BAMM 2012: HIV and Malaria Co-infection

A source of one of the biggest obstacles I have faced so far this year as Malaria Activities Coordinator is the incredibly high HIV rate. The latest reported HIV prevalence rate for Mozambique was 11.5%, and some districts in the country still report rates in the mid-twenties (while other districts have very low rates). As crude as it sounds, HIV is definitely one of the “sexiest” and most glamorous topics in public health right now—there is so much money and attention given to the subject. PEPFAR (President’s Emergency Plan For AIDS Relief—comes the US Government) is all over Mozambique, whether it’s directly funding events, projects, and activities, or indirectly doing the same thing by funding partner organizations. All of the Health sector Peace Corps Volunteers are funded through PEPFAR, which means that they should be primarily HIV-prevention workers. Money talks. Since so much funding is in HIV prevention, the same amount of focus is on HIV prevention. During Peace Corps’ Pre-Service training it seems like every session can be tied back to HIV prevention. But PCVs in Mozambique only receive two hours of Pre-Service Training on the subject of malaria. All of the PCV youth projects (REDES, the coed youth group JUNTOS, Science Fair, English Theater, and Future Business Leaders) are funded by PEPFAR, so they must have HIV components. So far this year I have experienced resistance to malaria projects because the organizations are “supposed” to focus on HIV, since this is where their money comes from. HIV/AIDS is clearly a debilitating problem in Mozambique and deserves extensive attention and prevention efforts, but not at the expense of other life-threatening diseases, especially malaria, which is actually the number one killer in Mozambique (though this statistic itself is a little tricky because nobody actually dies from AIDS, but from the other diseases that capitalize the body’s weakened immune system. Malaria being one of these opportunistic diseases). The irony though, is that a high HIV rate should make diseases like malaria MORE of a priority. As scary as HIV and malaria are individually (two of the most fascinating and “clever” diseases I have ever learned about), together they are far more dangerous and deadly. Pregnant women and children under 5 are targeted in malaria prevention campaigns as being most at risk, as they have lower immunity than the general population. HIV (which stands for Human Immunodeficiency Virus) positive people fit into this category as well. Let me attempt to explain some of the terrifying effects of HIV/malaria co-infection. HIV positive people have the Human Immunodeficiency Virus in their bodily fluids. The amount of virus (called the “viral load”) varies: it is high immediately after infection, drops for a while (months or years) before beginning to climb again (this is when the person begins to show signs of AIDS). The level of the viral load (quantity of little viruses in a drop of, say, semen) impacts the probability that HIV will be transmitted, given an exposure (unprotected sex, breastfeeding, sharing a needle/knife). The malaria parasite raises the viral load in an HIV positive person, which in turn raises the probability that this person will transmit the virus to someone else, be it a sexual partner or their baby. Repeated bouts of malaria seem to lead to faster progression into AIDS (HIV is the virus that attacks the immune system. It can remain dormant in the person’s body for months or years, during which time the person is HIV positive, but does not have AIDS yet. Once a person’s CD4 cells—immune system fighting cells—dip below a certain level, this person’s immune system is severely compromised and this person is considered to have AIDS). Also, as I said before, AIDS (Acquired Immunodeficiency Syndrome) doesn’t kill you, it is a state of compromised immunity and being more vulnerable to diseases like malaria, which ultimately kill you. HIV infection makes a person more susceptible to malaria and more likely to have severe malaria or die from malaria. In summary: malaria makes HIV worse and HIV makes malaria worse. Because of this, I hope that organizations here in Mozambique will come to realize that malaria is not LESS of a priority because of our huge HIV problem, but MORE of a priority because of it.