A new report from the Public Health Watch project of the Open Society Institute (OSI), looks at the preventable but growing global TB epidemic, its interaction with HIV/AIDS, and the inadequate response to the two diseases in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand. The study. Civil Society Perspectives on TB/HIV Policy, was released in August and is available online.

“The need for early identification and treatment of TB is desperately urgent,” says the UN Secretary-General’s Special Envoy for AIDS in Africa, Stephen Lewis, in the foreword to the report. “We must never forget that in many countries, the majority of people who die of AIDS succumb to tuberculosis. TB and HIV act on each other with fatal forceóa combination made in hell, which must be expunged from the catalogue of communicable disease.”

Through a review of TB and TB/HIV policy, and extensive consultation with policymakers, activists, and patients, the report reveals that the interaction between TB and HIV/AIDS is particularly deadly in many sub-Saharan African countries due to widespread stigma, low levels of awareness, poorly coordinated services, and a lack of mobilization at the local, national and international levels.

In Tanzania, for example, the number of TB cases increased by almost six-fold between 1983 and 2003, from approximately 12,000 cases to 64,500, with 60 percent of the increase in TB incidence attributable to HIV.

HIV/AIDS is also fuelling the TB epidemic in Nigeria, the nation with the largest number of new TB cases in Africa, with a 6 percent annual increase in TB prevalence, and a four-fold increase in HIV rates among people living with TB between 1991 and 2001.

While Bangladesh, Brazil, Nigeria, Tanzania, and Thailand face varying rates of TB/HIV coinfection, the report points to the need for decisive governmental action to coordinate TB and HIV/AIDS policies and programs, both in countries with high coinfection rates such as Tanzania, as well as in countries at high risk for a burgeoning coepidemic such as Bangladesh.

In all five countries examined, people living with HIV/AIDS face serious obstacles to receiving prompt, effective treatment for TB, including lack of proper diagnostic tools.

Brazilian Public Health Watch researcher Ezio T·vora dos Santos Filho, who is living with HIV and has survived TB twice, asserts that even in middle-income Brazil, “only an individual with good connections and access to top-quality medical assistance (including rapid TB diagnostic tests) can survive a complex TB/HIV coinfection.

While the report emphasises that community mobilisation has proven essential in advocating for research, development of new tools, and increased resources for the fight against HIV/AIDS, the people and communities most affected by TB often lack resources and opportunities to engage in policy processes. TB-associated stigma also reduces advocacy on the disease.

Greater social mobilisation around TB and TB/HIV will be essential to reduce TB and TB-related deaths among people living with HIV/AIDS. According to the report, this will not occur without a concerted and sustained effort on the part of donors, policymakers and community activists to engage TB and HIV patients as partners.

This report – which focuses specifically on TB/HIV policy and the effects of the HIV/AIDS epidemic on TB control efforts – is a preview of a series of in-depth studies of the five countries that will be launched on Nov. 1, 2006, at the annual International Union Against Lung Disease Conference in Paris.

Source: Press release, Public Health Watch

A copy of the study is available at:

http://www.publichealthwatch.info