In Your Neighborhood

Can we talk about mosquitoes, travel, sex and women?

The spread of the Zika virus, and the response by public health officials, offers an opportunity to change the conversation about women in the developing world

Photo courtesy of Mexico Tourism Bureau

A post-card image from the Mexican tourism website promoting travel with the teaser: Come visit, we're open, despite the apparent threat of the Zika virus.

By Toby Simon
Posted 2/8/16
The spread of the Zika virus in Latin, Central and South American exposes a more virulent policy question: the status of women and their limited ability to control their own destiny and engage in collective decision-making with a partner about if and when they want to become pregnant.
What can be learned from epidemiological evidence of previous outbreaks, such as in the Yap Islands in 2007? When does herd immunity come into play? What is the current status of the Zika outbreak in Venezuela? When will federal support be given to efforts to develop recombinant vaccines and diagnostics for neglected tropical diseases such as Zika, Chikungunya and Dengue? How will this change the dynamics around the priorities and costs of developing new drugs? How will the first diagnosis of Zika transmission in the U.S., not from mosquitoes but from sex, from the virus in semen, change the equation?
The role of women and their ability to control their own health and decision-making about their bodies is one of the fundamental undercurrents in the American political landscape these days, but it is goes to the heart of so much of the political strife in developing countries – in the Middle East, in Africa, in Asia and in Latin and South America. The response to the ZIKA virus offers an opportunity to change that conversation in a very positive direction – and women athletes competing in the 2016 Summer Olympics in Brazil have an opportunity to be leaders.
The spread of mosquito-borne illnesses also exposes a big flaw in the arguments of those who deny the fact that the ocean is warming and the weather patterns are changing: there is no wall, no matter how high, that is going to control or repel the growing range of mosquitoes. Instead, it requires a new approach to public health as a global initiative where we are all interconnected.

PROVIDENCE – Last week I received an email from a dear friend in Texas. She was inquiring about the Zika virus, specifically wondering whether we were still planning on taking a family vacation to Mexico this month.

We are. Mexico is on the list of countries where there are concerns about Zika. This year our vacation includes all three of our adult children, their spouses/partners and our three young grandchildren, the youngest being 10 months old. No one is pregnant – I did ask – and there are no new baby plans for the moment. 

There are preventive steps we can take. And we will. Since the mosquito which transmits Zika bites in the daytime, we will wear DEET all the time.

We’re lucky, because where we are staying there are screens on windows as well as air conditioning that will help avoid transmission.

And since 80 percent of people with Zika don’t have any symptoms, it’s considered a relatively benign virus. The big exception and still a bit of an unknown, is the threat to the developing fetus.

DEET works!
In 2014 I traveled to Haiti just as the Chikungunya virus was beginning to take hold on Hispaniola. Chikungunya is transmitted by the same genus of mosquito that transmits Dengue fever and Zika.

I was with a group of Bryant University MBA students and instructed them to wear DEET all the time. They were compliant but I wasn’t careful enough, especially during the daytime. I was the only one in our group who got Chikungunya. I realize a sample size of eight isn’t reliable but by summer of 2014, Chikungunya was a huge epidemic in Haiti. Estimates were that some 6 million people, out of 9 million, had the virus.

Unlike Zika, Chikungunya is not at all a benign illness. For the first two weeks, you feel like you’ve been hit by an enormous truck.

There’s fever, aches, pains, a rash. It is particularly dangerous for infants and the elderly. Joint pain persists for months after the virus is out of your system. Although there were cases of Chikungunya in the U.S. that were mainly the result of travel to countries with the virus, it never reached epidemic proportions in our country.

Return to Haiti
I returned to Haiti in October of 2014. Again I instructed our group to use DEET. Yet every Haitian we spoke to told us that the disease was gone. “Pa genyen, se fini” [There isnt any, its all over], we were repeatedly told. We still wore DEET; even though I now have antibodies and won’t get it again, I still wore the stuff, in solidarity with my travel companions. 

But the Haitians were right; Chikungunya was gone. What’s known as “herd immunity” had taken place: so much of the population had gotten sick, there were very few susceptibles in the country, i.e, people to infect.

Lessons to be learned about Zika
Herd immunity to Zika has yet to take place in the South American countries affected. Not enough research exists on the epidemic and its relationship between Zika and microcephaly in newborns. 

In an earlier outbreak of Zika on the Yap Islands in Micronesia in 2007, it affected 73 percent of their population, so it’s possible that herd immunity was reached there. But the Yap population is miniscule compared to Brazil. Now the Caribbean and Latin American countries are also seeing cases.

On Feb. 1, the World Health Organizations declared the Zika virus and its suspected link to birth defects an international public health emergency. Basically, the emergency designation allows the health agency to coordinate all the efforts needed to understand and study Zika.

WHO didn’t go as far as advising pregnant women not to travel to affected regions although American health officials have. Nor did the WHO advise women to postpone pregnancies, although I do wonder whether political reasons were behind that decision.

In El Salvador, the government has recently asked women to avoid getting pregnant for two years, clearly a delicate issue in a conservative, religious country. For starters it would require the constant use of contraception, which can be complicated in a place that is more than 50 percent Roman Catholic.

But, perhaps more importantly, the question is whether the status of women in El Salvador is high enough so that women actually have choices about when they want to start a family or have another baby.

If El Salvadorian women are similar to other women in the developing world, their self-worth is often defined by their ability to bear children. Will women even have a voice in this discussion?

Such a policy would require people to actually talk about sex as a recreational vs. procreational activity. I’m not sure the Catholic Church is ready for that. And, as Paula Young Lee wrote in Dame, the "three letter word missing from the Zika virus warnings is men," because the government officials are advising women to to avoid pregnancy, as though men have no say in the matter. To which I say, "Amen."

The Zika scare is real, especially for pregnant women, so avoiding travel to places where the epidemic is happening is sound advice.

However, our real concerns – as well as our research – should focus on women without options: those who live in parts of the world where mosquitos thrive in standing water, where there are no screens on windows, no mosquito netting for beds, and no access to insect repellent.

Sadly these are often the same countries in which the status of women is low, a woman’s ability to control her own destiny is limited, and she can’t engage in collective decision-making with a partner about if and when they want to become pregnant.

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