Monday, August 18, 2008

Disease and culture

This week in section we will be discussing the interplay between disease and culture. We've already talked in lecture about several instances of culture/behavior impacting disease transmission. For example, boarding up windows in nineteenth century London kept the "miasma" out and the Tuberculosis bacteria in. Likewise, as mentioned today, people who like to hike around and live in rural, wooded areas in the Northeast are at greater risk for Lyme disease.

Sexually-transmitted diseases like HIV/AIDS are ripe with potential for both cultural differences in transmission and disease impacts on culture. Some reports (from research done mostly in Kenya and Uganda) have shown that circumcised men are around 50% less likely to contract HIV from heterosexual sex. In these countries, where circumcision in infancy is not the norm, the clinical trials involved circumcising adult men in a safe medical procedure. Many people may not know that in western countries, the female-to-male sexual transmission rate of HIV is very low (as shown in studies like this one). In a sense, western (American and European) females are essentially a dead-end host for HIV, since they can get the virus sexually from men but do not pass it on. Most of infected men contract HIV either by having sex with men or through intravenous drug use. On the other hand, women in Africa seem to be a more competent host, and African men contract HIV from heterosexual sex much more readily there. Though the scientific community does not yet know why, some reports suggest that this may be related to circumcision rates and concurrent STIs.

Finally, another huge source of new HIV cases in the US is from intravenous drug users (IVDUs, in the public health lingo). Australia has addressed this problem by creating needle-exchange programs that allow intravenous drug addicts to get clean needles. The US has thus far refused to adopt this strategy, which Australian National Affairs Editor Mike Steketee argues is a case of "ideology sometimes get[ting] in the way of saving lives." Is giving out clean needles as a public service antithetical to the "War on Drugs"? Does it promote drug use, or save lives? A similar ethical issue surrounds the question of whether or not to give school kids access to condoms in conjunction with sexual education. These are all direct ways in which our own culture may facilitate or inhibit disease transmission.

1 comment:

John Latto said...

It is tempting to consider whether any sexually transmitted diseases modify behavior in a way that enhances transmission. Although this has been suggested for a number of diseases (eg syphilis)there is really no evidence. The fact that some notorious syphilitics had a lot of partners (eg Henry VIII) is not because the syphilis changed their behavior but because their behavior would have increased their chance of getting syphilis.

In other animals there is some evidence of sexually transmitted diseases altering behavior. Some diseases of ungulates interrupt the oestrus cycle and cause the female to be permanently in heat.

There is also a sexually transmitted disease of horses and donkeys called Dourine that has been anecdotally linked to increased sexual activity in stallions.