THE INCREASED BURDEN OF GLOBAL ENVIRONMENTAL CHANGE ON HIV/AIDS MORBIDITIES AND MORTALITY AMONG FARMERS IN MUFINDI DISTRICT, IRINGA REGION, TANZANIA
James Chrispin¹, Kerario Mwita², Goodluck Nchasi¹
¹ Department of Public Health, Catholic University of Health and Allied Sciences, Tanzania
² Department of Epidemiology and Global Health, Umea University, Sweden
Correspondence to jameschrispn@gmail.com: Planetary Health Campus ambassador and chairperson of Planetary Health Club from Catholic University of Health and Allied Sciences
INTRODUCTION
Global environmental change has directly and indirectly affected human health and diseases dynamics. Changes in weather patterns have been associated with emergence and increased transmission of vector-borne diseases and water- borne diseases such as diarrhea, malnutrition, non-communicable and infectious diseases, physical injuries, and mental health impacts resulting from extreme weather events (1)(2). Healthcare systems, which are the main defense against these health effects resulting from climate change, have also been affected and destroyed by the impacts of global environmental change, such as floods. About 13 million annual deaths are linked to modifiable environmental factors such as air, water and soil pollution, chemical exposure, ultra violet radiation and climate change, which is 23% of all deaths globally (3). At the same time HIV, the virus that causes acquired immunodeficiency syndrome (AIDs), is a major global health challenge. HIV has infected over 75 million people since its first reported case in 1981. Globally 38 million people are living with HIV and over 39 million deaths total were due to HIV since 1981 (4)(5). Climate change threatens the global response to HIV. It interferes with HIV treatment and prevention services, exacerbates food insecurities, increases forced migration, and destroys healthcare infrastructure (6). Climate change has increased susceptibility to comorbidities and opportunistic infections that worsen and cause poor outcomes in people living with HIV (6). These factors in turn pose increased risks to HIV infection and communities are prone to suffer more from HIV burden. Climate change and HIV are two global crises that have synergistic effects on each other and require combined interventions.
Sub-Saharan Africa is disproportionately impacted by HIV and carries more than 70% of the global burden; about 25.5 million people infected with HIV are in Sub-Saharan Africa (7). Tanzania is among the countries with the largest HIV burden, whereby 1.7 million people were living with HIV in the year 2019 and the prevalence of HIV was 5.1% of Tanzania’s total population (8). In developing countries, climate change’s impact on communities and HIV control are influenced by vulnerability factors including poverty, cultural beliefs and geographical location. This makes developing countries, particularly Tanzania, more impacted as they experience the double burden of both HIV and climate change.
SOCIODEMOGRAPHICS OF MUFINDI
Mufindi District, encompassing 6,710 km² of land, is in the southern part of Iringa Region, bordering Kilolo District to the northwest, Iringa District to the north, Njombe Region to the south, and Mbeya Region to the west. As of 2012, Mufindi District has a population of approximately 265,830, with an annual growth rate of 0.7% since 2002. The population constitutes more women (52.6%) compared to men (47.4%). Mufindi’s population is quite youthful; an estimated 44% of the population is below the age of 15 years, nearly 33% is aged 15−35 years, and less than 5% is above 65 years. This implies a young and growing labor force. Nevertheless, there is a higher percentage of young people ages 15−35 in urban areas (41%) than in rural areas (32%), likely due to male emigration to urban areas in search of work. Approximately 51% of the Mufindi District population is of working age (15−65). The working-age population is also concentrated in urban areas, pushing the district’s dependency ratio higher. Literacy levels within the district sat at 79% in 2012 and had increased by 5% since 2002. Approximately 15% more men than women are literate as a result of limited family funds for schooling and lower valuation of women’s education.
THE SITUATION OF HIV INFECTION IN IRINGA AND PARTICULARLY MUFINDI DISTRCIT, AND ITS IMPACT ON FARMERS
HIV is a problem in the Iringa region, particularly in the Mufindi district. According to National Aids Control Program reports (2007) on HIV/AIDS, the Iringa region had the highest prevalence of HIV among all regions in Tanzania, with a prevalence of 15.7% well above the National average prevalence of 6%, according to the Tanzania HIV/AIDS and Malaria Indicator Survey (URT, 11) in 2008. In the Mufindi district, the prevalence of HIV/AIDS is estimated to be as high as almost 14%. A big reason for this is the enormous immigration labor force that is required for agricultural activities, as they fail to seek proper treatment at Care and Treatment Clinic (CTC) for HIV and a lack of access to HIV treatment and preventive services. Decreased precipitation and an increase in average temperature have led to decreased agricultural production, which in turn has led to immigration of labor force. Farming and agriculture are the main economic activities in Mufindi, most of which are carried out by small scale, seasonal farms.
Another reason for high prevalence of HIV in Mufindi is increased stigmatization and risk behaviors such as overconsumption of illicit drugs and alcohol, transactional sex for money and food, unsafe sex practices, and having multiple sexual partners which increases the risk of acquiring HIV/AIDS among locals
PATHWAYS CONNECTING CLIMATE CHANGE AND HIV/AIDS
- CLIMATE CHANGE IMPACT ON THE HEALTH SYSTEM
The healthcare sector is the main driver in HIV prevention and treatment, while at the same time extreme weather events such as flooding and storms are destroying healthcare facilities’ infrastructure, supply chains of essential medication, and accessibility of HIV preventive services (9). Flooding destroyed public infrastructure and transportation and caused the loss of CTC cards which interfered with follow-up and clinic visits among people living with HIV (10). Reported flooding in Namibia has destroyed more than 30 government healthcare facilities and 41 private health facilities, and 23% of people living with HIV were reported to lack access to antiretroviral therapy services due to floods (11).
2. FORCED MIGRATION
People were forced to migrate to other areas due to flooding, droughts, and other extreme weather events relating to climate change. Migration of people has a risk of increasing HIV transmission and decreasing health outcomes for those living with HIV as they miss proper visits to a CTC clinic, thereby negatively affecting access to HIV care and treatment services (12)(13).
3. FOOD INSECURITY
Food insecurity results from drought, floods, extreme weather events, and other climatic factors such as temperature and precipitation variabilities (14). This result decreases food availability and crop production. Food insecurity can drive transactional sex for money and food together with other forms of gender violence that predispose them to develop HIV (15)(16). Lacking access to essential nutrients is associated with poor outcomes in individuals with HIV and increased HIV-related morbidity and mortality (17). It is also associated with malnutrition and a high risk of vertical transmission from mother to child (18).
4. CLIMATE CHANGE RELATED COMORBIDITIES AND OPPORTUNISTIC INFECTIONS
Climate-related vector-borne diseases such as malaria and dengue and water-borne diseases including diarrhea and zoonotic diseases can cause severe complications in individuals with HIV (19). People living with HIV are immunocompromised and are more vulnerable to these kinds of diseases compared to the general population. Opportunistic infection and outbreaks of fungal infections such as cryptococcosis, pneumocystis, and histoplasmosis are related to environmental changes such as decreased precipitation and increased temperature (20). The reason behind this is increased fungal spore traveling and higher rates of transmission. This can have serious consequences for immunocompromised people and further increase their risk of infection.
OBJECTIVES
- A call to conduct research focusing on HIV infection among the farmer’s population in the Mufindi area.
- To promote policy formulation to risk practices among seasonal migrant farmers which increases the risk of HIV transmission
CONCLUSION
Global environmental change has a direct impact on infectious diseases, including HIV. Therefore, there is a need to integrate environmental measures into ongoing HIV programs. Food insecurity, migration, and poor mental health which result from global environmental change, need to be taken into consideration as they cause poor outcomes in people living with HIV and increase HIV transmission.
Author: James Chrispin
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