1. Geography of Disease

2. Vocabulary Epidemic : when new cases of a certain disease exceed the “normal” amount – restricted to one locale Pandemic : an epidemic that spreads to other countries or continents

6. 20 th Century Experts thought we were “done” with widespread disease Improved medical establishments, hygiene standards, drugs, etc.

7. Were we “done”? 1990s - World Health Organization (WHO) Infectious diseases claiming more lives Diseases that had been in decline are now resurgent Why not?

12. Urban and agricultural expansion into previously wild habitats Intense farming methods (larger population = larger “herd” to support the pathogens) Deforestation (ideal conditions for mosquitos and other carriers to breed) Globalization (world is increasingly interconnected)

13. HIV/AIDS in Africa

14. HIV/AIDS AIDS (Acquired Immune Deficiency Syndrome) – disease that weakens the immune system HIV (Human Immunodeficiency Virus) – the virus that causes AIDS A person can live with HIV for years before becoming ill with the disease HIV is exchanged through sexual intercourse, sharing a needle, unscreened blood transfusions, and pregnancy.

15. Pandemic At the end of 2001, 40 million people were estimated to be living with HIV/AIDS 70% of those infected live in Sub-Saharan Africa, with the largest concentration in eastern and southern Africa

17. Why Africa? Disease is hypothesized to have originated in Africa Lack of leadership (denialism/ignoring the problem) Not a single African head of state attended the 11 th international conference on AIDS in Zambia in 1999 (not even the president of Zambia) Medical suspicion Economic factors “Brain Drain”

18. Results of AIDS Pandemic Orphans Families struggle to provide for the sick Purchase expensive medications (if available) Social stigma

19. The Story of Uganda In the early 1990s, 18% of the population was estimated to be living with HIV/AIDS In 2001, it was estimated that 6.5% of the population was now infected How?

20. Yoweri Museveni

21. HIV/AIDS was one of his national priorities Strongly supported education on both the disease and how it’s transmitted

22. Results (UN report) 98% of Ugandans know that HIV is transmitted mainly through sex The proportion of young people aged 15-19 who have not had sex rose from 20% in 1990 to 50% in 1995 Use of condoms rose from 15% (boys) and 7% (girls) in 1989 to 36% (boys) and 25% (girls).

23. A Cure Antiretovirals (ARTs) – a combination of drugs that prolongs the length and quality of life for those living with HIV/AIDS Most effective combination of ARTs = $10,000 a year per patient Uganda’s per capita income = $1,200 a year

24. Lowering the Cost Many blame drug companies for not being willing to sacrifice lower profits in order to lower their prices Drug companies maintain that the cost of ARTs reflects the true cost of researching and producing the drugs Drug companies are protected by international trade agreements and cannot be forced to sell their drugs for less

25. Moral Obligation India, Brazil and South Africa have ignored the patents protecting the original drug developers and have begun to copy and produce these drugs locally with no payments to the original drug companies ARTs produced in these countries = $300 per year This is in violation of international trade and property protection agreements – but is it worth it?

26. What do you think? Are these countries justified in breaking the patents of international drug companies? Do the 600,000 HIV/AIDS victims in Uganda have a right to drugs that would prolong and increase the quality of their lives?

27. Your Turn Write a letter to a major drug company that produces ARTs. In this letter, either support or challenge the position of major drug companies in protecting their product in Africa, Asia and Latin America. In addition to addressing the ethical issues, be sure to detail what you consider to be the major financial and logistical issues involved in providing ARTs to patients in countries like Uganda.