or Liverpool schools of tropical medicine. Additionally, they must spend two years at one of the UK centers approved for tropical medicine (located in London, Liverpool, or Birmingham). Physicians in the UK who wish to be certified in tropical medicine must spend at least a year abroad in an area lacking resources. Only then can they become certified in tropical medicine. The training of United States tropical doctors is similar, though it is not a board recognized specialty in America. Physicians must first complete medical school and a program focusing on infectious diseases. Once completed, physicians can take the certification exam from the American Society of Tropical Medicine and Hygiene in order to receive the Certificate of Knowledge in Clinical Tropical Medicine and Travelers' Health. Challenges HIV In developing countries alone, 22 million people are living with HIV. Most infections are still in Africa, but Europe, Asia, Latin America, and the Caribbean are now seeing large numbers of infections as well. 95% of expected new infections will occur in the low-income countries in the tropics. The expected number of new infections is 3-4 million per year. Risk factors such as needle use and unprotected sex are much more prevalent in tropical and underdeveloped areas. Once HIV is transmitted to a tropical area it is spread throughout the sexually active population. Though how fast and how far it spreads varies, some African countries have an HIV prevalence of 10%. More alarming still, in urban areas, prevalence among pregnant women can get as high as 30%. Healthcare professionals themselves are at great risk of exposure to HIV. An HIV prevalence of 10% means any given workforce will also have a 10% prevalence, and this does not exclude the healthcare team. Tuberculosis is thought to cause a more rapid disease progression. Tuberculosis is prevalent in tropical and under-developed countries, only making HIV more devastating. Without the expensive and high-tech medical equipment of developed, western countries, physicians in the tropics are left with few options. If they are able to catch an HIV-related bacterial or mycobacterial disease they can diagnose and manage the disease with basic drugs and standard treatment protocol. Many under-developed countries do not have a care strategy, and of those that do, they aren't as effective as they need to be to stop the spread of HIV. Malaria Malaria is a parasitic disease transmitted by an Anopheles mosquito to a human