Features

Malaria milestone

"Malaria milestone" Continued...

Issue: "Endings & beginnings," Jan. 13, 2007

Ironically, the OK on indoor spraying means that USAID and other agencies may not be able to keep up with demand. So few countries have been doing it, many need training to do it well and safely.

"There's not a lot of capacity to do spraying out there," said Roger Bate, a resident fellow at the American Enterprise Institute. "North of Zambia no one had experience doing indoor residual spraying, with the exception of Ethiopia and Eritrea."

Bate was one of the main experts who exposed USAID's fumbling malaria program. He sees many improvements in the past year but cautions that some habits remain. One is the agency's tendency to rely on large Beltway contractors to do malaria work in Africa. By nature, they work for a few years without helping to build the skills and public-health systems countries need. But now, Bate says, the agency should risk losing some funds to ensure African nations learn to fight malaria on their own.

In Zanzibar, known for its long history in trading spices like cloves and cinnamon, Ziddawi knows the trick is making sure malaria stays away. Twice the islands eradicated the disease, only to have it resurge. But Jiddawi was confident: Speaking at the White House conference, he proffered, "You are welcome to visit our soon-to-be malaria-free Spice Islands."

'All one fight'

Scientists track an AIDS-malaria connection in Africa

By Lynde Langdon

A recent study of public health in Kenya strengthens the argument that malaria accelerates the spread of HIV in Africa. Researchers from the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle claimed in the study that since 1980 the diseases in combination caused 8,500 more HIV infections and 980,000 more malaria cases in one area of Kenya than they would have caused alone.

Doctors already knew that people with HIV are more likely to infect someone else if they also have malaria. Malaria increases the amount of HIV in the bloodstream almost 10-fold and more than doubles a person's risk of transmitting the virus, according to the study's authors.

Until recently, scientists had not quantified the effect of that interaction on a population. To document the HIV-malaria connection, they went to Kisumu, the third-largest city in Kenya and ground zero for HIV and malaria epidemics in the western part of the country. The city is sandwiched between Lake Victoria to the east and a large rice field to the west, making the region a mosquito-breeding haven. Estimates of malaria rates in Kisumu range from 10 percent to 90 percent of the population, depending on the time of year and the area of the city. To describe malaria in some parts of the city, scientists use the word holoendemic, meaning: Everybody has it and it never goes away. UNAIDS estimates that 35 percent of the people in Kisumu-more than one in three-have HIV.

The Seattle scientists used mathematical models to draw their conclusions, published in the Dec. 8 edition of the journal Science. James Kublin, one of the study's scientists, did not hide his own agenda behind the study, telling National Public Radio that he set out to disprove the belief that sexual promiscuity was the reason HIV radiated so quickly through sub-Saharan Africa. Since Kublin and his colleagues released their results, media and aid organizations have jumped aboard, calling for uniting malaria and AIDS relief efforts. On Dec. 18, a few days after the White House Summit on Malaria concluded, The New York Times and The Washington Post published editorials calling on the government, the UN Global Fund, and private donors to increase anti-malaria efforts as a strategy to fight AIDS in Africa. The editorials stated that improving overall public health in Africa was key to controlling the AIDS epidemic. "Donors eager to fight AIDS have shown less interest in improving Africa's health systems, training health workers and equipping clinics," read the Times editorial. "The biggest lesson of the new study is that it is all one fight."

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