Malaria

populations that face the greatest risk

Global health

Malaria
HIV/AIDS
Neglected tropical diseases

Malariatransmission

The parasite enters the

human body in one of
three ways

The bite of infected

Anopheles mosquitoes
In utero (from a mother
to her fetus)
Transfusions with
infected blood

Malaria - interventions

Insecticides to kill mosquitoes

Malaria is a disease of poverty

must be taken continuously to reduce infection

Too expensive for people living in endemic areas

The parasite is becoming resistant to older medications

A vaccine for malaria?

In Tanzania, a new push to combat malaria 8:55

http://www.pbs.org/newshour/video/module_byid.html?s=news01n3dd1qb8e

Sickle-cell Anemia

but is also a cause of poverty

Malaria hinders economic development

DDT used indoors to kill mosquitoes w/o harming environment

Mosquito nets for beds (Anopheles is a night feeder)

Anti-malarial drugs

Socio-economic effects

impact includes costs of health care

working days lost due to sickness
days lost in education
decreased productivity

Each year 250-500

million people are
infected
Vast majority of
victims are children
under 5

Increases resistance to
malaria
The geographical distribution
of sickle-cell anemia closely
matches the occurrence of
malaria in Africa

Genetic disorders:

Sickle-cell Anemia

A recessive genetic disorder

Caused by a mutated gene that
produces a defective version of
hemoglobin
The hemoglobin sticks together
and produces a stiff red blood
cell with a sickle-shape
Sickled RBCs are destroyed
rapidly, leading to anemia

The AIDS pandemic

HIV/AIDS

What makes HIV so lethal?

The problem is massive

4th leading cause of death

worldwide
~40 million people are
infected
95% live in developing
countries

HIV highjacks immune cells

HIV binds to the plasma

membrane of helper T cells
Penetrates the cell
Viral RNA is integrated into
the cell genome
Human cells manufacture
the virus
Infected cells are killed
eventually

The HIV virus highjacks immune cells

HIV infects and destroys the very cells that normally
suppress viral infections

Long incubation period

the helper T cells of the human immune system

The victim feels healthy but is highly infectious

Where is the virus?

HIV is found in all body fluids

Only semen, blood, breast milk and
vaginal discharge have enough virus to
transmit HIV
Saliva, tears and sweat do not

HIV life cycle 3:10

http://www.youtube.com/watch?v=9leO28ydyfU&feature=related

How is HIV transmitted?

Unprotected sexual intercourse

Direct contact with infected blood

Sharing needles
Blood transfusions

Heterosexual or homosexual

3 Common Misconceptions

blood is tested for HIV (not always in poor countries)

Mother-to-child

HIV can infect the fetus in utero, or during birth

Breast-feeding

Without treatment, rate of transmission is 25%

Risk of HIV infection

Why prevention is critical

90% of HIV-positive people do not

know they are infected

HIV can spread through casual contact

HIV infects only homosexual men and
drug users
Sexual intercourse with a virgin will cure
AIDS

90% of HIV-positive people dont know theyre

infected

Long incubation period btwn infection

and major illness
Most people have no access to testing
Stigma
If theres no treatment available, why get
tested?

Long incubation period btwn infection and major illness

Most people have no access to testing
Stigma, absence of confidentiality
If theres no treatment available, why get tested?

Prevention is key

ABCs of prevention

Treating AIDS:
Antiretroviral (ARV) therapy

Prevention efforts have lagged

ABC program - ineffective

New approaches
Routine HIV testing: Know your status
Take ARVs reduce level of HIV and transmission
Male circumcision
Female condoms
Still in R&D stage

Vaginal microbicides
HIV Vaccine the holy grail

Abstinence
Be faithful
Condoms

>30 drugs have been developed that

suppress the virus
Usually given in a cocktail of 3 - 4 pills
Expensive, must be maintained for the rest
of the patients life

Avoid developing resistance to drugs

Still no known cure or vaccine for HIV

AIDS
More than a health problem

AIDS is not gender-neutral

Low social status of women

in developing countries
magnifies their vulnerability

Women are forced into early

marriage
Unable to refuse sex with
husbands who frequent
prostitutes
Often no option of using
condoms

Orphans

What does it mean for a society to lose 20 to 30% of

its population to AIDS?

Fewer people are educated

Health care systems are overwhelmed

AIDS impacts nutrition and food security

The private nature of sex and complex cultural attitudes

toward it lead to silence, denial, stigma and discrimination

Teachers, medical personnel and other professionals

are dying - leaving huge gaps in social services

Preventing mother-to-child
transmission

Botswana offers anti-HIV drugs to

infected pregnant women and
newborns

2003: less than half of PG women

were tested for HIV
2004: implemented routine testing
2007: 83% of PG women were tested

90% of HIV+ moms chose to take

ARVs

Transmission to babies dropped

from 40% in 2001 to 4% in 2007

Retards economic growth

Increases poverty

Socio-economic impact of AIDS

AIDS kills the reproductively active - and most

productive - members of society
HIV is invisible

Impacts economy,
social fabric

AIDS is different

Crisis for developing

countries

Children leave school to replace the labor of sick or dying

parents
Nurses and teachers die faster than they can be replaced
Fewer adults are able to farm
Livestock is sold to pay funeral expenses
Poverty and hunger Increase

MDG 6:
Combat AIDS, malaria & TB

In hard hit areas, more than half of those

living with HIV are women
Care of orphans is an enormous social
problem

Interventions:

Expand access to treatment

In 2006, of the ~40 million people

living with HIV, ~2 million received
antiviral therapy (5%)

Intensify prevention efforts

Testing - know your status

Anti-HIV drugs reduce transmission

AIDS orphans in Kenya

Status report: MDGs

Recent developments (2010)

GOAL: Combat AIDS and malaria

Good

Average

Poor

New HIV cases dropped >20% over last

decade (UN report)
A prevention pill

AIDS deaths reduced to 2 million (2.2 million

in 2005).
Use of malaria-fighting bed nets increased
18% since 2000.

AIDS drug (Truvada) helps prevent new infections

in high risk groups (gay and bisexual men)

Vatican opened way for condom use to

prevent AIDS

Using condoms is a lesser evil than infecting a

sexual partner with HIV

Neglected Tropical Diseases

Neglected Tropical Diseases

Neglected Tropical Diseases

The 3 most common NTDs are

caused by parasitic worms that
live in the intestines

Large common roundworm, Ascaris

Ascaris roundworm

Children have trouble learning in school

Adults workers are less productive

Filtering water

These diseases are

named "neglected"
because they exist
exclusively in the
poorest and the most
marginalized
populations.

Neglected Tropical Diseases

Most are parasitic or bacterial

infections
Dont often kill, but they debilitate by
causing severe anemia,
malnutrition, delays in cognitive
development
They help perpetuate poverty

Affect ~1 billion people

Diseases of poverty

Afflicts 800 million people

Whipworm 600 million

Hookworms 600 million

Rob children of nutrients, stunting

their growth

NTDs 3:21
http://www.pbs.org/newshour/video/module_byid.html?s=news01pb88

Treating NTDs

The good news: these NTDs

can be treated simply and
cheaply
But treatment programs
reach less than 10% of
people suffering from NTDs
Strategy: fold treatment in
with other interventions

Anti-malaria bed nets

Childhood immunizations
Nutritional supplements such as
vitamin A

Fighting poverty
Better health leads to
more wealth