AA vs AS: Who Really Gets Malaria More?

If you have ever been part of a genotype conversation, you already know the line:

“AA people always have malaria.”

“AS people don’t fall sick easily.”

“SS people rarely have malaria.”

This belief is widespread, but like most health myths.

Let’s break the science down clearly.

First: What Does Genotype Mean?

Genotype is the combination of hemoglobin genes a person inherits from their parents.

·       AA – normal hemoglobin

·       AS – sickle cell trait (carrier but not diseased)

·       SS – sickle cell disease

These genotypes have different relationships with malaria, but not the way many people assume.

Why People Say “AA Gets Malaria Easily”

1. AS Has a Natural Protective Advantage

People with AS genotype (sickle cell trait) have partial protection against severe malaria, especially Plasmodium falciparum, the most dangerous species.

Their red blood cells are slightly altered, making it harder for the malaria parasite to grow and multiply.

This is why, in regions with heavy malaria, the AS gene persisted through evolution: it offered survival advantage.

2. Because AS Has Protection, People Think AA Is “Weaker”

AA genotype has normal red blood cells, so they do not have the protective advantage that AS carriers have.

This does NOT mean AA people “fall sick too much”; it simply means:

·       They have the normal risk of malaria

·       AS people have reduced risk

·       SS people have a different type of risk (explained below)

But unfortunately, people compare AA to AS and conclude:

“AA always gets malaria.”

That is an exaggeration, not a medical fact.

So, Are AA People More Likely to Get Malaria?

Yes, but not the way people think.

Scientific truth:

👉 AA people have normal susceptibility to malaria.

👉 AS people have reduced susceptibility.

So compared to AS:

·       AA seems “more prone”

·       But AA is actually just normal

Where Does SS Fit Into This?

People with SS genotype (sickle cell disease):

·       Can still get malaria

·       BUT malaria is often more severe and dangerous for them

·       It can trigger painful crises, anemia, and complications

They do not have immunity. They also do not have the AS-level protection.

Because SS patients are frequently hospitalized for other reasons, people mistakenly assume they “don’t get malaria,” but in reality, malaria is extremely dangerous for them.

Let’s Clear the Myths Properly

Myth 1: AA genotype attracts malaria.

❌ False. AA just lacks the partial protection that AS carriers have.

Myth 2: AS genotype cannot get malaria.

❌ False. AS can get malaria. The risk is simply lower, and severity is often reduced.

Myth 3: SS genotype does not get malaria.

❌ False. SS patients can get malaria, and it can be severe.

Myth 4: Genotype determines everything.

❌ False. Other factors matter more:

·       Mosquito exposure

·       Use of insecticide-treated nets

·       Environmental conditions

·       Immune system strength

·       Preventive measures

Genotype is only one small factor.

What This Means in Everyday Life

1. AA people should not panic

Having AA genotype does not mean you will constantly have malaria. It simply means you do not have AS-level protection.

2. AS people should not feel “immune”

AS genotype offers partial, not complete, protection. They still need malaria prevention.

3. SS patients need special care

Malaria can be life-threatening in SS. They need strict preventive measures:

·       Prophylaxis (doctor-prescribed)

·       Treated nets

·       Early testing when fever occurs

So Who Should Be Worried About Malaria?

Everyone.

Genotype does not replace prevention.

Whether AA, AS, or SS, the key is:

·       Avoid mosquito bites

·       Sleep under treated nets

·       Treat stagnant water

·       Use repellents

·       Test quickly when fever comes

Final Message

The idea that “AA genotype people get malaria easily” is a misunderstanding of medical science.

The truth is:

·       AS genotype has partial protection

·       AA has normal malaria risk

·       SS is more vulnerable to complications

Genotype affects malaria slightly, but behavior, environment, and prevention habits matter far more.

Good malaria prevention protects everyone: AA, AS, and SS alike.