“Keep the Promise” on World AIDS Day by Fighting TB

By Lucy Chesire

December 1, 2005 — World AIDS Day — Citizens and health workers around the world are calling on world leaders to keep the promise to do more to halt and reverse the HIV/AIDS pandemic.

At the 2004 International AIDS Conference in Bangkok, Nelson Mandela made another call to action, “We cannot win the fight against AIDS unless we do much more to fight TB.” In this vein, this World AIDS Day, we must also urge our leaders to commit to fighting the tragic escalation of TB–HIV.

In September, the World Health Organization declared tuberculosis an emergency in Africa. On average, someone is dying from TB every minute of the day in Africa. What’s worse is the deadly synchronicity of TB and HIV/AIDS. More than half of those with HIV actually die because of TB, an opportunistic infection which preys on the immune systems of those weakened by HIV/AIDS.

Five years ago, having already lived with HIV for ten years, I became consumed by night sweats, loss of appetite, fever, and a persistent cough that refused to respond to antibiotics. I was finally diagnosed with TB, but the worst was yet to come. As HIV had weakened my immune system, TB was destroying my body.

My doctor urgently put me on anti-retroviral medications (ARVs) to strengthen my HIV weakened immune system. I also began a regimen of drugs to treat my TB. These drugs saved my life. At the same time however, they caused changes to my immune system, which spread the TB to various parts of my body. Tests showed the TB was destroying my knees, chest and lymph nodes.

Though I had access to medical care which millions do not, after seven months of hospitalization, two surgeries of the knee and another on my neck, I lay in my bed waiting to die. Although the care and support I received from loved ones frequently filled me with hope, death seemed inevitable.

One year later, after prolonged treatment but free of tuberculosis and moving slowly on crutches, I left the hospital. My long illness catalyzed my commitment to speak out, so that others would not suffer needlessly from TB, the world’s most widespread curable killer and the number one cause of death for those with living with HIV/AIDS. When I left that hospital, I became the first health care worker in Kenya to publicly talk about my battle with TB and declare my HIV status.

As I have learned firsthand, although TB is opportunistic, preying on those whose immune systems have been weakened by HIV, TB also presents a tremendous opportunity. Because the two diseases work in deadly synergy, TB clinics can serve as critical sites for HIV testing, prevention and care services.

An HIV positive person whose TB is treated and cured can live years instead of just weeks. An HIV-positive person with access to ARVs can continue to support her family, contribute to her community, strengthen her nation’s economy — she can continue to live.

The great news is that the United States can make a difference in several ways in fighting this global killer in Africa. Seven countries with the highest number of TB cases (Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Tanzania and Uganda) already receive help from the U.S. Emergency Plan for AIDS Relief (PEPFAR). If PEPFAR could ensure that every person living with AIDS who becomes infected with TB receives TB treatment and that every TB patient is tested for HIV, innumerable lives could be saved.

Additionally, the Global Fund to Fight AIDS, TB and Malaria, a public-private partnership and the world’s largest funder of projects to combat tuberculosis, now requires that AIDS programs address TB and vice versa. The Global Fund is planning to target more resources toward controlling TB in Africa, provided donor governments significantly increase their financial support.

France, Japan and the UK more than doubled their support to the Global Fund for 2006. The United States has yet to make a similar announcement and in fact has underfunded the Global Fund by $150 million for 2006 forcing the fund to triage live saving proposals. The U.S. must make up this shortfall and in addition must aggressively push for a 6th round of grant proposal in 2006 so that life saving momentum is not lost.

Additionally, despite the fact that an entire six month course of TB drugs costs approximately $15, fewer than 45 percent of those sick with infectious TB have access to the drugs that saved my life. This translates to millions dying because they lack of access to an already cost effective cure. This is unacceptable. No one should die from a curable condition. We must do more.

Finally, we need better tools and diagnostics to fight TB. The test for TB is more than 100 years old and too often misses TB in people living with HIV. The drugs to treat TB are more than 40 years old and can have adverse side effects for patients who must endure a lengthy and complex treatment regimen. Investing in new technology and treatments is essential to not only saving the lives of those with TB but treating them and their struggle with dignity.

Many think that tuberculosis is a disease of the past — an ancient plague. But in fact, more people are infected with TB today than at any other time in history and nearly 1500 people die each day because of TB — two million people worldwide every year. In 30 years the Ebola virus has not cost as many lives.

We must keep the promise on HIV/AIDS. We must stop TB.

(Lucy Chesire is a Clinical Nutritionist by profession. Lucy was the first public health worker in Kenya to openly declare her HIV Status. Having survived TB/HIV co-infection, Lucy now works as an advocate both in Africa and internationally for increased attention and resources to TB/HIV. Lucy also is the Community representative on the STOP TB Coordinating board and also the TB/HIV working group)