The Global Pulse Journal Blog

From Science Speaks, an excellent blog from the staff of the Infectious Diseases Center for Global Health Policy, comes an interview with Dr. Eric Goosby, the U.S. Global AIDS ambassador.

Q: Roxana Rogers, USAID’s South Africa health team leader, said recently in South Africa that, “US government funding is going to come down dramatically over the next five years.” True?
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For the past seven years, the United States has supported and expanded its program to fight HIV/AIDS in developing nations, underwriting almost half of the world’s AIDS relief. But some are concerned by recent setbacks in the global campaign to fight disease in the developing world. At a time when the numbers of people infected with HIV is beginning to increase after stabilizing in countries like Uganda and the number of people in need of treatment is rapidly expanding, the US funding has not kept pace. With updated World Health Organization guidelines, the number of HIV-infected people eligible for treatment has expanded to 14 million, a large increase from the only 4 million people current in treatment.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

According to recent data from the WHO and UNAIDS, the number of people infected with the HIV virus has remained relatively stable, around 33 million around the globe, for the last two years. The data suggests that the number of cases probably peaked in 1996 with the disease stablizing in most regions since then.  The WHO/UNAIDs report suggests that their were 17% fewer new infections worldwide in 2008, compared with 2001. A notable exception is the number of HIV infections in many parts of Africa which remains alarming. Although the rate of new infections has decreased worldwide, only two out of five of those newly infected begin treatment. While around 4 million people were receiving antiretroviral medications at the end of 2008 compared to 3 million in 2007, an additional 5 million people in need of antiretrovirals were not receiving treatment.

It has long been established that high adherence to antriretroviral therapy is associated with slowed progression of HIV infection and increased survival, but a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health suggest that high antiretroviral therapy adherence is also associated with lower health care costs. Their study suggests that improved health outcomes associated with high adherence to HIV therapy results in an overall median monthly health care cost savings of $85 per patient in a cohort of 6,833 HIV-infected adults in South Africa. A large component of this cost savings resulted from a decreased need for hospitalization in patients with high adherence to antiretroviral therapy. These results suggest that effective, practical strategies are needed to encourage and actively monitor antiretroviral therapy adherance in order to improve patient outcomes and, in the process, save much need health care resources.

More details on the study can be found in the January 5, 2010 issue of Annals of Internal Medicine.

This is a guest post by Leah Bevis and Alison Hayward, MD for Uganda Village Project, an IFMSA transnational project. There are many ways to get involved with UVP, including through summer internships. – Sujal Parikh

Naigaga Florence lives in Bulumwaki Village, a small, extremely rural community in eastern Uganda. A thin, toothless, but smiling old woman, we first sighted her at a village outreach – in her arms was the most malnourished child that any of us had ever seen. The child’s eyes were dull, his hair a few blondish wisps on a dry skull. His tiny limbs were mere bones draped in shriveled skin, and his head lolled on his neck as if about to fall off completely. His name was Alfred, and he suffered from severe malnutrition, since his mother had died and was unable to breastfeed him. Without breastmilk’s protection, babies in the rural villages of Uganda face a grim prognosis. They are fed a thin gruel of flour and water which provides hardly any calories, or the protein they need to grow.   Read the rest of this entry →

Katherine Ellington shared this video with us last weekend at the 2009 AMSA Global Health Leadership Institute in Virginia.  Chimamanda Adichie, author of the acclaimed novels Purple Hibiscus and Half of a Yellow Sun, gives a TED Talk on her childhood in Nigeria and her personal discovery of how biases and assumptions are embedded in the stories we hear and read: Read the rest of this entry →

Part four of this series introduces telemedicine technology and one application of such technology, teledermatology.

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This is from the Washington Post (free subscription required):

For the women of eastern Congo, a U.S.-backed Congolese military operation meant to save them from abusive rebels has turned into a nightmare of its own.

An already staggering epidemic of rape has become markedly worse since the January deployment of tens of thousands of poorly trained, poorly paid Congolese soldiers, with people in front-line villages such as this one saying the soldiers are not so much hunting rebels as hunting women. Read the rest of this entry →

In the second part of this series I hope to introduce the healthcare system of Botswana.

Botswana has two parallel health systems—the public system and private system—each with its own hospitals, clinics, and physicians. Care in the public sector, including laboratory testing, hospitalization and medications, is free for all Batswana (citizens of Botswana are known as Batswana). Read the rest of this entry →

This summer I have had the opportunity to travel to Botswana to participate in global health work and contribute to research investigating the use of telemedicine technology for various healthcare applications. This is the first in a what I hope will be a series of blog entries in which I will discuss health care and medical issues in Botswana.

Botswana is a landlocked country about the size of Texas located just north of South Africa in southern Africa.

The majority of the 1.84 million population are Setswana (or Tswana) and are concentrated along the eastern part of the country due to the largely uninhabitable Kalahari Desert which occupies most of the rest of the territory. 35% of the population are 0-14 years old; 61% are 15-64 years old; and only 4% of the population is older than 65 years.

70% of people living in Botswana are Christian, 7% have indigenous beliefs, and 20% have no religion. While English is the official language, Setswana is still widely spoken and many older Batswana only speak Setswana.

Formerly known as the British colony of Bechuanaland, Botswana gained independence from the British in 1966, but has a long history of democracy through the tribal meetings of the kgotlas. The country is now a stable democratic parliamentary republic and has a market-based economy among the strongest in Africa. Most of Botswana’s wealth comes from diamond mines most of which are co-owned by DeBeers and the Botswana Government. Beef exports and tourism also contribute to the economy. Despite this socio-economic stability, poverty remains a concern with a large gap between rich and poor existing and unemployment remaining close to 40%. Education and healthcare are free, and the national literacy rate is greater than 80%.

For more general information about Botswana, check out the Botswana Tourism Board and check back for more entries!