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financing for hiv/aids
On April 18, 2018, the Center for Strategic and International Studies (CSIS) partnered with the Kaiser Family Foundation to host a discussion of the current state and future of financing for HIV/AIDS. The Borgen Project was invited to attend this critical summit and hear from the leading voices in this space.

About 36.7 million people worldwide were diagnosed with HIV/AIDS by the end of 2016; one million of those cases resulted in fatality. A disease that still affects so many requires adequate funding for care, treatment and prevention.

The fight against AIDS began in 1981 when the Centers for Disease Control and Prevention (CDC) published a Morbidity and Mortality Weekly Report which detailed one of the first cases of the disease. From there, the CDC began to work on discovering risk factors.

Between 1996 and 2000, spending on HIV/AIDS from major donor countries increased from $248.45 million to $749.37 million. According to Christopher J.L. Murray, one of the panelists and a professor at the University of Washington, “If you cumulate total spend since 2000, the world has spent just around half a trillion dollars on HIV/AIDS.”

The amount of financing for HIV/AIDS continuously increased through the years up until 2011. Murray pointed out current spending trends using a graph. “From basically 2011, with the exception of 2012, we have been flat,” meaning that total spending from donor assistance channels, such as the WHO and World Bank, has not increased since 2011. Though some individual channels may have increased financing for treatment and prevention, others have decreased spending, making total spending fairly consistent in recent years.

Another concern for financing for HIV/AIDS is the limited spending coming from countries with the highest numbers of affected people. The majority of financing is coming from the upper and upper-middle income countries. J. Stephen Morrison, the Senior Vice President and Director of the Global Health Policy Center, pointed out some of the most striking realizations that have come from new data on HIV/AIDS.

“It also begins to show us a way in which there has been an erosion of the financial and political commitment dedicated to those low-income countries with the greatest burden and the greatest prevalence,” Morrison noted. “The most dramatic point was in saying that since 2012, 2013, a 23.7 percent decline in the levels of donor assistance into those countries from just over 12 billion to 9.1 billion dedicated to HIV.”

The stagnant spending is a severe problem considering the rate of population growth. Mark Dybul, one of the panelists and a professor at Georgetown University, pointed out the hypothetical: “You double the population, you’re going to double the size of the infection rate.” A Business Insider estimation claims that more than half of the population growth that will occur between now and 2050 is going to occur in Africa. As Africa is also the site of the highest number of HIV/AIDS cases, this means that the rate of those infected with HIV/AIDS will likely increase significantly.

The future of financing for HIV/AIDS is looking challenging to Dybul given the difficulties in raising funds. “The reality is, there is no argument that’s going to get an increase in donor funding for HIV. We are at the highwater mark, we are not going up.” Dybul suggested that, instead, change will come through smarter investing, including focusing on prevention first, and treatment second.

Additionally, Dybul suggested that some change is needed in how we talk about the epidemic. As he pointed out “Young people in Africa don’t think about HIV anymore, they think about other things.” In this way, raising awareness may be crucial in fighting HIV/AIDS.

Moving forward with financing for HIV/AIDS will be a challenge considering stagnant spending across the board, little spending from low-income countries, and the drastic population growth expected in Africa in the coming years. But with changes in how organizations and governments invest and heightened awareness of the epidemic, it is possible to win the war against HIV/AIDS.

– Olivia Booth

Photo: CSIS

Common Diseases in BotswanaBotswana, located directly north of South Africa, has been victim to epidemics of deadly diseases such as HIV/AIDS, tuberculosis (TB) and malaria. Prevention and treatment of these diseases is a top priority for Botswana’s ministry of health. Since these diseases have high mortality rates, it is important to look at the root causes and risk factors associated with common diseases in Botswana.

According to the Centers for Disease Control and Prevention (CDC), the deadliest common diseases in Botswana and the percent of deaths for which they are responsible are the following: HIV (32 percent), malaria (7 percent), tuberculosis (6 percent), diarrheal diseases (4 percent), cancer (4 percent), pre-term birth complications (2 percent), Ischemic Heart Disease (2 percent), stroke (2 percent) and STDs (2 percent).

The top three common diseases in Botswana — HIV, malaria and TB — are all communicable diseases, meaning that they are transmitted through contact. Communicable, maternal, neonatal and nutritional diseases comprise the deadliest category of diseases in Botswana. The next two categories of diseases with the highest mortality rates are non-communicable diseases and injuries, respectively. Cardiovascular diseases and cancer account for nearly half of deaths from non-communicable diseases. The top causes of deadly injuries in Botswana are self-harm and interpersonal violence, unintentional injuries and transport injuries, respectively.

Unsafe sex is the most prevalent risk factor for deadly diseases, accounting for about 60 percent of behavioral risk factors for contracting a deadly disease. It is by far the most common risk factor for HIV/AIDs and TB. Unsafe water, sanitation and handwashing habits account for 46.3 percent of environmental risk factors, followed by air pollution accounting for 37.1 percent of environmental risk factors. These are the most common risk factors for contracting diarrheal and infectious diseases. Alcohol and drug use is also a prevalent risk factor for contracting a deadly disease, such as HIV through needle sharing, or for certain injuries.

Several projects have been implemented for disease prevention and treatment, specifically for HIV as it causes almost one in three deaths in Botswana. Areas of focus for the national HIV program include high-quality prevention, care and treatment services; HIV counseling; blood safety and early infant diagnosis.

Evidence-based public health procedures are effecting change in Botswana for preventing HIV. The Botswana Combination Prevention Project evaluates the effect of proven HIV-prevention measures to reduce the number of new HIV infections over time.

Some procedures for prevention and treatment that have decreased the incidence of HIV cases. These include HIV testing, which positively changes behavior, prevention of mother-to-child transmission and antiretroviral treatment for those infected with HIV, which can cure the patient while also preventing the transmission of the disease to another partner.

Additionally, the CDC works to strengthen healthcare systems in order to sustain an effective HIV program. Strengthening healthcare systems includes improving workforce development, disease surveillance and epidemiology, health information systems and program monitoring.

As of 2012, 96 percent of men, women and children in Botswana in need of HIV treatment received it. The mother-to-child transmission rate of HIV has decreased to less than 4 percent. Botswana has integrated their TB and HIV programs, which improved the quality, impact and coverage of both programs.

Education for prevention and access to these services are very important. These steps for prevention and treatment, however, require resources that developing countries like Botswana do not have. This is where foreign aid strongly benefits a developing country. Through PEPFAR and the establishment of CDC Botswana, the U.S. government has had a significant impact in ameliorating common diseases in Botswana, specifically HIV. Foreign aid will continue to be a key component in tackling global health crises.

Christiana Lano

Photo: Flickr

Common Diseases in TaiwanTaiwan is an island located 180 kilometers east of China with a population of 23.55 million people. Although Taiwan is considered to be well-developed, some common diseases in Taiwan are still deadly. Here are some of the common diseases in Taiwan.

  1. Japanese encephalitis (JE)
    JE is a viral infection caused by RNA viruses belonging to the Flavivirus genus. It is an animal disease that can be spread to humans. Mosquitoes that feed on infected animals, such as birds and pigs, are the main transmitters. According to the Centers for Disease Control (CDC), during 2010 and 2015, the majority of reported cases were in central and southern Taiwan, and most of the infected were male. JE transmission occurs between May and October and peaks in June and July. Children under the age of 15 and adults between 30 and 59 are the most likely to get infected.Outbreaks of JE typically occur after rainy seasons, especially the summer months. A majority of JE patients do not exhibit symptoms, which usually occur five to 15 days after exposure. Symptoms include fever, vomiting, diarrhea, general weakness and severe headache. The disease is fatal in 20 to 30 percent of cases. If the patient survives, long-term neurologic, psychiatric or cognitive problems are possible.A vaccine for Japanese encephalitis has been developed, and children are required to have it when they reach the age of 15 months. Long-term travelers to Taiwan are recommended to receive the vaccine. The best and easiest way to avoid infection is to wear long sleeves and long pants when visiting mosquito-prone places.
  2. Severe Acute Respiratory Syndrome (SARS)
    SARS is one of the common diseases in Taiwan. It is a viral respiratory illness caused by SARS coronavirus. Like JE, it is passed from animals to humans and can then be passed to other humans. The main source of transmission is close person-to-person contact.Early SARS symptoms are high fever and chills or headache. In two to seven days, SARS patients may develop a dry, nonproductive cough accompanied by or progressing to a condition in which the oxygen levels in the blood are low. SARS can result in serious complications such as respiratory failure, heart failure and liver failure.Taiwan experienced a huge SARS outbreak in 2003. According to the CDC, as of May 22, 2003, a total of 483 probable cases had been reported. Among all those cases, 84 had been discharged and 60 had died. A travel alert was issued to prevent more spreading. On July 17, 2017, the travel alert for Taiwan was removed.

    Although SARS has not been reported since 2004 in Taiwan, it is always good to be alerted. Washing hands frequently and wearing disposable gloves when touching any bodily fluids are proven ways to prevent SARS.

  3. Scrub typhus
    Another of the common diseases in Taiwan is scrub typhus, also known as bush typhus, and is caused by bacteria called Orientia tsutsugamushi. Scrub typhus is transmitted through infected chiggers. Symptoms include fever, headache and body aches. The disease can cause organ failure and bleeding and can be fatal if left untreated.According to the CDC, as of June 2016, 117 scrub typhus cases had been confirmed. The cases were reported throughout the year, increasing in numbers in May and peaking in June and July. The second outbreak lasted through September and October.There is no vaccine for scrub typhus. The main prevention and control strategies in Taiwan are case identification and increased public awareness. Wearing long-sleeved shirts and pants can prevent bites, which reduces the chance of infection. Avoiding sitting on the bare ground can also be an effective prevention tactic.

Taiwan is a relatively safe place. All of the common diseases in Taiwan are dangerous, but not deadly if properly treated. Public education is important to help people to identify symptoms in order to avoid unnecessary fatalities.

Mike Liu

Photo: Flickr

Five of the Top Diseases in Greece
Though often envisioned as an ideal vacation spot, home to thousands of sites, islands and beaches, Greece is not exempt from the list of countries affected by diseases, and it is necessary that travelers be aware of this.

    1. Coronary Heart Disease
      According to WHO, Coronary Heart Disease (CHD) is one of the top diseases in Greece, responsible for 26.17 percent of the country’s total deaths. Statistically, CHD occurs in men between the ages of 50 to 79, and in women ages 70-79. Controllable factors include arterial hypertension, diabetes, dyslipidemia, obesity, smoking and lack of physical activity. Non-modifiable factors include gender, age and family history of premature CHD.

  1. Stroke
    Falling second in the list of top diseases in Greece, mortality from heart disease and strokes has reached 35,000 deaths per year, which is high compared to other regions like Portugal or Spain. As a result, life expectancy for Greeks has fallen. Statistics showing 33 percent of adults smoking daily and 19.6 percent of the population being overweight or obese contribute to the issue.
  2. Malaria
    In 2011, a total of 20 cases of malaria occurred among Greek residents in the Evrotas, Laconia district, caused by the parasite Plasmodium vivax. The following year, 17 additional locally acquired cases were reported. According to the Centers for Disease Control, it is recommended that travelers take an anti-malarial medication and follow insect protection measures to reduce the risk of mosquito bites.
  3. Legionnaires’ disease
    A total of 14 cases of Legionnaires’ disease were reported in the island of Corfu in 2011. Legionnaires’ disease is a bacterial infection which typically causes pneumonia but can also involve other organ systems. The disease is usually transmitted through contaminated water sources, such as air conditioners and showers. Common symptoms include fever, cough, chest pain, difficulty breathing, headache, muscle pains and diarrhea.
  4. West Nile virus
    An outbreak of West Nile virus infections surfaced in 2010, causing 262 confirmed cases and 35 deaths. West Nile virus is carried by Culex mosquitoes. Most infections are mild but can affect the central nervous system, leading to fever, headache, confusion, lethargy, coma and in most serious cases, death. Because there is no treatment for West Nile virus, prevention methods should be taken by keeping cover and applying insect repellents.

For both locals and visitors, such recent outbreaks emphasize the importance of taking safety precautions and preventing further transmission of top diseases in Greece. Since most of these illnesses cannot be cured, undergoing certain treatment methods or making lifestyle changes help with recovery.

Mikaela Frigillana

Photo: Flickr

Liberian_Peace_Corps
Liberia has seen some tumultuous times in the past few decades. Civil war ravaged the country in the 1990s leaving many citizens in extreme poverty and disrupting educational opportunities for children. Recently, Liberia was hit with Ebola and has suffered from the disease, including the Peace Corps, who needed to suspend their work for a time.

Yet, much good ground work has been done by the Liberian Peace Corps team to help the country overcome the ramifications of such dire events while the country and volunteers wait for the program to resume. The Peace Corps is also partnering with other entities to help rid the country of Ebola.

The Peace Corp first worked in Liberia from 1962-1990 helping with education, rural development, agriculture and health education. But volunteers left the country in 1990 because of the civil war that had broken out. In 2009, Peace Corps volunteers were asked by the Liberian president to return to the country. This time, volunteers focused on educational efforts in the country, specifically math and science at the secondary level.

The Liberian Peace Corps Educational Program defined their purpose as the following: “Liberian students, male and female, will gain access to personal, professional and academic opportunities through math and science education.”

They gave three main educational goals for their work in Liberia: Increase Student Success, Improve Teaching and Improve the School Community. In addition, the volunteers gave after school activity opportunities to the secondary students that have been broken down into four broad priorities: “1. Gender Equality and Women’s Empowerment, 2. Youth as Resources, 3. Stomp Out Malaria [and] 4. Food Security.” By using these supplemental goals as a guide, volunteers conducted after school tutoring, encouraged library development, organized various after school clubs, taught English and gave girls a specific opportunity to learn various life, vocational and/or math skills.

Peace Corps volunteers immerse themselves into the community, most volunteers committing two years to the Peace Corps while developing relationships with the locals.

Unfortunately, Liberia is one of the West African countries that has been hit with Ebola quite extensively.

The World Bank says that while in the last 10 years Liberia has seen great economic gains, “the outbreak of the Ebola Virus Disease (EVD) has threatened the peace and stability of the country.” The country’s gross domestic product growth has declined due to the economic repression that the country has experienced: “The epidemic is projected to have a significant impact on Liberia’s economy in terms of forgone output; higher fiscal deficits; rising prices; food security challenges, lower real household incomes and greater poverty.”

Ebola has affected Liberia so drastically that the Peace Corps was forced to remove their volunteers in 2014. But that hasn’t stopped the Peace Corps form working in West Africa with the efforts to stop the spread of Ebola.

The Centers for Disease Control, USAID, NGO partners and many more are working to improve conditions in those countries. The Peace Corps has printed educational material that has been distributed to volunteers, staff and communities in other African areas working to stop the spread of the disease. Volunteers in surrounding areas are also providing hand washing classes to the locals in the efforts to stop Ebola.

Even though Ebola has forced the program to be put on pause, the last few years of educational work has been impressive indeed. So much good has been done in the region that one can hope that local leaders will be able to stand in those communities that are suffering from Ebola. Hopefully soon, the efforts to rid West Africa from Ebola will prove effective and the program can restart. With such a strong reputation of good work in the country, the resolve looks good.

– Megan Ivy

Sources: CDC, Peace Corps, Peace Corps Liberia, U.S. Embassy in Liberia, World Bank
Photo: Peace Corps