The International Federation of Red Cross and Red Crescent Societies (IFRC) has just released its 2008 World Disasters Report. The report observes that, “The AIDS epidemic has been with us for more than a quarter of a century but the statistics never fail to shock. Around 25 million people have died and about 30 million are living with HIV today. Many of these men, women and children are among the worldâ€™s most vulnerable people and, although it is too simplistic to say that poverty is a main driver of the epidemic, many people living with HIV are among the poorest on earth â€“ particularly women.”
HIV/AIDS is a major global disaster because, “Even though anti-retroviral treatment is now available, it does not reach the majority of those who need it in developing countries. Nor are medicines for the opportunistic infections associated with AIDS readily available in many places. It is not just a question of funding, which has increased at a considerable rate. In most affected countries, as in many parts of the developing world, health services are overstretched, with poor infrastructure, and are losing the trained workers they desperately need to the rich countries of the West. Development gains that were achieved in the past two decades have in many cases been reversed. Poverty reduction, income generation, food security â€“ all remain on the agenda for the humanitarian world, and not just in places where major emergencies have occurred.”
While the report quotes the World Bank as saying, “HIV/AIDS, malaria, and armed conflict have contributed to these falling life expectancies,” it does not acknowledge how the negative interaction between HIV and malaria make both problems worse. Skinner-Adams and colleagues summarize the problem as follows: “Although the consequences of co-infection with HIV and malaria parasites are not fully understood, available evidence suggests that the infections act synergistically and together result in worse outcomes.”
According to WHO’s Global Malaria Program, “Malaria and HIV are two of the most devastating global health problems of our time. Together they cause more than 4 million deaths a year. The resulting co-infection and interaction between the two diseases have major public health implications.”
- HIV-infected people must be considered particularly vulnerable to malaria;
- Antenatal care needs to address both diseases and their interactions;
- Where both diseases occur, more attention must be given to specific diagnosis for febrile patients.
Clearly we do not want to start a debate about which disease is more disastrous, and one might even make the case that HIV has a more disastrous effect on the health system, but we do want to stress that solutions require an integrated approach.Â People with HIV definitely need protection against malaria as one part of the effort to ameliorate this disaster.