HIV/AIDS Worldwide

Worldwide, an estimated 33.4 million people are currently living with HIV, and a recent WHO report indicates that 68 percent of these individuals live in sub-Saharan Africa. Though HIV is prevalent in the developing world, infection rates in the United States continue to be a major health concern. Reports indicate that at the end of 2006, an estimated 1.1 million people were living with HIV in the U.S. and these figures have continued to grow. Though education, testing, and treatment efforts have increased worldwide, ensuring that all individuals with HIV are aware of their status and have access to life-saving medications, remains an enormous challenge.

The human immunodeficiency virus (HIV) was first recognized in 1981. The virus destroys specific cells that are imperative to the functioning of an individual’s immune system known as CD4+ T cells. An individual’s HIV status can be determined by administering an antibody test, which detects the substances that the body produces in response to HIV infection. If an individual with HIV does not receive treatment, their condition will progress to the point at which they will be diagnosed as having acquired immune deficiency syndrome (AIDS). A healthy individual has a CD4 count of more than 500 cells per cubic millimeter (mm3) of blood, but when an individual’s CD4 count is below 200 mm3, they are diagnosed as having AIDS.

Though anyone can contract HIV, there are certain behaviors known to increase the risk, including promiscuous and/or unprotected sexual contact, using intravenous drugs, homosexual intercourse, and sexual intercourse with individuals who have been incarcerated. According to Carla Bruni-Sarkozy, wife of the President of France and Global Fund’s Ambassador for Protecting Women and Children Against AIDS, children born to mothers with HIV are also at an increased risk, and over 400,000 babies are born with HIV each year. New study findings also suggest that the risk of female-to-male transmission of HIV doubles during pregnancy, but the reason for this increase has not yet been identified. Individuals with HIV can suppress the virus and stop its progression through the use of antiretroviral therapy (ART), which consists of the use of at least three antiretroviral (ARV) medications. Reports indicate that the United States now supports more than 2.5 million individuals receiving ART, the WHO estimates that at least 9.7 million people, primarily in low- and middle-income nations, are in need of these lifesaving medications.

In the hopes of identifying more effective treatment options, research is ongoing to explore how HIV infection progresses in the body. Though it is no longer used following the eradication of smallpox, experts have found that the smallpox vaccine may interfere with how HIV replicates. Additionally, tests have been conducted using experimental vaginal gels containing antiretroviral elements, and they have been seen to reduce transmission of a virus closely related to HIV in monkeys. Researchers have also identified a bacterium found in the human throat which secretes a toxin that has been found to enable antibodies to destroy viral particles in the blood.

Though promising, it remains to be seen if this research will yield any substantial advancement towards finding a cure for HIV. Until a cure is found, expanding existing treatment options and ensuring the provision of testing and education programs are essential to shunting the spread of the virus.

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Innovative Appropriate Technologies

Some high-tech healthcare devices can be created inexpensively and may be beneficial worldwide. Devices which utilize local resources, often referred to as Appropriate Technologies, are especially valuable as they often make use of the skills of local craftsmen and rely on readily available materials. According to Danielle Zurovcik, student researcher at MIT, these devices have the potential to greatly improve care in clinics that “don’t have power, don’t have a lot of supplies.”

Using automobile parts, including headlights, an HVAC, and tires, which are common in even remote regions of the world, researchers have created an incubator in the hopes of decreasing infant mortality rates. By using car parts, researchers were able to create a device that could be fabricated and repaired by auto mechanics and others with limited or no training building or repairing medical equipment. In addition, the prototype incubator uses electricity, but also has a motorcycle battery to provide power if it is not available.

Low-cost diagnostic and treatment devices have also been developed to allow for access to these services in areas where they might otherwise be limited. Undergraduate students at Rice University have developed a centrifuge that can be constructed using a salad spinner and other common plastic items. Like conventional centrifuges, it is able to separate blood samples in only 10 minutes. These samples can then be used to test for anemia, as well as tuberculosis, malaria, and HIV/AIDS. Another simple device was created by students at MIT to help speed the healing process of wounds. The small molded plastic pump can be used to apply suction to a wound, helping to keep the draw away bacteria and wound clean, as well as allowing it to heal more quickly.

Medical devices and aids for individuals with disabilities have also been conceived for use in areas with limited resources. In many areas, low vision is a tremendous problem, affecting literacy and employment rates. In spite of the great need, eyeglasses and the personnel needed to properly fit them, are frequently not available. To address this need, Oxford University professor Josh Silver devised a solution: eyeglasses with fluid filled sacs inside the lenses, whereby the amount of fluid can be adjusted by the user to change the power of the lens. Simple, low-cost devices have also been created to allow individuals with disabilities to communicate with care givers. The Communication Board was developed by the Center for International Rehabilitation’s (CIR) Yeongchi Wu, MD in the early 1980s using only a sheet of paper and pen. The simple and low-cost device can also be used in nursing homes or intensive care units.

Innovative Appropriate Technologies which utilize local resources can help improve the quality and availability of healthcare worldwide. There is often a stigma attached to lower-cost and lower-tech devices, as more expensive can be perceived as better, however their use in the developed and developing world may prove beneficial in reducing overall healthcare costs.

Vote for the Communication Board on Instructables – May 23-30, 2010

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On Malaria Worldwide

Nearly half the world’s population – roughly 3.3 billion people – are at risk of contracting malaria. Though individuals in Latin America, the Middle East, and Europe are among those most often affected by the disease, the Centers for Disease Control and Prevention reports that 98 percent of global malaria deaths occur in 35 countries - 30 of them in sub-Saharan Africa and five in Asia. Every year there are nearly 250 million cases and an average of one million deaths due to malaria. Reports show that in 2008, an estimated 863,000 people died from malaria infection, indicating some improvement in diagnosis and treatment outcomes. Transmission is possible to any individual, however some groups are at an increased risk. These include young children who have not yet developed full immunity, pregnant women whose immunity has been decreased by pregnancy, international travelers who lack immunity, and individuals with HIV/AIDS or others with compromised immune systems.

Malaria is a preventable and curable acute febrile illness caused by the bite of Anopheles mosquitoes which have been infected with Plasmodium parasites. The long lifespan of the Anopheles species found in Africa contributes to the disease’s prevalence in the region, and experts note that more than 85 percent of the world’s malaria deaths occur in Africa. Symptoms are usually seen seven days after the infective mosquito bite, and include fever, headache, chills, and vomiting. If diagnosed quickly, malaria can be treated using artemisinin-based combination therapy (ACT), however if treatment is not initiated, malaria can progress and lead to severe anemia, respiratory distress, or death.

In countries where malaria is endemic, access to diagnostic tools and medications may be limited. Less than 15 percent of these individuals are able to begin treatment within 24 hours of the onset of fever, which is when treatment must be started. Malaria diagnosis relies on either microscopy or rapid test procedures to allow healthcare providers to quickly determine if patients have the disease and require treatment. The Malaria Product Testing Evaluation Programme recently completed an assessment of 29 rapid diagnostic tests and found that 16 of them met the minimum performance criteria set by the WHO. According to Robert Newman, the director of the WHO’s Global Malaria Programme, using rapid tests allows healthcare providers to “test people who cannot access diagnosis based on microscopy in remote, rural areas where the majority of malaria occurs” and thus improves treatment outcomes.

In addition to improved testing, global efforts are underway to control malaria by eliminating the mosquitoes that transmit the disease. During the past decade, the distribution of treated bed nets has increased rapidly in 11 African nations, helping to reduce infection rates. Reports indicate that in 2008, 31 percent of African homes had insecticide-treated nets (ITNs), compared with 17 percent in 2006. Through the use of ITNs, as well as spraying of homes with insecticide chemicals, 10 African nations reduced the number of cases of malaria by at least 50 percent between 2000 and 2008.

Though there is no vaccine for malaria, more effective prevention measures, diagnostic tests, and medications can help to improve treatment outcomes for those affected. Government agencies, including the World Bank, and other groups, such as Roll Back Malaria global partnership, have made efforts to increase global awareness about malaria. By utilizing social media and online tools it has been possible to improve the effectiveness of outreach and fundraising for efforts which may help to eradicate malaria worldwide.

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