Climate change and how it impacts human health in the context of HIV / AIDS and its associated co-morbidities in Sub-Saharan Africa
James Chrispin | jameschrispn@gmail.com
Planetary Health Campus ambassador from Catholic University of Health and Allied Sciences
BACKGROUND
Climate change is a global threat and Africa is disproportionately affected by climate change. There is an increase in temperatures, extreme weather events, food and water insecurity, diseases, socio-economic effects all relating to climate change. Increases in temperature and heavy rainfall have increased susceptibility to vector borne diseases (1), food and water insecurities have significantly affected human health in Sub-Saharan Africa and we still experience poverty, and our health infrastructure cannot respond fully to these challenges (2).
Sub-Saharan Africa carries a larger burden of HIV, accounting for more than 70% of HIV global burden and about 25.5 million people infected with HIV live in Sub-Saharan Africa (3). There were 730,000 HIV related deaths in Africa in the year 2016.
Climate change and HIV/AIDs are synergistically related which poses global public health effects which disproportionately impact regions such as Sub-Saharan Africa and Southeast Asia (4). Climate change is linked with food and water insecurity, vector borne diseases and other infectious diseases together with Non-Communicable Diseases such as Cardiovascular diseases, human migration and destruction of healthcare infrastructure which all this lead to poor health outcome, increased opportunistic and co-morbidities in people living with HIV. In particular, people with untreated HIV are more likely to suffer catastrophic consequences from secondary infections and to disseminate the virus because immunological activation increases HIV viral load (5).
Flooding, droughts, and other extreme weather events also cause human migration that increases HIV transmission and worsens outcomes for people who already have the infection. For instance, human movement leads to the expansion and extension of new sexual networks, which also fosters an environment that is favorable to substance abuse. Human migration also impacts health outcomes for persons infected with the virus by limiting access to ART and HIV care (6).
Access to HIV prevention and treatment services is impacted by the destruction of the transportation and health infrastructure caused by floods and other severe weather disasters. Due to the decreased availability of condoms and other HIV preventive services as well as the disruptions in ART access and treatment, health outcomes among individuals who are already infected are worsened (7).
Prevention in transmission control, and proper management are key players in reducing morbidity and mortality resulting from HIV/AIDs.
According to a 2019 study, drought conditions were substantially linked to riskier sex behaviors and higher HIV prevalence rates among rural females in Lesotho aged 15 to 19 (8). A 2014 research of 19 Sub-Saharan countries found that after each recent drought, the rate of new HIV infections rose by almost 11% in HIV-endemic areas (9).
Food Insecurity
Due to the strong correlation between crop production and climate variables like temperature and precipitation, such as climate change, food insecurity is intrinsically related to them (10).
HIV and food insecurity have a complicated relationship as well. Food insecurity encourages transactional sex for money or food, heightens the risk of sex without condoms and gender-based violence by escalating women’s disempowerment, and increases HIV transmission (11). It causes rural-to-urban migration and disrupts social networks. Food insecurity also fosters the use of drugs and contributes to poor mental health. The risk of vertical mother-to-child transmission is also increased among mothers who are food insecure due to malnutrition and risky infant feeding practices (12).
Vector Borne and Water Borne Diseases
Many infectious diseases, including those transmitted by vectors like Lyme disease, Dengue fever, and Malaria, as well as a number of water-borne illnesses and fungus, their epidemiology and distribution have shifted as a result of climate change (13). Those with untreated HIV infection and the immunocompromised are prone to develop serious infection from these diseases.iIt is also known that HIV-infected people who are simultaneously co-infected with malaria and other water- or insect-borne have poor health outcomes (14).
Entamoeba histolytica, Vibrio cholera, Giardia lamblia, and soil-transmitted helminths are typical diarrhea-causing organisms that may become more prevalent as a result of climate change (14). HIV co-infection is linked to considerable morbidity and death in people with diarrhea-causing infections, particularly in settings with scarce human and financial resources. Rapid and severe dehydration in these circumstances can worsen the immune system, cause acute renal failure, and raise the risk of septicemia (15).
Cardiovascular Diseases
Air pollution, extreme weather, and dietary choices all contribute to an increased risk of cardiovascular disorders brought on by climate change. Air pollution and a rise in the concentration of air pollutants cause an increase in the mortality and morbidity from cardiovascular illnesses (16).
In comparison to non-infected people, people living with HIV have a 1.5–2 times higher risk of developing CVD. Those living with HIV/AIDS have a much higher risk of developing several cardiovascular problems, such as acute myocardial infarction, heart failure, cardiac arrest, peripheral artery disease, and stroke (17).
Migration
Rising sea levels, harsh weather, conflicts due to diminishing natural resources, and food insecurity are the result of climate change and contribute to human migration (18).
Migration has led to increased sexual networks, sexual exploitation brought on by food insecurity, increased drug use, urbanization, decreased accessibility to prevention and treatment services, and decreased adherence to antiretroviral therapy are all factors that contribute to HIV transmission and poor HIV outcomes (4). Several researches indicate that immigrants, particularly seasonal or temporary immigrants, are more likely than non-immigrants to have enlarged sexual networks and participate in risky sexual behaviors.
For instance, research conducted in the area with the highest HIV prevalence in the world — the borders of South Africa, Mozambique, and Zimbabwe — have repeatedly revealed significant rates of migrant economic and sexual exploitation (19).
Poor Health Infrastructure
Increases in natural disasters and harsh weather conditions are expected to weaken the public health infrastructure already in place, especially in the world’s poorest regions where such infrastructures are already under pressure from a lack of resources, transportation, and trained personnel. (20)
Without a solid public health infrastructure, effectively delivering HIV prevention or treatment services to communities is challenging.
DISCUSSION
Climate change and HIV is having global public health concern and Sub-Saharan Africa is highly affected, there is need to set measures and strategies to minimize the effect of climate change so that to have co benefit in control of HIV/AIDS. Mitigation and adaptation measures on the use of renewable sources of energy, reducing greenhouse gas emissions, electrification of industrial processes, use of environmentally friendly diets and proper agricultural practices.
Vector control and measures to eradicate the effect of vector borne diseases such as malaria, water sources preservation.
Community awareness on the interaction between HIV and climate change, collaborations, international partnership and interdisciplinary approach is needed by engaging people from various sectors to get the desired outcome. Evaluation of policies and new policies should be implemented, for example a carbon tax.
Research and funding to understand more the interaction between HIV and climate change.
REFERENCES
1. Geirhos R, Jacobsen J-H, Michaelis C, Zemel R, Brendel W, Bethge M, et al. Shortcut learning in deep neural networks. Nat Mach Intell. 2020;2(11):665–73.
2. Anugwom EE. Reflections on climate change and public health in Africa in an era of global pandemic. Contemp Dev Perspect Int Heal Secur 2. 2021;
3. Kharsany ABM, Karim QA. HIV infection and AIDS in sub-Saharan Africa: current status, challenges and opportunities. Open AIDS J. 2016;10:34.
4. Talman A, Bolton S, Walson JL. Interactions between HIV/AIDS and the environment: toward a syndemic framework. Am J Public Health. 2013;103(2):253–61.
5. Kublin JG, Patnaik P, Jere CS, Miller WC, Hoffman IF, Chimbiya N, et al. Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: a prospective cohort study. Lancet. 2005;365(9455):233–40.
6. Voeten HACM, Vissers DCJ, Gregson S, Zaba B, White RG, de Vlas SJ, et al. Strong association between in-migration and HIV prevalence in urban sub-Saharan Africa. Sex Transm Dis. 2010;37(4):240–3.
7. Schatz JJ. Floods hamper health-care delivery in southern Africa. Lancet. 2008;371(9615):799–800.
8. Low AJ, Frederix K, McCracken S, Manyau S, Gummerson E, Radin E, et al. Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016–2017. PLoS Med. 2019;16(1):e1002727.
9. Burke M, Gong E, Jones K. Income shocks and HIV in Africa. Econ J. 2015;125(585):1157–89.
10. Wheeler T, von Braun J. Climate Change Impacts on Global Food Security. Science341: 508–513. 2013.
11. McCoy SI, Ralph LJ, Njau PF, Msolla MM, Padian NS. Food insecurity, socioeconomic status, and HIV-related risk behavior among women in farming households in Tanzania. AIDS Behav. 2014;18:1224–36.
12. De Vogli R, Birbeck GL. Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. J Heal Popul Nutr. 2005;105–20.
13. Ebi KL. Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030. Global Health. 2008;4(1):1–9.
14. Von Seidlein L, Wang X, Macuamule A, Mondlane C, Puri M, Hendriksen I, et al. Is HIV infection associated with an increased risk for cholera? Findings from a case–control study in Mozambique. Trop Med Int Heal. 2008;13(5):683–8.
15. Lew EA, Poles MA, Dieterich DT. Diarrheal diseases associated with HIV infection. Gastroenterol Clin North Am. 1997;26(2):259–90.
16. Jacobsen AP, Khiew YC, Duffy E, O’Connell J, Brown E, Auwaerter PG, et al. Climate change and the prevention of cardiovascular disease. Am J Prev Cardiol. 2022;100391.
17. Barnes RP, Lacson JCA, Bahrami H. HIV infection and risk of cardiovascular diseases beyond coronary artery disease. Curr Atheroscler Rep. 2017;19:1–9.
18. Malcolm JR, Markham A, Neilson RP, Garaci M. Estimated migration rates under scenarios of global climate change. J Biogeogr. 2002;29(7):835–49.
19. Crush J. Linking Migration, Food Security and Development, 2012. 2012;
20. Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD. Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS Behav. 2010;14:778–84.
