The AIDS-Malaria Connection

Editorial | 18 Dec 2006
New York Times

AIDS prevention has seen two breakthroughs this month. The big news is the protective value of circumcision. But there is another important finding: AIDS and malaria feed on each other, with disastrous effects.

In a paper published in the journal Science, researchers looked at health records from Kisumu, Kenya, a city of 200,000 with high levels of both diseases. They calculated that the interaction of the diseases increased AIDS cases by 8 percent and malaria by 13 percent. Over 25 years, that meant 8,500 additional AIDS cases and almost a million extra cases of malaria. The researchers drew on earlier findings that H.I.V.-positive people who get malaria experience a six- to eight-week spike in the level of the AIDS virus in their blood. During that spike, they are supercontagious, with double the usual chance of infecting a sexual partner. People with H.I.V. have also been proved more likely to catch malaria.

One important lesson of the study is that protecting H.I.V.-positive people from malaria would also limit the spread of AIDS. They need insecticide-treated bed nets to sleep under, and should take a daily dose of the antibiotic cotrimoxazole. Combining bed nets and cotrimoxazole with antiretroviral therapy reduced malaria cases in H.I.V.-positive people by 95 percent in one study. Cotrimoxazole is cheap, but is not yet widely used in poor countries.

The findings should add extra urgency to the fight against malaria, which has always lagged far behind AIDS in both money and attention. Last week President Bush convened a forum on malaria, but the fact that more than a million people — most of them under 5 — die each year from a disease that is easily preventable and curable speaks volumes.

The study also sheds new light on why Africa's AIDS rates are so much higher than elsewhere: Africans' health is poor, and they are more likely to suffer from diseases — malaria, genital herpes and others — that make H.I.V. more transmissible.

Donors eager to fight AIDS have shown less interest in improving Africa's health systems, training health workers and equipping clinics. The biggest lesson of the new study is that it is all one fight.