HIV/AIDS Progress

In the 30 years since it was first identified, the global response to AIDS has achieved significant results. More people than ever before have access to treatment, allowing them to manage their condition, and according to the United Nations rates of new HIV infections are falling by nearly 25 percent. In spite of these successes, it is important that efforts continue to ensure that progress is made towards further improving treatment options and outcomes.

Since 1981, a reported 25 million people worldwide have died from AIDS and an additional 34 million are infected with HIV. According to a recent United Nations report, in the 33 worst-affected countries, the rate of new HIV infections fell by 25 percent between 2001 and 2009, and in India and South Africa, the countries with the largest populations of individuals living with HIV, new infections fell by 50 percent and 35 percent, respectively. According to Michel Sidibé, Executive Director of UNAIDS, through the use of antiretroviral therapy (ART), “AIDS has moved from what was effectively a death sentence to a chronic disease…Antiretroviral therapy is a bigger game-changer than ever before – it not only stops people from dying, but also prevents the transmission of HIV to women, men and children.”

A decade ago, half of the population of several nations in southern Africa were expected to die of AIDS-related causes, but as ART has become more widely available, the death rate is dropping. An estimated 6.6 million people in low- and middle-income countries were receiving ART at the end of 2010 – a nearly 22-fold increase since 2001. In spite of this increase, reports indicate that there are 16 million people worldwide living with HIV/AIDS who could benefit from these medications but many do not receive them. Even in the United States and other developed nations, individuals living with HIV/AIDS are frequently put on long waiting lists to gain access to these life-saving drugs as the supply is not able to meet the demand for them.

While expanded access to ART can help to improve the lives of individuals with HIV/AIDS and help to prevent new infection, a major gap in treatment still exists. Access to treatment for children is significantly lower than for adults, and only 28 percent of all eligible children were receiving treatment in 2009, compared with 36 percent for people of all ages. In addition, while the rate of new HIV infections globally has declined, the total number of individuals with HIV remains high and certain groups, including women of reproductive age, remain at increased risk of infection. By ensuring that antiretroviral medications and education and treatment programs are widely available, it may be possible to further decrease the number of new HIV/AIDS infections worldwide as researchers continue to work to track the spread of the disease and find a cure.



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On MRSA Infections Worldwide

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly common in recent years, due in large part to overuse of antibiotics. According to a 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), the average number of MRSA infections doubled nationwide between 1999 and 2005 – from 127,000 to 278,000. During the same period, the number of annual deaths from MRSA infection increased from 11,000 to more than 17,000. By increasing awareness about the risk factors associated with and steps that can be taken to avoid MRSA infection, it may be possible to reduce or eliminate its spread.

MRSA infection is caused by a strain of Staphylococcus (staph) bacteria that has become resistant to the antibiotics commonly used to treat staph infections, which include methicillin and penicillin. Generally, MRSA is spread through skin-to-skin contact, openings in the skin (cuts or abrasions), contact with contaminated surfaces, crowded living conditions, or poor hygiene. MRSA frequently manifests first on the skin as a reddish rash with lesions resembling pimples which may begin to drain pus, or lead to cellulitis, abscesses, and impetigo. In addition, the initial skin infection can spread to almost any other organ in the body, resulting in more serious symptoms and potential complications.

Designations are made between types of MRSA infection based on the location where the infection took place. Hospital-acquired MRSA (also called health-care-acquired, HA-MRSA, or HMRSA) remains one of the most common types of infection. Individuals who are hospitalized, those with invasive medical devices such as catheters, and those residing in nursing homes are at an increased risk of acquiring HA-MRSA. Community-acquired MRSA (CA-MRSA or CMRSA) is another common type of infection, and is seen most frequently in individuals participating in contact sports or those living in crowded or unsanitary conditions. While the average adult death rate among individuals with MRSA is estimated at five percent of infected patients, individuals with HA-MRSA are at an increased risk of experiencing complications including organ damage.

Dr. Marc Siegel, an associated professor of medicine at New York University, and others recommend an evaluation of the overuse of antibiotics by humans as well as in livestock as a means of eradicating MRSA and reducing drug resistance in other strains of bacteria. In addition, experts note the importance of good hygiene practices including washing hands frequently, keeping wounds covered with bandages until they have healed, and washing soiled clothes and sheets in hot water can help to prevent the spread of MRSA. The timely diagnosis of individuals infected with MRSA achieved through an analysis of a skin sample helps to better ensure not only treatment for the individual, but also a decreased risk of infecting others.

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On Non-Communicable Diseases

In 2008, non-communicable diseases (NCDs) accounted for 63 percent of all deaths worldwide. According the World Health Organization’s (WHO) recent Global Status Report on Non-communicable Diseases, without an intervention, NCDs are “projected to kill 52 million people annually by 2030." By informing the public about their risk, encouraging them to make healthy lifestyle changes, and improving treatment for individuals with NCDs, it may help to reduce the incidence of these diseases globally.



NCDs, which include diabetes and cancer, are defined as chronic conditions or diseases which do not result from an acute infectious process. The Centers for Disease Control and Prevention (CDC) report that half of all deaths in the U.S. each year are due to heart disease, cancer, or stroke. In addition to the incidence of NCDs in developed nations, a reported 80 percent of the 36.1 million NCD-associated deaths in 2008 occurred in developing nations. While NCDs can present a burden for any nation’s healthcare infrastructure, Dr. Margaret Chan, WHO Director General, notes that “for some countries it is no exaggeration to describe the situation as an impending disaster.”

Reports indicate that cardiovascular diseases account for the majority of NCD-related deaths, or 17 million annually, followed by cancer (7.6 million annually), respiratory disease (4.2 million annually), and diabetes (1.3 million annually). These four groups of diseases account for nearly 80 percent of all NCD deaths, and share four common risk factors: tobacco use, inadequate physical activity, harmful alcohol use, and poor diet. Almost six million people die as a result of tobacco use each year, and 2.5 million die from alcohol-related causes. In addition, lack of exercise and poor diet contribute to obesity, increasing individual’s risk of heart disease, stroke, and diabetes.

To lessen the impact that NCDs have on global health, the WHO has suggested that a number of measures be taken, including banning smoking in public places and promoting public awareness about the importance of diet and exercise. Encouraging individuals to make healthy lifestyle choices and providing them with information about how to improve their health, it may be possible to reduce the number of NCD-related deaths worldwide.



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On Measles Worldwide

The World Health Organization reports that in 2008, there were 164,000 measles deaths globally, more that 95 percent of which were in low-income countries with weak health infrastructures. This rate equates to nearly 450 a day or 18 per hour. In recent years, targeted vaccination campaigns have greatly reduced the number of measles deaths each year, though in developing nations with weak health infrastructures complications or deaths related to measles infection are still not uncommon. By increasing awareness about the importance of vaccination and making vaccines available in regions where they are needed, the virus that causes measles could be eradicated.



Measles, also called rubeola, is a common and preventable childhood disease, also sometimes seen in individuals with compromised immune systems. Most frequently, infection is marked by a fever lasting a couple of days, followed by a cough, runny nose, and conjunctivitis. Soon after, patients exhibit a rash on the face and upper neck, spreading down the back and trunk to the arms and legs. Reports indicate that 30 percent of people infected with measles will experience complications, ranging from ear infections to pneumonia. Further, one in every 1,000 people will develop inflammation of the brain. If left untreated, the complications associated with measles infection can be life threatening. In regions without widespread access to medical care, an estimated five percent of children die of measles-related causes.

According to William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine, the measles virus infects more than 80 percent of unvaccinated people exposed to it. Though the transmission of endemic measles was declared eliminated in the U.S. in 2000, the disease remains common in other regions and can be imported by travelers. Reports from the Centers for Disease Control and Prevention (CDC) indicate that during 2008, nearly 90 percent of measles cases in the U.S. were either acquired abroad or linked to imported cases. While a safe and cost-effective vaccine is available, more than 20 million people are affected by measles each year and the majority live in developing nations and/or countries with low per capita incomes and weak health infrastructures.

Though measles outbreaks continue to be problematic in some developing regions, the World Health Organization reports that between 2000 and 2007, 576 million children were vaccinated against measles, resulting in a 74 percent decrease in measles-related deaths worldwide. By increasing awareness about the importance of vaccinations and ensuring that vaccines for measles are available, rates of infection, complications due to infection, and death could be even further reduced.

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On Stroke Worldwide

Stroke, sometimes called a “brain attack” or cerebrovascular disease, is the second leading cause of death worldwide and the third in the United States, killing approximately 137,000 people each year. Though many individuals recover from strokes, at least two-thirds of survivors experience some type of disability. A reported 80 percent of strokes are preventable, and by increasing awareness about stroke prevention and treatment, it may be possible to improve individuals’ recovery.

Individuals with high blood pressure or high cholesterol, those over 55 years of age or who have a family history of stroke, and those who smoke or use alcohol are at an increased risk of having a stroke. Though stroke predominantly occurs in middle-aged and older individuals, in recent years an increase in the number of young people affected by stroke has been seen. According to experts, this may be due in part to an increase in the incidence of obesity worldwide.

A stroke occurs when a blood clot blocks an artery or when a blood vessel breaks, interrupting blood flow in an area of the brain. Approximately 87 percent of strokes are Ischemic, meaning that they are caused by a gradual build-up of plaque and other fatty deposits or blood clots which block arteries so that blood cannot be delivered to the heart. In the case of Ischemic stroke, clot-busting medications must be administered as quickly as possible to improve the patient’s chances of survival and minimize the potential of complications. In contrast, Hemorrhagic strokes, which account for 13 percent of all strokes but more than 30 percent of stroke-related death, occur when blood vessels in the brain burst, leaking blood into the brain. For individuals experiencing Hemorrhagic stroke, emergency treatment focuses on controlling bleeding and may involve surgery to repair the broken blood vessel. In addition to the medications commonly used for stroke treatment, new research suggests that a drug derived from turmeric, CNB-001, may be able to help the body repair some of the damaged caused in the immediate aftermath of a stroke.

By depriving brain cells of oxygenated blood, strokes kill off brain cells and trigger a chain reaction that can widen the damaged area and increase the level of disability suffered by the patient. Because the risk of brain damage increases the longer a stroke goes untreated, experts suggest using the F.A.S.T. test to quickly determine if an individual has had a stroke. The procedure for the F.A.S.T. test is as follows:

1. Face: Ask the person to smile. Does one side of the face droop?
2. Arms: Ask the person to raise both arms. Does one arm drift downward?
3. Speech: Ask the person to repeat a simple sentence. Is the speech slurred?
4. Time: If any signs are observed, call 9-1-1 immediately or seek medical attention.

The most common symptom of a stroke is sudden weakness or numbness in the face, arm, or leg, most frequently on one side of the body. Individuals may also experience confusion, difficulty speaking and understanding speech, difficulty seeking with one or both eyes, dizziness, or severe headache with no known cause.

By increasing awareness about the risk factors that contribute to stroke and encouraging individuals to make healthier lifestyle choices, it may be possible to lessen the chances of its occurrence. In addition, providing information about how to determine if an individual is having a stroke can help ensure that those who do will receive life-saving treatment more quickly.

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Water Availability

Though water is the body’s principal chemical component the World Health Organization (WHO) reports that 1.1 billion people lack access to a potable water source. In addition, approximately 2.6 billion people – half the population of the developing world – do not have access to even a simple latrine. While this raises concerns regarding quality of life and lack of resources in general, individuals who do not have access to clean drinking water and sanitation services are at an increased risk of contracting diarrheal illnesses, including cholera. Though these conditions are easily treated, the regions where they are most prevalent frequently also do not have the necessary medications. By increasing awareness about ways to improve the availability of safe water and sanitation services, it may be possible to reduce transmission and infection rates.

Reports indicate that each year the deaths of 1.6 million people – approximately 90 percent of them children under five years of age - are due to diarrheal illnesses that can be attributed to a lack of access to safe drinking water and basic sanitation. The WHO defines “basic sanitation” as “the lowest-cost technology ensuring hygienic excreta and sullage disposal.” Further, individuals are said to have “access to drinking water” - “drinking water” defined by the WHO as “water which is used for domestic purposes, drinking, cooking and personal hygiene” - if they are within 1 kilometer of a source that can reliably produce 20 liters per household member per day. According to Siemens, more than a billion people worldwide currently survive on only 3.8 liters (one gallon) of water per day, though experts suggest an intake of approximately 1.5 liters per day.

According to UN Secretary-General Ban Ki-moon, over the past decade, the number of individuals living in urban areas who lack access to drinking water in their home or the immediate vicinity has increased by an estimated 114 million, while the number who lack access to basic sanitation facilities has risen by 134 million. An estimated 51 million people in the Democratic Republic of Congo have no access to safe drinking water, and between 30 and 60 percent of the urban population of sub-Saharan Africa has no access to the municipal water supply. In these and other regions worldwide where access to potable water and sanitation services are limited, individuals may employ alternative methods of purifying water, such as boiling, chemical disinfection, and filtration. While these methods offer an effective means of generating a supply of safe drinking water, the quality of water used in farming is also critical, as water-borne pathogens on crops can cause diseases such as typhoid and cholera.

Both governmental agencies and non-profit organizations have established initiatives aimed at increasing the availability of water, purifying existing water sources, and improving sanitation services worldwide. By ensuring that safe water is available for consumption and farming, and that sanitation services are sufficient, the transmission of water-borne illnesses can be mitigated. In addition, providing individuals in regions facing shortages of potable water with information about water purification options and treatments for cholera and other diarrheal illnesses can improve the healthcare infrastructure in these areas.

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On Crisis Mapping

Web-based mapping tools have been used to track disease outbreaks, and more recently have been employed in response to natural disasters. Many humanitarian relief efforts have employed crowd-sourcing as a means to gather and share information. By utilizing crowd-sourcing tools including digital maps, government agencies, non-governmental organizations, and other interested parties can collaborate more effectively and improve humanitarian relief responses to natural disasters. For example, crowd-sourced maps can provide disparate networks of volunteers with a simplified way to share information, and can give local relief workers a clearer picture of the situation on the ground as they establish priorities for food, shelter, sanitation services, and healthcare facilities.

The web-reporting platform Ushahidi has been used by human rights and humanitarian aid workers to document and track progress during and immediately following crisis and natural disaster situations. Unlike other similar tools, Ushahidi is open source, and allows for information to be input using cell phones and other web-connected devices. Specialized versions of the Ushahidi crisis-mapping tool are frequently developed following natural disasters, including the recent earthquake in Japan, to allow individuals on the ground to text the locations of individuals in need of assistance or the locations of clinics or hospitals. Recent iterations of Ushahidi have integrated “check-in” functionality as well, further simplifying the process of adding data to the map.

Though crisis-mapping tools were utilized following the 2010 earthquake in Haiti, the majority of their use was by international aid organizations. In contrast, updates to the Japan Crisis Map have been posted by volunteers, government employees, and others. By encouraging the active participation of more individuals, these types of crisis maps can give a fuller understanding of the situation on the ground. In addition, representatives from academic institutions are participating in efforts to examine the data gathered using crowd-sourced crisis maps and identify ways of improving how information is shared during and immediately following natural disasters. A recent report entitled “Disaster Relief 2.0: The Future of Information Sharing in Humanitarian Emergencies” is guiding these efforts by examining how new technologies can influence emergency relief work. The report documents how technology was used during the earthquake in Haiti and in the weeks and months following to locate survivors, provide information about where to receive assistance, and gather donations for aid organizations.

According to experts, “the crisis-mapping response to the earthquake that struck Haiti in 2010 was striking proof of the potential of new mapping tools,” and by examining the successes and shortcomings, the tools and technologies can be improved faster, and more efficient.”

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