Global and National Declines in Life Expectancy: An End-of-2021 Assessment

Timely, high-quality mortality data have allowed for assessments of the impact of Covid-19 on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by .92 years between 2019 and 2020 and by another .72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed in rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the HIV/AIDS pandemic.

Total elbow arthroplasty for active primary tuberculosis of the elbow: a curious case of misdiagnosis

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pandemic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%–5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative synovial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts post total elbow arthroplasty (TEA). Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good functional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should investigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.

From Internationalism to Nationalism

The steady rollout of Covid-19 vaccines comes attached with a series of difficult questions. Are vaccines a human right? Should patents be enforced in a way that puts people in the global South behind in a global queue? These questions are not new; the world struggled with these ethical dilemmas during the HIV-AIDS pandemic at the end of the twentieth century, when global South governments led by Nelson Mandela fought multinational pharmaceutical corporations for the right to essential life-saving drugs. Can the same strategies be mobilized to deal with inequalities in the distribution of the Covid-19 vaccine? This article demonstrates a technological and geopolitical shift in the last two decades that hinder global South solidarities actualized during the HIV-AIDS pandemic. Instead, Banerjee argues that in the present, multinational corporations and Euro-American governments are trying to reverse some of the key political visions and victories of HIV-AIDS internationalism, exploiting the urgency of the Covid-19 crisis to put in place a new vaccine apartheid.

Signature changes in gut microbiome are associated with increased susceptibility to HIV-1 infection in MSM

Background Men who have sex with men (MSM) have been disproportionately affected by HIV-1 since the beginning of the AIDS pandemic, particularly in the USA and Europe. Compared to men who have sex with women (MSW), MSM have a distinct fecal microbiome regardless of HIV-1 infection. However, it is unclear whether the MSM-associated gut microbiome affects the susceptibility and progression of HIV-1 infection. We studied fecal microbiome profiles, short-chain fatty acids, and blood plasma inflammatory cytokines of 109 HIV-1 seroconverters (SC) from the early, 1984–1985 phase of the HIV-1 pandemic in the Multicenter AIDS Cohort Study (MACS) before and after HIV-1 infection compared to 156 HIV-1-negative MACS MSM (negative controls [NC]). Results We found that family Succinivibrionaceae, S24-7, Mogibacteriaceae, Coriobacteriaceae, and Erysipelotrichaceae were significantly higher (p<0.05), whereas Odoribacteraceae, Verucomicrobiaceae, Bacteroidaceae, Barnesiellaceae, and Rikenellaceae were significantly lower (p<0.05), in SC before HIV-1 infection compared to NC. At the species level, Prevotella stercorea, Eubacterium biforme, and Collinsella aerofaciens were significantly higher (p<0.05), and Eubacterium dolichum, Desulfovibrio D168, Alistipes onderdonkii, Ruminococcus torques, Bacteroides fragilis, Bacteroides caccae, Alistipes putredinis, Akkermansia muciniphila, Bacteroides uniformis, and Bacteroides ovatus were significantly lower (p<0.05) in SC before HIV-1 infection compared to NC. After HIV-1 infection, family Prevotellaceae and Victivallaceae and species Bacteroides fragilis and Eubacterium cylindroides were significantly higher (p<0.05) in SC who developed AIDS within 5 years compared to the SC who were AIDS free for more than 10 years without antiretroviral therapy (ART). In addition, family Victivallaceae and species Prevotella stercorea, Coprococcus eutactus, and Butyrivibrio crossotus were significantly higher (p<0.05) and Gemmiger formicilis and Blautia obeum were significantly lower (p<0.05) after HIV-1 infection in SC who developed AIDS within 5–10 years compared to the SC who were AIDS-free for more than 10 years without ART. Furthermore, plasma inflammatory cytokine levels of sCD14, sCD163, interleukin 6, and lipopolysaccharide binding protein were significantly higher in SC with p<0.05 before HIV-1 infection compared to NC. Conclusions Our results suggest that pathogenic changes in the gut microbiome were present in MSM several months prior to infection with HIV-1 in the early phase of the AIDS pandemic in the USA. This was associated with increased inflammatory biomarkers in the blood and risk for development of AIDS.

The Influence of Parenting Style and Parent Educational Level on Perception of HIV/AIDS Pandemic among Secondary School Students in Calabar Educatioin Zone, Cross River State, Nigeria

The study sought to determine the extent to which parenting style and parental educational level influence perception of HIV/AIDS pandemic among secondary school students in Calabar Education Zone. Ever since the discovery of HIV/AIDS, concerted efforts have been made by international bodies, agencies, the government etc., to curb the scourge of the malignant virus. This effort has made many to know the potential threat the epidemic possess to human existence. However, in spite of these efforts, many students still perceive HIV/AIDS as a mirage that does not exist. Perception of HIV/AIDS refers to the amount of knowledge about causes, mode of transmission, prevention and treatment, possessed (especially intuitive), on HIV/AIDS. The main purpose of this study was to determine the influence of parenting style and educational level on perception of HIV/AIDS pandemic among secondary school students in Calabar Education Zone. The population of this study comprised of all the SS1, 2 & 3 Students and 1,200 students randomly selected as sample for this study. Data collection instrument was a facts finding questionnaire titled family variables and students perception of HIV/AIDS’ (FVSPA). The major findings were that; parenting style has significant influence on students’ perception of HIV/AIDs. Parental educational level has significant influence on students’ perception of HIV/AIDs. It was recommended that the school management in collaboration with the school guidance counsellors should frequently use forums such as PTA’s to organize trainings in order to sensitize parents on the adoption of most appropriate style of parenting for their children.

Christian Advocacy Ministry on Pandemics: The Ghanaian Example on HIV/AIDS

The study is an examination of the various Christian advocacy approaches that the church in Ghana has adopted in its role in the fight against the AIDS pandemic. The study seeks to make the Ghanaian experience available for Christian advocacy ministry for other pandemics. The study as a qualitative one focused on library research. Available primary and secondary materials on the church’s participation in the AIDS pandemic were examined and analyzed. Much attention was paid to reports, addresses, study materials and policy documents on the pandemic by the World Council of Churches, Christian Council of Ghana and the Presbyterian Church of Ghana. The study has observed that provision of leadership, capacity building of church leaders, education and awareness creation, the relevance of the Christian message of hope in a moment of despair and Christian advocacy ministry have made significant contributions to the Christian advocacy on the HIV/AIDS in Ghana. The study further provides insights for studies in church and society and the construction of public theology on pandemics in African Christianity. Keywords: Advocacy Ministry, Pandemics, Capacity Building, Church Leadership

Retroviral Infections of the Nervous System

Retroviruses are a family of RNA viruses that replicate by reverse transcription. The family includes HIV and human T-lymphotropic virus. This chapter reviews neurologic manifestations of these retroviruses. A retrovirus in the genus Lentivirus, HIV has 2 forms, HIV-1 and HIV-2. HIV-1 is associated with the global AIDS pandemic, whereas HIV-2 causes an AIDS-like illness primarily in West Africa, although pockets of infection exist globally.

Reversing the Tide

The tide turned in public health due to the fight for AIDS treatment access around the world. While prevention, not treatment was the focus of most health interventions in the 20th century, based on this SPHC model, AIDS resulted in a reversal of the gains made in the child survival revolution. Entire communities collapsed under the weight of AIDS which struck down mothers, fathers, teachers, farmer, and health workers. This chapter focuses on the AIDS pandemic, beginning in the 1980s, and traces the global spread of this deadly disease. Importantly, the chapter covers the emergence of the movement of people living with AIDS both in accelerating the discovery of antiretroviral and as a movement that focused the right to health for all. It is the force of this movement that resulted in novel funding of global health.

Combating workplace discrimination on the basis of HIV status through disability law in Zambia

Zambia has within the last two decades enacted several pieces of legislation aimed at enhancing equality in the labour market and the workplace. However, despite being one of the countries that has been severely devastated by the HIV/AIDS pandemic, Zambia does not yet have specific legislation targeted at HIV-related stigma and discrimination in the labour market and workplace. Apart from the general prohibitions against discrimination on the basis of health or social status, it remains to be seen whether concepts such as reasonable accommodation have a place in the fight against discrimination and stigma of HIV/AIDS in the Zambian workplace. The purpose of this article is not to argue for the enactment of HIV/AIDS specific legislation in Zambia but to instead argue that despite the absence of such legislation, HIV/AIDS discrimination and stigma can be addressed within the context of the Country’s existing disability discrimination law. The arguments advanced in this article are considered largely within the context of the Zambian High Court case of Stanley Kingaipe & Another v The Attorney General.