Transcript GLOBAL IMPACT OF INFECTIOUS DISEASES

GLOBAL IMPACT OF
INFECTIOUS DISEASES
Teresa Smith de Cherif, MD, MIA
Fellow, Division of Infectious Diseases
People in the developed world consume most of the world’s resources.
25% of global deaths are from infectious diseases, but the burden of
disease is carried largely in the developing world.
Infectious Diseases Mortality
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There are marked
differences between
developed &
developing nations
with regard to
mortality from
infectious diseases.
SCENARIOS
Rather than using statistics
alone to provide brief
snapshots of infectious
diseases, I hope to aim
broader:
to use the African tradition
of story telling,
to think outside the box,
to explore how seemingly
unconnected events &
trends can work together
to expand or limit an
epidemic.
“The decisions we make
about the future are
guided by our view of
how the world works and
what we think is possible.
Scenarios are stories
about the future, but
their purpose is to help
make better decisions
about the present.”
--AIDS in Africa: Three
Scenarios to 2025
Diving hippo illustrates that the patterns of behavior lie below the
surface, and the structure of the system lies deeper still.
Overview
Explore and expand understanding of the AIDS
epidemic, particularly in Africa.
 Understand that the AIDS epidemic is a small
part of a wider international peace and
development crisis, requiring an exceptional
response within its wider social and economic
contexts.
 Understand that infectious diseases affect not
just individuals, but collectives—families,
communities, nations, the world.
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Front page, New York Times Book Review, 11 December 2005.
Perceptions: Is AIDS a health problem or is it a symptom of underdevelopment
and poverty?
Will there be incentive and capacity to deal with AIDS?
2/3 of all people living with HIV are
Africans. Nations most affected: South
Africa, India, Nigeria.
From Algiers to Cape Town, Dakar to Dar esSalaam, the red earth of Africa is dotted with 15
million white tombstones, because that is how
many people have died from AIDS.
The primary social events in South
Africa at present are funerals.
Prevalence of HIV in Africa
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The number of all new and old cases of HIV in Africa
during a particular period.
The prevalence of HIV infection has stabilized in Africa,
but let’s not be misled.
Stabilization does not necessarily mean that the
epidemic is slowing.
“Stabilization” can mask the reality that equally large
numbers of people are being newly infected with HIV
and are dying of AIDS.
Prevalence is also affected by data capture. In rural
South Africa, where voluntary test and counseling is in
place, prevalence is at 30-40%.
Africa is three
times the size
of the United
States.
Presently, Africa has
inadequate resources to
face the burdens of
AIDS, TB, malaria, and
other infectious diseases.
AIDS has led to a resurgence in
the incidence of TB. 1/3 of
Africans carry a latent TB
infection. Each year, 5-10% of
those co-infected with TB & HIV
develop active TB; up to 50%
will develop TB at some point.
African governments
actually are reducing health
expenditures in order to
repay external debt.
Africa is precariously dependent on the
resources it supplies to the world.
Poverty: Informal settlements surround the urban centers of
Africa.
More than 1 in 4 South Africans—12.5 million
people—live in shantytowns. Within the last year,
~900 protests over squalid conditions erupted.
AIDS deepens the traps of poverty, underdevelopment, and
marginalization in a globalizing world.
AIDS has spread by poverty and
war.
Countries at war and bordering nations experience increased HIV
transmission.
Impact of Conflict on Children
Hotel Rwanda
African women & HIV
60% of HIV+ African
adults are women.
 75% of all women
with HIV, worldwide,
are African.
 Young African women
of childbearing age
have the highest
incidence rates.
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As the most productive
members of society—teachers,
agricultural workers,
healthcare personnel, public
service staff—are dying from
AIDS, the continent is being
robbed of its human capacity.
Life expectancy has dropped to <40
years in 9 African countries, among
them Zimbabwe. There, life expectancy
was 52 years in 1990; in 2003, it fell to
34 years.
Economic Costs of Disease at the National Level
“Doctor, who is going
to take care of my
children?”
AIDS stresses
families, as
grandparents take
care of orphaned
children.
Parents die, there is
loss of income to the
family, debt is
incurred.
Fikelala Children’s Centre in Khayelitsha (Cape Town), South Africa.
Infants whose mothers had no access to antiretroviral therapy are being born
with HIV and soon after are left as orphans.
If present trends continue, by 2025, there will be a missing generation of
grandparents. Will there be a sense of family, community? The large number
of children orphaned by AIDS will be less skilled, less nurtured, and less
socially integrated than their parents were.
South Africa: Africa’s most
developed country.
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Yesterday
South Africa is being cast into
deepening poverty. The postapartheid political, social, and
economic gains risk being reversed
by the downward spiral in health.
How can South Africa partner for
prosperity with other African
nations?
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RSA has the highest number
of people living with HIV in
the world, >5.3 million; ~3
million women.
One in 4 South Africans is
HIV+.
AIDS is the leading cause of
death.
More than 1/5 of the
workforce is HIV+.
Absenteeism from the
workplace has risen with
employee deaths from AIDS.
The RSA Dept. of Health Study
2002 estimated that 250
babies per day were infected
by mother to child
transmission.
AIDS-related illnesses are
responsible for 40% of deaths
in kids <5 years.
Scenarios: Which way forward?
43 million new HIV infections could be prevented over the next 20 years if African
governments implement comprehensive strategies and if global assistance is increased.
Presently, in
most cases,
palliation is all
we have to offer
to African
individuals
suffering from
advanced AIDS.
Confronting this devastation will require strengthening human &
institutional capacities, including scaling up HIV prevention programs and
implementing large-scale treatment programs.
PREVENTION
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New ABC
(Acknowledgement of
the realities of sexuality; Behavioral
changesafer sex; Communicating).
Investment in health
systems infrastructure
 Voluntary test and
counseling
 Infection control
 Safe blood banks
 Vaccine*development
 EDUCATION
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Immunization can eradicate
infectious diseases. Most famous
example: small pox. Others: polio,
measles, H. influenzae type B,
Yellow Fever.
Treatment
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Less than 5% of Africans
are on highly active
antiretroviral therapy
(HAART).
Roll out of HAART must
progress.
Reverse African brain
drain.
Invest in drug
manufacturing capacity in
Africa.
Projected Costs of Tackling the
AIDS Crisis
Global spending on
AIDS has increased
15-fold since 1996 to
approximately 5
billion dollars
annually.
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falls short of UNAIDS
estimates of $12
billion required
annually.
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Everyone must participate…
Leverage what is
available to achieve more,
especially given limited
resources.
 No AIDS funding without
investment in social and
economic development.
It shouldn’t be easier to
get HAART than adequate
nutrition & H20.
 Fikelala. Xhosa, “reaching
out.”
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Change
South Africa’s first democratic
election, 1994.
It may seem futile to challenge the
world’s “misery, injustice, and
violence…But, it is through numberless
acts of courage and belief that human
history is shaped. Each time a person
stands up for an ideal, or strikes out
against injustice, he sends forth a tiny
ripple of hope, and crossing each other
from a million different centers of energy
and daring, those ripples build a current
which can sweep down the mightiest
walls of oppression.” –Robert F. Kennedy
at the University of Cape Town