[vc_row][vc_column width=”1/2″][text_output]North America has an amazing, unique diversity of vertebrates, ranging from birds to mammals but also reptiles and amphibians. Sadly some members of these groups are being hit hard by several emerging infectious diseases that have led to massive declines and extinctions. Diseases caused by fungal agents are some of the most well-known culprits.
Bats in Canada and North America are being decimated by an introduced Eurasian fungus called Pseudogymnoascus destructans that causes a disease known as White-nose syndrome (Warnecke et al., 2012). This fungus attacks bats during hibernation and millions upon millions of bats have already died of the disease. The first study on treating the fungus with probiotics, a bacteria that inhibits the growth of the fungus, on living bats, seems to be promising.
Snakes in North America aren’t safe either. Another fungus, Ophidiomyces ophiodiicola, now dubbed as “Snake fungal disease” is eating the skin of snakes (keratin) and mortality rates are extremely high (Allender et al., 2015). See Snake Fungal Disease page for more info.
The most well-known fungal disease affecting wildlife is, of course, the chytrid fungus Batrachochytrium dendrobatidis or simply Bd which has led to enormous declines and extinctions of frogs and neotropical salamanders in the Americas, Australia and other places on the globe in the past decades (Berger et al. 1998). Bd has been called the most devastating wildlife disease ever and in 2013 we learned that it has a close relative that also has a deadly appetite for amphibians: salamanders to be exact.
Scientists from Ghent University Belgium identified a novel chytrid fungus in 2013 (Martel et al., 2013). They named it Batrachochytrium salamandrivorans (Bsal): the eater of salamanders. They traced its origins back to Asia where it co-evolved with the local salamander fauna for millions of years. Meaning, salamanders in Asia have adapted to the fungus. However, via the international pet trade Bsal hitched a ride to Europe where it made its way into Dutch fire salamander populations. This salamander species, as are all European newts and salamanders, are naive to the pathogen and die quickly when infected (Martel et al. 2014). Some of their American counterparts also appeared to be highly susceptible to the disease.
The pathogen is now spreading from its initial entry points in the Netherlands to Belgium and possibly other nearby countries. With North America being the salamander capital of the world (nearly 50% of all salamanders occur in North America) scientists fear that if Bsal is introduced in the Americas it will wreak havoc on a truly epic scale. But for the first time ever we have a chance to stop this from happening and with no mitigation or cure for Bsal in wild, infected populations this is a very welcome scenario indeed!
Yap et al. (2015) published their findings and recommendations on preventing Bsal from entering North America in Science. The authors created a map using a predictive model where they identified suitable habitat for Bsal and overlapped this with areas with high salamander diversity. The most important high-risk zones are the SouthEastern US (Appalachian mountains), the Pacific Northwest, the Sierra Nevada mountain range, and the highlands of Central Mexico. In addition, they identified the most likely entry points of Bsal, five US ports (Los Angeles, Tampa, New York, Atlanta, and San Francisco. All are very near to these vulnerable zones. From 2010 until 2014, 779,002 salamanders (of which 99% from Asia) came through these ports. Three Asian newts species have been identified as carriers of Bsal: blue-tailed fire-bellied newt (Cynops cyanurus), Japanese fire-bellied newt (Cynops pyrrhogaster), and the Tam Dao salamander (Paramesotriton deloustali). These two genera contribute for 91% of salamanders imported to North America.
Yap and her colleagues call for an immediate ban of salamander imports to North America. Protocols to stop Bsal have to be established and implemented first. For the time being a stop of salamander imports could have a very positive effect of introducing the disease. This could very well be a chance for us, like the title of the Science paper says, to avert a North American biodiversity crisis!
By Tariq Stark
Allender M.C., Raudabaugh D.B., Gleason F. H. , Miller A.N. 2015. The natural history, ecology, and epidemiology of Ophidiomyces ophiodiicola and its potential impact on free-ranging snake populations. Fungal Ecology
Berger, L., Speare, R., Daszak, P., Green, D. E., Cunningham, A. A., Goggin, C. L., Slocombe, R., Ragan, M. A., Hyatt, A. D., McDonald, K. R., Hines, H. B., Lips, K. R., Marantelli, G., and Parkes, H. 1998. Chytridiomycosis causes amphibian mortality associated with population declines in the rain forests of Australia and Central America. Proceedings of the National Academy of Sciences, USA. 95: 9031-9036.
Martel, A.; Spitzen-van der Sluijs, A.; Blooi, M.; Bert, W.; Ducatelle, R.; Fisher, M. C.; Woeltjes, A.; Bosman, W.; Chiers, K.; Bossuyt, F.; Pasmans, F. (2013). “Batrachochytrium salamandrivorans sp. nov. causes lethal chytridiomycosis in amphibians”. Proceedings of the National Academy of Sciences of the United States of America 110 (38): 15325–15329.
T. A. Yap, M. S. Koo, R. F. Ambrose, D. B. Wake, V. T. Vredenburg. Averting a North American biodiversity crisis. Science, 2015; 349 (6247): 481 DOI: 10.1126/science.aab1052
Warnecke L, Turner JM, Bollinger TK, et al. Inoculation of bats with European Geomyces destructans supports the novel pathogen hypothesis for the origin of white-nose syndrome. Proceedings of the National Academy of Sciences of the United States of America. 2012;109(18):6999-7003. doi:10.1073/pnas.1200374109.
Yap, T.A., Koo, M.K., Ambrose, R.F., Wake, D.B., Vredenburg, V.T. 2015. Averting a North American biodiversity crisis. Science.[/text_output][/vc_column][vc_column width=”1/2″][text_output]Above: Photo © Sara Viernum[/text_output]
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HIV-related stigma and discrimination refers to prejudice, negative attitudes and abuse directed at people living with HIV and AIDS. In 35% of countries with available data, over 50% of people report having discriminatory attitudes towards people living with HIV.1
Stigma and discrimination also makes people vulnerable to HIV. Those most at risk to HIV (key affected populations) continue to face stigma and discrimination based on their actual or perceived health status, race, socioeconomic status, age, sex, sexual orientation or gender identity or other grounds.2
Stigma and discrimination manifests itself in many ways. Discrimination and other human rights violations may occur in health care settings, barring people from accessing health services or enjoying quality health care.3 Some people living with HIV and other key affected populations are shunned by family, peers and the wider community, while others face poor treatment in educational and work settings, erosion of their rights, and psychological damage. These all limit access to HIV testing, treatment and other HIV services.45
The People Living with HIV Stigma Index documents the experiences of people living with HIV. As of 2015, more than 70 countries were using the HIV Stigma Index, more than 1,400 people living with HIV had been trained as interviewers, and over 70,000 people with HIV have been interviewed.6 Findings from 50 countries, indicate that roughly one in every eight people living with HIV is being denied health services because of stigma and discrimination.7
Why is there stigma around HIV and AIDS?
Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side. Every time AIDS has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human solidarity, and the human perseverance to find new paths and solutions.
- Michel Sidibé, Executive Director of UNAIDS8
The fear surrounding the emerging HIV epidemic in the 1980s largely persists today. At that time, very little was known about how HIV is transmitted, which made people scared of those infected due to fear of contagion.
This fear, coupled with many other reasons, means that lots of people falsely believe:
- HIV and AIDS are always associated with death
- HIV is associated with behaviours that some people disapprove of (such as homosexuality, drug use, sex work or infidelity)
- HIV is only transmitted through sex, which is a taboo subject in some cultures
- HIV infection is the result of personal irresponsibility or moral fault (such as infidelity) that deserves to be punished
- inaccurate information about how HIV is transmitted, which creates irrational behaviour and misperceptions of personal risk.9
How stigma affects people living with HIV
My daughter refused to go hospital to receive medicines. My daughter died because of the fear of stigmatization and discrimination
- Patience Eshun from Ghana, who lost her daughter to an AIDS-related illness10
HIV-related stigma and discrimination exists worldwide, although it manifests itself differently across countries, communities, religious groups and individuals. In sub-Saharan Africa, for example, heterosexual sex is the main route of infection, which means that HIV-related stigma in this region is mainly focused on infidelity and sex work.11
Research by the International Centre for Research on Women (ICRW) outlines the possible consequences of HIV-related stigma as:
- loss of income and livelihood
- loss of marriage and childbearing options
- poor care within the health sector
- withdrawal of caregiving in the home
- loss of hope and feelings of worthlessness
- loss of reputation.12
HIV stigma and key affected populations
Stigma and discrimination is often directed towards key affected populations such as men who have sex with men (sometimes referred to as MSM), people who inject drugs and sex workers.
These people are increasingly marginalised, not only from society, but from the services they need to protect themselves from HIV. For example, in 2016, 60% of countries in the European Economic Area reported that health care professionals’ negative and discriminatory attitudes towards men who have sex with men and people who inject drugs hampered the provision of adequate HIV prevention services for these groups.13
More than 90% of new HIV infections in Central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, who accounted for 45% of new HIV infections worldwide in 2015.14 Recent studies suggest that, globally, people who inject drugs are 24 times more likely to acquire HIV than the general population, sex workers are 10 times more likely and men who have sex with men are 24 times more likely. Moreover, transgender people are 49 times more likely and prisoners are five times more likely to be living with HIV than adults in the general population.15
How stigma affects the HIV response
UNAIDS and the World Health Organization (WHO) cites fear of stigma and discrimination as the main reason why people are reluctant to get tested, disclose their HIV status and take antiretroviral drugs (ARVs).16
One study found that participants who reported high levels of stigma were over four times more likely to report poor access to care.17 This contributes to the expansion of the global HIV epidemic and a higher number of AIDS-related deaths.
An unwillingness to take an HIV test means that more people are diagnosed late, when the virus may have already progressed to AIDS. This makes treatment less effective, increasing the likelihood of transmitting HIV to others, and causing early death.
For example, in the United Kingdom (UK), many people who are diagnosed with HIV are diagnosed at a late stage of infection, defined as a CD4 count under 350 within three months of diagnosis. Although late diagnosis of HIV has declined in the UK in the last decade, from 56% in 2005 to 39% in 2015, this figure remains unacceptably high.18
In South Africa, stigma stopped many young women involved in a trial on HIV prevention from using vaginal gels and pills that would help them stay HIV free. Many reported being afraid that using these products would lead them to being mistakenly identified as having HIV, and so the fear of the isolation and discrimination that being identified as living with HIV would bring led them to adapt behaviours that put them more at risk of acquiring the virus.19
The epidemic of fear, stigmatization and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected. This hinders, in no small way, efforts at stemming the epidemic. It complicates decisions about testing, disclosure of status, and ability to negotiate prevention behaviours, including use of family planning services. 20
In 2015, WHO released new treatment guidelines that reflect the need to address stigma and discrimination as a barrier to accessing HIV treatment.21
Forms of HIV stigma and discrimination
HIV and AIDS-related stigma can lead to discrimination, for example, when people living with HIV are prohibited from travelling, using healthcare facilities or seeking employment.
Self-stigma, or internalised stigma, has an equally damaging effect on the mental wellbeing of people living with HIV or from key affected populations. This fear of discrimination breaks down confidence to seek help and medical care.22
Self-stigma and fear of a negative community reaction can hinder efforts to address the HIV epidemic by continuing the wall of silence and shame surrounding the virus. Negative self-judgement resulting in shame, worthlessness and blame represents an important but neglected aspect of living with HIV. Self-stigma affected a person's ability to live positively, limits meaningful self agency, quality of life, adherence to treatment and access to health services.23
In Zimbabwe, Trócaire and ZNNP+ designed, implemented and evaluated a 12-week pilot programme to support people living with HIV to work through self-stigmatising beliefs. After the 12 weeks, participants reported profound shifts in their lives. The majority of participants (61%) reported a reduction in self-stigma, depression (78%) and fears around disclosure (52%), and increased feelings of satisfaction (52%) and daily activity (70%).24
Evidence suggests people from key affected populations are also disproportionally affected by self-stigma. For example, a study of men in China who have sex with men found that depression experienced by participants due to feelings of self stigma around homosexuality directly affected HIV testing uptake.25
Similarly, a study of men in Tijuana, Mexico who have sex with men found that self-stigma was strongly associated with never having tested for HIV, while testing for HIV was associated with identifying as being homosexual or gay and being more ‘out’ about having sex with men.26
In countries that are hostile to men who have sex with men and other key populations, innovative strategies are needed to engage individuals in HIV testing and care programmes without exacerbating experiences of stigma and discrimination.
I am afraid of giving my disease to my family members-especially my youngest brother who is so small. It would be so pitiful if he got the disease. I am aware that I have the disease so I do not touch him. I talk with him only. I don’t hold him in my arms now.
- woman in Vietnam27
A country’s discriminatory laws, rules and policies regarding HIV can alienate and exclude people living with HIV, reinforcing the stigma surrounding HIV and AIDS.
In 2014, 64% of countries reporting to UNAIDS had some form of legislation in place to protect people living with HIV from discrimination.28 While, conversely, 72 countries have HIV-specific laws that prosecute people living with HIV for a range of offences.29
Criminalisation of key affected populations remains widespread with 60% of countries reporting laws, regulations or policies that present obstacles to providing effective HIV prevention, treatment, care and support.30 As of 2016, 73 countries criminalised same sex activity,31 and injecting drugs use is widely criminalised, leading to high incarceration levels among people who use drugs.32
More than 100 countries criminalise sex work or aspects of sex work.33 Even in countries where sex work is at least partially legal the law rarely protects sex workers and many are at risk of discrimination, abuse and violence from both state and non-state actors such as law enforcement, partners, family members and their clients.34 For example, some 15,000 sex workers in China were detained in so-called custody and education centres in 2013.35
Case study: Ending criminalisation of HIV transmission in Australia
Laws that criminalise HIV non-disclosure, exposure and transmission perpetuate stigma and deter people from HIV testing and puts the responsibility of HIV prevention solely on the partner living with HIV.36
In May 2015, the Australian state of Victoria repealed the country’s only HIV-specific law criminalising the intentional transmission of HIV. The repealed law - Section 19A of the Crimes Act 1958 - carried a maximum penalty of 25 years imprisonment, even more than the maximum for manslaughter (which is 20 years).37
The legislation to repeal the law was developed through the collaboration of several stakeholders, including legal, public health and human rights experts and representatives of people living with HIV. It was seen as a major step forward for the rights of people living with HIV.38
Restrictions on entry, travel and stay
As of September 2015, 35 countries have laws that restrict the entry, stay and residence of people living with HIV. In 2015, Lithuania became the most recent country to remove such restrictions.39