Disease outbreak news 
3 July 2019

On 25 April 2019, the local administration in Larkana district was alerted by media reports of a surge in human immunodeficiency virus (HIV) cases among children in Ratodero Taluka, Larkana district, Sindh province, Pakistan. A screening camp was initially established at Taluka’s main hospital. Later, screening was expanded to other health facilities including selected Rural Health Centers (RHCs) and Basic Health Units (BHUs). HIV rapid test kits that were initially used were replaced with pre-qualified WHO test kits.

From 25 April through 28 June 2019, a total of 30,192 people have been screened for HIV, of which 876 were found positive. Eighty-two per cent (719/876) of these were below the age of 15 years. During the screening, several risk factors were identified, including: unsafe intravenous injections during medical procedures; unsafe child delivery practices; unsafe practices at blood banks; poorly implemented infection control programs; and improper collection, storage, segregation and disposal of hospital waste.

This is the fourth reported outbreak of HIV in Larkana district since 2003. The first outbreak in 2003, was among people who inject drugs (PWID), the second was among 12 pediatric patients in a pediatric hospital in 2016, and the third, also in 2016, was among 206 patients in a dialysis unit.

Prior to this event, Larkana district had only one antiretroviral therapy (ART) clinic, which was for adults exclusively (2,568 registered cases by May 2019).

Public health response

The response to the event has been led by the provincial Department of Health (DOH) and the Sindh AIDS Control Program (SACP). The response has been supported by UN partners, the Pakistan Field Epidemiology & Laboratory Training Program (FELTP), Aga Khan University, and other partners.

A new HIV/AIDS ART Treatment Center for children has been established at Shaikh Zaid Children Hospital. Unauthorized laboratories, blood banks, and clinics have been closed.

A mission led by the Federal Ministry of Health (MOH) and WHO, supported by other UN partners and academia has been conducted through the first half of June. The objectives were to identify sources and chains of transmission of HIV, map the high-risk areas, and identify gaps in HIV diagnosis, care and treatment.

WHO risk assessment

Pakistan is one of the countries in the WHO Eastern Mediterranean Region where new HIV infections are increasing at an alarming level since 1987¹. The current HIV epidemic in Pakistan is defined as a concentrated epidemic. Although the overall prevalence is still less than 1% in the adult population, the latest estimate (2017) of people living with HIV (PLHIV) was 150,000² . In 2018, 21,000 new PLHIV cases were recorded.

Regarding this event, the overall risk of disease spread within Larkana district is high due to:

• Non-availability of sufficient information to determine the complete extent and magnitude of the event;
• Number of cases among children (mostly under 5 years age group);
• Date / period of exposure of HIV to the cases is unknown;
• Lack of information regarding all possible sources of exposure;
• Insufficient treatment options due to lack of appropriate ARV drugs;
• History of repeated HIV outbreaks in the same geographical area;

Further epidemiological investigations will help determine the magnitude of the event, and whether this event is acute and isolated in nature, or a longer duration situation with these cases (accidentally diagnosed) representing the tip of the iceberg of a larger epidemic. 

The risk at regional and global levels is considered very low because the mode of transmission of HIV is very specific and limited to mother to child transmission, contact with contaminated blood through contaminated syringes/other surgical instruments, blood transfusion or sexual contact with PLHIV. The situation is being closely monitored, and the risk will be re-assessed according to the results of the preliminary investigation.

WHO advice

This event highlights the importance of using high-impact interventions to reduce vulnerability and prevent transmission mainly in health care settings. It also takes into consideration the prevention of sexual transmission in high risk groups, transmission through injecting drug use and mother-to-child transmission.

WHO recommends that after 18 months of age, three different assays may be required to establish the diagnosis of HIV infection . However, infants less than 18 months of age who are born to HIV infected mother should be diagnosed through nucleic acid testing (NAT)³.

WHO stresses the importance of immediately linking all those diagnosed with HIV infection to antiretroviral treatment (ART), where the test should be repeated to rule out errors in diagnosis (in case second test is negative⁴) and, thereafter, ART should be started without any delay.

For more information,please see:

• Global Health Sector Strategy on HIV 2016-2021, World Health Organization,2016
• Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations – 2016 Update

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• PARTNERSHIP COMBINES Abbott’s global expertise of tracking AND characterizing viruses and YRGCARE’s knowledge of HIV and ExTENSIVE REsEARCH NETWORK

• INDIA becomes the newest addition to Abbott’s global viral surveillance efforts

MUMBAI, 9 January 2018 – Strengthening India’s efforts in combating HIV and hepatitis viruses, Abbott has announced its partnership with Y.R. Gaitonde Centre for AIDS Research and Education (YRGCARE) to study the country’s viral diversity to improve accuracy of diagnostic tests. Abbott will provide study protocol and diagnostic equipment and YRGCARE will help in screening and sequencing rich patient data from infected populations in India.

HIV and viral hepatitis are among the biggest public health threats in India today as they can produce many genotypes*, which keep combining to form recombinant strains or mutations making detection trickier. Therefore, understanding the distribution of genotypes and recombinants is critical to the development of diagnostic tests.

With more than 2.1 million people living with HIV, India has the third largest HIV incidence in the world with a large part co-infected with hepatitis C virus (HCV). People who inject drugs (PWID) and sex workers are identified as key affected populations for which the epidemic is growing.

Speaking about the partnership Dr Sushil G Devare, Director of Diagnostics Research at Abbott said, “In the fight against HIV and viral hepatitis, we are pleased to collaborate with YRGCARE as they are pioneers of AIDS research and have extensive experience in understanding the HIV patient communities across the country. With sequence data generated under this partnership, Abbott endeavours to understand new viral mutations and variations of HIV and HCV leading to the development of newer tests and diagnostic kits to improve detection. We are confident that our joint efforts will offer unique insights into the genetic diversity of HIV and HCV including those that are found in higher risk groups like PWID.”

Dr Sunil Suhas Solomon, Chairman, YRGCARE said, “We are excited to partner with Abbott to study emerging patterns of HIV and viral hepatitis in India. Drug using populations or PWIDs in India bear a disproportionate burden of HIV and HCV, and it’s critical to understand the transmissions in this group. Sequencing data in these affected populations will help us understand the evolutionary nature of the viruses enabling optimal treatment interventions to maximize impact.” 

Established more than twenty years ago, Abbott’s Global Surveillance Programme spans 40 countries across six continents, identifying and characterizing more than 5,000 virus strains, ensuring that current diagnostic tests to detect a wide range of HIV and hepatitis viruses and determine the need for newer tests to stay ahead of evolving viruses.

India is the latest addition to Abbott’s recent surveillance efforts in Asia-Pacific to provide new insights on the strains and transmission of these viruses specific to India. Abbott is the only diagnostic test manufacturer with such a unique, longstanding and large-scale virus Surveillance Programme. Besides India, Abbott has collaborated with partners in China, Australia, Vietnam, Laos and Pakistan to ensure its Surveillance Programme covers key regions. In addition, Abbott works with commercial partners in Nepal the Philippines as well as the Red Cross in Thailand to gain access to circulating strains of HIV and hepatitis viruses, thus ensuring a real representation of the prevalent infections.

About Abbott:

At Abbott (NYSE: ABT), we’re committed to helping you live your best possible life through the power of health. For more than 125 years, we’ve brought new products and technologies to the world — in nutrition, diagnostics, medical devices and branded generic pharmaceuticals — that create more possibilities for more people at all stages of life. Today, 94,000 of us are working to help people live not just longer, but better, in the more than 150 countries we serve.

Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott and on Twitter @AbbottNews and @AbbottGlobal.

About Y.R. Gaitonde Centre for AIDS Research and Education:

YRGCARE was established in 1993 by the late Dr Suniti Solomon and since inception has provided HIV prevention and treatment services to over 21,000 HIV infected persons in India. YRGCARE is amongst the largest HIV care providers in the private sector and has an extensive research portfolio of clinical, laboratory and behavioural research across the country.

Connect with us at www.yrgcare.org, on Facebook at www.facebook.com/yrgcare, on Twitter @yrgcare and on Instagram@yrgcare

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• National Family Health Survey (2015-2016) of Haryana states only 30% of women (aged 15-59) is aware of HIV infection.
• National AIDS Control Organization (NACO) 2016-2017 reports that 1836 HIV infections are transmitted to Female Sex Workers and 786 IV drug users.
• Over 25 Lakh Indians are infected by HIV and 14 Lakh not aware of it.
• Awareness initiatives, sexual education, opioid substitution therapy and new anti-retroviral treatment helping combat the disease in the state.  

Gurgaon 30th December, 2017: Victims contract AIDS when the HIV virus disrupts their immune system and the body loses its ability to fight against various parasites surrounding us. These infections include certain types of cancer, tuberculosis, pneumonia and other infections.

Dr Rajesh Kumar Sr. Consultant – General Physician Paras Hospitals Gurgaon “AIDS is usually the end stage of HIV infection and refers to the late stages of infection. The diagnosis of HIV is simpler and less complicated than the diagnosis of AIDS. Determining AIDS is also through opportunistic infections that can be caused by various parasites making the immune system relatively weak. The transmission of HIV virus are primarily sexual, contact of blood through open sores or affected gums, intravenous drug users etc. In Haryana alone, there have been numerous cases of female sexual workers who have contracted HIV infection.

HIV/AIDS is a chronic disease but with advancement in technologies and pharmaceutical innovations, people can survive through the disease for a considerable amount of time. Initially diagnosis of HIV/AIDS was considered a death sentence. But with remedial therapies like antiretroviral treatment and drugs, organizations around the world are making considerable improvement in eliminating the epidemic virus. With India reportedly being the third largest HIV-infected country in the world, with approximately 25 lakh HIV patients, new treatment medicines with reduced side effects can help improve adherence to treatment.

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JOHANNESBURG, South Africa, 3 August 2017 – Six years after the first Africa Regional Dialogue on HIV and the Law and five years since the report of the Global Commission on HIV and the Law was released, over 140 advocates are gathering this week in Johannesburg, South Africa, to take stock of progress on the implementation of the Commission’s recommendations and discuss how to overcome challenges that remain in the HIV and tuberculosis (TB) response.

The 2^nd Africa Regional Dialogue is being hosted by the AIDS and Rights Alliance for Southern Africa (ARASA) in partnership with the United Nations Development Programme (UNDP) under the Africa Regional Grant on HIV: Removing Legal Barriers in Johannesburg, South Africa on 3 and 4 August 2017.

“While most African countries have made national, regional and international commitments to protect human rights and address HIV and TB, legal barriers continue to impede the health and rights of people on the continent,” said Michaela Clayton, Director of the AIDS and Rights Alliance for Southern Africa. “This is an important opportunity for us to review how far we have come in implementing the recommendations of the Global Commission report, to identify the barriers that remain to implementing these recommendations and to identify how we can overcome these barriers.”

The dialogue brings together over 140 representatives of government ministries, civil society, members of parliament, the judiciary, United Nations agencies and development partners to discuss progress in Africa on the implementation of the recommendations of the Global Commission on HIV and the Law and to evaluate their impact, highlight issues and countries that continue to face challenges, and make strategic recommendations on the way forward. Given the high rates of HIV and TB co-infection in Africa, the dialogue is also focusing on the impact of laws, policies and practices on the TB response.

Although significant progress has been made in the HIV and TB responses across Africa, significant challenges remain with respect to legal and policy environments for key and vulnerable populations, including people living with HIV and TB, sex workers, people who use drugs, men who have sex with men and lesbian, gay, bisexual, transgender and intersex people.

The first Africa Regional Dialogue was held in 2011 and helped to inform the Global Commission on HIV and the Law – whose 2012 report revealed that bad laws and policies were obstructing the global HIV response. The Commission advised governments to dismantle legal barriers to HIV prevention and treatment, end discrimination against people living with and affected by HIV and to implement laws and policies that are grounded in evidence and human rights.

“For UNDP, human rights are central to effective HIV responses and to the 2030 Agenda for sustainable development and the commitment of ‘leaving no one behind’,” said Mandeep Dhaliwal, Director, HIV, Health and Development Group, UNDP. “We are pleased to be working with government, civil society and UN partners in 88 countries to advance the recommendations of the Global Commission on HIV and the Law. Work on law and policy is vital from both a public health and development perspective. It is challenging but we know that progress is possible and essential.”

“The question is what needs to be done differently to include those who are already being left behind, such as people living with HIV or TB and key populations and vulnerable groups,” said Advocate Bience Gawanas, Special Advisor to the Namibian Minister of Poverty Eradication and Social Welfare. “These groups need to have their voices heard – and this dialogue is an important mechanism to do so.”

This week’s dialogue features sessions on laws and policies that mitigate or exacerbate violence and discrimination lived by women; laws and policies that discriminate and create barriers to services for children and young people; laws, policies and practices that create barriers to access to HIV and TB treatment; and laws and practices that effectively criminalise people living with HIV and TB and key populations.

Since the Commission’s report in 2012, significant progress has been made in addressing legal barriers to effective HIV and TB responses across Africa. For example, Mozambique has revised its law on criminalising unintentional HIV transmission and the High Court of Kenya has found a law criminalising HIV transmission to be unconstitutional. Further, Seychelles decriminalised adult consensual same-sex relations in 2016 and the High Court of Botswana has ruled that foreign prisoners living with HIV are entitled to receive lifesaving antiretroviral treatment. In Ghana, a stigma and reporting system has been developed that allows key populations and people living with HIV to file complaints about human rights abuses and seek redress.

“Robust evidence-based law reform creates conditions that can accelerate an end to the HIV and TB epidemics and premature deaths amongst the poorest populations in the African region. The time is now!” said Vuyiseka Dubula, Programmes Director at Sonke Gender Justice.

About the AIDS and Rights Alliance for Southern Africa 

Established in 2002, the AIDS and Rights Alliance for Southern Africa (ARASA) is a regional partnership of 115 non-governmental organisations working together to promote a human rights approach to HIV and TB in Southern and East Africa through capacity building and advocacy. ARASA partners comprise a diverse mix of more and less well-established organisations including networks of people living with HIV, legal aid organisations, women’s organisations, youth organisations and other AIDS service organisations. The basis of the partnership is solidarity and shared responsibility for advancing social justice in the region, with a focus on the realisation of the right to health. For more information, visit: http://www.arasa.info/

About UNDP and the Africa Regional Grant on HIV: Removing Legal Barriers

UNDP partners with people at all levels of society to help build nations that can withstand crisis, and drive and sustain the kind of growth that improves the quality of life for everyone. On the ground in more than 170 countries and territories, we offer global perspective and local insight to help empower lives and build resilient nations. For more information visit: http://www.africa.undp.org/

The Africa Regional Grant on HIV: Removing Legal Barriers aims to strengthen the legal environment in an effort to reduce the impact of HIV and of Tuberculosis on key populations in Africa. The programme is supported by a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. UNDP, the Principal Recipient of the grant, coordinates the programme in cooperation with four civil society organizations – AIDS and Rights Alliance for Southern Africa (ARASA), ENDA Santé, KELIN, and Southern Africa Litigation Centre (SALC). For more information visit: http://www.africa.undp.org/content/rba/en/home/about-us/projects/africa-regional-grant-on-hiv/

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6 JUNE 2017 | GENEVA – New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the World Health Organization’s (WHO’s) Model List of Essential Medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The WHO Essential Medicines List (EML) is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations.

“Safe and effective medicines are an essential part of any health system,” said Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

New advice: 3 categories of antibiotic

In the biggest revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped antibiotics into three categories—ACCESS, WATCH and RESERVE—with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.

The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics that are needed when all others fail. These changes support WHO’s Global Action Plan on antimicrobial resistance, which aims to fight the development of drug resistance by ensuring the best use of antibiotics.

WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

The third group, RESERVE, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.

WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

“The rise in antibiotic resistance stems from how we are using—and misusing—these medicines,” said Dr Suzanne Hill, Director of Essential Medicines and Health Products. “The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse.”

Other additions

The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new paediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:

• two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease;
• sofosbuvir + velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C);
• dolutegravir for treatment of HIV infection, in response to the most recent evidence showing the medicine’s safety, efficacy, and high barrier to resistance;
• pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection;
• delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB;
• child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol and pyrazinamide for treating paediatric TB;
• fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care.

The WHO Model List of Essential Medicines was launched in 1977, coinciding with the endorsement by governments at the World Health Assembly of “Health for all” as the guiding principle for WHO and countries’ health policies.

Many countries have adopted the concept of essential medicines and have developed lists of their own, using the EML as a guide. The EML is updated and revised every two years by the WHO Expert Committee on the Selection and Use of Essential Medicines.

The meeting of the 21st Expert Committee was held 27-31 March 2017 at WHO Headquarters. The Committee considered 92 applications for about 100 medicines and added 55 to the Model List (30 to the general EML and 25 to the children’s EML).

The updated EML is available here:
http://www.who.int/medicines/publications/essentialmedicines/en/

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The first recorded instance of people travelling to obtain medical treatment dates back thousands of years and refers to Greek pilgrims travelling from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of Asklepios – the Greek God of medicine . Asclepius represented the healing aspect of the medical arts; his daughters being Hygieia (“Hygiene”, the goddess/personification of health, cleanliness, and sanitation), Iaso (the goddess of recuperation from illness), Aceso (the goddess of the healing process), Aglæa/Ægle (the goddess of beauty, splendor, glory, magnificence, and adornment), and Panacea (the goddess of universal remedy).

In its most basic avatar, Medical Tourism refers to the act of visiting a foreign country to obtain medical treatment. It started when people from one country, allegedly patients from underdeveloped, third world countries sought medical succor in countries with highly advanced medical facilities, primarily in the West. However, over time, there was a distinct trend reversal, with the term coming to refer to patients from the developed countries seeking out low cost destinations where treatments are available at a fraction of the cost in their home countries. This was brought about by a variety of reasons including some treatments being illegal in their home countries, such as some fertility procedures, or for treatments that borders on ethicality and calls for organ transplants which are freely available in the seamy underbelly of the healthcare system, especially in developing and less developed economies. The desire to avoid the waiting period in many advanced countries (especially in those offering public health-care systems) for certain types of treatment, more so in view of the availability of treatment of similar standards at attractive price points, coupled with the ease of travelling has and continues to feed this phenomenon. Similar is the case of Circumvention tourism, like for example, tourism for abortion.

The steady growth of medical tourism around the world and the emergence of highly sought after destinations for the same, however, does not mean that there are no downsides. Some countries, especially those on the wrong side of the tropics have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having a natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis among others. Again, as diseases run the entire gamut in economically challenged tropical nations, where concerns for sanitation in medical practices are not as stringent as in the west, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid as possible threats. It will not be out of place to mention here that there have been cases in the West, where patients have been consistently misdiagnosed for years because such diseases are perceived to be rare, even generally unknown in the West.

The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be grossly different from US or European standards. Traveling long distances soon after surgery can also increase the risk of complications. Health facilities treating medical tourists may even lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients, especially foreign ones.

Medical tourism in India is a growing sector, which was pegged at above US$ 3 billion in 2015 and is expected to go upward of US $ 8 billion by 2020. As a matter of fact, as one report pointed out, India offers one of the lowest cost and highest quality of all medical tourism destinations. She offers a wide variety of procedures at about one-tenth the cost of similar procedures in the United States. However, not all the inbound patients are from the states with a bulk of the people seeking medical help in India coming from countries where medical facilities are either conspicuous by their absence, or are prohibitively expensive. Patients from Bangladesh and Afghanistan make up a large part of this group, followed by patients from Russia and the CIS while the rest is made up of those seeking succor from Africa and the Middle East, especially the Persian Gulf countries.

However, it is wrong to believe that the medical tourism industry in India is dependent only on foreign patients. As a matter of fact, the medical tourism trails within India too, are getting more and more pronounced with every passing day. This is being brought about by the infrastructural disparities within the country which forces patients from states / regions with less advanced facilities to seek help and remedy in states where such facilities are available.

The city of Chennai for example has been termed as “India’s health capital”. Multi- and super-specialty hospitals across the city bring in an estimated 150 plus international patients every day. Chennai attracts about 45 percent of health tourists from abroad arriving in the country and 30 to 40 percent of domestic health tourists according to one study. Factors behind the tourist inflow in the city include low costs, little to no waiting period and state of the art facilities offered at the specialty hospitals in the city which are more often than not at par with those available in advanced countries. The city has an estimated 12,500 hospital beds, of which only half is used by the city’s population with the rest being shared by patients from other states of the country and foreigners. Kolkata too is fast emerging as a medical destination, especially in view of the fact that patients from the North Eastern parts of the country along with those from neighboring countries like Nepal, Bhutan and Bangladesh are increasingly looking at the city to provide them with the much needed medical support. This has been brought about to a very great extent by the legacy that the city has traditionally enjoyed from the time the British ruled the country as a premier destination for the study and practice of medical science and because of the fact that a number of multi and super specialty hospitals have come up which are expanding the city’s medical horizons.

There is one grave concern though. If current trends are to be believed, unscrupulous elements that were once involved in the running of pyramid money-management schemes are now increasingly turning their attention to medical tourism, especially in the relatively poorer states of eastern India, from where they are herding patients to locations in the south. With a variety of sleekly designed pay packages that are aimed at pulling the wool over the hapless and often helpless patients coming from the back of beyond, this is nothing but organised crime in another garb and often works in cohorts with  the rackets involved in the illegal organ trade and human trafficking. As a matter of fact, if some reports are to be believed, medical tourism is often the legitimate face of these highly organised gangs and their tentacles have already spread to not only many Indian states, but also to many neighboring countries.

The piece was originally written for the Express Health Guide 2016.

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June 16, 2015, Washington, D.C.—Bad weather in Africa south of the Sahara increases the spread of HIV, according to a study published in the June 2015 issue of the Economic Journal. When the rains fail, farmers in rural areas often see their incomes fall dramatically and will try to make up for it however they can, including through sex work. Analyzing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behavior, a year of very low rainfall can increase local infection rates by more than 10%.

The results have important policy implications for fighting the spread of the epidemic, said co-author Erick Gong, an assistant professor of economics at Middlebury College.

“Existing approaches to stopping the spread of HIV—such as promoting condom use and the use of anti-retrovirals—remain critically important,” he said. “But our results suggest that other policy approaches could be very useful too—in particular, approaches that provide safety nets to rural households when the weather turns bad.”

Policies and investments seemingly unrelated to HIV—such as the promotion of rural insurance or household savings schemes, or the development of drought-tolerant crops—might have surprising benefits in slowing the HIV epidemic. Co-author Kelly Jones, research fellow at the International Food Policy Research Institute said the HIV epidemic remains “one of the world’s greatest health challenges, with over a million new infections per year in Africa alone.”

“Our results expand the menu of options for addressing the epidemic, and highlight some surprising options that are not at the forefront of people’s minds,” she added.

The research sheds valuable light on why HIV continues to spread in Africa. Previous studies have documented in limited settings that poor women often alter their sexual behavior in response to an income shortfall. But until now, there has been little evidence that this response is big enough to affect the trajectory of the HIV epidemic.

To fill this gap, the researchers combined data on the HIV status of thousands of people across Africa south of the Sahara with data on the recent rainfall history in each individual’s location.

Because years of low rainfall can lead to much lower incomes in these locations, particularly in rural areas where people depend more heavily on agriculture for their livelihoods, variation in rainfall provides a way to study how changes in local economic conditions affect infection rates. Co-author Marshall Burke, assistant professor of environmental earth system science at Stanford University, said the team was “surprised by how strong the relationship is between recent rainfall fluctuations and local infection rates.”

“As expected, the relationship is much stronger in rural areas, and particularly for women who report working in agriculture,” he said. “These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet.”

The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. IFPRI was established in 1975 to identify and analyze alternative national and international strategies and policies for meeting the food needs of the developing world, with particular emphasis on low-income countries and on the poorer groups in those countries. www.ifpri.org. 

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