World AIDS Day and Malaria

The recent announcement that global HIV/AIDS estimates were in over six million cases lower [http://www.nytimes.com/2007/11/20/world/20aids.html] is probably not a cause for celebration on World AIDS Day since those who actually are affected and infected still suffer. According to the New York Times, “In only a few countries, such as Kenya and Zimbabwe, do the figures reflect widespread behavioral changes, such as decisions by many people to have sex with fewer partners.” The rest of the reduction is due to changes in the way the estimates were calculated. Now Nigeria and South Africa top the list with the most people living with HIV/AIDS. The fact that a large portion of those who suffer also live in malaria endemic areas, is cause for further concern.

CBS News HealthWatch of 24 October 2007 posted the news that, “Malaria is fueling the spread of AIDS in Africa by boosting the HIV in people’s bodies for weeks at a time, says a study (by University of Washington researchers reported in Nature) that pins down the deadly interplay between the dual scourges. It’s a vicious cycle as people weakened by HIV are, in turn, more vulnerable to malaria.” (http://www.cbsnews.com/stories/2006/12/07/ap/health/)

itns-help-reduce-hiv-mortality.jpgRecent studies have shown that there is need to combine efforts in malaria control and HIV/AIDS management to save lives. Kamya et al. (AIDS 2007; 21:2059-2066) reported from Uganda that a combination of prophylaxis with Trimethoprim-sulfamethoxazole and insecticide treated bednets was associated with “a dramatic reduction in malaria incidence among HIV-infected children.” Similar results had been found with adults.

Also in Uganda a study by Malamba et al. concluded that, “HIV-infected children with severe malarial anemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.” (http://www.malariajournal.com/content/6/1/143)

Distribution of ITNs to people living with HIV/AIDS is underway in a number of PEPFAR supported programs. More collaborative efforts are needed between malaria, HIV and MCH programs, and countries need joint planning for HIV and malaria control when preparing and implementing their Global Fund grants.

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