A Disease of Poverty: Tuberculosis

Tubercolosis, also known as MTB or TB, is an infectious disease which is often associated with poverty. It is spread through the air when people who have active MTB infection cough, sneeze, or spit.

Causes

The cause of TB is primarily a small aerobic non-motile bacillus. It divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour. MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but tuberculosis can be cultured in vitro.

There are various risk factors which come into play:

• Persons with silicosis have an approximately 30-fold greater risk for developing TB. Possible indoor sources of silica include concrete, cement and paint.
• Persons with diabetes mellitus have a risk for developing active TB that is two to four times greater than persons without diabetes mellitus, and this risk is likely greater in persons with insulin-dependent or poorly controlled diabetes. The correlation between diabetes mellitus and TB is concerning for public health because it shows a distinct connection between a contagious disease and a chronic disease.
• Low body weight is associated with risk of tuberculosis. A body mass index (BMI) below 18.5 increases the risk by 2—3 times. On the other hand, an increase in body weight lowers the risk.
• Another condition that increases the risk is the sharing of needles among IV drug users.

Symptoms
Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and fatigue.


Treatments
Treatment for TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which makes many antibiotics ineffective and hinders the entry of drugs. The two antibiotics most commonly used are isoniazid and rifampicin.TB can either be latent or active. Latent TB treatment usually uses a single antibiotic, while active TB disease is best treated with combinations of several antibiotics, to reduce the risk of the bacteria developing antibiotic resistance. People with latent infections are treated to prevent them from progressing to active TB disease later in life.

Strategies to cope with HIV/AIDS

Thailand

The first case of AIDS in Thailand occurred in 1984. For the next few years, gay men, sex workers, injecting drug users and tourists were more commonly affected than other groups. The government took some basic measures to deal with the issue, but an epidemic was not yet apparent. Most of these measures were aimed at high-risk groups, as the government believed that there was not yet sufficient reason to carry out prevention campaigns among the general public.

The above table shows the current situation in Thailand.

Thailand once led the way in world HIV prevention, with a series of successful campaigns that helped to reduce the national HIV prevalence. However, in the new millennium there were signs of complacency; prevention programmes received just 8% of the national HIV/AIDS budget in 2000, and by 2001 the level of domestic funding for HIV prevention was half of what it had been in 1997. In 2006, UNAIDS reported that Thailand’s government had reduced its HIV prevention budget by two-thirds. From 2008 to 2009, the percentage of the total AIDS budget spent on prevention decreased from 21.7% to 13.7%.

There were concerns that the declining focus on prevention was putting the public at risk. Reports suggested that condom use had decreased and the rate of STI transmission had risen. Without new prevention campaigns, there was a risk that safe sex messages would be forgotten and a new generation of young people would grow up ignorant of the risks they face.

In September 2006 following a military coup, a new Thai government was installed. In light of the concerns about a resurgence of the epidemic, the new government decided to increase HIV/AIDS prevention efforts. In 2007 a three-year strategic plan was announced, which would focus on those most at risk of HIV infection, and difficult-to-reach groups.

^{In conclusion, Thailand (and Brazil and Haiti for that matter) has shown the world,  that it is possible for a developing country to form an effective response to HIV and AIDS. For all its successes, though, there are still certain regions and groups badly affected by the epidemic.}

The government's complacency during the first half of the millennium and subsequent shortage of prevention programmes is thought to have contributed to a lack of awareness of HIV and AIDS. A rise in STI transmission and high-risk sexual behaviour means there is now a fear that the country will witness a second wave of the epidemic.

Thailand's national strategic HIV and AIDS plan for 2007-2011 shows its commitment to increasing prevention efforts. If fast, effective action is taken, thousands of deaths could be prevented; otherwise, Thailand’s past achievements will soon be forgotten.