Readings 9/30/09

The possibility of mother to infant AIDs transmission most provoke the most helpless feeling in the mother, who carried this baby within herself for nine months just to have such high odds that as soon as it’s born, its life expectancy starts the countdown. When such intrinsic processes as breastfeeding are detrimental to the most precious members of the future, something must be done. But, as the article “Mother-to-child transmission of HIV-1: timing and implications for prevention” points out, breast feeding is almost vital to an infants growth, especially within the first six months, and alternatives are far too expensive for poor regions of the world. Also, I wanted to remark on the fact from the article that C-sections greatly decrease the possibility of transmission from mother to baby during birth. This is a great discovery, but also very dangerous and costly for many underdeveloped countries. Last of all, the multitude of medications suggested would be a great addition to the increase of the baby’s chances, but of course would cost a great deal and require funding from outside sources for all the areas of the world that cannot afford such technology. Who should provide this funding or the services to perform the C-sections or distribute medications? Does this responsibility rest on all equally? I find it fascinating and yet disgusting how so many people ignore such problems, and yet, here I am, going about my life and not so actively contributing to these people infected with HIV/AIDs. I am excited to learn how to help.

Readings 9/23/09

These first two chapters threw out so many statistics that I felt overwhelmed at the magnitude of the situation, which I already knew was severe. As I read, however, I questioned at the accuracy of the numbers because of the impracticality of measuring such things as infections and diseases in such huge populations of people all across the globe, especially in underdeveloped countries and poor areas.

One aspect of this reading that I found particularly intriguing was on page 5 of chapter one when the authors brought up the issue of what humans value today. I especially liked the quote “Apart from the purely humanitarian aspects—that we do not want to see others suffer and our heartstrings are torn by the sight of the derivations among swathes of the world’s population—on cool reflection, labour is not required in the quantities that once it was” (Barnett and Whiteside 8). In our developed, advanced society today, is that all that underprivileged people are good for? I like that the authors subtly posed this question and revealed this side of rich society mentality. Most people would probably completely deny this thought, because they wouldn’t want to seem cold or un-empathetic. It is interesting to ponder the emotions large populations feel towards this epidemic because from personal experience, I feel very detached from the disease as well as from information on it. Such a stab at the mindset of much of mankind is quite a radical approach, albeit unsurprisingly radical in today’s world of fantastic literature, but it’s a provocative statement that hopefully causes many another to pause.

Reading 2 (9/30)

Perhaps it is my naïveté, but I was rather shocked (and pleased) by Kourtis’ (Lee, Abrams, Jamieson, and Bulterys) research in mother to child transmissions. As a disease with such a high transmitting rate through blood (drug use, intercourse, blood transfusion, etc.) I was very surprised to learn that mother to child transmission, although present and therefore a problem, was not 100%. Moreover, medication was extremely successful in help reducing the number of mother to child transmissions.

It shocked me that for the most part, children were able to stay HIV-free antenatal. Only at birth or through breastfeeding was it likely for the HIV to be transmitted. This was pretty incredible to me, that although the child was living inside its mother sharing many of the same nutrients, it was able to separate itself enough to protect itself from HIV.

As a research experiment, Kourtis’ work was very well executed and explained. As researchers began to see a trend in mother to child transmission and breastfeeding, Kourtis quickly separated the two: breastfeeding and non-breastfeeding to ensure far results. In addition, Kourtis, seeing the development in the child as a major variable, broke down the timing in which medication was taken, antepartum to postpartum. Differentiating these two variables in the beginning was plainly explained and critical in succeeding in positive data.

Kourtis went on to describe his research in great detail. It was alarming how successful all drugs seemed to have (varying from drug to drug). Some drugs were almost 80% successful in preventing mother to child transmission. In addition, Kourtis’ conclusion was sensible and thought provoking, explaining additional research needed to be done along side his findings.

9/30 Reading: Mother to Child Transmission

Kourtis et al researched a very pressing question and gave us some much needed answers in this article, though there is so much more that we do not know about mother to child transmission. An important point that they addressed that took me surprise is the idea that the time of viral exposure is not necesarily the time when infection occurs. How absolutely novel! It is very interesting to think that an fetus's blood can be contaminated with virus but will not be infected up until 2 days of life if ever; it kind of sounds like HIV is sometimes dormant in infants. It is understable that it is usually waiting for the infant's immune system to be activated in order to complete reverse transcription but the authors also said that sometimes, the virus never activates and eventually decays. Now I am sure this case is pretty rare but it from the authors, it sounds like it does happen sometimes. How does that work? As the authors said there are so many more questions that have not been answered and it is important to focus on mother child transmission because it is one of the hardest methods of transmission to avoid. One can avoid getting sexually infected by using protection or knowing whether his/her partner is infect; but how can a mother avoid contaminating her baby when her baby is inside her virus ridden body? And how does a mother choose between refusing to breast feed, which could lead to her child starve and practically feeding her child contaminated milk? Hence the importance of continued research on possible ways of evading postnatal transmission which is the largest cause of infection in all infants.
Reading this article, I realize how far research has progressed in the long and arduous search for a solution (any solution) to mother to child transmission especially in developing world countries where breastfeeding could be the difference between life and death for newborn. It is also interesting to learn how transmission is more likely to occur more or less depending on the stage of pregnancy. Obviously, it is most likely during labour and deliver, only after breast feeding, and as the authors strongly suggested, it would help to research more ways infection could be avoided even at these most risky stages. The area of mother to child transmission of HIV-1 is very complex and commands that one put into consideration a wide spectrum of ideas. It is also a very important area because this transmission is not easily preventable.

AIDS in different parts of the world

When AIDS was first discovered and named in the early 1990s, it was named GRID, and thought of as primarily a gay man's disease. Soon it became clear that IV drug users were also included in the susceptible population. In The United States, AIDS is still seen as a disease afflicting primarily people engaging in marginalized risky behavior: people who share needles or have unprotected sex.

In Africa, where AIDS began to emerge as the great scourge of the twenty-first century, AIDS is a much more widespread phenomenon. Where in the US, HIV affects primarily the urban poor, in Africa the disease is not as socioeconomically particular. In Africa, AIDS is spread through what many see as normal behavior. Men with many concurrent sexual partners, some of whom might be sex workers, spread it to their wives, who then infect their children through breast milk. Because in some African cultures, monogamy is not considered the norm, these methods of transmission are harder to curb because there is no cultural stigma against these behaviors in and of themselves.

Lately, AIDS has begun to become endemic to a much larger degree in parts of Asia, which had previously remained largely unaffected by AIDS. The first chapter of Disease, Change, Consciousness and Denial asserted that "Asia will overtake sub-Saharan Africa in absolute numbers [of AIDS cases] before 2010." The reservoir for HIV in southeast Asia, in particular, has been sex workers and IV drug users, somewhat similar to the afflicted population in the United States. Yet while prevention strategies seem to be working n Africa, whose AIDS prevention campaign has a multimillion dollar budget, new cases of AIDS are steadily appearing in Cambodia and Thailand. Methods of prevention are largely ineffective and inadequate in this region, which has no structured prevention or treatment system in place. For example, in Thailand, 80% of gay men have never been tested for the virus, only half of female sex workers report regularly using a condom, and 35% of intravenous drug users use non-sterile injecting equipment.

AIDS in Asia is an emerging phenomenon that has the potential to reach Africa's proportions if a better healthcare safety net is not put in place as soon as possible to ensure that high risk populations do not disseminate the disease throughout the region. The cultural and geographic diversity of Asia would make it nearly impossible to develop a blanket strategy for curbing the spread.

Katie Nelson

9/30

Response to Iliffe, Barnett and Whiteside 9/23

John Iliffe takes an interesting point of view in his book. As an historian and not an epidemiologist or medical doctor, his perspective is unique and important especially when it comes to a virus that has had such a profound impact on human history in all aspects for the last three decades. I was especially interested in the his attempt to date the history of the virus itself based on several accounts from different researchers and doctors since the 1950's. Ever since I learned about the emergence of HIV/AIDS in the United State in the 1980s I always wondered where and how it eventually arrived here especially since it is said to have jumped into the human species from chimpazees in western Africa. In common and general literature, people only talk about HIV/AIDS beginning in 1980 when the first American cases were reported. It seems like it does not occur to some writers to include a history of the viruses travels before it reached the United States. Sometimes, as is evident in many other examples of diseases, people in developed countries only start to worry about a disease when it reaches their mainland, regardless of how many people it has infected or killed in other less "important" countries. Iliffe somewhat hints at this idea but I strongly express it; one classic example is the smallpox eradication program which was launched mostly to ensure that no cases would be imported into the Western world which had by then eradicated the disease on its mainland. Barnett and Whiteside are perfectly on point when they say that the most important step before even beginning to fight this epidemic is to first realize that "welfare is a global common good" because AIDS is an "epidemic of globalisation" which has "spread rapidly because of the massive acceleration of communication, the rapidity with which desire is reconstructed and marketed globally and the flagrant inequality that exists within and between societies" (4). In this manner, AIDS has united the world in a way that probably would have not been possible otherwise. Now, when people aspire to find a while to stop this pandemic, it is not because they are afraid that it is going to be imported into their country but because they realize that the turmoil and destruction it causes in third world countries ultimately affects everyone in some way or another; others just can't stand to see people suffering so much. Yet others, especially government leaders and policy makers refuse to recognize the wide range of impacts that AIDS has. Most people who aspire to stop the epidemic are not policy makers or government leaders, because these people in charge, who are supposed to be the ones people turn to have continually disappointed their citizens so much that the able citizens have taken the matter into their own hands. There are alot of efforts in process right now to fight AIDS but most of them are undertaken not necessarily with willing governments if any at all. But these leaders must realize that unless they learn to accept wide range of impacts AIDS has had and will continue to have on all aspects of society and attack it with the right weapons for each aspect, the disease will continue to spread and if it eventually dies out, it will not have been because of us.

9/30 Response to Iliffe and Barnett and Whiteside Readings

In considering the social, economic, political and biological factors that affect the spread of the HIV/AIDS epidemic, I had not ever considered that the timing of the epidemic in various areas of the world could be so influential. Yet, Iliffe makes an interesting point in Chapter 7 when he theorizes that "the fundamental reason why Africa had the worst AIDS epidemic was because it had the first AIDS epidemic" (pg. 58). As Boxes 1.6-1.7 in Barnett and Whiteside's first chapter demonstrate, extensive AIDS epidemics exist outside of sub-saharan Africa as well. However, the concern that an epidemic as dramatic as that seen in sub-saharan Africa may explode in parts of Asia and eastern Europe has proven largely unfounded. Barnett and Whiteside predict in Box 1.2 that "Asia will overtake sub-Saharan Africa in absolute numbers before 2010," (pg. 9), yet thus far, this does not appear to be the case. While timing is obviously not the only factor contributing to the explosiveness of the African AIDS epidemic, I would be interested to further explore the idea that governments elsewhere in the world were better able to prepare for the possibility of a devastating AIDS epidemic, and thus better able to keep the epidemic confined to specific core groups in society.

As Barnett and Whiteside assert on page 15, the world has, until very recently, largely chosen to "deny what is happening and not to recognize the global implications of this epidemic for the welfare and well-being of others." From my own experiences working in HIV clinics in KwaZulu Natal, South Africa, I can attest to the enormous role that denial within a society can play in furthering the spread of HIV/AIDS and contributing to stigmatization of the disease. Government denial plays a particularly destructive role in fighting the spread of HIV/AIDS, which brings me to Iliffe's discussion of the South African epidemic. Illife asserts that "It would be naive to think that even the most vigorous, stable, and popular government could have protected South Africa from a major epidemic" (pg. 43). While he further says that "better political leadership could have reduced the impact of HIV," I believe Iliffe underestimates the role that government denial, particularly on the part of South African president Thabo Mbeki, played in allowing the South African epidemic to continue spreading. A recent Harvard study attributed the death of at least 330,000 South African AIDS victims to the policy of AIDS denialism followed under the Mbeki administration. Mbeki and his Minister of Health extensively delayed the rollout of ARV's and mother to child transmission drugs well past the point at which these drugs were available to South Africa. Furthermore, the psychological effects of AIDS denialism within government leadership are still impacting HIV/AIDS treatment and prevention efforts. Thus, as Barnett and Whiteside discuss as well, I believe government attitudes and policies have a dramatic impact on the spread of the HIV/AIDS epidemic.

Reading 1

The first chapter of Disease, Change, Consciousness and Denial, brought forth a number of interesting ideas within the social and economical impact of HIV and AIDS. At the very central point of their argument, Barnett and Whiteside stress the large discrepancy between rich and poor and the care they receive. As HIV and AIDS have “affected every single continent and every single country,” it’s clear to see how the countries of a higher per capita income can literally buy a healthier life. They don’t however go into detail as to why this discrepancy exists. Do they lack healthcare or education? Is it a cultural or purely monetary difference?

Barnett and Whiteside also stress the lack of political compliance with this blatant data. “Few senior policy makers and even fewer politicians have been prepared to consider the potential consequences of the epidemic and what be done about them.” Moreover, those properly versed have found an easy solution: denial.

However, what struck me most was not a heavily emphasized point by the authors. In fact it seemed almost skimmed over. From an economic standpoint, the most startling data, to me, lay in their predictions. For most large geological regions, Barnett and Whiteside discussed a few key HIV points, most specifically: the data of deaths, the data of the dying, and the data of the future dead. Although sub-Saharan Africa led the overall numbers as well as percentages in current statistics astoundingly, “the coming decade promises two potential hot-spots: the world’s most populous countries, India and China.” I would add to that. Two of what are considered the most favored in economic growth and what many consider to be the future in many aspects of the world, could be crippled by HIV and AIDS.

Week 2 (9/29): MTCT

The research methods that Kourtis et al. used to determine when HIV is transmitted from mother-to-child and what percent of transmission cases occur at which times really intrigued me. The design of the experiment, taking into account both breastfeeding and non-breastfeeding mothers, was carefully thought out, and its results provide important data in crafting the most effective regimen for preventing/reducing MTCT.

However, since reflecting upon the article, I am wondering how realistic some of these prevention methods are for (prospective) mothers living in rural areas, especially in Africa. A number of questions come to mind when considering how to implement these findings in such areas.

First, due to both a lack of money and of trained staff, the possibility of administering these regimens to pregnant women seems difficult. Currently, single-dose nevirapine is the cheapest and easiest choice, as it requires little to no training from medical staff. Yet, these single-doses also increase the likelihood of resistant viruses in both the mother and infant. So, what resources will it take to implement zidovudine regimens in rural villages, and correspondingly, how likely is it that this goal will be realized?

In addition, the possibility for women to get a C-section in these villages is unlikely, as well, considering that there are few trained doctors who would be able to carry out this procedure. As a result, it seem as though preventative measures during breastfeeding are the best (and by ‘best,’ I mean most feasible) option for pregnant women. Yet, as we discussed in class, breastfeeding is important both to many cultures and to a mother’s psychological wellbeing. Although mothers may know about the options they have for breastfeeding, from what I’ve observed, not all mothers actually implement this knowledge – I met two women in Tanzania who were living with HIV, and they both had children. Even though they knew about the different ways to prevent MTCT, they didn’t actually use any of them. While I’m not sure if this gap between having knowledge and then implementing it is widespread, I am wondering how we can encourage and ensure behavior change in this area.

Preventing pediatric AIDS in developing countries.

The article Mother-to-child transmission of HIV-1: timing and implications for preventions by A. Kourtis, talks mainly about the timeline of when and through what media the child is most vulnerable to the contraction the HIV virus from its mother. The two main ways that an infant can contract the disease is either during birth, or after birth through post-natal care. The article concludes that in breast feeding populations, “postnatal care exposure to HIV-1 could account for about 40% of all transmissions making it the most important time interval for all transmission of HIV to the infant.(730)” Furthermore, states that formula-fed children are less vulnerable to contracting the disease through their mothers’ breast milk. This shows that perhaps formula milk could play a huge role in prevention of pediatric AIDS. However, in developing countries, it might be very difficult for impoverished families to purchase formula milk for their new born infants. This statistic confirms Barnett and Whiteside’s argument in Disease, Change, Consciousness and Denial, that “ The relationship between inequality, poverty and infectious disease is observable (15)” and that there is a “link between malnutrition, parasitosis and susceptibility to infection in general ( 15)” in less developed countries. Perhaps if governments or charitable organizations could work at least providing the resources for infants whose parents are infected to have access to formula milk, then infants could have the opportunity to live an HIV-free life. However, this proposition could only work provided that children did not contract the disease during birth. According to Kourtis’ article, “In non-breastfeeding populations, about half of all HIV-1 cases caused by mother-to-child transmission occur in the days before delivery and during labor, when the placenta separates from the uterine wall. Another third occur during late labor and actual passage through the birth canal. (730)” An effective way to combat this transmission from mother to child at birth, would be through c-sectional delivery. Again this poses another issue of health-care shortage in a lot of developing countries, where it would probably be hard to find expert doctors to help perform c-sections for HIV-infected mothers. Therefore, the prevention of pediatric AIDS remains a hard one to combat, especially in developing countries.

Kesaobaka Modukanele

HIV/AIDS: Biology, Behavior and Global Responses

BLOG ENTRY 2 ( Response to Wednesday September 30th Class)

Pediatric HIV

The Kourtis article seemed to offer a glimmer of hope amidst the overwhelming and grave scope of the HIV/AIDS epidemic. It is encouraging to know that mother-to-child transmission is largely preventable (with the right resources, of course). It seems to me that this particular area of HIV prevention has potential to combat some of the cultural barriers that others have brought up in their blog posts (denial, apathy, etc.). For example, it's one thing for people not to treat themselves because they figure they're going to die anyway, but I would think that people would have a different attitude concerning children. Perhaps mothers who know that their adherence to drug regimens affects their children would be more likely to seek out and follow through with treatment. This is all speculation of course, as I do not have much understanding of the many cultures we refer to. I think we should be careful not to make too many assumptions about realities and cultures that we have not experienced.

In class last week and in some of our blog posts, culture always seems to be thought of as an obstacle. I'm wondering, is there a way to use cultural practices and beliefs as allies/tools in combating HIV/AIDS? Does anyone have any examples of culture actually helping to fight the epidemic? I'd be very interested to know!

As I was reading about all the treatments of mothers and children affected by HIV, I was wondering about how the drugs (which Dr. Thairu mentioned are quite strong) affect the development of the child. Are there side effects? I was amazed that infants are able to avoid infection even when the mother started the drug regimen late in her pregnancy (or even in labor) - paradoxically their unformed immune system seems to actually protect them! I'm also curious about why infection rates are so different between "emergency" and planned C-sections. Perhaps it has to do with physician preparation, or the health/drug regimen of the mother?

That post had a lot of questions... please respond with any thoughts/answers if you have them!

Rachel Kelley
Blog Post 2: 9/30

9/23 Reading

After reading the first chapter of AIDS in the Twenty-First Century: Disease, Change, Consciousness, and Denial, I was thoroughly surprised by the impact that AIDS will have on the rest of the world. Before this reading, I had thought that the disease was mostly localized in sub-Saharan Africa and found sparsely around the world. Having grown up in Taiwan, I had only encountered one AIDS case, so the disease felt distant to me. However, the statistics given by Box 1.2 to 1.7 on the current global situation of AIDS showed that my previous beliefs were rather naive. For now, sub-Saharan Africa may be the most affected by the virus, but it is spreading dramatically throughout Asia. According to the statistics, “Asia will overtake sub-Saharan Africa in absolute numbers before 2010; by 2020 Asia will be the HIV/AIDS epicentre.” Thus, currently Asia is quite close to overtaking sub-Saharan Africa already. This fact just totally shocks me. It is difficult to imagine that in the near future on AIDS prevention ads, instead of seeing an elderly Ugandan woman like described in the introduction, I will see an elderly Chinese woman who resembles my grandmother. The demographics of Asia may resemble those of Uganda’s as illustrated in Figure 1.3 in which the cohorts between ages 20 and 50 are deficits. This realization makes me even more eager to help find a solution to this problem, because now the disease feels so close to home. However, many of the problems associated with prevention that are brought up by the article also apply to Asia. Asians are just as concerned about lineage and passing down names as Africans, making it difficult to promote abstinence, especially in rural areas. Moreover, AIDS is and will be affecting the more underdeveloped areas of Asia where nutrition is poorer and treatment less available, contributing to the spread of the disease. Hopefully, the solutions to these problems will be addressed later on in the text. The statistics provided by this chapter has enhanced my interest in the topic of this class because AIDS is now a disease I can relate to.

9/23 Response to Lecture on Biology and Epidemiology of HIV/AIDS

The distinction between HIV/AIDS "prevalence" rates and "incidence" rates made by Professor Thairu struck me as incredibly important, particularly as these statistical terms relate to the differences in the epidemiology of AIDS in various countries. The difference between these two terms seems to create a situation in which HIV/AIDS statistics, which are already difficult to accurately obtain, can ultimately misrepresent the status of the epidemic in a particular area. As we discussed in class, the prevalence of HIV/AIDS can drop while the incidence remains the same. The behavioral, social, economic and biological factors affecting the pattern of HIV/AIDS epidemics are already incredibly numerous and complex, as Iliffe discusses in his analysis of the spread of the African epidemic. Thus, the fact that prevalence can decrease while incidence remains the same introduces yet another variant into the cause and effect relationship between HIV/AIDS risk factors and the spread of the epidemic. Are AIDS deaths responsible for drops in prevalence in, for instance, eastern Africa? Or are treatment and prevention plans experiencing enough success to result in a decline in both prevalence and incidence rates? Furthermore, it is obviously very difficult to assess how accurate HIV/AIDS statistics are, due to the impossibilities of testing entire populations. If more accurate data were available, would comparative statistics between various countries change, resulting in changes in public health policy and international aid distribution for HIV/AIDS?

As several other students noted, I was also struck by the diversity of the epidemic. I was aware that HIV had various subtypes; however, I was not aware of the biological implications of this variation in terms of transmission and virulency. Iliffe discusses the patterns of subtype C in Ethiopia in contrast with the prevalence of subtypes A and D in the majority of eastern Africa (pg. 30), and I was struck by how the existence of various subtypes introduces yet another factor in the search for explanations as to where the epidemic exploded, and where it stayed relatively stable. In general, both Professor Thairu's lecture and Iliffe's reading highlighted the importance of statistics in studying HIV/AIDS yet also cautioned against relying too heavily on statistics, as available data may not always present the most complete picture of the behavior of the epidemic.

Social Perspectives on HIV/AIDS.

“ I cannot think about this AIDS business. I could drown tomorrow. There are too many girls here.”

“ Live for the present”

“Every death is a death”

These are some of the attitudes that Barnett and Whiteside noted in Disease, Change, Consciousness and Denial, from people living in countries most struck by the HIV/AIDS pandemic. It is clear that such mental frameworks emerge from a sense of denial, or indifference about the disease, perhaps as a way of providing to themselves some kind of comfort or self assurance by being apathetic. Perhaps it might be a way to pull away from being labeled victims, and rather, to pretend that the problem of HIV/AIDS is not really a problem at all. I believe that such cultural stances on the issue of HIV/AIDS should be dispelled completely as part of prevention interventions that any government adopts to fight the disease. It is one thing to try and promote the use of condoms, or try and encourage people to know their HIV/AIDS status, or try and set up more testing sites, but all of these attempts could render futile if people pretend that HIV/AIDS is not that imperative.

I don't think the issue is so much that people fail to see or realize the impact of HIV/AIDS in their lives, especially in such countries that are most affected. This is very plain in the elderly lady’s lamentation “Abantu Abaafa” – clearly stating what “everybody knows” ( 3) that people are dying. However, I think such statements emerge from a culture of sexual concurrency that people have overtime become overly comfortable with and do not realize that it is time to quit such behavior. Perhaps one place to begin to fight this culture of sexual concurrency is to begin with sex workers. According to Barnett and Whiteside, “ There are numerous records of women who say that they cannot think of the long-term risks of illness and death when they have to undertake commercial sex work without a condom so as to feed themselves and their children” ( 19). Perhaps it might be worth it creating rehabilitation centers for commercial sex workers, where they would be shown that there are other avenues of self sustenance outside of sex trade. Regardless, it still remains very difficult to revolutionize an entire culture.

Kesaobaka Modukanele

The AIDS Epidemic: Biology, Behavior, and Global Responses

Blog Entry 1 (Response to September 23rd class)

9/23 lecture

During Wednesday’s introduction to AIDS, there were a couple of points Ms. Thairu mentioned that I found new and interesting and would like to discuss in this blog entry. First, I was surprised by the diversity of the HIV virus. I knew from previous exposures to the virus that there were various strains that should be treated differently, but never have I imagined that there could be nine subtypes of the virus. This poses a challenge to global milestones such as the 6th Millennium Development Goal, Target 2 to grant universal treatment access, because the numerous strains may require unique treatments and the number of strains suggests that the virus may mutate to resist the current treatments available. Moreover, it is difficult to determine the right time for treatment, because starting treatment too early causes side effects and induces resistance from the virus as well. In addition, I found the part about children whose parents were infected with AIDS intriguing since most of my experience with AIDS came from working with AIDS orphans. I learned that for young children, it is difficult to determine whether they have AIDS because their CD4 count varies during age. Therefore, my algebra teacher could not have known if the child he adopted had AIDS. Prior to this lecture, I had believed that most HIV patients were infected through IV drug use or homosexual relationships. However, the pie graph that Ms. Thairu showed the class illustrated that 80% of the infection came from heterosexual relationships. I would guess that most people are not aware of that number, and if they were, they would have been more cautious in their relationships. In addition, I had never thought that AIDS, one of the leading causes of death, could have positive effects like revealing weakness in health systems and creating behavior changes in condom use, fewer concurrent partners, and later sex debut. Of course, the devastating effects of the disease outweigh these benefits, but perhaps the awareness of AIDS has helped us become more prepared for another possible epidemic and also helped fight other sexually transmitted diseases. In conclusion, I thought this lecture made me look forward to what I will learn later in this seminar.

Week 1: Response to 'The African Aids Epidemic: A History' - John Iliffe

The worst epidemic occurred (is occurring) in Africa because this is the first epidemic of such a scale with such characteristics (pg.1), and neither the African governments nor the rest of the world were prepared to respond quickly and effectively. In addition, the context in which the first AIDS cases came to light is important as well – many of the governments were in their early years, just beginning to establish and maintain control, causing them to ignore the budding signs of a massive epidemic. However, once people recognized the seriousness of HIV/AIDS, the scientific community was quick to identify the virus and how it is transmitted, indicating the quick human ability to elicit concrete, factual knowledge. Yet, when we consider the conditions now, we see that HIV/AIDS has not abated, and actually continues to spread, despite our extensive knowledge in its transmission, prevention, progression, biology, epidemiology, etc. Our inability to create a vaccine and the impossibility to create a cure reveals the limitation of science. Thus, we cannot depend solely on scientific advancements to combat the HIV/AIDS epidemic – rather, we must start changing our behaviors (and encourage others to do so) that put us at high risks. Further, behaviors such as practicing safe sex (through condoms use, abstinence, and/or faithfulness) will remain important to general sexual health, even after HIV/AIDS has been eradicated. However, there exist many factors that have contributed to the ‘rise’ and continuation of HIV/AIDS, which further reflect the complicated problem of eradicating HIV/AIDS – social and economic factors trigger many people to continue to engage in these risky unprotected behaviors. Thus, to get to the desired endpoint of a world where people have the liberty to make healthy sexual choices with all things considered, we must also eliminate those problems (e.g. gender inequalities, forced sex, sex workers, better education, etc.), which cause them to deprioritize their sexual health in the first place.

About data....

Before reading the chapters we had to read for class this week, I never realized that there was such a lack of reliable, thorough data about the HIV/AIDS epidemic. My impression was that there was a great supply of data because it seems that every mention of the epidemic is accompanied by some shocking and significant-sounding statistic. Upon reading the article, however, it makes sense that there is a real dearth of data - particularly considering the social, political, and economic obstacles to collecting it! Collecting a more comprehensive and up-to-date data set should be an international priority (and I hope it already is!). To achieve that goal, however, I would imagine that many more resources would need to be dedicated to the task. It would obviously be unacceptable to simply be conducting research while people are dying from lack of preventative efforts or direct care.

I had not before considered in any depth how nuanced the collection of such data truly is. Not only are there the scientific considerations of sample sizes, methods, composition, etc., but there are also social and practical considerations related to what resources are available to implement the survey and how participants may suffer from social stigmas. International politics even plays a role! I was very interested to read about how Zimbabwe adjusted its reported AIDS cases to 119 after learning that South Africa had reported 120. In our discussion in class last week, we briefly mentioned how political aid efforts such as PEPFAR are as well. It is somewhat surprising, given that many foundations and organizations are seeking to give out aid, that better surveys have not been conducted (at least, at the time of the press for the book). I would like to think that they are seeking to assist affected population with an understanding informed by research/data, but perhaps this is not the case.

Rachel Kelley
Blog Post 1: 9/23

Ro & AIDS-- Epidemiological Inaccuracy

The basic reproductive number of disease, R0, is generally used to estimate the spread of an epidemic. It is used by epidemiologists and public planners to estimate the spread of an outbreak, and the level of response that will be necessary to quash it. In our reading for this week, HIV's R0 is estimated at 4, and I would like to take a closer look at what this means. In its most basic form, R0 expresses the disease's factor of contagion-- if one person has the virus, this 'patient zero' is likely to spread it to 4 people in a susceptible population. In order to be considered infectious, R0 for a pathogen must be greater than 1 (or else the disease will die out and not spread).

However, there are other important factors when considering the spread of infectious diseases. In a formula measuring an epidemic's potential impact, the timing of the incubation and contagious periods must be taken into account. Additionally, the 'susceptibility' of the population in question may vary. In today's society in which the movement of people and goods takes place at hyperspeed and on a massive scale, R0 values are not always a good indicator of a disease's infectiousness.

A virus like HIV, additionally, has several confounding factors that makes it extremely difficult to obtain a standard value. Most basic reproductive numbers are based solely on past epidemic statistics, not on any biological data. With a disease like AIDS, which manifests itself with a wide variety of symptoms and can take decades to fully develop, good statistics are difficult to come by. R0 values also assume that the potentially affected population is homogeneous. It is abundantly clear that in the case of HIV, some people are far more likely to be infected than others, and transmission generally requires a specific network of behaviors. For airborne diseases like influenza, only the most fleeting of contact is necessary to spread the virus, but with HIV, people engaged in specific behaviors are at infinitely higher risk of infection. Yet IV drug users, gay men, and sex workers do not fit into a homogeneous population model, and do not share its epidemic trends.

Thus far, epidemiologists have been unable to develop a disease model that reflects the real world.

Katie Nelson
9/23

Welcome!

Global HIV/AIDS-ers,

Welcome to the class blog!

We hope this site will be useful as you synthesize your thoughts around global HIV/AIDS throughout the quarter. Feel free to make use of this blog as much as possible; the more you post and discuss with one another, the better!

Again, as a reminder please send your Gmail e-mail addresses to Aaron Kofman by Thursday September 24, 8 PM. Once you receive your invitation from Aaron to join the blog, you are free to begin posting.

Happy blogging and looking forward to a great quarter working with all of you,

David Katzenstein
Lucy Thairu
Aaron Kofman