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International Health

From the Chair
Robert Black, MD MPH 

Robert BlackThe dual scourges of AIDS and tuberculosis (TB) continue to be threats to the global population. HIV/AIDS caused 1.8 million deaths in 2009 and TB another 1.3 million; 380,000 of the deaths with HIV/AIDS also had TB. There are some positive signs, as well as many remaining challenges to bring these diseases under better treatment and control. 

Nearly three decades from the recognition of the HIV/AIDS epidemic, the global incidence of disease is declining. New infections in sub-Saharan Africa were about 20% lower in 2009 than in 2001, in spite of population increases. More than 5 million people with HIV/AIDS are on treatment. This is due in large part to the President’s Emergency Fund for AIDS Relief (PEPFAR) and technical support from programs such as TSEHAI in which our faculty work with Ethiopian colleagues on prevention, diagnosis, and care of HIV/AIDS, as well as research. 

These positive developments must be balanced by the grim reality that only a third of those with HIV/AIDS meeting the current criteria are on treatment, and many programs have insufficient funds to expand access. While global incidence is declining, rates of new HIV infections are increasing in Central Asia in countries bordering on Afghanistan. Thus, the innovative HIV surveillance designed and implemented by our faculty in that country is critical to track the spread of HIV in populations at high risk.

Our faculty, working with colleagues in Peru, have developed a diagnostic test that provides a faster and more sensitive detection of multidrug resistant TB, which is globally a serious problem, especially in HIV/AIDS patients. Other faculty working in Brazil, South Africa and Zambia are developing novel approaches to prevent and treat HIV/AIDS and TB. Both HIV/AIDS and TB require sustained treatment with several antimicrobial drugs, and the involvement of family members and community health workers has been shown to be influential in assuring adherence with these treatments, further demonstrating the importance of community-based health care that was pioneered by the late Professor Carl Taylor, our distinguished alumnus Dr. Raj Arole, and other faculty and alumni of the Department.

It is exciting that PEPFAR and NIH have funded a very substantial program, the Medical Education Partnership Initiative, to build capacity in African institutions for training health workers and conducting research that will improve implementation of interventions to reduce the burden of HIV/AIDS, TB and other infectious diseases. And I am especially gratified that of the 11 program grants to the African institutions, three of these, in Ethiopia, South Africa and Uganda, asked our department to partner with them for this important effort. Progress has been made in control of these lethal and debilitating diseases, but much more is needed and global partnerships are essential to greater success.