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HIV & TB Q4 2020

Fighting HIV and TB co-infection in the shadow of COVID-19

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Dr. Siobhan Crowley

Head of HIV, The Global Fund to Fight Aids, Tuberculosis and Malaria

Showcasing the link between HIV and TB is vital to understand the risks and impact on the most vulnerable in society.

A co-infection is the occurrence of two or more infections – at the same time. HIV is a preventable chronic infection, that when left untreated damages and weakens the immune system. This puts people living with HIV at greater risk of infections and cancers.

Tuberculosis (TB) is one of the common and most harmful infections people living with HIV are at risk of contracting. People with HIV are 18 times more likely to develop active TB compared to people without HIV. TB is still the leading cause of death among people living with HIV.

Who are the people primarily affected by HIV/TB co-infection?

People living with HIV are at risk of developing active TB. TB is airborne, so when a person living with the disease coughs, sneezes, shouts or sings, droplets containing TB are released. Depending on the environment, these particles can remain suspended in the air for several hours. Therefore, people who live or work in crowded places, with bad ventilation (prisons, slums, mines), bad quality of air or greater time of exposure like healthcare workers are at greater risk of TB infection.

People with HIV are 18 times more likely to develop active TB compared to people without HIV.

The poorest and most marginalised communities are also most at risk of HIV. TB and HIV groups often experience greater difficulty accessing health services due to stigma and discrimination, violence, harassment or restrictive laws or policies.

In the context of HIV, this includes sex workers, people who inject drugs, men who have sex with men, transgender people and people in prison and detention. In the context of TB, this can also include migrants, refugees, miners and indigenous populations.

What impact has the COVID-19 pandemic had on HIV and TB?

COVID-19 has widely disrupted health service delivery and demand worldwide. Lifesaving treatment and prevention activities for people with HIV and TB has been interrupted, increasing the risk of drug resistance and deaths. 

The latest data provided by the WHO has shown significant reductions in TB case notifications, with a 25-30% drop reported in three high burden countries – India, Indonesia, the Philippines – between January and June 2020 compared to the same six-month period in 2019.

If people are not tested and treated, they can continue to transmit the disease to others, or die. This is a tragedy. It may derail years of progress against HIV and TB. The international community must urgently invest far greater resources in the fight against COVID-19 and to mitigate its devastating impact on the fights against HIV and TB.

The Global Fund is playing a critical role in the global response to COVID-19 by providing up to US$1 billion to support response in more than 100 countries. These funds aim to maintain essential health services, mitigate the impact of COVID-19 on HIV, TB and malaria, purchase and distribute tests, and provide personal protective equipment to frontline health workers.

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