The Global Pulse Journal Blog

With heavy flooding covering much of the country and leaving millions of people homeless in Pakistan, concerns over the potential for a major outbreak of cholera are growing. With continuing rains throughout the region, Dr. Michael Merson, the founding director of the Duke Global Health Institute believes that ”Basically there is no question” there’s a major risk of an outbreak. With a lack of adequate aid to the area to ensure a consistent, clean water supply, the risk of this diarrheal illness is immense. While the flood has already killed over 1,500 people thus far, even more are at risk from a potential cholera outbreak with 3.5 million people in Pakistan lacking access to clean water. In the past year, cholera epidemics in Zimbabwe killed over 4,000 people with over 350 killed by the disease in Nigeria over the last three months, demonstrating the deadliness of this disease. Without adequate rehydration therapy, victims can die within a day or two from overwhelming dehydration secondary to extreme diarrhea with up to a liter of stool output every hour. But with adequate rehydration therapy to replace fluids and restore electrolytes, death rates can be lowered to less than one percent.

The World Bank and USAID are hosting a series of debates exploring emerging issues in global responses to HIV/AIDS and worldwide evolving approaches to development aid, .  The debates attempt to lay out the best evidence and information available to assist world governments, civil society organizations, and other development organizations in interpreting and responding to the shifting dynamics of the epidemic and our collective responses to the challenges it presents.

This global discussion series began this past May with a debate entitled “Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?” which looked at testing and treating strategies with a focus on their role in Africa.

In June, a debate on “Behavior Change in HIV Prevention” took place looking at dynamics involved in behavior change approaches and their past ineffectiveness.

Check out these past debates and the ones still to come including theis week’s August 26th debate on “Discordant Couples and HIV Transmission” and continue to follow this debate series for future conversations.

A  new survey from the Centers for Disease Control and Prevention (CDC) suggests that  heterosexuals living in impoverished communities are as much as five times more likely to be HIV-positive than the general U.S. population, regardless of race or ethnicity. In the US, the overall HIV prevalence rate for African Americans is eight times the rate for whites, and the rate for Latinos is three times the rate for whites. Yet in very-low income areas this CDC study found that these disparities do not exist. The study examined 9,000 people in 23 cities, finding that 2.1% of heterosexuals living in high-poverty urban areas were infected with the HIV virus, including 2.4% of those living below the poverty line and 1.2% of those living above it. This is in comparison to the 0.45% rate of HIV infection in the general US population. The authors hypothesize that the findings could account for many of the ethnic and racial disparities in HIV infections in this country, since African Americans are 4.5 times as likely and Latinos four times as likely as whites to live in poverty.

The International AIDS Society in partnership with the Kaiser Family Foundation is providing online access to various developments taking place at the XVIII International AIDS Conference (AIDS 2010),  in Vienna, Austria.

Selected sessions are webcast live each day with past sessions also available for viewing. Find the complete guide-to-coverage as well as the webcasts already available for viewing including the Opening Session, Monday’s plenary with former President Bill Clinton, and Tuesday’s session on the study which found Microbicides containing HIV drugs lower the infection risk in women.

Today’s schedule includes:

This week at the International AIDS Conference in Vienna, Austria, the World Health Organization announced that 5.2 million people in low- and middle-income countries received antiretroviral drugs for their HIV infections in 2009. This represents the largest increase in the number of people accessing treatment in a single year, with an additional 1.2 million people added to the four million who received antiretroviral therapy in 2008. While the increasing access to antiretrovirals is encouraging, over 10 million people infected with the HIV virus worldwide are still in need of therapy.

The WHO is calling for earlier treatment of those infected with the HIV virus, suggesting that if people are treated before their immune systems become weakened by the virus, HIV-related mortality can be reduced by 20% between 2010 and 2015. In addition, early therapy also has a benefit in preventing transmission of the virus. These new guidelines expand the number of people eligible for antiretroviral therapy from around 10 million to about 15 million people. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that the cost needed for HIV treatment in 2010 will be about US$ 9 billion.

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

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Source: Wikipedia

This is the first in a series of posts for the American Public Health Association’s National Public Health Week.

Most of us associate biodiversity with images of tropical rain forests and coral reefs. While these ecological hot-spots are an important source of medications and global ecosystem services, biodiversity also plays a key role in neighborhoods across the US through regulating the spread of diseases such as Lyme disease. But how is that possible, you might ask, and what can you do about it?

Lyme disease  affects hundreds of thousands of people across the US, with a greater concentration in the northeast. Recent decades have seen an explosion of urban sprawl across the northeast leading to decreased species diversity along with people living in close proximity to fragmented habitats.  But how are these related?

The connection is explained succinctly in Sustaining Life: How Human Health Depends on Biodiversity:

“The Blacklegged Tick (Ixodes scapularis) is the vector of Lyme disease, as well as of several other pathogens in the eastern U.S., and the primary reservoir for Lyme disease in this region is a common rodent, the White-Footed Mouse (Peromyscus leucopus)…Mice live in many different habitats, from pristine old-growth forest to degraded woodlots, garden sheds, and even kitchens. Several studies have demonstrated that populations of White-Footed Mice become very concentrated in small forest fragments, probably due to the absence of other vertebrate species that prey upon, or compete with them (forest fragmentation…affects predators over prey disproportionately). As a consequence, tick populations in small forest fragments have many White-Footed Mice, but few other mammalian hosts on which to feed, resulting in a high proportion of the ticks being infected and able to infect people. In contrast, in more extensively forested areas, the combination of fewer White-Footed Mice and more abundant, alternative, reservoir-incompetent hosts (an incompetent reservoir for Lyme does not pass on the Lyme bacteria to ticks that bite them, or does so poorly) results in a lower proportion of the tick population being infected.”

This phenomenon is known as the Dilution Effect: As species richness declines there is a subsequent decrease in the “dilution” of host-species making Lyme disease easier to spread. As the authors note, the dilution effect is not unique to Lyme, the same mechanism also operates in Hantavirus and West Nile Virus and possibly many others. As sprawl-based development patterns spread to more areas of the planet, we can only expect to see an increase in the number of dilution effect diseases unleashed upon populations worldwide.

So how can you increase biodiversity in your community and thereby help protect the health of your family and neighbors?

Get involved with your local conservation commission and bring these dangers to their attention. Find ways to support local parks and nature preserves. Also, if you have a yard or garden, try to plant local species that help support wildlife.  Most importantly: Education! If you are in college or school, talk to your professors about integrating awareness of biodiversity into curriculum.  Thanks to the UN and various donors, Sustaining Life is available at a very affordable price and can serve as a great textbook without placing a great financial burden on students. In addition, local schools can serve as great sources of biodiversity through gardens and planting of local species on grounds. Often these locals are less expensive to maintain, requiring less water and fertilizer.

These are just some ideas…we’d love to hear from GP readers with their experiences and success stories.

Home to over 400 million people, the Ganges river winds through India’s history, culture and countryside. Unfortunately, rapid industrialization and urbanization has left an unholy mark on the Ganges as dangerous amounts of untreated industrial pollution and human excrement enter the river every day.  These conditions are all too common in rivers worldwide  and create an environment ripe for diseases ranging from schistosomiasis to Cryptosporidium.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

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.