HIV/AIDS and Malaria: A Deadly Combination
159th Independence Day Commentary
By
Syrulwa Somah, PhD
The Perspective
Atlanta, Georgia
July 25, 2006
AIDS is now one of the leading causes of death in Liberia and other countries in sub-Sahara Africa where an estimated 7, 000 Africans are buried daily. According the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), nearly two-thirds of the world's HIV-positive people are sub-Saharan Africans. An estimated 20 million Africans have died from AIDS since the disease was diagnosed on the Continent in the early 1980s.
It is even worrisome yet that the current projection which warns that by 2010 an estimated 40 million children in developing nations will lose one or both parents to HIV/AIDS. Hence, in a nation like Liberia, this glooming projection means that one in every 4 to 6 Liberian children would lose a parent to HIV/AIDS in 2010. This also means that AIDS-induced illnesses will have immense bearing on our nation and people, including productivity, reproduction, national security, agriculture, demographic, education, healthcare, economics, and independence.
Perhaps, no one captures the magnitude of the impact of HIV/AIDS on Liberian society than a doctor quoted in a report (Liberia: Extremely Vulnerable to HIV) by Sarah Martin of Refugees International that “AIDS is going to be a big problem in Liberia…We are seeing full blown cases of AIDS but there is nothing we can do for them.” We must take these words as a harbinger of what awaits if we don’t act now.
In deed, HIV/AIDS has become a menace in Liberia alongside malaria in the last 14 years, with the HIV/AIDS cases rising from a mere two percent in the 1990s to 5.9 percent in 2003. The Central Intelligence Agency (CIA) reported in 2001 that 1.8 million Liberians (or 2.8 percent of the adult population of Liberia) between the ages 15-64 were vectors of the disease, which statistically meant that 1 out of 62 Liberians were infected with HIV/AIDS. In addition, between 2003 and 2005 when the transitional government in Liberia was able to track and test for the HIV/AIDS virus, the rate of HIV/AIDS cases in Liberia claimed to eight percent based on the test results of 100,000 Liberians, which meant a 20-percent increase in the rate of HIV/AIDS in Liberia, according to a Liberian Health Ministry report. But the most disturbing aspect of the report is that the age group (15-19) most affected by the HIV/AIDS comprises the future leaders of Liberia. Adolescents and young adults between the ages of 15 and 19 are the socio-economic pillars of any nation, so the affectation of this very population young people by HIV/AIDS would pose a grave national security threat to Liberia because our nation would rely on these young people for future development in sports, agriculture, medicine, business and industry, reproductive services, military service, and overall national production.
Equally alarming is that the infestation rate of HIV/AIDS among the local population in Liberia jumped from eight percent in 2003 to 12 percent in 2005, mainly affecting women and girls who are the seed-bearers or reproductive lifelines of our nation. This figure, when put in proper perspective, means that unless we in Liberia take concrete national action through public-private collaboration to crush the HIV/AIDS menace, we may face a serious national socio-economic and health crises in the future. In fact, CIA reported in 2004 that out of the more than 300,000 Liberians who were infected with the HIV/AIDS virus, an estimated 5,000 who were carriers of full brown AIDS disease died that year. In other words, if we were to presume for a moment based on the 2004 AIDS deaths that an average of 5,000 Liberians die each year from AIDS-related diseases, then AIDS accounted for the deaths of 70, 000 Liberians within the course of the 14-year civil war in Liberia from 1989 to 2003.
Hence, if we were to compare the monetary costs associated with the treatment of HIV/AIDS in other African countries like the Congo Republic and Kenya, then the experts’ opinion would be that Liberia will need more than $100 million per year to combat the HIV/AIDS disease. This is, in deed, a very serious cause for concern because if we take for granted that Liberia just passed 130 million annual budget, and allocation for public healthcare services is only 5.62 percent or US $ 7.2 million, how will she raise 100 million per year to combat HIV/AIDS alone? The chances are very slimmed!
Regarding malaria, an estimated 4,500 cases were reported for the latter part of the 1980s up 2005. In 2006, when the Liberian national malaria program had the chance to look at malaria cases in Liberia, the figure too is scaring. The rate of malaria death in Liberia is 20,000 individuals per year, with an annual economic overlay of $40 million in treatment costs. Calculating the death rate for malaria as we did HIV/AIDS, or by extrapolating the period of the 14-year civil war during which an estimated 20,000 individuals died from malaria and multiplying it by 14 years, we are likely to get about 280,000 deaths and $5.6 million expended on malaria treatment alone.
On average, though, both diseases took 350,000 lives and 19.6 million dollars during the last 14 years. Sadly, we now have both diseases to take on which all indications show will accelerate death in Liberia because anyone with HIV/AIDS who already has weakened immune system gets malaria that also targets destroying the red blood cells and elevating the body temperature will have little chance to live. This is the gorilla that is in the closet that a lot of people do not know. This is one of the reasons Liberians must act now or we are going to loose our nation not only to foreigners who are taking over its territory, women, and jobs, but also we will kill ourselves for complacency and our inability to act on time. As aforementioned, I believe that a nation of merely 3.2 million people should not let the combined forces of malaria and HIV/AIDS to reduce it to shambles.
We need to be smart here and come out in support of immediate malaria eradication with the cheapest treatment so that we cannot have a big mess in our hand. I respect other Liberians who hold the view that HIV/AIDS kills more Liberians than malaria, though I believe that malaria kills more people simply because no death certificate had ever listed HIV/AIDS as the cause of death but other diseases and opportunistic infections. In fact, about 26 "AIDS-defining illnesses" have not only been listed which formed a part of “syndrome” (collection of illnesses), but AIDS is described by the medical community as the most advanced stage of HIV disease or that HIV is the main cause that oxygenates the lifeline of AIDS. But that is another discussion for another day.
The main concern here is that malaria is currently unknown in the developed world because it was defeated in the developed world more than 40 years ago, so malaria shouldn’t be killing our people because there is a tested cure for malaria. We in Liberia are wasting valuable limited resources on poor malaria treatment and control measures by allowing other people to take advantage of us to make money at the expense of our lives by forcing on us the malaria treatment they think is good for Liberia. This is genocide, 9/11, tsunami, apartheid, holocaust, slavery, a violation of human rights, and it must be put stop to. If certain forms of malaria treatment and control were safe and effective enough to eradicate malaria in developed countries, the same safe and effective treatment should be good for use in Liberia.
How HIV/AIDS destroys the body defense system
The human body, like a nation, has its military unit
or radar system that attacks any invading force or forces
that violate its territorial integrity. The military
or radar system is commonly referred to as the immune
system. The immune system is made up of expert cells
in the bloodstream that are capable of combating invading
germs and viruses to keep the body functioning healthy.
Various names such as "T" cells or "T4,"
"helper-T," or "CD4" cells which
are the central commend or brains of the operation,
are used to described the military or radar units of
the body that are on guard non-stop to track germs.
As soon as a germ enters the body, these white blood
cells identify the invaders and give command to the
military unit-type cells, which then declare an all-out
“civil war” on the various germs, bacteria,
viruses, cancers, fungi, and parasites that can make
a person sick.
Like all viruses, HIV has one objective in life, which
is self-reproduction or self-preservation. In other
words, as soon as the HIV/AIDS virus attacks and moves
into a “T” cell, it not only changes that
cell’s whole chemistry into a “virus factory”,
but the “virus factory” also produces so
many new viruses in the cell that the “T”
cell cannot handle so it explodes, thereby scattering
the HIV back into the bloodstream. It is like pumping
air into a balloon that pops the air when it exceeds
the capacity of the balloon. When that happens, the
virus goes on to look for new “T” cells
and starts the process all over again. As long as the
HIV virus is in the person’s bloodstream, it can
destroy virtually all of an infected person's “T”
cells using the same tactics.
Symptoms that are associated mostly with the vector
of AIDS include abscess, lack of energy, unexplained
weight loss, frequent fevers and sweats, frequent yeast
infections (oral or vaginal), continual skin rashes,
flaky skin or pale skin, white patches or spots inside
or around the mouth, pelvic inflammatory disease in
women that does not respond to treatment, and short-term
memory. HIV/AIDS also produces opportunistic infections
symptoms such as shortness of breath, seizures, coughing,
lack of coordination, difficult or painful swallowing,
fever, vision loss, nausea, shingles, abdominal cramps,
vomiting, severe and persistent diarrhea, weight loss
and extreme fatigue, severe headaches, and coma.
Now, when the HIV conquers majority of the CD4 cells
or inflict serious damage or infections, a person then
has AIDS. When someone has AIDS, it means that he or
she has less than 14 percent or 200 CD4 cells per cubic
millimeter (a size of maggi cube that Liberians cook
in their soup) of blood. An adult person who is healthy
has CD4 and “T” cell counts of 1,000 plus.
How malaria destroys the body defense system
In the case of malaria parasite, when it enters the
body by a mosquito bite, the parasite recedes from circulating
blood within an hour and congregates in the liver. Several
days later, infected red blood cells (RBCs) with merozoites
emerge from the liver and the merozoites invade and
destroy other red blood cells in the human body. As
the destruction of red blood cells spills wastes, toxins,
and other debris into the blood, the human body responds
by producing fever, an immune response that speeds up
other immune defenses to fight the foreign invaders
in the blood. The fever usually occurs in intermittent
episodes, which begins with sudden headache, muscle
ache, malaise, nausea, vomiting, diarrhea, coughing,
violent chills (or what we called in Liberian the person
trembling), followed by an intense fever and then profuse
sweating. Upon initial infection with the malaria parasite,
the episodes of fever frequently last 12 hours and usually
leave an individual exhausted and bedridden. Repeated
infections with the malaria parasite can lead to severe
anemia, a decrease in the concentration of red blood
cells in the bloodstream because the malaria parasite
usually consumes or renders unusable the proteins and
other vital components of the infected person’s
red blood cells.
Untreated, the sporozoites divide repeatedly to form
30,000 to 40,000 merozoites in liver cells over the
course of one to two weeks. The colony of merozoites
departs the liver to enter the bloodstream, where they
invade red blood cells. While in the blood cells, the
merozoites multiply quickly thereby forcing the red
cells to burst, while releasing into the bloodstream
a new generation of merozoites that go on to infect
other red blood cells until serious organ failures occurs
from severe malaria. Some of the severe malaria include
cerebral malaria, meaning an abnormal behavior that
causes impairment of consciousness, seizures, coma,
or other neurologic abnormalities; hemoglobinuria or
urinating with blood due to hemolysis; cardiovascular
collapse and shock, acute kidney failure; excessive
acidity in the blood and tissue fluids, and decrease
in blood platelets), are just few examples of how malaria
can further weaken the immune system of someone who
is HIV/AIDS positive.
Considering HIV/AIDS and malaria synergistic behavior
of the body defense system and symptoms, imagine a Liberian,
your brother, sister, mother, father, husband, son,
or daughter has HIV/AIDS or he or she already has a
weakened system or 14 percent CD4 cells and is stricken
with the deadly malaria. At this point his or her immune
system will no longer recognize and fight off common
organisms. Besides malaria and HIV/AIDS working on the
body, there are other organisms that may be lying dormant
or inactive in the body already, or may invade from
the integumentary system or environment. In other words,
weakened immune system can cause an opportunity for
an opportunistic infection (a dormant parasite) to wake
up, multiply, and cause illness.
The phrase "opportunistic infections" is used
to describe illness that are in the body which could
cause any harm when the “T” cells are very
strong and healthy to the point that those with fully
functioning immune systems are almost never troubled
by these "opportunistic infections.” In terms
of "opportunistic infections” our nation
has a ton of them. HIV/AIDS have found a treasure trove
of opportunities to thrive among our tragic conditions
egged on or fueled by civil war, poverty, abuse, violence,
prejudice and ignorance. For example, it was reported
that after screening ex-combatants during the de-mobilization
process, sexually transmitted infections (STIs) prevalence
rate stood at 93 percent for male, while female prevalence
rate stood at 83 percent. And the general population
STIs prevalence rate is around 75-80 percent. In other
words, the STIs go far beyond former combatants and
touch the general population. Among the different 35-50
known STIs, herpes, gonorrhea, syphilis, Chlamydia,
and trichomoniasis were diagnosed with the general population
who were screened.
In deed, Liberia has serious health problems that challenge
all of us to provide the blueprint for elimination of
the HIV/AIDS and malaria diseases so that we can concentrate
on the bigger challenges. Malaria, together with HIV/AIDS,
STIs and TB, will not only increase the death rate in
our nation but also pose major public health challenges,
thereby undermining the development of our nation, and
fostering population extinction, so we need to take
concrete action to reverse this trend. Our future generation
and their generation are threatened because many children
with HIV infection do not only gain weight or grow normally,
but also HIV-infected children frequently are slow to
reach important mental development and milestones in
cognitive skills such as physical growth, crawling,
and walking and speaking, which are key factors that
define our social, spiritual, intellectual, environmental,
and emotional characteristics. Therefore, we must guard
our children against HIV/AIDS and malaria because as
these diseases progress in our children, the children
are likely to develop neurological problems such as
difficulty walking, dull performance in school, seizures,
and other symptoms of neurological dysfunction and disease.
We can have all the independence celebrations and elections
we want and spend 200 million dollars on the military,
but without the creative talents of all the sons and
daughters of our nation to defeat these diseases, our
military personnel won’t be strong enough to protect
our boarders, our farmers would be too weak to feed
our nation, our future generation would be too sick
to learn, our teachers too weak to teach, our employees
too weak to work, and our women too sick to bear children.
The end result would be the loss of autonomy and dependency
on other people to feed us. And if we cannot protect
our boarders, feed ourselves, and govern our nation,
we would only exist in name.
I believe, my Liberian compatriots, while we still have
eyes to see for our nation, while we still have legs
to walk for our nation, while we still have ears to
listen for our nation, while we still have minds to
think our own thoughts for our nation, and while we
still have mouths to speak power to true for our nation,
let us begin combating malaria with these divine gifts
of God and defeat it as soon as possible before it gets
out of hand. And while we still have time, let us use
these divine gifts of God to not only guarantee independence
for the next generation who are coming after us, but
to also give them the gift of life. I think anyone who
believes in the independence of Liberia and loves the
next generation of Liberians ought to join in the fight
against HIV/AIDS and malaria regardless of personal
or organizational differences. Malaria eradication in
Liberia should be the pre-requisite to channeling all
our energies in the combat of HIV/AIDS and sustaining
our nationhood and longevity. Therefore, to effectively
and efficiently combat the HIV/AIDS epidemic, malaria,
which unlike HIV/AIDS is curable, must be eradicated
so that it doesn’t continue to bring additional
pressure to bear on the healthcare sector of our country
and take money away for treating HIV/AIDS, which is
not curable at this time. Our collective and individual
action on malaria eradication is a moral imperative
and must demand resolve from us all to actively strive
for malaria free Liberia so that the God of our parentage
can reward us for our courage to reprieve ourselves
from the violence of these fragile flies that keep us
underdeveloped.
Happy Independence Day! Long live Liberia!
About the Author: Syrulwa Somah, Ph.D., is an Associate Professor of Environmental and Occupational Safety and Health at NC A&T State University in Greensboro, North Carolina. He is the author of several books, including, The Historical Resettlement of Liberia and It Environmental Impact, Christianity, Colonization and State of African Spirituality, and Nyanyan Gohn-Manan: History, Migration & Government of the Bassa (a book about traditional Bassa leadership and cultural norms published in 2003). Dr. Somah is also the Executive Director of the Liberian History, Education & Development, Inc. (LIHEDE), a nonprofit organization based in Greensboro, North Carolina. He can be reached at: somah@ncat.edu or infor@lihede.org
© 2006 by The Perspective
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