May 23, 2017 – HIV/AIDS and Respiratory Health

  1. If government and policy are the big barriers to reducing causes of respiratory global health issues, how do we move forward with decreasing risk?

Respiratory issues have a variety of causes all over the world including transportation, industrialization, outsourcing, coal use, and a lack of regulation. Problems like transportation are common all over developed and developing nations like China or India, thus respiratory issues are likely to develop in a variety of countries. However, due to things like industrialization and outsourcing, especially from the United States, countries like China and India have been forced to pay the price and suffer from thick smog and dangerous pollution levels causing all sorts of respiratory problems. This also is due to a lack of regulation, especially over the high use of coal especially in that region. Standards need to be introduced to countries like these in order to get people to recognize this issue and find a way to lower the risk. In recent years China has been looking into clean energy use, which would help lower pollution and in turn lower the prevalence of respiratory infections. However, solutions like these may be a long way off, and they are not particle for small villages where money is as readily available. In Ghana the clean cookstove trial has been proposed to help with respiratory illness in the home. The study specifically tested whether or not using clean cookstoves would increase infant birthweight and reduce pneumonia during a baby’s first year of life. (Jack et al.) While there are many setbacks to this study, including cultural differences, ethical issues, funding, and feasibility over the course of a lifetime, this idea of clean cookstoves is a great initial solution to the problem in small local villages if the idea were tested and refined. Other more immediate solutions would be to try to remove causes of respiratory illness like by introducing better house ventilation, reducing emissions from transportation, and educating people on pollution and prevention by using things like nose and mouth masks. Though it is hard to get around government and policy in regards to pollution, there are steps being made to change this, and there are things people can do on an individual scale to try to change their risk of respiratory infection.

  1. What are the similarities and differences of the Polypill and PrEP?  Does applying the same polypill principle to HIV/AIDS change your view on whether or not you’d use it?

PrEP (pre-exposure prophylaxis) is an antiretroviral medication used to reduce the risk of HIV infection in people who have not been infected with the virus previously. According to the CDC taking PrEP daily reduces the risk of getting HIV more than 90% from sex, and 70% from injecting drugs. For PrEP to be fully effective it must be taken every day for the rest of a person’s life. If a person stops taking it without using any other prevention methods a person’s immune system may not be strong enough to fight off the HIV infection. PrEP is similar to the idea of polypill as it must be taken everyday to be effective, both medications are highly effective, they are both fairly cost effective compared to other treatment methods. Both also require significant patient adherence to have full effect in preventing diseases like HIV and AIDS. Some of the differences are that PrEP is a fully tested method that is already in use, while polypill is not something that is currently in use for something like cardiovascular disease. Another difference is that PrEP is only used for prevention of HIV and has no effect on someone who already carries the disease, while polypill can be used for both prevention and treatment of cardiovascular disease. Applying the polypill principle to HIV/AIDs probably wouldn’t change my opinion that much on the idea of it because PrEP already has many of the same characteristics as the polypill. The only benefit making it a polypill would have would be for it to help with both prevention and treatment. In the developing world however I feel like giving either PrEP or polypill for HIV/AIDs would still pose many difficulties especially in things like education, patient adherence, access to clean water to take the pill, and cultural differences. PrEP or polypill would both similarly be very expensive for someone in a developing nation to be able to realistically afford and take for the rest of their life. Someone living in a rural area may also not be able to return to the doctor to get more medication and so they may stop taking it and end up with the same health risks to getting HIV. In some cultures, taking medication is not accepted and so many people may just not take the pill as they should. Solving problems like these in the developing world would require coming up with new solutions such as a vaccine where someone would only have to get it once or twice and then be protected for the rest of their life. PrEP is a good idea for a medication in the developed world, however, there need to be significant changes in order to prevent HIV in the developing world.

  1. Here’s a short video on LifeStraw.  What are the strengths of this global health initiative? What are the areas for growth?

LifeStraw is an initiative to help bring clean water to developing countries while also reducing the release of CO2 from the atmosphere by boiling water. As a global initiative it has had a great start in small villages and as seen in the video they make a point to install the device and then thoroughly educate the family on how to use it, and why it is important to use, while also documenting and tracking which families have the device install using a database. The family LifeStraw gets rid of “virtually all bacteria (99.9999%), protozoa (99.99%), and viruses (99.999%) that can contaminate water” (LifeStraw) and is very user friendly, as all you have to do is pour the water in and let it filter through. It is also chemical free and lasts several years before having to be replaced. As said in the video it is not just to help increase clean water in villages, it is also meant to help reduce deforestation and reduce CO2 emissions due to the burning of wood for fires to boil water. While the LifeStraw has many great benefits there are also limitations to the product. For one, it says in the video that this is a for-profit organization so it wasn’t clear whether or not they make the villagers pay for it or if they donate to them. If they do make them pay for it this is a big consideration for a family because they may not be able to replace it after it is no longer effective anymore. Also how would a family know when the LifeStraw no longer works anymore. If they kept using it after it was no longer working to purify water properly the family may get sick. It says on the website that to increase the lifespan of the product that people should clean it after each use, but if they have no clean water to clean it with then how would they have the means to clean it frequently (LifeStraw). The smaller scale LifeStraw has even more drawbacks, the biggest being that it doesn’t remove viruses, heavy chemicals or salt from the water so people are still at risk of getting sick while using it. It also is more for personal use so having a big family would make this product not practical in that scenario. For all products LifeStraw makes there is also a cultural barrier in which people may feel embarrassed to use the product because it is not what they are used to. They may not feel comfortable going outside and using the small straw to drink from a river because they may look strange in their culture. To combat many of these problems LifeStraw will have to educate everyone on the product so that everyone understands how beneficial it is. Additionally, they will have to keep track of the families who have the product so that they can go back and replace it every few years when necessary.

 

Jack, Darby W et al. “Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial.” Trials 16.420 (2015): 1-10. Web.

“We make contaminated water safe to drink.” LifeStraw. LifeStraw, n.d. Web. 24 May 2017.

 

 

 

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