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Infectious Diseases

Connecting HIV and TB services will be a life-saver


Michel Sidibé

Executive Director, UNAIDS

Tuberculosis — the leading cause of death among people with HIV — has to be thought of as a social justice issue rather than just a disease, says Michel Sidibé Executive Director, UNAIDS.

You’re about to read a story of two halves: HIV and tuberculosis (TB). As far as HIV is concerned, it is no longer the world’s leading infectious killer. That title has now been claimed by TB.

There is, however, a deadly crossover between the two diseases. At least one-third of people living with HIV have latent TB; and, indeed, TB remains the leading cause of death among people living with HIV.

No-one should be under any illusions: TB can be fatal. Yet it is also very curable. So, what’s going on?

TB should be considered a social justice issue

Well, for too long, TB has been thought of as ‘just another disease’ — a medical problem that can be addressed by technicians, doctors and other medical professionals. This must change.

Instead, the TB response has to be reframed as a social justice issue because, like HIV, it often affects the poorest and most vulnerable in society — such as migrants and refugees — millions of whom are not being reached by HIV and TB services.

It was a dynamic social movement that called for change and pushed politicians at the highest levels to respond to the deadly danger of HIV. A similar movement is needed — and quickly — if we are to counteract the deadly danger of tuberculosis. The UN High Level Meeting on TB in September is an important opportunity in this regard.

Reducing time between diagnosis and treatment

I said that this a story of two halves. And that, actually, is part of the problem, because HIV and TB are really two sides of the same coin. We cannot deal with these two diseases in isolation. Instead, we need better collaboration between HIV and TB programmes and a fully integrated approach that considers the person, not their disease.

We need strategic HIV and TB services that are readily accessible to people wherever they live and work, so they can receive rapid diagnosis and treatment at community level. We need to reduce the time to minutes — not months — between diagnosis and treatment; and we need new TB drugs, diagnostics and vaccines. Current treatment is long, antiquated and toxic with side-effects that can lead people to stop taking it, with disastrous consequences.

Save lives by screening for TB and HIV, together

There are reasons for optimism. Malawi, for example, offers a one-stop-shop for free-of-charge TB and HIV services. Ninety-eight per cent of its people living with HIV are screened for TB; and 85% of those presumed to have TB are tested for HIV. What’s more, treatment is immediate. This type of joined-up programming saves lives.

So, let’s stop putting HIV into one corner and TB into another. The fact is that HIV and TB are working together in order to kill people. The TB and HIV movements must now work together in order to save them.

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