Influenza
There are three broad varieties of influenza - types A, B and C. The virus tends to spread across the world in wave-like epidemics on regular cycles. Type A reappears every two to three years and type B every four to five.
The 1919 epidemic killed 40m people worldwide. It is the most serious to date, though pandemics in 1957 ("Asian flu") and 1968 ("Hong Kong flu") both killed millions around the world. Influenza was first described by Hippocrates in 412 BC and the first well-described pandemic of influenza-like disease occurred in 1580.
The infection is spread by coughing and sneezing. As the virus enters the body they attack the cells that line the upper respiratory tract. Symptoms include chills, fevers and muscular aches. Death - when it occurs - is frequently from complications such as pneumonia and bronchitis.
Mortality is low among the young but older people are especially vulnerable. A 1999 outbreak in Britain left 20,000 people dead from related illnesses. Its ability to kill stems from the fact that the virus can mutate quickly, often producing new strains against which human beings have no immunity.
There is evidence that new strains come from animals. The 1919 epidemic is traced back to pigs and the later pandemics from birds. A 1997 outbreak of a new strain of avian (bird) flu in Hong Kong led to the slaughter of 2000 chickens. No cure exists for influenza and the most commonly followed course of action is to develop a vaccination for the next anticipated strain.
Dengue fever
The WHO estimates that there are more than 50m cases of this flu-like fever each year. This mosquito-borne infection is endemic in more than a hundred countries worldwide. Before 1970 only nine countries had experienced an epidemic.
Dengue is the leading cause of childhood mortality in several Asian countries. In adults it can lead to a temporary incapacitation but rarely death. With intensive treatment fatality rates are around 1%, but left alone they can exceed 20%.
Besides fever, the disease is characterised by extreme pain and stiffness in the joints. There is no specific treatment and immunisation is difficult since the virus has four principal strains. Protection against only one or two of them could increase the risk of more serious disease. The most successful prevention is to destroy mosquitoes and their breeding grounds.
TEXT 6
HIV/AIDS
The AIDS epidemic is an emergency threatening human welfare and prosperity throughout large parts of the world.
HIV/AIDS has caused a development crisis in sub-Saharan Africa and has made deep inroads into economic and social development in Asia, Latin America, the Caribbean and Eastern Europe. In many countries, the AIDS epidemic has undermined the institutions and human resources on which a society’s future health, security and progress depend. In the hardest hit countries, over one-quarter of the medical staff who are needed to help those living with HIV/AIDS are themselves infected. In some countries, experienced teachers are dying faster than new teachers can be trained. Heavy industry and the military suffer, because men who have to work away from their homes often have higher rates of infection than the general population. Where high prevalence and poverty coincide, the impact is greatest.
In subsistence, small-scale agriculture in sub-Saharan Africa, labour shortages exacerbated by HIV/AIDS combined with declining household incomes are compounding food and livelihood insecurity and contributing to changes in farming practices and farming systems. Morbidity and mortality have already cut the production of many crops by more than 40% in households affected by AIDS. The burden on women is particularly great, as they are often the primary care givers. The rapidly increasing number of children orphaned by AIDS poses major challenges for their well-being, as well as for the development of the communities in which they live.
Poverty—often in tandem or conjunction with racial oppression—has become one of the major sources of vulnerability, as well as of stigma and discrimination, as HIV/AIDS epidemics have ‘matured’. In many countries, numerous health problems derive from the legacies of colonialism, racism and apartheid. They include migrant labour, the rural-urban drift, lack of housing and lack of educational opportunity. Diseases such as tuberculosis, pneumonia, measles, polio and gastro-intestinal infections are strongly associated with poverty, even when they are rare among elite sectors of the population.
Within such contexts, it is perhaps hardly surprising that the incidence of HIV/AIDS will increase rapidly.In conditions of extreme poverty, sex for money or other forms of reward may be a not unreasonable survival strategy from the perspective of those living in extreme poverty. In circumstances where everyday survival is more important than what might happen in two or three years time, it is hardly surprising that ‘planning for the future’ may not take the same form as it does in more affluent circumstances. These are undoubtedly some of the reasons why, all over the world, it is the poor and disenfranchised – and within them racially stigmatised minorities – who suffer the most.
Xenophobia and racism interact in complex ways with HIV/AIDS. Like many other sexually transmitted infections – most notably syphilis in 15th and 16th century Europe – HIV/AIDS was first perceived as a disease of ‘outsiders’. Who counted as an ‘outsider’ depended on where you were situated. In the early 1980s for much of the world AIDS was seen as closely linked with the USA, including, for example, among gay and other homosexually active men in Europe and Australia. In the eyes of some African and Asian leaders, HIV and AIDS have been viewed as diseases of the West – linked to the weakness of family structures, liberal social values and moral decline. With the passage of time, and for diverse reasons, in most countries of the world AIDS has come to be associated with sub-Saharan Africa.
Racial divisions within society intersect with those of gender and sexuality to the systematic advantage of some groups and the disadvantage of others. Women and sexual minorities within racially oppressed groups are frequently doubly disadvantaged by virtue of gender and sexuality as well as by ethnicity. In South Africa, racism historically deprived many black people of education and access to healthcare, and the legacy of apartheid can still be felt at all levels of society. Recent evidence from antenatal surveys shows very high levels of HIV infection, and these surveys over-represent black women by virtue of their extensive use of public health facilities. Investigations are being undertaken to conduct general surveillance amongst private sector clinic attendees as a means of better understanding HIV prevalence rates amongst women from other population groups. Pervasive perceptions that HIV/AIDS is a Black disease, and the lack of public attention to levels of infections in other groups, fuels both a kind of fatalism and a false sense of security in groups whose self-perception is that they are less affected.
TEXT 7
AIDS ALTERED THE FABRIC OF NEW YORK IN WAYS SUBTLE AND VAST
Before AIDS, there was no breast cancer walk in Central Park. Babies needing foster parents languished in hospitals for weeks, sometimes years. Clinics doled out medicines and sent the sick on their way, rarely looking at what it was in their lives that helped to make them ill.
In many ways, New York City after AIDS is somewhat like America after World War II — a place physically unscathed yet socially transformed, missing slices of entire generations of its citizens, its lasting effects at times concrete and at others evanescent.
It changed the speed at which social services moved, and changed the people with whom city politicians curried favor. It made patients with all types of critical illnesses press their doctors harder for information, and took public health workers out of their offices and into neighborhoods where they learned why certain diseases were prevalent.
AIDS altered the insurance, fashion, philanthropic, health care, real estate and music industries. Many of the changes, particularly those involving health care, were boosted along by myriad other factors — managed care, a booming economy and the Internet, to name just a few.
But there is no question that AIDS — which has killed 75,000 New Yorkers, nearly 20 percent of the Americans who have died of AIDS since it was first identified more than 20 years ago — altered the city in ways both so widespread and at times so subtle that those shifts are no longer consciously associated with the disease. And while the rest of the country was also reeling from the epidemic, many lasting cultural changes began here.
New York, the birthplace of the Gay Men's Health Crisis and Act Up, was among the first American cities where groups concerned with other diseases learned from AIDS groups how to successfully hector the government for access to new treatments and services.
"I think there is a very direct relationship between breast cancer activism and AIDS activists," said Ann Northrop, a longtime Act Up member. "Act Up created the concept of patient empowerment, it specifically ruled out that phrase “victim”, and that was a whole new concept. Suddenly there was patient involvement in issues like drug approval."
The AIDS walk begot breast cancer walks, and public parades for other illnesses are now as much a rite of spring in Central Park as softball and Shakespeare.
For gays who did not take part in the coming out in the 1960's, AIDS brought about an inevitable if unwelcome second opportunity. Some men who became visibly ill, for instance, were suddenly out to their co-workers. Others whose past political acts were limited to voting suddenly found themselves taking to the streets.
"What AIDS did was to bring many more people out of the closet and politicize the group of privileged white men who thought they had already entered the mainstream," said one pre-eminent gay historian. "Then obviously the movement swelled."
Gays have become a political constituency in the city, one that rivals traditional voting blocs like religious Jews and African- Americans in some neighborhoods. Now there are several gay elected officials in New York, a shift in political representation that has fanned out around the country.
Dealing with Disease
In the mid-1980's, an unprecedented move in the State Health Department changed the way hospitals in New York cared for those with AIDS, with sizable implications for hospitals dealing with future illnesses.
In 1983, the Health Department set up the AIDS Institute to focus attention on and distribute money for the epidemic. At that time, hospitals and medical clinics were loath to care for AIDS patients, because of their costly and complicated needs, and out of fear over the stigma they would attract to the institutions.
With a clever Medicaid trick, the institute solved its problem. It offered hospitals the chance to be named AIDS Designated Care Centers, in exchange for Medicaid payments that were 20 percent higher than normal rates for Medicaid patients. New York hospitals leapt at the chance to become so designated.
What hospitals had to do was come up with a plan giving AIDS patients a sort of buffet of services, rather than just minimal health care to keep them alive. "It was not just going to be an infectious-disease person who was provider of care," said Ms. Hill, a deputy health commissioner. "AIDS and H.I.V. patients required an interdisciplinary team of doctors, nutritionists, social workers, psychiatric workers, all to be put together in team approach." This special Medicaid rate system was later replicated for tuberculosis in the late 1980's.
And the system of coordinated care that the hospitals devised for AIDS has trickled down into the management of other illnesses, like asthma, strokes and cancer. To have a cancer patient wander an entire hospital campus for chemotherapy, radiation and psychotherapy is almost anathema in many hospitals; before AIDS it was standard.
Taking its cues from grass-roots groups like the Gay Men's Health Crisis, the Health Department began to reach out directly to people living in specific communities where problems ranging from infant mortality to asthma seem the most stubborn, rather than just working through local clinics. In one case, health care workers descended on a neighborhood to discuss methods for quitting smoking; it was learned that what the residents, many of them elderly, really cared about was the fact that people kept falling on the broken sidewalks.
New Urgency and Shift in Focus
AIDS brought an immediacy to social services that simply did not exist before, but whose legacy lingers. Intractable problems like poverty, addiction and homelessness were given a new urgency because many of those who suffered from them were now also dying, and quickly.
For example, before AIDS, drug policies in New York City focused almost entirely on getting people off drugs. Groups that provided housing for poor people recovering from their addictions often required users to be drug-free for several months.
But unlike past drug users, whose treatment and relapse trajectory tended to snake over the course of many years, addicts with AIDS were dying and needed housing quickly. Rules had to change. Instead of saying people could not use drugs, house rules at group homes were altered to reflect that people now should not steal, or destroy property. Soon, the shift in focus from abstinence to what is known as harm reduction was in place for all addicts.
The world of social services for children was also altered. The availability and quality of foster care improved along with increased need to fast track "boarder babies," those children born H.I.V.-positive or with crack in their systems, who were left behind in hospitals, into foster care.
The growing need led nonprofit agencies to lobby the government for more money to recruit appropriate foster parents. The effort moved into neighborhoods, with social service workers approaching potential parents directly or working through places like churches. And in many ways, many people in social services felt compelled to simply speed up the way they worked.
"We learned the measuring of what is important," Ms. Hill said. "With mental illness, for instance, getting better is not necessarily stopping having mental illness. There are other kinds of getting better, but it comes down to how you measure better now. Is it a job having a $50,000, or is it being able to have relationships with other people or not being hospitalized? There is more focus now on living in the moment in our work now. AIDS let us never forget that."
TEXT 8
PRICE OF SUCCESS IN AIDS TREATMENT
The 20-year onslaught of AIDS has radically changed the economics of patient care, and its effects are still being felt throughout the health care system.
In the first years, when AIDS patients generally needed prolonged bed care and little could be done to keep them alive, hospitals across the country scrambled for resources to treat them.
Now many AIDS patients are much healthier, as long as they adhere to complicated drug regimens. They are less likely to be admitted as hospital inpatients, but their treatments require fine-tuning and monitoring in outpatient clinics and the offices of primary care doctors.
That care also requires extensive services and expertise on the part of hospitals and doctors. But unfortunately for hospitals, money to pay for the expensive new treatments has not always followed the patients from the inpatient floors to the clinics. Some hospitals are reporting heavy losses on outpatient care for H.I.V. and AIDS patients today, particularly as the disease has spread beyond an affliction primarily among gay men to attack more low-income people who are without insurance, including heterosexual intravenous drug users and their spouses.
Many family physicians and internists have been significantly affected by the sweep of AIDS as well. In the early days, they were often reimbursed by indemnity insurance plans that covered all services when they cared for AIDS patients.
Now, although they often find themselves spending as much or more time with patients who are controlling their AIDS with complicated drug regimens, health maintenance organizations often pay a flat fee for physicians' services, classifying AIDS as routine general care.
AIDS has been anything but routine for patients and the health care system, however.
Although hundreds of hospitals treat some AIDS patients, much of the activity was concentrated in a few. Five percent of the nation's hospitals are treating 55 percent of all AIDS patients. Public hospitals like Bellevue have been among the largest providers of care for H.I.V. and AIDS patients, including many poor residents. For example, 50 percent of the H.I.V. patients in Dallas County have been getting their care in the public Parkland Health and Hospital System.
In cities particularly hard hit, hospitals transferred nurses and resident physicians to AIDS duty from other units, especially cancer floors. In addition to the sheer logistical challenge, hospitals had to contend with the stigma associated with AIDS and the fears of contagion from the strange new illness, even among hospital staff.
Concerns about finances took a back seat, for the most part, in the early years of the epidemic. Many of the early AIDS patients were young, white, homosexual men whose indemnity insurance paid for almost every test and medical service and some national hospitals saw AIDS treatment as a lucrative business opportunity.
The economics began to change in the mid-1990's as the first AIDS drug cocktails revolutionized treatment. As the drugs gave many patients their lives back, but left them on complicated treatment regimens, hospitals found themselves facing the loss of a major revenue source but still needing to treat the same patients in outpatient clinics.
Insurance companies and major employers who were faced with heavy costs for AIDS and other medical care began switching workers to managed care plans. And insurance companies started paying a flat fee for each day a patient was in the hospital or a case rate depending on the diagnosis. Hospitals could no longer bill for each service, no matter how necessary, and administrators pushed for quicker discharges.
Using the following expressions, make up your own sentences and translate them (try to develop a coherent passage)
Conservative estimate; injecting drug users/ drug injectors; to show no sign of curbing the exponential growth; to understate the real growth; to capture just a fraction of the infections; to be the major spur to HIV transmission; to fuel drug use; to create more effective avenues to HIV prevention; mass screening; interministerial committee; awareness –raising campaigns; sexually transmitted infections; outpatient clinic; to make inroads into the general population; to yield a clearer picture of infection trends; a watershed law; to endorse the principle of voluntary HIV testing; to isolate HIV-positive inmates; stringent budgetary restrictions