Rinderpest and HIV and Rabies (Oh my!)

Good news – Rinderpest has been eradicated! Bad news – there are still a ton of really devastating infectious diseases out there (and right here), and many of them are not likely to ever be eliminated.

I'm currently reading Paul Farmer's book Infections and Inequalities: The Modern Plagues which, in combination with conversations about some friends' research on HIV, has really gotten me thinking about what's going on here in Kisumu and the rest of Nyanza province. In this part of Kenya, the HIV prevalence is the highest in all of Kenya – despite CDC/KEMRI and an enormous number of HIV-focused NGO's working in the area. There are various estimates of just how widespread it is, but all of them indicate that the answer is "very"… a friend's poster I read recently says 25% of women and 18% of men are infected, and another study conducted in 2003-2004 in the district where I work found that 36.5% of women aged 25-29 and 41.1% of men aged 30-34 were seropositive. The other night, as a birthday party I was at was winding down, a couple of drunk HIV researchers brought up their work. One woman is studying the impact of coital injuries on transmission, and she indicated that there are a number of cultural practices that significantly increase this risk, but the primary risk for women, as Paul Farmer also discusses, is being poor and therefore having very limited sexual agency. Back to cultural practices, though, because other friends of mine are assessing the acceptability of male circumcision in this area where traditionally circumcision has not been practiced (male circumcision has been shown to reduce the risk of transmission of HIV). The majority of people here are from the Luo tribe, who not only don't traditionally circumcise, but have a number of other traditional practices that really don't help slow transmission. According to my friend, many Luos engage in concurrent relationships, which basically means that any "ex" isn't ever actually ex. I also keep hearing about the importance of sex in funeral rites, although I haven't ever been able to get a clear picture, and this article is not available for free. ( Does someone with library access want to send it to me?) My very basic understanding is that recent widows have to be "cleansed" by having sex, and widows are also inherited by their deceased husband's brother. You can imagine that when a man dies of AIDS and his presumably also HIV+ wife is forced to take another husband this can contribute to the spread of HIV. I just found another article which includes all of this stuff, please read here.

Okay, now some optimistic news – my supervisor's supervisor, Sarah Cleaveland, has devoted her career to eliminating canine rabies and the human rabies cases that result from it. It will be a very long time until the Wikipedia page for Rabies says "was an infectious viral disease" [can you imagine how gleefully that edit was made??] but Sarah has shown that it is possible to eliminate canine rabies and that a lot more attention and resources should be directed towards this task – currently there are about 55,000 human rabies deaths each year, with almost all caused by bites from rabid dogs, and of course, the vast majority are in Africa and Asia. I haven't done the calculation myself but according to Jo H. that means someone dies from rabies every 8 minutes. Sarah also played a large part in the founding of World Rabies Day, and here in Kisumu we are doing our part in extending it to last all year (it was supposed to happen in late September) because our shipment of rabies vaccines has been delayed. Our mass dog vaccination campaign will probably happen this Saturday or next, and I'm super excited to be a part of it. Rabies is a disease that I find fascinating, it's a deadly generalist virus that can infect essentially any species of mammal, and the reservoir of domestic dogs with rabies has led to devastating outbreaks in lion and African wild dog populations. Thinking about the ecology of all the interactions and connections…wow. And it's vaccine preventable! Seems like a good disease to devote a career to. But there are so many other neglected diseases…good thing no one is forcing me to pick one disease to study!