Appropriate Responses To Infectious Disease Anthropology 393 – Cultural Construction of HIV/AIDS Josephine MacIntosh 4/16/2017

Modes of Disease Transmission Vector-borne: transmitted via non-human hosts such as mosquitos, lice, fleas etc West Nile virus Avian influenza Malaria Typhus Bubonic plague (McGrath, 1991) plague, West Nile 4/16/2017

Modes of Disease Transmission Direct contact: transmitted via respiration, fecal-oral contact or sexual contact (there is no non-human vector) Measles Syphilis Most influenzas Chickenpox HIV/AIDS (McGrath, 1991) plague, West Nile 4/16/2017

Modes of Disease Transmission Environmental contamination: transmitted via contact with pathogens living in food, water, air, or on items such as contaminated clothing or needles Cholera Typhoid Salmonella HIV/AIDS (McGrath, 1991) 4/16/2017

Recall… with HIV Blood transfusion is the most efficient route for HIV infection Sexual transmission is the most common route for HIV infection Most HIV/AIDS transmissions are the result of direct contact, although some infections are the result of environmental contamination (e.g. dirty needles) 4/16/2017

Case Reproduction The degree to which secondary cases are generated from primary cases depends on the transmission efficiency of the infectious agent Transmission efficacy is an expression of the probability that an uninfected, susceptible individual will come in contact with an infected individual, multiplied by by the possibility that transmission will occur during such contact (Anderson, 1996) 4/16/2017

Recall… Classical epidemic curve is bell-shaped Steepness of slope is a measure of infectivity or contagion Length of the curve describes duration of epidemic Highly infectious diseases (like measles): Short period of infectiousness (generally 2 weeks) Relatively short duration (typically 6 months to a year) 4/16/2017

But… Not so with HIV/AIDS Marked by elongated curve Lengthy period of infectivity, enduring over generations Several distinct peaks As it moves through different populations (MSMs, IDUs, etc) 4/16/2017

Appropriate Biological Responses Elimination of the source of infection Including vector populations, pathogenic organisms, sources of environmental contaminants Elimination of adequate contact Between sources of infection, susceptible hosts and susceptible vectors Reducing infectivity Of vectors, hosts, or environments Reducing host susceptibility (McGrath, 1991) 4/16/2017

Appropriate Social Responses Appropriate: cause little social disruption Inappropriate: cause much social disruption Inappropriate responses may increase the biological impact by increasing incidence of disease Common social responses Flight Adoption of extraordinary measures Scapegoating, social ostracism (McGrath, 1991) 4/16/2017

Improve Public Health Biologically appropriate interventions: Eliminate source of infection and/or Eliminate contact with source and/or Reduce infectivity and/or Reduce susceptibility Socially appropriate interventions: Limit social and economic disruption Promote stability along prevention/care continuum 4/16/2017

Appropriate Responses? Eliminate source of infection Genocide of those infected Eliminate contact with source Use of latex condoms Universal precautions Partner notification Restrict travel, impose quarantine, or jail terms Mandatory testing, involuntary follow-up testing Deny traditional rituals like funerals & marriage 4/16/2017

Appropriate Responses? Reduce infectivity Large scale distribution of drugs, as proposed in the World Health Organization ‘3 by 5’ plan (WHO, 2003) See: http://www.who.int/3by5/en/ Provision of vaccines (when they become available) to ‘at risk’ populations (WHO, 2003) Reduce susceptibility Dietary supplements (i.e. selenium) See: Foster, Harold (2001). “What Really Causes AIDS”. Trafford: Victoria. Online: www.hdfoster.com/WhatReallyCausesAIDS.pdf 4/16/2017