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Opinion - Health


Act against TB and HIV, now

Stuart Flavell

TB is thought to be responsible for one in three AIDS deaths worldwide. TB and HIV co-infection can happen anywhere in the world, but it hits hardest in poverty-afflicted areas with limited access to adequate health services. Seventy per cent of the cases of TB and HIV co-infection are in Africa.

In India, Raj Kumar has not been able to work now for almost a year after falling ill with tuberculosis (TB), complicated by the fact that he is also HIV (human immuno-deficiency virus) positive. His twelve year-old daughter has had to leave school to help earn money to ensure the family has food to eat.

In Britain, Sandra Martin, a university lecturer, fell ill with a multi-drug resistant strain of TB. She nearly died. It took a year of intensive therapy on a hospital isolation ward before she could return to work. It was in the course of her stay at the hospital that she discovered she is HIV positive.

In Zambia, Winstone Zulu has buried five of his brothers in the last 10 years — all lost to TB and AIDS (acquired immuno-deficiency syndrome). Winstone himself is co-infected with TB and HIV. Despite that, he tirelessly lobbies for intensified action to tackle both diseases.

RAJ, Sandra and Winstone are but three of an estimated 14 million who have both TB and HIV. People living with HIV are particularly susceptible to developing tuberculosis, since a weakened immune system facilitates the flourishing of Koch's bacilli, the bacteria causally associated with TB. Indeed, according to statistics from the World Health Organisation, in the last decade there has been more than a 20 per cent rise in TB cases, largely due to the HIV pandemic.

TB is thought to be responsible for one in three AIDS deaths worldwide. TB and HIV co-infection can happen anywhere in the world, but it hits hardest in poverty-afflicted areas with limited access to adequate health services. Seventy per cent of the cases of TB and HIV co-infection are in Africa, and in the eastern and southern regions of Africa the percentage of co-infected individuals may be even higher. But there is hope.

A person can be treated for TB, regardless as to whether he or she is also HIV-positive. Treatment of TB can improve the quality of life of HIV-positive people and significantly prolong their lives.

However, lack of access to TB care in many parts of the world remains a major challenge. In most of eastern and southern Africa, less than one-third of TB patients receive a full course of antibiotics; in Russia, the figure is even lower. In both areas, the number of TB cases is rising dramatically — by 4 per cent a year in Africa, and even more in Russia.

Health experts tell us a more coordinated approach to tackling TB and HIV can yield good results in the fight against the two epidemics. Efforts to fight AIDS can be improved by detecting and treating TB in people with HIV, and by providing an entry point to HIV prevention and care for people diagnosed with TB.

And efforts to fight TB can be improved by providing antiretroviral therapy to people living with HIV who need it. Unfortunately, according to recent estimates, six million people with HIV/AIDS are in urgent need of antiretroviral treatment in the developing world, and only 3,00,000 have access to it.

This week many AIDS organisations from across the world have joined the United Nations Joint Programme on HIV/AIDS and the World Health Organisation at the Stop TB Partners' Forum in New Delhi, India, to explore solutions to the dual epidemic of TB and HIV. Committed political leadership is key to ensuring the essentials: An uninterrupted supply of effective drugs, knowledgeable health workers, and mobilised communities.

Yet AIDS and TB remain low political priorities in many countries. People living with HIV/AIDS and their allies can help apply the pressure needed for this to change. With help from communities and organisations, we can also involve a broad range of actors in the fight against TB and HIV.

We have learned in our more than 20 years of fighting HIV/AIDS that an effective response cannot rely on one sector's acting alone. Effective joint action is urgent, especially in areas of highest HIV and TB prevalence, and we must work to bring it about.

Many AIDS organisations are doing excellent work to combat TB, but we can do more. Winstone Zulu lost five brothers to TB and AIDS. Rarely a day goes by that he does not talk to governments, international agencies and the media about the need for more action on AIDS and TB. This is not just his fight. It is our fight too.

  • Some names have been changed.

    (The author is International Coordinator, Global Network of People Living with HIV and AIDS.)

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