‘The Deadly Duo’: Talking about TB at AIDS 2016

Leila (far right) with colleagues from ACTION Global Health Advocacy Partnership and the #DeadlyDuo of TB and HIV at AIDS2016 in Durban.

By Leila Stennett, Campaigns Director RESULTS International (Australia)

Nelson Mandela (1918 – 2013) was born on July 18. Today we honour the life and work of the first black President of South Africa and a tireless advocate for human rights, freedom and public health. Today is also the first day of AIDS 2016 – the world’s largest conference on any health or development issue – convening this year (for the second time in its history) in the South African city of Durban.

By his own admission, Mandela did not give sufficient attention to HIV during his time in office. However, after he stepped down, he became a high-profile international champion for action on HIV and AIDS. Sadly, he was personally touched by the illness with the death of his last surviving son in 2005 due to AIDS-related complications. Mandela’s public disclosure of his son’s illness and insistence that AIDS be treated like any other “normal illness” helped break down the stigma in his country.

Nelson Mandela also had first-hand understanding of tuberculosis (TB). He was diagnosed with early-stage TB in 1988, during his 27-year prison term for anti-apartheid activism. Fortunately, he was cured relatively quickly and became a hugely influential global spokesperson on the disease. He also helped build visibility for the deadly link between HIV and TB.

I’m writing this blog today from AIDS 2016 in Durban. This year, for the first time, we’re talking about TB alongside HIV. That the pre-conference event TB 2016 is being held reflects the growing global interest and concern over the interaction between the two diseases, building on the first ever TB-HIV Networking Zone hosted by RESULTS and ACTION in 2014. TB is an airborne bacterial infection that can spread through the lymph nodes and bloodstream to any organ in the body. It can remain inactive within the body and if the immune system is weakened – such as in people living with HIV – TB can become active and cause tissue death in the organs it infects. Active TB can be fatal if left untreated. TB and HIV have been called a ‘deadly duo’ because each heightens the risk, intensifies the damage, and thwarts efforts to treat the other. That’s why TB is the leading cause of death among people living with HIV, responsible for one in three AIDS-related deaths.

While in Australia we are fortunate to now have very low rates of TB infection, the TB-HIV interaction is an urgent and serious problem not far from our shores. The three countries with the highest proportion of AIDS-related deaths in our region – India, China and Indonesia – among them also account for 40% of the world’s TB burden. While it’s great news that TB prevalence is decreasing, in 2014 there were still 9.6 million new TB infections and 1.5 million deaths (400 000 of these among HIV-positive people).

In the 16 years since this AIDS conference was last held in Durban, the world has made amazing progress on HIV prevention and treatment, and in making these advances available to people everywhere who have or are at risk of HIV. The notion that people living with HIV in our region could instead lose their lives to TB – a completely treatable infection – is unacceptable.

HIV remains a significant burden in our region and the serious consequences of TB for people living with HIV means the prevention and treatment of TB should be a natural focus for Australian aid. The best approach is an integrated one, to jointly test, treat and work to prevent TB and HIV. In Australia you don’t go to one GP for a cold and one for a stomach ache, so in areas where primary health is already under resourced, an integrated approach to TB prevention and treatment is a cost effective and simple solution. A collaborative, regional approach to addressing TB and HIV is an investment in the health, security and prosperity of both the region and of Australia.

At the XV International AIDS conference in 2004, Nelson Mandela gave a speech that addressed this need to integrate the response to the twin epidemics of TB and HIV. He concluded that “the world has made defeating AIDS a top priority. This is a blessing. But TB remains ignored. Today we are calling on the world to recognize that we can’t fight AIDS unless we do much more to fight TB as well.” Today on his birthday this message rings just as true as ever. We won’t see an ‘end to AIDS’ globally unless we are just as committed to ending TB.

P.S This September, funding for The Global Fund to Fight AIDS, Tuberculosis and Malaria will be decided. RESULTS is calling on Australia to pledge to contribute $300 million, our fair share of the total three-year budget. In the coming weeks, RESULTS grassroots advocates across the country will be visiting their local MPs to tell them about the Global Fund and the importance of Australia’s pledge for our region. Want to be involved? Here’s how!

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