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.
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 2025SCENARIOS
Diving hippo illustrates that the patterns of behavior lie below the surface, and the structure of the system lies deeper still.
Front page, below the surface, and the structure of the system lies deeper still.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 es-Salaam, 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.
Africa is three times the size of the United States. earth of Africa is dotted with 15 million white tombstones, because that is how many people have died from AIDS.
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.
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.
Countries at war and bordering nations experience increased HIV transmission.
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 agricultural workers, healthcare personnel, public service staff—are dying from AIDS, the continent is being robbed of its human capacity.
“Doctor, who is going to take care of my children?” agricultural workers, healthcare personnel, public service staff—are dying from AIDS, the continent is being robbed of its human capacity.
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 is being cast into deepening poverty. The post-apartheid 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?
Scenarios: Which way forward? 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.
43 million new HIV infections could be prevented over the next 20 years if Africangovernments 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.
Immunization can eradicate infectious diseases. Most famous example: small pox. Others: polio, measles, H. influenzae type B, Yellow Fever.
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