PRAGUE — Fatima, who lives in western Tanzania near Lake Tanganyika, has been suffering for more than a month from a dry, hacking cough. She trembles to think that it might mean she has tuberculosis. Fatima knows that she can find out and, if necessary, receive treatment at the nearest health clinic, a one-hour bus ride away. She ponders asking her husband for the bus fare (about 60 euro), but decides against it. She needs this money to feed her children. Besides, if she tests positive for TB, her husband and all of their neighbors will assume she also has AIDS.
We have interviewed many people living with TB in Tanzania and Nigeria, and Fatima’s fears and concerns are not unique. People with TB are commonly stigmatized in sub-Saharan Africa. Lack of accurate information about the disease is widespread.
These realities prevent people who believe they are infected with TB from seeking treatment. In many regions — and especially in rural areas — people still believe that TB patients have been bewitched, poisoned, or, as one Nigerian doctor put it, “cursed by the gods.”
More than half a million Africans and two million people globally die each year from TB, the leading infectious cause of death for people with HIV/AIDS.
To make matters worse, HIV/AIDS is fueling a dramatic resurgence of TB. In Tanzania, for example, the number of TB cases increased almost six-fold between 1983 and 2003, from approximately 12,000 to 64,500. HIV/AIDS has resulted in a 6 percent annual increase in the prevalence of TB in Nigeria, which now has the highest number of new TB cases in Africa.
Yet TB is commonly considered a disease of the past. Most people — even those at greatest risk of contracting the disease, including people living with HIV/AIDS — lack accurate information about TB’s symptoms or where to seek treatment. Despite the fact that in many parts of sub-Saharan Africa more than half of all TB patients are HIV-positive, most HIV/AIDS testing sites do not offer TB diagnostic and treatment services. Those sites that do offer such testing find it much more difficult to diagnose TB among patients infected with both diseases, because current diagnostic tests fail to detect active TB in 60-80 percent of people with HIV/AIDS.
Political leaders across the globe have made a series of public commitments to address the deadly double impact of TB and HIV/AIDS. One year ago, in Maputo, Mozambique, for example, African health ministers declared TB a “regional emergency” and lined up behind a new “Global Plan to Stop TB,” which includes specific targets and guidelines for addressing TB/HIV coinfection.
Some positive steps have been taken. Tanzania has experimented with community-based programs that send health workers to the homes of TB patients in order to monitor treatment compliance and provide support.
Yet these efforts have not been taken on a large scale and are not sufficient to stem the dramatic resurgence of TB caused by HIV/AIDS. The political will to implement the commitments that governments have undertaken is still lacking. TB programs continue to lack the resources needed to deal with the rising number of cases; health workers are overworked and underpaid; and better tools for diagnosing and treating TB/HIV coinfection are desperately needed.
For Fatima and thousands of people like her, government declarations will become meaningful only when they are translated into better services. This means rapid expansion of TB centers, so that patients don’t have to choose between treatment and caring for their families.
It also means careful coordination of TB and HIV programs, so that people living with both diseases can receive treatment in the same location. Finally, significant assistance and investment in research and development from wealthy countries is needed, so that free TB treatment is truly available and accessible to all.
The resurgence of TB has become a grave health emergency, and the world can no longer afford to be lethargic in addressing it. As Stephen Lewis, the U.N. secretary general’s special envoy on HIV/AIDS in Africa, has stated, “TB and HIV act on each other with fatal force — a combination made in hell.” HIV/AIDS activists and policymakers need to focus much greater attention on TB. Fatima and those like her deserve nothing less.