The Prevention and Control of HIV/AIDS, TB and Vector-borne Diseases in Informal Settlements: Challenges, Opportunities and Insights

Abstract

Today_s urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today_s urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the Bsocial determinants of disease^model, preventing and controlling HIV/AIDS, TB and vectorborne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda.

The global health threat of African urban slums: the example of urban tuberculosis

“…Significantly, health care is particularly absent in slum areas. As expected, TB is common in urban slums (David, Mercado, Becker, Edmundo, & Mugisha, 2007), and resistant strains are also common -perhaps increasingly so (Githui et al, 2004).…”

Priorities and needs for research on urban interventions targeting vector-borne diseases: rapid review of scoping and systematic reviews

“…A scoping review was found that summarized the impact of urbanization on the epidemiology of infectious diseases, including some VBDs in tropical countries and the emergence of infectious diseases over time [20]. Given that urbanization increasingly affects the epidemiological characteristics of infectious diseases, more research is needed to study the VBD-specific effects of urbanization.…”

The Centers for Disease Control and Prevention Revised Recommendations for HIV Testing: Reactions of Women Attending Community Health Clinics

“…Holtgrave also noted that the opt-out approach may not address racial/ethnic health disparities because HIV disproportionately affects communities of color, such as the African American community. More specifically, David, Mercado, Becker, Edmundo, and Mugisha (2007) addressed the needs of those living in slums and similar situations in urban areas, noting that these individuals needed to be provided with opportunities equal to those of the rest of the population to access proven interventions. Even with these newer data, Valdiserri (2007) cautioned that prevention efforts should not be limited to only opt-out and targeted testing methods.…”