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On World AIDS Day 2011, we speak with Dr Martin S. Hirsch, MD, FIDSA to find out the latest news on the global fight against AIDS. Dr. Hirsch is editor-in-chief of The Journal of Infectious Diseases, professor of medicine at Harvard Medical School, professor of infectious diseases and immunology at the Harvard School of Public Health, and a physician at Massachusetts General Hospital. – Nicola

Q: Thirty years after the first reports of AIDS, why is HIV/AIDS research still important?
A: Although we have made enormous progress in developing effective combination antiretroviral therapies to control HIV infection, we have been far less successful in preventing infection. Thus, in the US, as well as in the rest of the world, there are more people living with HIV infection today than ever before; worldwide, this number is over 30 million. Many individuals who are infected do not know that they are and, thus, they continue to spread virus to contacts by sexual contact, needle sharing, or mother-to-child transmission. We are not near having an effective preventative HIV vaccine, nor is a cure for those already infected on the immediate horizon. The risk of emerging drug-resistant viruses is also always with us. For all these reasons and more, it is essential that research efforts continue until we can say that HIV has been eradicated or is no longer a public health problem in the world.

Q: What notable important discoveries or research findings have there been in the field recently?
A: In my view, the most notable research advances in the field recently have been in efforts to prevent new HIV infections by using treatment as prevention and pre-exposure prophylaxis. Studies published this year by Myron Cohen and colleagues have shown in placebo-controlled studies that by treating HIV-infected members of discordant couples (one infected, one not), new infections can be reduced by up to 96 percent. This emphasizes the need for early recognition of infections and early treatment. It has also been established that pre-exposure prophylaxis with antiretroviral drugs can reduce transmission in high-risk populations, whether they be heterosexual or men who have sex with men. Pre-exposure prophylactic regimens have taken the form of oral therapy or topical administration of vaginal microbicides. The challenge now is to find ways to implement these strategies worldwide to prevent new infections in cost-effective ways.

Q: What should the public take away from these findings?
A: The public should be aware that only by early recognition of infection can we reduce the scourge of continued HIV transmission and disease. The US Centers for Disease Control and Prevention and other organizations have indicated the need for more routine testing of all populations who enter medical care in the US, and gradually our states and other public health authorities are implementing these suggestions. Nevertheless, there are still thousands of individuals in the US and millions in the world who do not know they are infected and who continue to spread virus. The public should insist on more HIV testing with appropriate measures to protect confidentiality among those tested. It is also critical that efforts to make effective therapies available to those in need not be curtailed in these times of budget stringency. Cuts at this time would reap bitter harvests in years to come.

Q: What do you see as the priority areas for future HIV/AIDS research? Where will the next great advances be?
A: There are several priority areas for HIV research in the years ahead. These include:

- Continued efforts to develop safe and effective prophylacti

To survive a zombie apocalypse you have to be very brave and stupid. Stupid by actually trying to, I mean the whole world is basically against you now. Your going to have to be fit and athletic. You also need to have good aim. If you fit this description then your story begins…

Chapter 1

When a zombie apocalypse first happens, this is the most dangerous part. Many people are going to get infected because they don’t know what the hell is happening. Now you probably don’t care about the other people but the more of them that get infected the worse it is for you. For now all you need is a weapon.

If your in an office or a business area (this includes hotels, hospitals, etc) your going to have to use your fists.  But really your going to run most of the time. If your nearer to the top floor do not go down the stairs UNLESS you have a weapon. It is really dangerous to go down there, you will get cornered no matter how tough you are. Though you’re going to have to get out before it gets any worse. To get a weapon try going to a janitor closest. If your no where near there go into any office and grab a keyboard, chair, anything light and gives you the ability to crack a head in one hit. Now if you are near a janitor closet go in and grab a mop and some spray, make sure the spray is flammable. If you have a lighter then you have an advantage. Matches will work too. Now you need the spray for 2 things, some idiots lock doors that you need to get through and hell no they won’t let you in. Just spray the lock and light it up. I’d hide behind something just in case it blows. If you don’t have any thing to light it up all you need is a plastic Id card and try to pick the lock. This is very easy actually. All you do is try to place the card between the lock and the wall, the door will slide open. If your running out of time, try to break the handle of the door. If all else fails try another door, in an office building they probably have an emergency exit. If the exit is over run by zombies you now have a weapon so you may now go to the stairs! Just be careful, use your mop to knock the zombies down the stairs. If your mop breaks, which might happen if you hit with it too hard, then use the longest end and use it as a spear. Aim for the head or just push em off the stairs. Once you reach the bottom floor avoid the exits until you make a distraction. If you have a lighter or matches then you have a distraction. Go to any hall away from the exits and spray a lot of fluid on the floor. Once the floor is wet smear the can in the fluid. Make sure your hands are not wet and there are no zombies around,  then use your matches on the fluid before it dries and run to an exit ( try to hide behind something before you get close to the exit to make sure no zombies are around. The spray can will eventually explode, if you sprayed enough fluid on the floor. If you didn’t just make sure no zombies are around and run to the exit. If the can explodes a lot of zombies will come, now you can just run to the exits while they are checking out what blew up. Now if you don’t have matches just make a run for the exit. Continue on chapter 2.

Now if your in a house or you were shopping (this includes restaurants, malls, apartments) then just lock all the doors leading in to the building. If you encounter a zombie on your way to lock the doors in a shop, run to any aisle with tools or anything sharp. Once there grab it and try to smash its head. Be careful not to get bitten. In the store you will encounter other people that will probably help you out. If your in your house then you’re safe for now since you already have your doors locked..I hope. If your at this step you can just skip to chapter 3.

Chapter 2

If you were on the road, in a car or was just taking a walk when this happened then all you need to do is get to the nearest police department. If you just escaped from you office building or business area then you need to get to a car since the nearest police department is no where near you. If you were walking get the hell back to your car or house if your walking the dog. Anyway once your in a car go to the police department. If it’s over run or they won’t let you in then drive out of the city or the popular parts of town to the suburbs or any where that’s not as populace. You can then just find a small store or pharmacy. A pharmacy would be best. Once you find one that’s not over run go in and lock ALL doors. Not one should be left open. If the doors are broken seal them with grocery carts. If you can’t find any, get anything like empty boxes or useless items like signs and billboards and pile them on the exit. Once you completely sealed all exits you can rest.

Chapter 3

If you were the person that ran out of the office then you need to regain your energy, eat some food or candy that you can find in the store and sleep you will probably of already slept by then. Just don’t eat to much candy and drink a lot of water. If you were already in the store or house and you completely sealed off all entrances and exits you don’t need rest, you need weapons. For now you can hold off on weapons since security and protection is more important. Try wearing a plastic rain coat if you have any and wear thick boots and pants, put on some gloves and test biting yourself, if the glove gets ripped it wont help you against the zombies. If you are in a store that has no clothes then make yourself some weapons. Knives are usually sold at food stores and flammable stuff like disinfectant spray are usually there too. But if your gong to use the spray then head to the aisle with matches, the bigger the better. Then just get empty boxes and billboard signs and seal off the entrance to the food aisle, just in case the zombies breach the doors. Though you better get a lot of water and food in your aisle before you seal it off. If there is a pharmacy or a drug aisle in the store get some pain relievers and any useful drug that might help in the future, probably a cream that disinfects cuts and scrapes. 

Chapter 4

Friends and family at the most part are probably dead, if they are not following this guide that is, so you you going to need somebody to help you out. If you were stuck in the store you probably already have people that are nagging at you. If your home alone or you were the person from the office and is in a store now you don’t really need help from anybody else you can skip to chapter 5. Now if you do have people the are willing to join you then your first going to have to share your supplies. This is fine because more people adds to your defences and brain power. Just give a knife or if they have good aim give em a few to throw them at zombie heads. But watch your back one of those knives might be planned for you…

Chapter 5

Your food supplies are probably getting low if you are at home. If your in an apartment building and need to escape go back to chapter 1. Now if your in a house then you might have a chance… If your house has a chimney then this is a possible exit. Just make sure you can fit. If you can’t or if your afraid of tight places head to the Attic and open a window. Try to climb up to the room using your window sill as a foot hold. If it’s too high, then try using another window. If you actually have a car then go back to chapter 2. Don’t forget your weapons. If you don’t know what weapons to use go to chapter 6.

Chapter 6

Weapons are a crucial part to surviving. Many things can be weapons. If you have a car you can just run over zombies no problem. If your at home a nail gun, hammer (If your actually gonna use a hammer make sure you have 2 since they are slow to hit with) mop, broom, keyboard, flammable spray, matches, knives and forks. For the forks you can throw them like darts, though your going to have to be a good aim and throw it hard enough to make any damage. If your at an office or hotel weapons like brooms, keyboards, flammable spray, matches, will work just fine. If your at a food store use anything like carts or knives. If your in a super center or a tool store you don’t really need help finding a weapon, they are every where!

Chapter 7

Surviving for a long time is hard and probably won’t be accomplished since your probably gonna get nuked. Your friends might turn on you or you starve or thirst to death. The only possible way of surviving is if you have a helicopter, gas, guns, food factory, water from a river with filter, and a mansion with steel walls and gates. Even if you have that stuff you will eventually die of old age anyway. It’s a horrible and sad tragedy that you will endure if you ever have to go through a zombie apocalypse. A zombie apocalypse might never happen but i could always be wrong…

To survive a zombie apocalypse you have to be very brave and stupid. Stupid by actually trying to, I mean the whole world is basically against you now. Your going to have to be fit and athletic. You also need to have good aim. If you fit this description then your story begins…

Chapter 1

When a zombie apocalypse first happens, this is the most dangerous part. Many people are going to get infected because they don’t know what the hell is happening. Now you probably don’t care about the other people but the more of them that get infected the worse it is for you. For now all you need is a weapon.

If your in an office or a business area (this includes hotels, hospitals, etc) your going to have to use your fists.  But really your going to run most of the time. If your nearer to the top floor do not go down the stairs UNLESS you have a weapon. It is really dangerous to go down there, you will get cornered no matter how tough you are. Though you’re going to have to get out before it gets any worse. To get a weapon try going to a janitor closest. If your no where near there go into any office and grab a keyboard, chair, anything light and gives you the ability to crack a head in one hit. Now if you are near a janitor closet go in and grab a mop and some spray, make sure the spray is flammable. If you have a lighter then you have an advantage. Matches will work too. Now you need the spray for 2 things, some idiots lock doors that you need to get through and hell no they won’t let you in. Just spray the lock and light it up. I’d hide behind something just in case it blows. If you don’t have any thing to light it up all you need is a plastic Id card and try to pick the lock. This is very easy actually. All you do is try to place the card between the lock and the wall, the door will slide open. If your running out of time, try to break the handle of the door. If all else fails try another door, in an office building they probably have an emergency exit. If the exit is over run by zombies you now have a weapon so you may now go to the stairs! Just be careful, use your mop to knock the zombies down the stairs. If your mop breaks, which might happen if you hit with it too hard, then use the longest end and use it as a spear. Aim for the head or just push em off the stairs. Once you reach the bottom floor avoid the exits until you make a distraction. If you have a lighter or matches then you have a distraction. Go to any hall away from the exits and spray a lot of fluid on the floor. Once the floor is wet smear the can in the fluid. Make sure your hands are not wet and there are no zombies around,  then use your matches on the fluid before it dries and run to an exit ( try to hide behind something before you get close to the exit to make sure no zombies are around. The spray can will eventually explode, if you sprayed enough fluid on the floor. If you didn’t just make sure no zombies are around and run to the exit. If the can explodes a lot of zombies will come, now you can just run to the exits while they are checking out what blew up. Now if you don’t have matches just make a run for the exit. Continue on chapter 2.

Now if your in a house or you were shopping (this includes restaurants, malls, apartments) then just lock all the doors leading in to the building. If you encounter a zombie on your way to lock the doors in a shop, run to any aisle with tools or anything sharp. Once there grab it and try to smash its head. Be careful not to get bitten. In the store you will encounter other people that will probably help you out. If your in your house then you’re safe for now since you already have your doors locked..I hope. If your at this step you can just skip to chapter 3.

Chapter 2

If you were on the road, in a car or was just taking a walk when this happened then all you need to do is get to the nearest police department. If you just escaped from you office building or business area then you need to get to a car since the nearest police department is no where near you. If you were walking get the hell back to your car or house if your walking the dog. Anyway once your in a car go to the police department. If it’s over run or they won’t let you in then drive out of the city or the popular parts of town to the suburbs or any where that’s not as populace. You can then just find a small store or pharmacy. A pharmacy would be best. Once you find one that’s not over run go in and lock ALL doors. Not one should be left open. If the doors are broken seal them with grocery carts. If you can’t find any, get anything like empty boxes or useless items like signs and billboards and pile them on the exit. Once you completely sealed all exits you can rest.

Chapter 3

If you were the person that ran out of the office then you need to regain your energy, eat some food or candy that you can find in the store and sleep you will probably of already slept by then. Just don’t eat to much candy and drink a lot of water. If you were already in the store or house and you completely sealed off all entrances and exits you don’t need rest, you need weapons. For now you can hold off on weapons since security and protection is more important. Try wearing a plastic rain coat if you have any and wear thick boots and pants, put on some gloves and test biting yourself, if the glove gets ripped it wont help you against the zombies. If you are in a store that has no clothes then make yourself some weapons. Knives are usually sold at food stores and flammable stuff like disinfectant spray are usually there too. But if your gong to use the spray then head to the aisle with matches, the bigger the better. Then just get empty boxes and billboard signs and seal off the entrance to the food aisle, just in case the zombies breach the doors. Though you better get a lot of water and food in your aisle before you seal it off. If there is a pharmacy or a drug aisle in the store get some pain relievers and any useful drug that might help in the future, probably a cream that disinfects cuts and scrapes. 

Chapter 4

Friends and family at the most part are probably dead, if they are not following this guide that is, so you you going to need somebody to help you out. If you were stuck in the store you probably already have people that are nagging at you. If your home alone or you were the person from the office and is in a store now you don’t really need help from anybody else you can skip to chapter 5. Now if you do have people the are willing to join you then your first going to have to share your supplies. This is fine because more people adds to your defences and brain power. Just give a knife or if they have good aim give em a few to throw them at zombie heads. But watch your back one of those knives might be planned for you…

Chapter 5

Your food supplies are probably getting low if you are at home. If your in an apartment building and need to escape go back to chapter 1. Now if your in a house then you might have a chance… If your house has a chimney then this is a possible exit. Just make sure you can fit. If you can’t or if your afraid of tight places head to the Attic and open a window. Try to climb up to the room using your window sill as a foot hold. If it’s too high, then try using another window. If you actually have a car then go back to chapter 2. Don’t forget your weapons. If you don’t know what weapons to use go to chapter 6.

Chapter 6

Weapons are a crucial part to surviving. Many things can be weapons. If you have a car you can just run over zombies no problem. If your at home a nail gun, hammer (If your actually gonna use a hammer make sure you have 2 since they are slow to hit with) mop, broom, keyboard, flammable spray, matches, knives and forks. For the forks you can throw them like darts, though your going to have to be a good aim and throw it hard enough to make any damage. If your at an office or hotel weapons like brooms, keyboards, flammable spray, matches, will work just fine. If your at a food store use anything like carts or knives. If your in a super center or a tool store you don’t really need help finding a weapon, they are every where!

Chapter 7

Surviving for a long time is hard and probably won’t be accomplished since your probably gonna get nuked. Your friends might turn on you or you starve or thirst to death. The only possible way of surviving is if you have a helicopter, gas, guns, food factory, water from a river with filter, and a mansion with steel walls and gates. Even if you have that stuff you will eventually die of old age anyway. It’s a horrible and sad tragedy that you will endure if you ever have to go through a zombie apocalypse. A zombie apocalypse might never happen but i could always be wrong…

Dorothy H. Crawford is a Professor of Medical Microbiology and Assistant Principle for the Public Understanding of Medicine at the University of Edinburgh. Her most recent book, Deadly Companions: How Microbes Shaped Our History, takes us back in time to follow the interlinked history of microbes and man, impressing upon us how a world free of dangerous microbes is an illusion.  In an excerpt this morning we looked at SARS.  The excerpt below looks at the effect of poverty on disease.

It is glaringly obvious from a glance at the figures that poverty is the major cause of microbe-related deaths. On a worldwide scale microbes are still major killers, accounting for one in three of all deaths. But the huge discrepancy in the death rates between rich and poor nations reveals the stark reality. Whereas only 1–2 per cent of all deaths in the West are caused by microbes, this figure rises to over 50 per cent in the poorest nations of the world, and it is in these highly microbe-infected areas where over 95 per cent of the global deaths from infections occur. Most of the 17 million killed by microbes each year are children in developing countries where the link with poverty is clear. It is the poor who are malnourished, live in filthy, overcrowded urban slums and go without clean drinking water or sewage disposal, and therefore they are the ones who fall prey to the killer microbes: HIV, malaria, TB, respiratory infections and diarrhea diseases like cholera, typhoid and rotavirus; all eminently preventable and treatable given the resources.

The spread of HIV is an excellent example of how microbes exploit the poor, striking at the most disadvantaged in the community. The virus emerged in Central Africa and spread silently throughout the continent in the 1970s, given a head start by its long silent incubation period, and aided by despotic leaders, corrupt governments, civil wars, tribal conflicts, droughts and famines. Carried by undisciplined armies and terrorists, the virus infiltrated city slums, infected commercial sex workers, was picked up by migrant workers and passed on to their wives and families. While malnutrition accelerated the onset of AIDs, breakdown of health-care services in the political turmoil of Africa excluded any possibility of medical support for the millions in need.

Now we are living through the worst pandemic the world has ever known, with 40 million living with HIV, 25 million already dead and around 10,000 dying daily—the equivalent of over three 9/11disasters every twenty-four hours. A third of people living in sub-Saharan African cities are HIV-infected, and while highly active antiretroviral therapy (HAART) has converted this lethal disease into a manageable chronic infection in the West, presently only a tiny proportion of Africans living with HIV receive this treatment; for most there is no hope of obtaining the drugs vital for keeping them alive.

The dynamics of HIV in Africa reflects its mode of spread. As the virus is sexually transmitted gender inequalities mean that women are particularly vulnerable. In general they are poorer and less well educated than their male counterparts, and are often powerless to choose or restrict their sexual partners, or to insist on condom use. Indeed many are forced to exchange sex for essentials like food, shelter and schooling. Now one in four African women are HIV-infected by the age of twenty-two years (compared to one in fourteen men of the same age), and women account for 60 per cent of all those living with HIV.

Over 90 per cent of HIV-positive women in Africa are mothers, and the virus has created 15 million orphans worldwide, 12 million of them in sub-Saharan Africa. These children are bearing the burden of the HIV pandemic; they miss school to care for their sick mothers or to earn the family income; the virus has not only deprived them of their parents but their childhood and their education as well.

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