To attack HIV and AIDS, put an end to TB
More than 20,000 activists, health experts and global leaders from nearly every nation are in Washington this week for the 19th International AIDS Conference.
One priority should be spearheading a joint, global effort against HIV and tuberculosis.
The rationale for a joint effort is clear. Where HIV and TB are most common, the epidemics have merged, or are in the process of merging, into a single co-epidemic.
We have both suffered from, and been cured of, TB. So let us explain how it works.
Imagine TB as kindling.
Two billion people — one-third of humanity — carry a latent TB infection. The vast majority of those infected live their whole lives without becoming sick with TB or spreading the infection. The body’s immune defenses seal the invading TB germs within a tiny capsule at the infection site — preventing the germs from multiplying.
Now picture HIV as a match.
HIV destroys the immune system. When this happens, the capsule containing the TB germs weakens and breaks. The germs spill out and multiply. The person becomes sick with tuberculosis, transmitting the germs to others through a telltale cough.
Those whose immune systems are weakened by HIV are at extreme risk of dying from TB.
In this way, HIV fuels TB. In addition, TB also makes people more likely to contract HIV. TB during pregnancy, for example, doubles the risk of passing HIV from a mother to her baby.
HIV caused levels of TB to quadruple in most African countries from 1990 through 2005, according to the World Health Organization. The disease is now the No. 1 cause of death among people living with HIV, responsible for one in four AIDS deaths.
With this deadly combination, it’s not surprising that Africa is the only region currently not on track to meet the health-related millennium development goals.
In South Africa, where more than 70 percent of TB patients are HIV-positive, we’re at the epicenter of the joint epidemic. But our country is also making some of the boldest moves.
The government took an important step last year with its first combined national strategy to fight HIV and TB. That 20-year plan is for zero new HIV and TB infections and zero preventable deaths from HIV and TB.
If South Africa can combine its forces against the two diseases and aim for zero TB and HIV deaths, there is no reason why any country should call for less.
And there is evidence that we can reach for these targets.
By scaling up simple measures — like giving a TB test to everyone who tests positive for HIV — we could save a million lives by 2015, according to a publication by the Stop TB Partnership, WHO and UNAIDS.
As delegates gather this week to discuss the conference theme of “Turning the Tide Together,” let us seize this opportunity to build partnerships for a joint, global fight against TB and HIV.
We have two requests.
First, President Barack Obama and Secretary of State Hillary Clinton should expand efforts to address HIV-TB co-infection through the President’s Emergency Plan for AIDS Relief.
As the world’s largest global AIDS program, this plan can make the fastest progress against HIV-TB and provide lessons for other large-scale programs.
That support for HIV-TB activities — offering routine HIV testing and preventive treatment to TB patients, and vice versa, plus other services — has remained flat. Just slightly more than 2 percent of PEPFAR’s budget for the past three years.
Second, we need the help of the AIDS community to raise demand for full access to TB services — including new technology that can diagnose TB in people living with HIV.
The standard TB test cannot reliably detect tuberculosis in people living with HIV. But a new test called Xpert MTB/RIF can — and without the need for a sophisticated laboratory. Xpert is the most cost-effective TB test available, according to a recent study in the journal AIDS. Thanks to the efforts of partners around the world, it is starting to be used in the communities where it is needed most.
We hope the AIDS community will help us demand more funding for rapid diagnosis. After all, once someone living with HIV is diagnosed with TB, he or she is supposed to be immediately eligible for anti-retroviral therapy, which in turn supports HIV prevention.
Because of the stigma and fear that surrounds TB, we also need leaders at all levels, including AIDS activists, to promote open discussion about TB and a culture of tolerance, compassion and respect.
Thanks to a series of recent scientific breakthroughs, this week’s conference is the first in 30 years that has activists seriously contemplating the end of AIDS.
Yet to see a real end to AIDS, we must put an end to TB. So let’s combine our efforts to reach these two goals.
Politico