MDG6: Combat HIV/AIDS, malaria and other diseases - Professor John Porter, LSHTM Tue, 2009-06-30 02:02

Progress is being made to achieve the targets for MDG 6 but there is more work to be done. Global trends for HIV show that the epidemic is beginning to plateau but the need for treatment and prevention continues to outpace current interventions. Malaria interventions with bed-nets and appropriate anti-malarial treatment for children under five are making inroads into reducing deaths. The global incidence of tuberculosis (TB) is levelling off but TB control strategies (DOTS) will need to be accelerated in sub-Saharan Africa and the Commonwealth of Independent States (CIS) if the global targets are to be achieved by 2015. Important themes of poverty, health systems and inter-sectoral collaboration are emerging as foci for future approaches to communicable disease control strategies. These interlinking themes will help to relate each of the MDGs to the overall goal of improving health worldwide.

Millennium Development Goal 6: Combat HIV/AIDS, malaria and other diseases

Professor John Porter, of the London School of Hygiene and Tropical Medicine (LSHTM), referred to certain progress in addressing HIV/AIDS, malaria and tuberculosis when he spoke at LIDC’s conference on 5 November. His review of MDG6, which aims to combat HIV/AIDS, malaria and other diseases , also highlighted the opportunities to integrate disease control with other MDG efforts, including poverty reduction. He said: “Communicable diseases are a very useful lens with which to look at broader public health issues”.

At the event called No Goals at Half-time: What Next for the Millennium Development Goals?, Porter compared MDG6’s targets with progress so far. The targets are to halt and begin to reverse the spread of HIV/AIDS, to achieve universal access to treatment for HIV/AIDS by 2010, and to halt and begin to reverse the incidence of malaria and other major diseases, including tuberculosis.

HIV/AIDS
Porter detailed the gravity of the HIV/AIDS epidemic and how, despite progress, the need for treatment and prevention continues to outpace current interventions. World Health Organization figures estimate 33.2 million people were living with HIV worldwide in 2007, including 22.5 million in southern Africa. According to UNAIDS there were 1.7 million new HIV infections in 2007 and 32 per cent of these were in southern Africa. Porter showed how global trends for HIV illustrate that the epidemic is beginning to plateau. UNAIDS data from 2007 claim a reduction of 16 per cent in global prevalence compared to 2005 due to a revision of global epidemiological statistics and HIV prevention efforts. The target to achieve universal access to treatment for HIV/AIDS by 2010 with a rollout of antiretroviral therapies (ART) was “not achievable” but nevertheless provided a focus for action. He said this reflected the “inappropriate” nature of the targets, one of the “intrinsic problems” with MDG6.

Malaria
The figures quoted when referring to malaria were also stark. In 2006 3.3 billion people were at risk of catching malaria and 881,000 people died. Overall, 80 per cent of the estimated 247 million episodes of malaria were from 13 countries in Africa. Yet interventions, including insecticide treated bed-nets, anti-malarial drugs, indoor spraying of insecticides and preventative treatment in pregnancy are having an impact. Tanzania, for example, is on track to meet the MDG6 malaria target as the number of cases per 100,000 has fallen dramatically from 500,000 in 2000 to 65,745 in 2005. Porter cited a UNDP statement on malaria which maintains that such “control efforts are paying off, but additional effort is needed”.

Tuberculosis
The analysis showed TB’s prevalence and mortality are falling, but the Stop TB Department at the World Health Organization says they need to fall faster to meet the MDG6 targets. Porter showed how TB and HIV are intimately associated with each other and how TB also closely overlaps with poverty by drawing on a recent study which shows the incidence of TB would be reduced by 34 per cent if malnutrition was removed from the equation. He illustrated the relative importance of the Directly Observed Treatment, Short-course (DOTS) approach to TB control and highlighted the encouraging treatment success rate, which is 84.6 per cent globally and 76 per cent in Africa (according to the Stop TB Partnership). Yet the presentation also emphasised that these strategies will need to be accelerated in sub-Saharan Africa and the Commonwealth of Independent States (CIS) if the global targets are to be achieved by 2015.

Links with other MDGs
Porter encouraged a cross-sectoral approach to the MDGs because of their interlinked nature, particularly between health, poverty, social justice and equity. He set out how elements within the target to halt and begin to reverse the spread of HIV/AIDS are closely related to education (MDG2) as they concern school attendance of orphans aged 10-14 years and the comprehensive correct knowledge of HIV/AIDS by 15-24-year-olds. Porter also discussed the synergy between TB and poverty (MDG1) and between combating malaria and improving child survival (MDG4). He asked whether such links are being used “appropriately”.

Professor John Porter trained in paediatrics and public health medicine in London and at the Centers for Disease Control and Prevention in the United States. He is affiliated to both the Clinical Research Unit, and the Health Policy Unit at LSHTM and he teaches courses on infectious disease control, ethics and policy. He is currently the director of the TARGETS research consortium, one of the DFID-funded research programmes on communicable diseases.