016. These are:

  • Good governance – promotes an approach in which health care is central to government policy and policies that protect citizens’ health and wellbeing are prioritized
  • Health literacy – ensures that citizens have the information they need to make healthy choices and to access health care.
  • Healthy cities – reinforces the need for high-quality health care services and planning at the local level, to improve the state of the country’s overall health care system.

Vietnam’s 1,332 hospitals, alongside its community services and laboratories, have significantly improved patient access to higher quality health care in recent decades. The work done, and aid given, from both American and global organizations has been vital to this record of success and continues to help Vietnam improve the standard of care that its citizens receive. Health care in Vietnam is more effective thanks to the enduring partnerships established between these organizations and the Vietnamese government.

– Martha Probert
Photo: Flickr

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RSV in Developing Countries and the Need for a Vaccine

RSV in Developing CountriesAs of 2022, pandemics such as COVID-19 and tuberculosis are still rampant around the world. But there is another respiratory virus called the respiratory syncytial virus (RSV) that poses a risk, especially for those living in low-income countries and young children.

RSV in Developing Countries

RSV is a contagious virus that affects the lungs and breathing passages. The reason why RSV is not as well known is because its symptoms are the same as a cold. These include cough, a runny nose and fever. RSV can infect people of any age, but elderly people and children ages 2 and under are at the most risk of catching the virus. And much like the flu and COVID-19, it spreads when an infected person coughs or sneezes when around others and touches surfaces and objects.

People infected with RSV may even develop severe infections such as pneumonia or bronchiolitis which is the inflammation of the small airways in the lungs. Despite the danger, however, RSV is preventable. People can protect themselves from infections by simply washing their hands with soap and hot water for 20 seconds, covering coughs and sneezes, wiping surfaces that have been frequently touched and maintaining distance.

With these simple prevention methods, one might be asking just why is RSV so dangerous. While cases of RSV can be mild and clear on their own, a person can be infected multiple times in their lifetime. Furthermore, for those with severe symptoms who lack access to health care services, the outcomes can be devastating.

The Importance of Medical Care

“A seasonal virus that emerges during the winter months” causes RSV. Infants are more at risk for catching RSV since they do not have immunity compared to adults. Not only that, but in recent months the virus has been surging and that is ironically due to the prevention protocols against the COVID-19 pandemic.

Prevention methods such as social distancing, hand washing and mask-wearing during the COVID-19 pandemic helped to limit the spread of RSV. As a result, there have been no RSV infections over the past few years. That also means that there are two to three-year-olds who have no immunity to RSV. 

The situation is most worrisome when it comes to tackling RSV in developing countries. Many kids in low-income countries may also live in remote areas without access to medical assistance. “More than 95% of RSV deaths occur in low-income countries,” according to Bill and Melinda Gates Foundation. Unfortunately, a percentage of those who do survive may suffer from long-term health issues such as lung damage.

The Future

Currently, there is no known drug or vaccine for RSV. However, a vaccine to prevent RSV is in development by Pfizer who announced at the end of 2022 that its vaccine “showed an efficacy of 82% against hospitalization among infants under 90 days old and 69% among those younger than six months.”

The only challenge left is facilitating vaccine access to low-income countries. On that note, the Bill and Melinda Gates Foundation announced a grant to support the development of affordable multidose vials for delivery. The foundation is “optimistic that this vaccine could be available to low-income countries at an affordable price by 2024.”

– Aaron Luangkahm
Photo: Flickr

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3 Facts About Measles

About MeaslesMeasles is a communicable disease caused by a virus. Persian physician and scholar Abū Bakr Muhammad Zakariyyā Rāzī discovered the disease in the ninth century but it became a global term in the 16th century. In 1757, measles-infected blood was transmitted to healthy donors where Scottish doctor Francis Home discovered that a highly infectious bacterium causes measles. Measles only become a nationally recognized disease in the United States in 1912, when there were 6,000 deaths annually. To this day, measles is considered to be one of the world’s deadliest diseases, especially in developing nations, despite treatment efforts. Here are three facts about measles.

3 Facts About Measles

  1. In 2022, the creator of the measles vaccine Samuel L. Katz passed away at the age of 95. Before the development of the vaccine, almost every child had measles by the age of 15 and nearly 4 million people were infected every year. Five hundred people died from measles each year, there were 48,000 hospitalizations and 1,000 people had swelling of the brain due to the infection, according to the Centers for Disease Control and Prevention (CDC). In 1956, there was a disease breakout at a school in Boston, Massachusetts, where John F. Enders and Dr. Thomas C. Peebles collected blood samples from infected students and isolated the disease within David Edmonton’s blood. In 1963, they developed Edmonton’s virus into a vaccine and it officially received a license in the United States, where Maurice Hilleman and his research team further improved it in 1968.
  2. Before the vaccine, there was an epidemic every two to three years that caused around 2.6 million deaths each year worldwide, according to the World Health Organization (WHO). Even after the vaccine, in 2018, 140,000 people died from measles, most of which were children under 5. Unvaccinated children, pregnant women and non-immune people are most at risk of getting measles, though it is particularly common in developing nations, such as countries in Africa and Asia. In addition, more than 95% of deaths happen in low-income households and countries with underdeveloped health services, WHO reports. Once one has measles, there is no anti-treatment available. However, vitamin A can reduce the complications and risk of death from measles after taking two doses a day apart. The vaccine is a routine procedure in the U.S. and costs $1 per vaccine. However, many developing nations cannot afford the vaccine. This has led to 19.2 million infants not receiving a single dose in 2018. Around 6 million of these infants were from India, Nigeria and Pakistan, where the number of cases is significantly rising.
  3. According to the WHO, measles spreads through coughing, sneezing and being in close contact with infected patients. It can stay airborne and on infected surfaces for as long as two hours and can infect people four days before and after a rash occurs. The first symptoms of measles show 10 to 12 days after exposure to the virus, lasting for four to seven days. It initially has cold-like symptoms, such as a runny nose, cough, red and watery eyes and a fever. Patients also develop small white spots on their cheeks. This develops into a rash after 14 days, which could last for six days. Without treatment, complications could occur, such as blindness, brain swelling, diarrhea, dehydration and ear and respiratory infections. Though, complications occur more in malnourished children with a lack of vitamin A or those who have weak immune systems from other diseases.

Looking Ahead

In 2010, the World Health Assembly stated three targets to eradicate measles by 2015. First, to enable more first-dose vaccines during routine coverage to more than 90%. Second, to reduce case numbers to less than five cases per million annually. Third, to reduce measles-related deaths by at least 95%. Furthermore, in 2012, the World Health Assembly supported the Global Vaccine Action Plan of “eliminating measles in four WHO regions by 2015 and five regions by 2020,” the WHO reports. These goals were successful and as of 2018, mortality rates had decreased by 73% with the development of the vaccine coverage. The Measles and Rubella Initiative, founded in 2001 and the Gavi Vaccine Alliance also supported this by preventing 23.2 million deaths, where most of the deaths would have been in Africa and the countries that the Gavi Alliance support.

– Deanna Barratt
Photo: Flickr

HIV/AIDs in Cameroon

HIV/AIDs in Cameroon
One of the most prominent challenges citizens in Cameroon are facing today is the prevalence of HIV/AIDs throughout the country. With the national infection rate being 3.7% in 2021, achieving epidemic control continues to be a constant battle. However, with the help of foreign aid, NGOs and the proactive efforts of the Cameroonian government, the country is making progress toward this goal. Here are the most important things to know about the history of HIV/AIDs in Cameroon and the state of the prevention effort.

History and Demographics

Like many countries in sub-Saharan Africa, there is a higher rate of individuals infected with HIV/AIDs in Cameroon than in most other parts of the world. The earliest reported case in Cameroon was in 1985 and by 1990 the country had an estimated 49,000 infected individuals. This number increased every year until it peaked at an estimated 520,000 cases in 2012. Since then, the annual rate has slowly but steadily declined to an estimated 500,000 cases in 2021.

Though many children have HIV/AIDs in Cameroon, people 15 years or older are by far the most common and represent an estimated 460,000 of the 500,000 currently infected, according to UNAIDS. Within the adult over 15 cohort, women are more than twice as likely to have HIV/AIDs than men.

Prevention and US Support

The first measure the government of Cameroon took to prevent the spread of HIV/AIDs was the establishment of the National AIDS Control Committee (NACC) in 1986. Its function was to facilitate cooperation between prevention efforts nationally. It expanded its efforts further in 2000 when it launched the first of three five-year plans to prevent the transmission of HIV/AIDs in the country.

There has also been a myriad of U.S.-backed efforts to help assist in the prevention effort. For example, in 2008 the U.S. Center for Disease Control and Prevention (CDC) partnered with Cameroon’s Ministry of Health as well as a host of NGOs to assist in the fight against HIV/AIDs. Through this collaboration the CDC aimed at “providing technical leadership on HIV epidemic control efforts within the country” but eventually expanded its operations to also include “direct clinical support” and help “scale-up access to HIV prevention and treatment services.”

Additionally, USAID has backed and helped execute a variety of HIV/AIDs prevention plans in Cameroon through the President’s Emergency Plan for AIDS Relief (PEPFAR). A few of these initiatives are The Continuum of Prevention, Care and Treatment (CoPCT) of HIV/AIDS with Most-at-Risk Populations in Cameroon (CHAMP), Reaching Impact, Saturation, and Epidemic Control (RISE) and Community-Led Monitoring (CLM).

In general, PEPFAR programs aim to mitigate the spread of HIV/AIDs in Cameroon through education, community outreach, reliable data collection and strengthening existing government and non-governmental healthcare agencies.

Looking Forward

Though it may seem like a sign of inefficacy that total infection numbers have only gone down by a small margin since 2012, it is important to remember that epidemics tend to grow exponentially and that the population of Cameroon has been increasing steadily at a high rate for the past several decades. With this in mind, a stagnated or only marginally decreased total infection figure is actually quite an accomplishment, as the government has to account for an enormous increase in population and the spread of infectious diseases is notoriously difficult to subdue.

Further, aid from countries like the U.S. was undoubtedly instrumental in achieving this feat and continued international support will be necessary as the national government continues to battle HIV/AIDs in Cameroon.

– Xander Heiple
Photo: Unsplash

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Diseases in Puerto Rico

Diseases in Puerto Rico
Chronic diseases in Puerto Rico have been on the rise in recent years. According to the Puerto Rico Report, more than half of the deaths reported on the island are due to chronic diseases. In 2010, 57% of deaths were due to heart disease, diabetes, cancer and strokes. The Puerto Rican Report also said more than one-third of Puerto Ricans have diabetes, more than 18% have arthritis and 17% have reported asthma throughout their adulthood.

Poverty and Chronic Diseases

Puerto Rico Report stated in an article that poverty has a connection with the increase of chronic diseases as households with an income of around $15,000 per year or less have higher chances of developing a chronic disease. Chronic diseases result in disabilities that can deteriorate the workforce and exacerbate the health care system. The CDC stated that 21% of Puerto Ricans have reported having serious mobility restrictions.

A study that the International Journal of Environmental Research and Public Health published stated that, compared to the general mainland population in the United States, chronic disease occurrence levels and mortality rates are higher for the people living in Puerto Rico. Around 44.3% of individuals who reported food insecurity in the study also reported that they perceived their health to be average or poor. The study also found that as of 2020, 5,000 doctors had left the island to work in the United States for economic reasons leaving the island, marking a 36% decline in medical staff on the island. Health care services in Puerto Rico currently face the risk of funding reduction in the Medicaid program that could lead to 1.5 million people losing health care coverage.

Financial Burdens

The Puerto Rico Report stated that citizens of the island are currently not eligible for Supplemental Security Income due to its status as a colony. The rising cost of pharmaceutical medicines and treatments has left the high levels of chronic disease to increase the financial burdens on the island. More than half of Puerto Rican residents are eligible for Medicaid. However, they do not receive enough funding to cover the cost of their disease’s treatment.

Solutions

In 2014, the Puerto Rican government released the “Puerto Rico Chronic Disease Action Plan” that focuses on collecting data, chronic disease self-management education, intervention plans within communities and increasing access to nutritious food and physical activity. The plan could strengthen the health care system on the island while increasing the economic position of Puerto Rico as the government looks to build medical manufacturing on the island to increase profit and medications. The plan is also looking to increase a clinical trial network within the island and develop local primary health.

The Puerto Rican government developed the model from the chronic model that the Pan American Health Organization/World Health Organization (PAHO/WHO) created and implemented in countries such as Brazil, Argentina, Colombia and the Dominican Republic. This model has reduced hospitalization rates due to diabetes, hypertension and other chronic conditions. It has also decreased the economic strain of the health care system in the different countries. “The model has six components: organization of care, community engagement, support for self-management, clinical information systems, design of service delivery systems, and support for clinical decisions,” PAHO stated.

The government has yet to release any update on the progress of the model due to the pandemic drawing attention away from the increasing risk of chronic diseases on the island. Chronic illnesses still present a big risk factor on the island from both the economic and health care perspective. However, many of the education sections of the model have increased health awareness on the island. As the island begins to move away from the COVID-19 pandemic hope increases for an increase in resources for chronic illness treatment.

– Nuria Diaz
Photo: Flickr

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How Epigenetics Predicts the Effects of Poverty

EpigeneticsEpigenetics is a recently developing branch of genetics that rose to prominence in the 21st century. Recent research has shown the biological effects of poverty through epigenetics. Epigenetics goes further than the genes a person inherits from their parents by showing how the individual’s genes react to their environment and other factors. One study that Molecular Psychiatry published concluded that children who grow up in families below the poverty line are “more prone to mental illness and alterations in DNA structure.” Since poverty brings numerous stressors such as poor nutrition and physical or psychological trauma, it can affect a child’s biological development, particularly in the brain. Epigenetics can help shape the future and bring to prominence that poverty can cause acute and chronic conditions.

What is Epigenetics?

The Centers for Disease Control and Prevention (CDC) defined epigenetics as “the study of how your behaviors and environment can cause changes that affect the way your genes work.” Epigenetics affects gene expression, specifically the process of protein creation. The environment and a person’s behaviors correlate with epigenetic changes; the connection becomes evident between a person’s genes, behaviors and environment.

There are three different mechanisms in epigenetics that can affect gene expressions, including DNA methylation, histone modification and non-coding RNA. DNA methylation turns the genes “off” and demethylation turns the genes “on.” More specifically, DNA methylation can directly inhibit the expression of genes. In this process, information from the gene becomes a functioning product such as proteins, which are essential molecules that help bodies function. Histone modification occurs with the adding or removal of chemical groups from histones. More specifically, it can also change if a gene is “on” or “off.” Finally, non-coding RNA is a biological function that helps control gene expression.

The Relationship Between Epigenetics and Poverty?

A 2019 article from Northwestern University explains that poverty can implement itself across genomes — “poverty leaves a mark on nearly 10% of the genes in the genome.” Previous research demonstrated that socioeconomic status is a significant determinant of human health and disease. For example, some factors such as lower educational attainment or lower-income increase the risk for heart disease, diabetes, different forms of cancers and other infectious diseases. Also, lower socioeconomic status is associated with other physiological processes that could “contribute to the development of diseases such as chronic inflammation, insulin resistance and cortisol dysregulation.”

In one recent study led by Dr. Adam R. Wende, researchers learned that end-stage heart failure patients had “cytosine-p-guanine, or CpG, methylation of the DNA in the heart.” This methylation was associated with race as the only variable between African Americans and Caucasians. In addition, researchers discovered through census tracking that African American patients lived in neighborhoods with higher racial diversity and poverty. This difference suggested to the researchers that “the underlying variable may be socioeconomic difference.”

Wende spoke about the impact of the study with UAB News. Wende stated that “we provide preliminary evidence that socioeconomic factors are likely associated with racial differences in cardiac DNA methylation among men with end-stage heart failure.”

Differences Between Children in Poverty and Higher Income Households

In another study published in 2016, scientists found that children who grew up in poverty had more DNA methylation than other children who came from higher household incomes. Researchers thought that this difference might have suppressed the impoverished children’s “production of serotonin transporter protein.” As a result, the kids in the impoverished households had less serotonin in the brain, which can lead to depression and other mental conditions.

Dan Notterman, a molecular biologist at Princeton University, found in his research that telomeres, the caps at the end of chromosomes, “[shorten] in children from impoverished families.” Research shows a link between telomere length, aging and poor general health, meaning that the shorter telomeres are, the worse a person’s health is and the faster the aging process is. In layman’s terms, poverty can cause children and adults alike to be more prone to mental and physical illnesses and hinder physiological processes at a genetic level.

Can Epigenetics Help Reverse Negative Health Outcomes?

Robert Philibert, a behavioral geneticist at the University of Iowa in Iowa City stated that “what this points out here is that if you really want to change neurodevelopment, alter the environment.” Epigenetics shows that the environment affects gene expression, and thus, the body’s biological functions.

Social determinants of health (SDH) are, as the World Health Organization (WHO) defines, “the conditions in which people are born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life.” SDHs can influence health and gene expression through “income and social protection, education, food insecurity, social inclusion and nondiscrimination.” According to the WHO, SDH plays a significant role in 30-55% of health outcomes. Epigenetics shows people must address the systems that allow poverty to thrive in order to ensure people do not experience a disadvantage at the beginning of life.

– Gaby Mendoza
Photo: Flickr

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Initiatives Against HIV in Haiti

HIV in Haiti
With an estimated “2.2% of adults” noting an HIV-positive status in 2010, Haiti faces “the largest [HIV] epidemic in the Caribbean.” In 2020, 150,000 children and adults in Haiti lived with HIV. People older than the age of 15 made up 93% of this population. In addition, 20% of Haitians living with the disease are unaware that they are HIV-positive. To help reduce the prevalence of HIV in Haiti, several initiatives are currently underway, run by the Centers for Disease Control and Prevention (CDC), UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

CDC Initiatives

Since the CDC’s Division of Global HIV & TB opened its office in Haiti in 2002, the CDC has launched several initiatives to address the country’s HIV epidemic. The first aim is to strengthen health systems by training medical personnel, supporting staffing needs and strengthening the Haitian Ministry of Health’s governance. The CDC has also aided in the development of the iSanté national electronic medical record (EMR) software to better monitor and track HIV patient data. These innovative tools help inform evidence-based treatment for this disease. In 2018, iSanté, “along with two other EMR systems,” could monitor the data of “96% of HIV care and treatment sites.”

Another goal of the CDC office in Haiti helps improve laboratory resources. Through a collaboration with the National Public Health Laboratory and GHESKIO, a medical treatment, research and training center in Port-Au-Prince, Haiti, the CDC has helped develop and expand several HIV testing methods. In addition, the CDC assisted in developing “an external quality assurance program and a training curriculum” to support lab accreditation.

Community-led Monitoring

With support from UNAIDS, the Ministry of Public Health and Population and the U.S. government via the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Haiti’s Civil Society Forum Observatory has initiated “community-led monitoring,” a program through which people living with HIV hold each other accountable throughout treatment. Community members are familiar with HIV patients from their community, and when patients do not follow through on treatments or follow-ups, community members know how to best communicate with them and encourage them to return. Community-led monitoring can provide valuable feedback on service delivery from a patient perspective, helping to improve on existing issues “to retain people in care.”

Community-led monitoring reveals the weaknesses of treatment plans for HIV in Haiti and brings corresponding solutions to light. For example, due to insight from community-led monitoring, the Civil Society Forum Observatory brings to light a need to increase the window of service hours and decrease patient wait times. It also recommends that stable HIV patients receive a six-month supply of antiretroviral medication. Through community-led monitoring and other resources, Haiti was able to allocate multiple months’ supplies of antiretroviral medicines to 88% of HIV patients during the COVID-19 pandemic.

Elizabeth Glaser Pediatric AIDS Foundation

The Elizabeth Glaser Pediatric AIDS Foundation strives to combat pediatric HIV worldwide through advocacy, research and initiatives for prevention and treatment. Although most HIV patients in Haiti are adults, 8,000 children younger than 15 lived with HIV in Haiti in 2020. Thus, addressing pediatric HIV in Haiti is an important health initiative.

Toward the latter part of 2020, the Foundation began its work in Haiti with the Delivering Technical Assistance Project. The project offers “cost-effective technical assistance (TA), capacity building and program implementation services” to HIV reduction programs. The technical assistance includes program management training, mentorship, consultations and workshops for health care workers.

These strategies, and many others throughout the country, are successfully helping lower HIV rates in Haiti. As organizations continue to implement HIV reduction plans, the severity of the HIV epidemic in Haiti may see a decline in the years to come.

– Aimée Eicher
Photo: Flickr