We cannot fight AIDS unless we do much more to fight TB
SAfAIDS\' statement on World TB Day : Nelson Mandela. International AIDS Conference. Bangkok 2004
Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) HIV/AIDS information: the power to make a difference. World TB Day: Statement "We cannot fight AIDS unless we do much more to fight TB" Nelson Mandela. International AIDS Conference. Bangkok, 2004 Today, Friday, 24th March 2006, marks World Tuberculosis Day and Nelson Mandela's statement is even more true today two years later. This year the world will commemorate the day under the theme, "Actions for Life: Towards a World Free of TB". With over 2 million people dying from Tuberculosis every year, actions to counter TB are urgently needed to save lives. Despite the fact that Tuberculosis (TB) is a curable and preventable disease it is still infecting and killing millions of people throughout the world. However some regions, more than others are bearing the brunt of the disease. For example, Sub-Saharan Africa has approximately 10% of the world's population and yet nine of the sub-Saharan countries are among the world's 22 TB high-burden countries. In Namibia, 751 out of every 100 000 people are infected with TB every year. In Botswana, the situation is equally as serious, with 657 new TB cases for every 100 000 people every year.[1] While TB is curable, its occurrence in people whose immune systems are compromised can be lethal. The combination of TB and HIV has to many deaths in the southern African region. In Malawi, 77% of TB patients are HIV positive, while in Zambia, 62% of TB patients are HIV positive. In Mozambique over half of the all the new TB cases are associated with HIV, making it one of the highest rates of TB/HIV co-infection in Southern Africa[2]. The factors that fuel the HIV and AIDS pandemic, are also driving the TB epidemic, particularly in Southern Africa. Poverty, malnutrition, non-availability of proper health care facilities, shortages of drugs and lack of information among others all contribute to the growing incidence of TB. It is encouraging to note that at local level, countries are beginning to take the initiative to address TB and HIV and AIDS as linked epidemics. In Malawi, the recognition of the HIV and TB co-infection has forced the long-established TB Control Programme to replan and redevelop TB control strategies to ensure collaborative TB/HIV activities. South Africa is demonstrating some of the best practices emerging from the region, in addressing the joint TB/HIV epidemic. A national TB/HIV coordinating body has been established to oversee collaborative activities. A similar approach has been taken in Zimbabwe. At a recent discussion forum hosted by SAfAIDS Dr. O. Mugurungi of Zimbabwe's AIDS and TB Unit said, "universal access [to treatment] as a holistic package, has to do with appropriate and adequate nutrition, prevention and management of opportunistic infections including TB". There are however many challenges to overcome in order to take action and save lives. As SAfAIDS, we can only endorse what Dr Tim France, the Managing Director of Health and Development Networks (HDN), and an advisor to the AIDSCareWatch (ACW) campaign said in a statement to commemorate World Tuberculosis day, "The two worst global health problems have combined forces well. But the institutions addressing them have not". We need to have a joint approach towards these co-pandemics and the lead must be taken by the three main actors responsible for controlling the two diseases - the World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the international Stop-TB Partnership. Dr Peter Piot has issued the call, "we are not in competition. We are as intimately allied as are the human immunodeficiency virus and the TB Bacillus. We must work together. If we are serious bout our missions to stop TB and HIV, finding new realistic pathways to the future is imperative." The drive for universal access to treatment has of necessity to include both TB and HIV. One cannot be addressed without the other. Countries in the region must therefore heed the call made by the Ministers of Health to urgently implement strategies to rationalise their plans for the two epidemics. Communities and Individuals need to be provided with adequate information and capacity to play a role in mitigating the impact of TB and HIV. We recognise the role played by major players like the Global Fund in the fight against HIV in the world92s worst affected countries. However more efforts are needed to address the increasing incidence of TB and HIV in many southern African countries. Advocacy efforts need to encourage governments and international funding agencies to develop appropriate responses to urgently address the co-pandemics. At community level, programmes should focus on mobilizing communities to also adopt health-seeking behaviour in relation to TB as well as HIV prevention, care treatment and support. As we commemorate World TB Day, it is time for all the players in this fight to take stock and re-evaluate our strategies so that we combine our collective energies to effectively fight Tuberculosis and HIV and AIDS. [1] Integrating HIV/AIDS and AIDS Efforts: The Challenge for the Presidential Fund. Report by the Network of Public Health Programs and Open Society Institute.2004 [2] ibid