Although this chapter was helpful in better understanding HIV, I felt like I already had a good understanding of the disease’s spread and social impact in the United States. With news articles and movies like “Normal Heart”, many people are familiar with the origins of AIDS in American and have a good sense of it in today’s society as well. What many people are not aware of, and what I appreciated learning about was the way in which the disease entered and affected global societies.

I was amazed at the different ways countries viewed the disease and went about treating it. It was interesting to see that while some countries tried to downplay the impact of the disease, others confronted it head on. Several leaders, like those from African countries and Thailand, took an open approach to the disease. When the President of the United States talked vaguely, if even at all about the disease, these foreign leaders travelled around to engage with local populations and made AIDS one of their talking points specifically. This government support for the identification and treatment of the disease was incredibly important in slowing down the spread of the disease and also diminishing the stigma surrounding it. In Thailand, specifically, key movement leaders even went so far as to have campaigns dedicated to distribution of condoms, normalizing the activity that spreads AIDS most commonly. Brazil has taken a similar approach in that they are open about their treatment and prevention methods as well, offering the youth free vaccinations.[1] Again, in addition to diminishing social stigma, methods such as these decrease the spread of the organism in general.

AIDS has been a huge global campaign, both in terms of its original identification and treatment, and now its prevention and social impact. Regardless of a country’s population size, GDP, political system, or any other usually divisive characteristic, everyone is subjected to the AIDS pandemic, perhaps at just different levels. Countries would benefit greatly if there were an increase in global communication regarding not only research to cure HIV/AIDS, but also to handle the social impacts of it as well in their respective societies.

[1] New York Times article

Help Received: Class movie and provided articles

Prior to this class, I could rattle off the names of infectious diseases and plagues, but I could not tell you much else. I could have told you how HIV was spread and the conditions that made cholera so prominent, but in my mind, and in my past learning, diseases such as these were studied in the context of isolated regions or periods. This class has opened up my eyes to the study of infectious diseases, and the realization that they are so much more than anything I had learned before.

Although I do my best to keep up with humanitarian crisis as an International studies major, not much of our class discussion is devoted to global health issues. While we talk about refugee crisis and camps that line borders in regions of conflict, we seldom consider the conditions as precursors to an epidemic. While we talk about the way women’s roles have changed an improved, we do not site their leading role in combating disease spread as found in India with the campaign against cholera. While we talk about the growing presence and strategic use of technology, we do not study its projected use in the case of health education. For something that touches so many lives, so deeply, it is astonishing how easy it is to overlook and avoid conversation regarding it.

While the sections on the plague were the most informative and frightening, the cholera and HIV sections were my favorite. The cholera chapter was fascinating because of the public education that was taking place in teaching areas how to avoid contraction of the disease. These are easy practices to put in place, and ones I was very motivated to support across the world in whatever way I can. The HIV section was also incredibly interesting because it is one of the more popular diseases, in that you hear a lot about it socially. To now have studied the scientific side of the disease, I can piece together all the other bits of knowledge I had on it previously and better understand the illness. I also really enjoyed the documentary that articulated how different countries handled/addressed the HIV crisis. It was fascinating to see the way different morals and cultures produced a variation of responses from the health sector on working to cure the disease. It shows that there is a lot countries can do to learn from each other and emphasizes the importance of international communication.

Perhaps is it true that I left class, on more occasions than not, a bit more paranoid than when I entered. This is because my eyes were opened to the easy in which diseases can spread, and with a growing number of drug resistant strands, the dangerous amount of time it historically took doctors to find a treatment, or in some cases a cure. The learning of this semester has made me a more conscious member of society, eager to uphold clean personal practices, and a more motivated advocate for the health sector. As I aspire to one day work for the government, I am glad to have had the learning of this class as it has ingrained in me a greater appreciation for the health sector where I support the ample donation and allotment of funds. Such funds will help for the quick reaction when diseases begin to spread, but also hopefully create greater preemptive measures and practices that can protect the population from such terrible outbreaks from occurring again.

Thank you for a great class this semester!

Cholera is a water or food borne disease that is most notably spread through the oral-fecal route from contaminated water and food. It attacks the lower intestine and causes an extreme loss of water and salts. Cholera originated in India around the 16^th century and has since had seven pandemics across the world. Colonists and merchants carried the illness across the seas to infect new countries and populations. Particularly after it was brought to America through the Irish immigrants, the disease came to be associated with the poor community. The spread rapidly increased, especially in London, with the urbanization that less living space and no proper sanitation.[1]

The waves of infection only diminished by the implementation of new sanitation and hygiene practices, and the work of researchers like John Snow, who studied the disease in depth to understand how it arises. He proposed the contagion model, rather than the miasma model, as an explanation for contraction. He was also instrumental in identifying contaminated public water as being a key factor in the spread of the disease. Others added to the conversation, like William Farr, who proposed the contingent contagionism model.[2]

In Haiti, the cholera crisis continues, particularly because the lack of proper sewage systems. Rather than have a stable and regular plumbing system, workers enter the streets each night to carry human waste by hand. Even then, the problem is not resolved as the waste is not taken to a sewage plant, but rather put back into the streets, into the water, anywhere it can be causally dispersed. With each rain storm or regular rain, the waste moves back into the streets and in human contact so facilitate the spread of Cholera.[3]

This is also an issue in Yemen and Mozambique. As humanitarian crisis rage through these places, there is not proper sanitation practices in place and the population is left vulnerable to the illness. In Mozambique, the lack of clean drinking water, hygiene, and the presences of hundreds of decomposing bodies makes the spread of cholera and other diseases much more serious.[4] In Yemen, the same situations are arising, and the cancellation of vaccine shipments and aid deliveries[5] sends the message that there is a solution, its just not being implemented to the necessary degree.

[1] Powerpoint

[2] Powerpoint

[3] https://www.npr.org/2017/07/30/540359412/haiti-s-bayakou-hauling-away-human-excrement-by-hand

[4] https://www.aljazeera.com/news/2019/03/mozambique-cholera-malaria-cases-reported-cyclone-hit-beira-190323060006297.html?utm_source=STAT+Newsletters&utm_campaign=ccc1e82acf-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-ccc1e82acf-149731405

[5] “Vaccines blocked as deadly cholera raged across Yemen”

Tuberculosis is an infection caused by a bacterium and mainly targets the lungs, kidneys, bones, lymph nodes, and brain. It is commonly spread through sneezing or coughing, but other forms/strands of TB are spread by blood and not contained strictly within the immune system. These are called military and resemble more seed like pockets than the cavities TB usually creates in the lungs. Tuberculosis in the bones, commonly called Pott’s disease, eats away at the spine for example, making the bones incredibly thin and fragile, but also warped. The disease can also infect the urinary tract and body parts like fingers and the skin.

Finding strands of TB from ancient Egypt, the disease is known to have spread in waves throughout the world bringing an extreme death toll. Moving through America, it brought fears of dancing, spitting, and kissing, all which were thought to spread tuberculosis. Crowding, dirty streets, and living conditions of the impoverished were all see as factors that made contraction of TB more likely. For that reason, the streets were disinfected, women shortened their dresses so not to drag on the streets, and fresh air was used as a treatment for the inflicted, breaking them from the busy population and placing them in isolation. Now, there is less mass fear surrounding accidental contraction of the disease, but rather greater methods of treatment. For example, there are currently 10 drugs approved by the FDA to treat TB. There is a heavy emphasis on proper and full treatment in that the inflicted take the prescribed medication, or combination of medication, for the fully prescribed period. Failure to do this can lead to more drug resistant strands of the disease to form. Medical researchers are also concerned with targeting low income populations and those infected with HIV to better control the disease and possible new strands that could form from their contraction and lack of treatment. The Lancet Commission states that this effort of appealing to this social community, as well as the universal efforts to treat and diagnose the disease will aid in the effort to end tuberculosis all together. Only if the powerful parties contribute considerable aid and attention to researching the disease will the People’s Plague be ended once and for all.

Help Received: Class Powerpoint, provided articles and reading

The Irish potato famine began in Ireland around 1845 and crippled the country’s crops. Potatoes were a staple to the Irish meals and tradition, as it was high yield crop with little labor necessity. When the blight struck the primary crop then, the population suffered dramatically as they lost close to a half of their most critical food product. This led to millions of deaths and mass starvation, disease, and emigration around the 1850s. It also led to a mass migration movement of Irish citizens to seek better living conditions in the United States.

The fact that only two primary variations of the potato crop were used made the famine more likely to occur. Oomycete was the fungus identified to have spread throughout the plantations, making the potatoes small, mushy, and inedible. This HERB-1 strand was thought to come originally from Mexico, and have traveled through North America before contaminating a ship that spread it across the world, particularly Ireland. With the undernourished population, people became more susceptible to contracting disease such as measles, TB, and whooping cough. Poor hygiene lead to diarrheal disease to also spread and even Cholera was spreading throughout Ireland. The Irish were suffering on several fronts. The Irish carried these with them as they fled the country, leaving one disaster, and creating another (mass infection).

To consider if something like this could happen again opens the discussion of plant gene modification. With use of CRISPR, gene ‘editing’, and full on modification, ethical issues and cost benefit analysis are discussed in depth. Conducting research on plant modification would have significant benefits in that it would produce a greater yield of crops, make their growth more controlled and less susceptible to natural disaster, and overall provide necessary and significant food security for our global future. The downside to this, however, is the concern that such new technology could be used as a biological weapon, since such could be spread by insects that are incredibly hard to regulate and control. Many people fear that, should we continue to advance and fully support such agricultural modification, it  would sent a dangerous precedent for other gene manipulation, perhaps in the context of animals and human embryos.

Prior to this class, the only thing I knew about Tuskegee was the role of their airmen in WW2. After the documentary on the syphilis experiment that took place there, however, I was not only applaud that such actions occurred, but that I had never heard of the horrific incident before.

The Tuskegee study sheds light on the ethical issues that arise in the treatment of diseases. In this case, issues arose between the desire to understand the disease and the extent of its infection, and the actual treatment of inflicted patients. It was clearly unethical to allow this population to continue to live with the disease even though they thought they were being treated. Attempts to rationalize it, however, come from viewing that the lose of lives in this study are minuscule compared to the number of people that would be saved from the disease after scientists had a better understanding of how it evolves long term. There were several other issues with the study in that the patients were not aware they were subjects of an extensive research experiment, one that targeted and was bias towards a particular racial group.  Unaware that they were still carrying the disease, they were not properly quarantined and poses a serious threat to the rest of the population they could have also infected.

The bias in this experiment had a significant impact on regional and racial aspects of disease treatment. Since the poverty rate was lower in this county than in other counties, and the participants were all African American, both of these became stigmatized as qualifications for contracting the disease. These continue today, but it has altered slightly to be perceived as primarily drug users. The CDC reports that the most concerning population for those who contract and spread disease are frequent drug users. Although syphilis was not originally spread sexual, it is now commonly spread as an STD and through shared needles. For this reason, the disease plagues lower income areas that have considerable drug issues. The betrayal of doctors in this test lead to a distrust of medical professionals, particularly from this population. Perhaps not exclusively from this social group, such distrust does still occur and threatens the overall health of the population when things such as herd immunity are not practiced or in place.

When an epidemic like smallpox takes route and begins to spread, the population attempts to understand why it is spreading and how they can prevent it. Often unable to answer the first question, people turn to homemade remedies and treatments.

During the spread of smallpox, people attempted a variety of methods to prevent the spread of the disease including bloodletting and leeching, thinking that they could target blood removal as a way to eradicate the DNA virus . They also used methods of fasting, laxatives, purgatives and diuretics to rid the body of the disease. They even attempted heat and cold treatment therapies –  anything they thought that could help treat the unfortunate disease that attacked the DNA and manifested itself in the skin.

On a spiritual level, most epidemics are thought to be curses from the gods, and smallpox was no exception. Many religions, like Hinduism, and in Chinese traditions there were specific smallpox gods that people would worship, honor, and try to appease in an attempt to prevent the spread of disease. This was one way in which disease had a significant impact on the religion and culture of the time.

Besides the home remedies and religious attempts, there were actual scientific advancements made in the development of treatments and vaccinations. Jenner lead this movement in 1796 as he started the process of inoculation and vaccination. Inoculation began with a test that hypothesized that there was a link between smallpox and cowpox. Jenner hypothesized that vaccinating with cowpox, or vaccinia, would prevent an individual from contracting smallpox. This test was administered and paired with practices of surveillance, advancing Jenner’s impact on disease treatment. Although there was a fear and stigma surrounding this initially, it decreased enough that many people participated in the process, including members of royal families and large numbers major US cities. The vaccination created a small, yet identifiable mark. The fact that it could be easily hidden, however, and was highly publicized as being a good thing, made the majority of the population willing to get the vaccination and made considerable improvements in disease control.

Although there were issues with the mass vaccination that followed the development of such test, such as the lack of refrigeration that left a large number of vaccines impotent after being exposed to heat or sunlight, the overall process and implementation was successful. It allowed several countries and even continents to reach the status of being considered smallpox free. To this day, although we are not dealing with any major outbreaks, the United States is prepared for such. Currently, and stored throughout the country, are enough vaccinations for everyone in America. This displays how serious the government considers this disease in that it is prepared to take control and implement preventative measures should it arise again.

Help Received: Class powerpoints

The Black Death that tore through Europe was indiscriminate; it took men, women, children, rich poor, anyone that crossed paths with the inflicted would soon fall to the disease as well. The origin and subsequent spread of the disease was attributed to fleas, rats, and the increase human contact that came from Mongols, merchants, and soldiers in conquest. With the increased travel, these groups carried the disease overseas and across land to quickly infect new portions of the population previously isolated. The poor living conditions, sanitation, and constant caring for the sick also enhanced the virulence of the disease.

Killing around 600 people a day, the population not only did not know how to cure the disease, but they were unable to prevent its spread, not knowing where it came from. With the unidentified carriers, society thought that perhaps God had sent the disease or that it came from a mysterious vapor. Eventually, they adopted practices of quarantining the sick and burying the dead as a means to try to control the disease but little impact was made. The death toll remained high and had great implications on what was the current state and progress of society.

Society was strained and divided under the pressure of the disease. Social groups were stigmatized as being primary carriers of the disease, some retaliated with violence and crime. Religious groups even submitted to cult like behavior as a means to protect themselves from infliction. There was mass hysteria in most cities. Despite the hysteria, there were still citizens working endlessly to make positive and longstanding contributions to society through the practice of medicine. Countless attempts were made and with tedious documentation, improvements were made that helped develop the modern practice of medicine. This makes one consider how many talents we lost access to as a society with the passing of such a large portion of the population. With so many deaths occurring, historians consider how many could-be renowned artists, architects, and philosophers perished. What contributions of theirs did society miss out on as a result of their death that came from the uncontrolled spread of the plague?

As the spread of the plague slowed down, however, society began to reform and did reach a point of growth and improvement. With less workers, wages increased, and the poor improved their economic standing. Benefitting the poor and often to the disadvantage of the rich, there was a reordering of social hierarchy after the passing of the plague. The standard of living rose and there was a slow but still increase in population. The Black Death remained active but did not spread through the world as it had with this first passing. It has reemerged in Madagascar and the United States, but not in the same capacity. The US had its first major outbreak in the early 1900s when an Asian chip carried infected rats and fleas. The primary regions of outbreak in the US are around the four corner region or California and Oregon. Globally, there have also been several cases in Madagascar as the disease reemerged there. At this point, we understand that the disease spreads through person to person contact of coughing, contaminated fluids or droplets, so practices of isolation aid in preventing the spread of the disease, in addition to the practices of rat, flea, and even cat control.

Sources: Class notes, movie notes, powerpoint, provided article

Emerging and re-emerging diseases are particularly dangerous as populations previously not exposed to such diseases have a lower immune system that makes them more susceptible to catching the virus and being unable to fight it. Such diseases, especially when spread by zoonotic sources, become even more dangerous as they threaten to spillover, meaning they can spread easily to a huge portion of the population. Examples of zoonotic factors that have facilitated the spread of disease are mosquitos that carried Zika in Uganda in 2015, and bats that carried Ebola in Guinea in 2013[1]. When diseases are spread in this way, it is harder to immediately identify or control the spread. This is because unlike infected humans, animals to not show sickly systems, and in some cases, like mosquitos for instance, contact is practically unavoidable.

Is there any way to combat this and better prepare or defend ourselves against a new outbreak of disease? The social implications of outbreaks could perhaps help with this.

Outbreak culture, which relies on the way that the spread of the infectious disease is portrayed in the public, could perhaps actually help this effort. Although the media can be flawed in its oversensationalization of events and threats, in the case of infectious outbreak, this is actually more helpful than not. Allowing the media to advertise the disease, its origin, its symptoms, and any sort of pattern that can be used to trace the outbreak, works in the favor of public health as the education can help bring forth new patients for diagnosis and keep the rest of the population away from possible sources of contamination[2]. The down side of this however, is the hysteria and social isolation that comes as a part of outbreak culture. Panic and fear of catching diseases can easily lead to cruel conditions for those with the disease. The AIDS epidemic was a prime example of this where the outbreak created an intense social stigma around what was labeled “the four Hs – homosexuals, heroin addicts,  hemophiliacs,  and  Haitians.”  [3] Is the ostracization of such social groups worth the impact such publicity may have on preventing the disease from spreading?

Past disease research suggests that it does not have to be an either-or decision. Scientists researching Ebola attempted to combat this isolation by naming the disease after a local river rather than the village where the most recent outbreak originated[4]. Their actions here not only prevented the creation of a stigma, but also aided preventing the spread of disease as enough information was still released. This is an easy habit to adopt, but what also must be adopted is a proactive mindset more than just a reactive mindset when it comes to disease prevention.

Without an active political agenda and government funds dedicated to researching new diseases, the United States will never be ‘ahead of the curve’ of infectious diseases. Investing in proper infrastructure and resources is essential to decreasing our susceptibility of another pandemic[5]. Also necessary is vigilant monitoring of populations and regions, such as West Africa, that are prone to the spreading of infectious diseases[6]. A rapid treatment, isolation, and monitoring plan that is put in place would be extremely beneficial in preparing for an attempting to counteract the next major outbreak.

[1] Spillover Movie

[2] “Media Messages and Perception of Risk for Ebola Virus Infection, United States”

[3] “Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola”

[4] Spillover Movie

[5] “Beyond the Ebola Battle — Winning the War against Future Epidemics”

[6] “After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics”