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A Look at The Top 7 Diseases in Nepal

Top Diseases in NepalAs of May 2023, 15.1% of Nepal’s population continues to live below the poverty line — less than $1.90 a day. In 2014, this number stood at 30.1%. Despite these drastic improvements, Nepal’s poorest continue to face significant challenges, as levels of malnutrition and air pollution remain critically high, and standards of water, sanitation and hygiene (WASH) remain critically low. As a result, communicable, maternal, neonation and nutritional (CMNN) diseases alone continue to cause 21% of deaths in Nepal, despite being largely preventable. Listed below are some of the most prominent diseases in Nepal. 

Top 7 Diseases in Nepal

  • Cardiovascular Disease (CVD) – Cardiovascular diseases (CVDs), such as coronary heart disease and strokes, are the leading cause of death in Nepal, with 24% of total deaths being attributed to CVDs alone in 2019. Cardiovascular disease is the general term for conditions that affect the heart or blood vessels. CVDs are the leading cause of death globally.
  • Malaria – Malaria poses a “serious and persistent threat to public health” in much of Southeast Asia, according to the World Health Organization, and it is the region with the second-highest estimated malaria burden globally. While Malaria remains the second-highest leading cause of death in Nepal, between 2015 and 2021, the country has seen a more than 40% reduction in the number of cases recorded, a global target set by the World Health Organization (WHO). The mortality rate from malaria has also decreased drastically between 2009 and 2019, a decrease of almost 82 deaths per 100,000 cases. 
  • Diarrheal Disease – Often caused by bacteria, diarrheal diseases are particularly common in countries such as Nepal, where there are poor water, sanitation and hygiene standards (also known as WASH) for the majority of the population. While numbers are improving, diarrheal diseases remain the third highest cause of death and remain one of the most prominent diseases in Nepal. 
  • Lower Respiratory Infection – Often used as a synonym for pneumonia, lower respiratory infections are any infections in the lungs or below the voice box. Largely a result of poor levels of WASH and dangerous levels of air pollution in the country’s capital, Kathmandu, currently standing at 4.9 times higher than recommended by WHO, lower respiratory infections are one of the top diseases in Nepal. 
  • HIV/AIDS – Around 30,000 people in Nepal live with HIV (Human Immunodeficiency Virus). If left untreated, HIV can develop into AIDS (Acquired Immunodeficiency Syndrome), which is often fatal. Since February 2017, the United Nations’ Test and Treat Strategy has aimed to prevent the spread and to administer treatment of HIV and AIDS, with highly positive results. More work, however, needs to be done to ensure the Test and Treat Strategy can be administered effectively and reaches Nepal’s most vulnerable, to ensure that one day it no longer ranks as one of Nepal’s most prominent diseases and leading causes of death. 
  • Tuberculosis (TB) – A serious bacterial infection of the lungs, the prevalence of tuberculosis in Nepal has been on the rise since 2018. Around 117,000 people in Nepal have been diagnosed with TB, and an estimated 69,000 of these developed TB in 2018 alone. WHO surveys estimate that around 40% of people who present with symptoms of tuberculosis do not seek treatment. Malnutrition is one of the main factors leading to the contraction of TB. 
  • Meningitis – A bacterial infection of the lining around the brain and the spinal cord, meningitis is particularly prevalent among Nepal’s youth. 83% of the cases occur among those under 25 years of age, while the highest age-specific attack rate is children under 1 year of age. With a lack of access to public health care services among Nepal’s poorest, the case fatality rate for meningitis in Nepal stands at 11%, making it one of Nepal’s deadliest diseases. 

Conclusion 

For each of Nepal’s most prevalent diseases, their fatality levels have decreased substantially over the last 15 years. This is in large part due to the work of NGOs and nonprofit organizations such as USAID and WHO helping to improve levels of malnutrition and standards of WASH. USAID is currently working with the Government of Nepal to improve the country’s public health services, providing critical care to Nepal’s poorest and most vulnerable. Yet communicable and preventable diseases in Nepal continue to be a leading cause of death, and more work needs to be done to ensure these numbers continue to improve. 

– Eleanor Lomas
Photo: Unsplash

Addressing the Top Diseases Impacting Uganda

Diseases Impacting UgandaFor Uganda, a country in East Africa, health is a major concern. Uganda’s population of 47 million has always been heavily impacted by illness and disease, with communicable diseases accounting for over 50% of deaths in the country. Malaria, tuberculosis (TB) and HIV/AIDS are three of the top diseases impacting Uganda and are among the leading causes of death. 

Here is more information about these diseases, and what is being done about them.

Malaria

Malaria is a life-threatening disease spread through mosquitoes that feed on humans, with symptoms such as high fevers and shaking chills. As one of the top diseases impacting Uganda, it is a risk to over 90% of the Ugandan population and is a leading cause of sickness and death, especially in children. Uganda has the highest malaria incidence rate worldwide, with 478 cases per 1,000 people per year, and malaria is estimated to have caused between 70,000 and 100,000 deaths per year, exceeding even the death rate of HIV.

In Uganda’s Ntungamo District, one of the districts most heavily affected by malaria, people have taken action to combat its spread. Village Health Teams (VHT) have been trained by the Ministry of Health and UNICEF to support Ugandan communities in fighting against diseases and assisting health care workers in providing health services. The teams also educate communities on malaria prevention methods, such as insecticide-treated mosquito nets, and prescribe Coartem, an anti-malarial medication that destroys the malaria parasites, to those affected by malaria. The efforts of the VHT have resulted in a remarkable decline in malaria cases — from 8,297 cases in December 2022 to 3,995 cases in March 2023. 

Tuberculosis

TB is an infectious disease that mainly affects the lungs. It is caused by a type of bacteria and is spread through the air when TB-infected people cough. TB is a leading cause of death worldwide, and Uganda is one of the countries with the highest burden of TB. Every day, around 30 people die of TB, and 240 people fall sick with TB in Uganda. Uganda is designated by the World Health Organization to be a TB and HIV high-burden country, with over 12,000 deaths to TB every year, and around half of those deaths are among those who are HIV-positive. Children under 15 account for an estimated 12% of TB cases, with young children vulnerable to developing a more severe version of TB. 

Since 2015, the Ugandan government has made significant progress in improving the coverage of TB preventive treatment that targets those living with HIV, made available at no cost for TB patients. Scaling up the coverage of preventive treatment has resulted in nearly 600,000 people living with HIV initiating this treatment from 2015 to 2019, and from 2016 to 2022, TB preventive treatment coverage for people living with HIV increased from 0.6% to 88.8%. Over the years, Uganda has successfully scaled up the provision of TB preventive treatment to those living with HIV, and the government has pledged to end TB by 2030 by continuing to accelerate the delivery of TB treatments.

HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) is a condition caused by the human immunodeficiency virus (HIV). HIV attacks the human immune system, leaving it vulnerable to infection and disease. Around 1.4 million people in Uganda live with HIV, among whom women are disproportionately affected. About 17,000 people die per year due to AIDS, 22% of whom are children under the age of 15. 

The nonprofit organization mothers2mothers (m2m) contributes to the prevention of mother-to-child transmission of HIV and has virtually eliminated mother-to-child transmission of HIV among its clients. It supports mothers who live with HIV by helping pregnant women access antiretroviral treatment (ART). In 2021, m2m took in and improved the lives of over 150,000 new clients; among these clients, 100% of HIV-positive women have been given lifetime ART, and 100% of HIV-exposed infants have been treated with ART as protection from infection. m2m has also intervened to end child marriage in Uganda’s Kamuli District, protecting adolescent women who are more susceptible to getting infected and increasing access to HIV care. 

Looking Forward

The measures taken to combat some of the most deadly diseases impacting Uganda have led to a decrease in mortality rates over the years. With continued efforts from organizations like m2m and local communities, Uganda will continue to make strides in minimizing the impact of malaria, TB, HIV/AIDS and other diseases. 

– Stephanie Chan
Photo: Unsplash

HIV/AIDS in Indonesia

HIV/AIDS in IndonesiaHIV/AIDS is an ongoing challenge in Indonesia. An estimated 540,000 people are living with HIV in the country. On average, there are 25,000-28,000 new HIV infection cases each year. The prevalence of HIV is increasing, with an estimated HIV prevalence of approximately 0.3% in the country. The age group most affected by HIV comprises individuals between 25 and 49 years old, while young people under the age of 19 make up approximately 5.8% of HIV cases. Alarmingly, only 64% of those living with HIV in Indonesia are aware of their positive status. 

Prevention Efforts and Treatment

Indonesia has implemented various strategies to prevent new infections, including education campaigns, condom distribution, harm reduction programs and targeted interventions for key affected populations. Specifically, an organization by the name of AHF Indonesia has been implementing HIV testing and treatment programs in Indonesia since 2016. It provides laboratory tests, free ART drugs and capacity building for hospital staff. Advocacy programs aim to revise community testing and early treatment strategies. Efforts focus on preventing HIV transmission through education, especially among key populations in urban areas. 

One of the most common methods of treatment is the ART drug. Consistency is vital in ensuring effectiveness. However, despite the importance of treatment adherence, it has been a significant challenge in Indonesia. Previous studies have highlighted numerous barriers and facilitators to adherence, such as stigma, discrimination and limited resources. This is why continued investments in prevention, early diagnosis and comprehensive treatment approaches are essential to reduce new infections and improve the quality of life for individuals living with HIV/AIDS in Indonesia.

Collaborative Efforts

The National AIDS Commission (KPA) and the Ministry of Health are key institutions responsible for developing and implementing policies related to prevention, treatment and care. These policies aim to address the challenges of the epidemic, promote awareness, reduce stigma and discrimination and ensure access to quality services. Additionally, collaboration between government agencies, civil society organizations and international partners is essential for effective policy implementation. The Indonesia HIV/AIDS Prevention and Care Project (IHPCP) is a collaborative initiative working in partnership with the Government of Indonesia. IHPCP has played a pivotal role in the country’s response to HIV/AIDS, making significant contributions in various areas. 

One notable achievement has been its pioneering work in implementing Needle and Syringe Programs (NSP) to prevent the transmission of HIV among people who inject drugs. Additionally, IHPCP has been instrumental in promoting and supporting methadone programs, which have proven effective in harm reduction efforts. The project operates through collaboration with both the public health system and non-governmental organizations (NGOs), ensuring a comprehensive and multi-sectoral approach to HIV/AIDS prevention and care in Indonesia.

Looking Ahead

As the fight against HIV/AIDS in Indonesia continues, there are promising prospects for the future. Strengthening prevention efforts, enhancing access to treatment and care and reducing stigma and discrimination are key areas that demand attention. Intensifying education and awareness campaigns, implementing innovative prevention strategies and expanding targeted interventions for key populations can contribute to reducing new infections. By prioritizing these areas, Indonesia can forge a path toward a future where new infections are minimized, quality care is accessible to all, and the impact of HIV/AIDS is significantly reduced.

– Elizabeth Watters
Photo: Flickr

What to Know About HIV/AIDS in Greece 

HIV/AIDS in GreeceIt has been more than a decade since the start of Greece’s government-debt crisis in 2009. Although the Greek financial crisis received global coverage, the effect that it had on the number of people living with HIV/AIDS in Greece is less known.

Between 2010 and 2011, the rate of HIV transmission in Greece increased by 60%, with data correlating the rise in HIV infections to the country’s declining GDP, decreased health care budget and increased national poverty. While Greece has seen a strong economic recovery in recent years, it continues to struggle with the aftermath of the recession-induced HIV/AIDS outbreak, which particularly affected its most vulnerable communities. However, there have been ongoing efforts to treat and prevent HIV/AIDS in Greece, support historically marginalized communities at higher risk of infection and educate the public to reduce stigma.

The Past and Present of HIV/AIDS in Greece

Prior to the recession, Greece had one of the lowest HIV infection rates in Europe. Yet, by 2010, the recession had left nearly a quarter of the country’s population at risk of poverty, living on incomes below 60% of the national median. The country’s worsening economic conditions and growing poverty levels had devastating effects on the prevalence of HIV/AIDS.

For instance, statistics reported by the Hellenic Centre for Disease Control and Prevention show that positive HIV results among people who inject drugs (PWID) increased 34-fold in Greece between 2010 and 2012. Furthermore, research has shown that lack of housing was “the most important predictor of HIV seropositivity” among PWIDs living in Athens during this period, with homelessness more than doubling their risk of HIV infection.

According to the World Bank, the overall prevalence of HIV among the Greek population aged 15 to 49 increased from 0.1% in 2011 to 0.2% in 2012, where it remained as of 2021. With an estimated 17,000 people living with HIV/AIDS, Greece is now among the top 10 European countries with the most HIV/AIDS-infected inhabitants, according to the CIA World Factbook.

The Good News 

Fortunately, several organizations are making a positive impact by providing support and resources for people living with HIV/AIDS in Greece. One notable example is Positive Voice, the Greek “Association of people living with HIV/AIDS.” Founded in 2009, Positive Voice is funded by the Los Angeles-based AIDS Health Care Foundation (AHF). Together, AHF and Positive Voice develop targeted interventions, for both people living with HIV/AIDS and the greater population. Positive Voice works to safely monitor and treat HIV/AIDS in Greece, as well as to educate the public and reduce stigma. It especially targets vulnerable communities most at risk of infection, including men who have sex with men, people who inject drugs, sex workers, refugees, Roma communities and people in prison. 

In 2022, Greek lawmakers also approved the use of pre-exposure prophylactic drugs (PrEP). PrEP is an antiretroviral medication, most often prescribed in a daily oral dose. It is highly effective at preventing HIV among individuals who are HIV-negative but at risk of infection. In fact, a 2021 modeling study showed that, if officials had detected the 2010 HIV outbreak in Athens one to two years earlier and introduced interventions like PrEP, the country would have saved between €35.2 million and  €53.2 million. Experts now widely support the use of antiretroviral drugs like PrEP as a safe, cost-effective intervention for managing HIV/AIDS in Greece.

The Future 

Greek leaders and organizations like Positive Voice have made notable progress in the fight to treat, prevent and educate the public about HIV/AIDS in Greece. For example, in 2021, Positive Voice tested Greece’s former Prime Minister George Papandreou for AIDS in central Athens in a symbolic effort to reduce stigma and misconceptions surrounding the virus. In 2022, Positive Voice also, with Gilead Sciences and the Hellenic Society for the Study & Treatment of AIDS, held free HIV testing in Monastiraki Square, promoting the slogan, “If you want to learn, you put your finger.” The same year, Positive Voice met with current Prime Minister Kyriakos Mitsotakis to discuss legislative action that the government is taking to prohibit workplace discrimination against people living with HIV/AIDS in Greece.   

While Greece has already seen new HIV diagnoses drop from 601 in 2020 to 402 in 2021, there is still room for progress. With continued efforts to target PrEP interventions at those most in need, provide support for the country’s most vulnerable and at-risk and eradicate stigma, Greece could improve the lives of those living with HIV/AIDS in the present and pave the way for a brighter, HIV/AIDS-free future.   

– Ben Hofmann
Photo: Flickr

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HIV/AIDS in Belgium

HIV/AIDS IN BELGIUMAccording to a study by BMC Infectious Diseases, HIV/AIDS in Belgium is “largely concentrated among men who have sex with men and sub-Saharan Africans.” According to 2011 data from the Belgian government, 98.2% of patients had links to HIV care, 90.8% were in care and 83.3% were receiving antiretroviral therapy. However, these statistics were disproportionate for certain sections of the population where sub-Saharan Africans on ART had less viral suppression while there was higher retention in care of men who have sex with men.

After carrying out a study, an organization called BREACH (Belgian Research on AIDS and HIV Consortium) concluded that potentially the weakest part of efforts to suppress the HIV/AIDS epidemic in Belgium was the undiagnosed HIV-infected population, which estimates have stated is around 20%. This was particularly prevalent amongst migrants in Belgium and it is a problem that requires attention.

There is also a link between poverty and those suffering from HIV/AIDS. When the Journal of the International AIDS Society conducted research into the link between AIDS and poverty, the results were that vulnerabilities relating to migration such as economic hardship and barriers to HIV testing mean that non-citizens are more likely to become infected by HIV/AIDS.

The Progress

Better sexual health awareness and an increase in levels of screening are some methods that have helped HIV/AIDS patients in Belgium live longer and enjoy better health. A research organization named Sciensano which targets health and disease has contributed to HIV/AIDS research in Belgium and has recorded encouraging statistics over the past few years. Based on a 2017 report, Sciensano found that there was a 2% decrease in HIV/AIDS transmission since 2016 and 27.5% compared with 2012.

The study also notes that “HIV transmission by intravenous drug use is exceptional in Belgium and was only reported for 1% of the HIV diagnoses in 2017.”

Belgium’s National Strategic Plan

A step that the Belgian government took to reduce the transmission of HIV/AIDS was the implementation of its National Strategic Plan on HIV in 2013. The monarchy of Belgium also endorsed this plan, which had three main goals: preventing HIV/AIDS, providing testing and treatment of HIV/AIDS and providing care and support. In setting up the plan, the government ensured it would specifically target vulnerable groups such as migrants.

In conclusion, Belgium has made significant progress in tackling HIV/AIDS. Government initiatives coupled with the work of other organizations have been effective enough to reduce levels of HIV/AIDS in the country and are a step forward for marginalized groups that the disease impacts the most.

– Claire Dickson
Photo: Flickr

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HIV/AIDS in Malawi

HIV/AIDS in MalawiWhile it remains in the top 10 countries with the highest HIV rates, there is a significant reduction in the rates of HIV/AIDS in Malawi. This plummet, from 14.9% in 2000 to 8.1% in 2020, is likely to continue its decrease with the improvements to the diagnosis and care system.

The introduction of the Malawi Population-based HIV Impact Assessment (MPHIA) in 2016 has made it easier to track the progress of testing and treatment for HIV/AIDS in Malawi. The data from the 2022 assessment shows that Malawi has met two-thirds of the UNAIDS targets, with at least 95% of those aware of their status initiating treatment and 95% of those on treatment experiencing viral suppression.

Prioritizing Testing

The one target that Malawi must still meet is for 95% of persons with HIV to be “aware of their status.” In Malawi, where 88.3% of those with HIV are diagnosed, this target is not out of reach, according to the Population-Based HIV Impact Assessment (PHIA).

HIV self-testing is becoming more common in Malawi and studies show that community-led delivery of self-tests is safe, economical and reliable.

However, money and availability are not the only barriers to accessing HIV tests. There is a global need to overcome the stigma surrounding HIV; with a strong correlation between prejudicial attitudes toward HIV and reluctance to test. For many sufferers, attending a testing site is a deterrent, which is another explanation for why many remain untested. The increasing number of home tests could be vital to overcoming this hurdle.

COVID-19

The pandemic saw a 35% drop in HIV tests, according to Nuha Ceesay, UNAIDS country director, exacerbating the struggle to reach the 95% target.

As we come towards the end of the COVID-19 health emergency, education to combat stigmas and increasing testing services are integral measures for Malawi to reach UNAIDS targets. COVID-19 exacerbated existing stigmas with the misconception that those with HIV are more likely to catch Coronavirus. The pandemic birthed a new discriminatory term for people diagnosed HIV positive, “corona carrier,” Reuters reports.

COVID-19 has not permanently regressed in the fight against HIV. Despite the pandemic’s detrimental impact on the health care system of the country, it sustained some positive progress. Of those suffering from HIV/AIDS in Malawi, 98.6% were still referred for vital antiretroviral treatment throughout this period.

Women and HIV

Uneducated young women are one of the main disadvantaged social groups at the center of this health care emergency.

Despite making some progress, Malawi is still far from achieving gender equality. Health care access issues are no exception to this and adolescent girls and young women are the most vulnerable to HIV.

Research suggests that women experiencing poor health are likely to delay seeking medical support, prioritizing their family due to social norms and expectations. Connecting issues, such as lack of education and unemployment, leads more women towards sex work, only increasing the likelihood of contraction.

Children and HIV

The lack of testing makes children vulnerable targets of the AIDS crisis, with UNICEF identifying 25% of children with HIV/AIDS in Malawi as unaware of their status and only half of the HIV-positive children receiving treatment.

This is a cycle mostly formed by the 20%-45% risk of HIV-positive mothers passing HIV onto their children. These children often lack lifesaving treatment, with 20% of infants dying before age one without antiretroviral therapy (in sub-Saharan Africa).

Improving resource allocation and support for women and children helps to interrupt this cycle. Through vital counseling on the necessities of treatment, training of health care professionals, education, career prospects and prevention of sex work, the epicenter of the HIV epidemic could be the focal point of change.

The Path Forward

Foreign aid is crucial for Malawi to reach its UNAIDS targets and USAID data shows it is one of the countries in the world most dependent on foreign aid, with 99% of its HIV expenditure coming from international financial support.

Prompting the government to prioritize international aid, such as funding the coronavirus response, would alleviate pressure from Malawi’s health care system and allow the dedication of more time and resources to HIV testing. Organizations such as MANASO, a major advocate and host of Malawi World AIDS Day, are striving toward lower infection rates.

Its current plans include the Family Planning Budget Accountability Project, focused on advocation for the government to fund family planning essentials and for the spending of these funds to be appropriate and effective. It has achieved success in meeting government officials, engaging in advocacy and conducting meetings and workshops with chief security officers (CSOs). The family planning budget has also received more funds, seeing an increase from 2017 to 2019, as a result of this work.

Lobbying one’s leaders and supporting groups like MANASO enables the fight against HIV in Malawi to progress, with international support having a vital impact on treatment, testing and prevention goals.  

– Lydia Tyler
Photo: Flickr

Progress Against HIV/AIDS in Thailand

Progress Against HIV/AIDS in ThailandIn the last decade, Thailand has made significant efforts to reduce HIV/AIDS transmission and deaths, resulting in a dramatic decrease in one of the world’s most stigmatized diseases and an effective model for other countries to follow.

HIV — first identified in 1981 — is a viral infection that attacks the human immune system and spreads through bodily fluids. If left untreated, it can cause AIDS, a condition with which most people only survive a few years. There is no cure for HIV/AIDS, but there are treatments such as antiretroviral therapy that can keep the infection from progressing to AIDS.

HIV/AIDS in Thailand

The first case of HIV/AIDS in Thailand was in 1985, and the country continues to have one of the highest rates of the disease in Asia and the Pacific. An estimated 470,000 people are living with HIV/AIDS in Thailand, and 14,000 AIDS-related deaths occurred in the country in 2019.

Like in other countries, the Thai populations most at risk for HIV/AIDS are those living in poverty or otherwise on the margins of society. These circumstances can reduce access to healthcare and testing, which is made worse by the heavy stigmatization of the disease.

Progress in Thailand

However, the Thai government has made substantial progress against the virus after making it one of the country’s prioritized health initiatives. In 2006, Thailand incorporated HIV services into its universal healthcare system, and now testing and treatment are free for anyone who might need them.

Awareness campaigns have also had a large impact on the state of HIV/AIDS in Thailand. The government has partnered with civil society groups to increase public knowledge both about the disease and preventative measures. Another important aspect of these partnerships has been specific efforts to reduce the stigma associated with HIV/AIDS.

Since 2010, the rate of new infections in Thailand has dropped 65%, and AIDS-related deaths have fallen 44%. These improvements have directly resulted from the efforts to increase awareness and improve access to healthcare and testing. Of the Thai population living with HIV, 80% are on antiretroviral treatment, and 78% have suppressed viral loads preventing the infection from progressing to AIDS.

Thailand is also the first country that has nearly eliminated mother-to-child transmission of HIV/AIDS. Now, less than 2% of children test positive for HIV after being exposed. This has significantly reduced the number of children who are infected and need antiretroviral care.

Future Goals

With all of this progress, the government is in a strong position to continue reducing the prevalence of HIV/AIDS in Thailand. The country still has not met UNAIDS’ 90-90-90 targets where 90% of those HIV positive are aware of their status, 90% are on antiretroviral treatment and 90% have suppressed viral loads. However, Thailand’s efforts remain an important international model of effective policy against HIV/AIDS.

Through its focus on decreasing the number of new infections and improving access to antiretroviral treatment, the prevalence of HIV/AIDS in Thailand has decreased. Along with its prioritization of spreading information and awareness about the disease and its transmission, Thailand has created an effective method for tackling HIV/AIDS.

– Nicole Ronchetti
Photo: Flickr

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The Untold Story of Russia’s AIDS Epidemic

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

The AIDS Epidemic in Russia

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

The Silent Spread of HIV

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

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

HIV During the COVID-19 Pandemic

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

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

Destigmatizing HIV/AIDs in Russia

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

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

A Call for Urgent Action

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

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

– Kieran Graulich
Photo: Flickr

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Preventing HIV in Kenya with an Injection

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

Cabotegravir or CAB LA

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

Kenya’s HIV Epidemic

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

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

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

The Potential of CAB LA for Preventing HIV in Kenya

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

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

– Charlotte Ehlers
Photo: Flickr

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Other Global Health Concerns During COVID-19

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

HIV/AIDS in South Africa

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

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

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

Malaria in sub-Saharan Africa

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

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

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

Toxic Gold Mine in Ethiopia

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

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

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

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

COVID-19 and Other Global Health Concerns

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

– Maddey Bussmann
Photo: Flickr