'Two by Four campaign' in lead up to World TB Day: 24th March

Have your say in the online consultation and key informant interviews in lead up to the World TB Day, 24th March 2013. 'Two by Four: 2by4' is a time-limited communications' campaign hosted by Citizen News Service - CNS, a partner of Stop TB Partnership, on the Global Stop-TB eForum and other platforms CNS is part of. The 2by4 campaign runs for two months from 24th February to 24th April 2013.

Why 2by4?
The campaign 2by4 refers to two key populations and four key issues CNS believes need more attention around World TB Day. 

The 2 key populations include children and women. The 4 key issues include: multidrug-resistant TB (MDR-TB), laboratory and diagnostics, private-public partnership (PPP) and TB-HIV collaborative activities.

2by4: Theme 1: Women and Tuberculosis: 24 February  10 March 2013

Join hands: How to have your say?

* Join the e-consultation: If you are not a member of the Global Stop-TB eForum, then send an email to: Stop-TB-subscribe@yahoogroups.com to have your say in the online discussion.

* Become an organizational partner and endorse the campaign: send your organizational endorsement to Bobby Ramakant at bobby@citizen-news.org

* Tweet on Twitter using hash-tag (#tag): #2by4 #lunghealth and other appropriate tags. Follow us on Twitter (@bobbyramakant)

* Follow us on Facebook page and have your say! www.facebook.com/CNS.page

* Email us your comments, perspectives and experiences at: stopTB@citizen-news.org

* Go online at CNS blog: www.citizen-news.org and publish your comments real time!

Reference: World TB Day website supported by the Stop TB Partnership

For more information, contact: stopTB@citizen-news.org

PARTNERS | 2by4 is endorsed by:
Abhinav Bharat Foundation
American Thoracic Society
Asha Parivar 
Citizen News Service - CNS
Global Alliance for TB Drug Development (TB Alliance)
Global Stop-TB eForum
National Alliance of People's Movements (NAPM)
Partnership for TB Care and Control in India
SEA-AIDS (Asia Pacific Regional eForum on HIV)
SMLS Trust (Amalapuram, AP, India)
TB Alert
Vote For Health campaign



    In 2005, Tariro Jack, 27, fell ill with Tuberculosis (TB) during her first year at college. She said that she struggled to cope not only with her own health but also managing people's perceptions. TB is an infectious disease that spreads through the air. The disease mostly affects young adults in their most productive years and 95% of TB deaths are in the developing world. Estimated TB incidence rates are highest in sub-Saharan Africa with over 350 cases per 100,000 population. Among African nations, Zimbabwe is one of those most heavily affected by TB. The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

    "I had TB at 21 in my first year at college and I know people thought that I was dying; I struggled a lot," Jack said, adding that when she was put on the World Health Organisation (WHO) -recommended Directly Observed Treatment Shortcourse (DOTS), matters only got worse as her health further deteriorated.

    "My skin was very smooth. When I started taking pills, I developed a rash and my legs became sore to the extent that I couldn't walk," she said.

    "Every time that I took the pills I would feel more sick that before and after, I used to throw up a lot. I used to go to the toilet frequently because the pills upset my whole system."

    To complicate matters, her doctor at the time told her that she was not responding well to the medication and recommened that she go and see a specialist. Other health officials did not help the situation by predicting Jack's demise.

    "I remember there is one time I was admitted to hospital and the sister-in-charge told the nurses not to waste their time on me because I was good as dead. That gave me strength to fight for my life," she said.

    Due to the close association between TB and HIV, Jack said that she had to contend with another struggle, that of being suspected to be HIV-positive. TB is a leading cause of illness and death for people living with HIV - about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. In spite of this close association, it is not automatic that when one has TB, they're also HIV positive. Stigma around this association is portent though and can lead affected to shun seeking medical attention.

    "When I had TB, everyone seemed to think I was HIV positive. I went for countless HIV tests and everytime they came out negative. This was to prove a point but I later realised I didn't live for people but for my self," Jack said.

    "I finally got better as I followed the treatment course until I was fine and I thank God because people who did not know me at the time cannot in any way tell that I once had TB."

    She said that the negative attitude that she received from some of the health personnel is still like a fresh scar in her memory.

    "To people with TB, whether you're HIV-negative or living with HIV, what you've to know is that TB is curable. You should just believe in your self and have a thick skin because people will always talk but I thank God because He gave me strength and now I can tell everyone of my experience. TB does not kill. Don't let anyone lie to you," she said.

    Chief K Masimba Biriwasha, Zimbabwe
    (originally written in March 2012 for CNS)

    (March 2008)

    "...Stigma is known to impede the responses to HIV and TB, and although many may feel that TB-related stigma is a story of the yesteryears, the studies done by Tuberculosis Research Centre in India establish the fact that significant number of women with TB become homeless once diagnosed with TB.

    India’s Health and Family Welfare minister Dr Anbumani Ramadoss said at the recently concluded Fifth International Microbicides Conference 2008 that: “studies done at Tuberculosis Research Centre in Chennai showed that women who develop Tuberculosis, 1 in 1000 lose their home. TB is the major co-infection of HIV.”

    Just a week ago, the body of a woman who died of TB in India, was not handed over to relatives for cremation but driven in a car for 5 days by her employers. It is clear that the TB-related stigma attains a worse magnitude and impact for women with TB.

    Millennium development goals speak about promoting gender equality, empowerment of women and improved maternal health to combat HIV. “It will be very difficult to achieve the above millennium development goals if the current trend of increasing HIV infections in women continues” said Dr Ramadoss.

    However what Dr Ramadoss said now, WHO had alerted in 1998 stating that “TB is the single biggest killer of young women.”

    "Wives, mothers and wage earners are being cut down in their prime and the world isn't noticing," had said Dr Paul Dolin of WHO's Global Tuberculosis Programme in a 1998 press release of WHO. "Yet the ripple effect on families, communities and economies will be felt long after a woman has died."

    Women, are biologically, socially and physiologically more prone for HIV transmission than men. “AIDS in India is not only a health issue, it is a social issue, it is an economic issue” said Dr Ramadoss.

    TB being the most common opportunistic infection for people living with HIV, it is vital for TB programmes to be accessible for women, especially those women who are most underserved and economically disadvantaged.

    The WHO recommended treatment for TB, Directly Observed Treatment Short-course (DOTS), should function in a manner so as to reduce the gender inequities. TB education programmes should reach women, especially those in hard-to-reach settings. The TB treatment centres should be more accessible and safer places to women to go regularly for their medicines.

    Health for many women is the last on the priority in a family. So it is not surprising that women get late in getting diagnosed for TB and eventually for treatment. Nutritionally the food they receive in many settings in India is often the least nutritious and inadequate in a family. Women with TB need not only to adhere to TB treatment but also to the nutrition they receive.

    It is high time for those working on reducing gender inequities and disease control interventions be it HIV or TB, to work more closely together.

    With closely approaching International Women’s Day (8 March) and the World TB Day (24 March), let us bring different stakeholders together to change the situation so that the most disadvantaged women can also ably say: ‘I can stop TB’..."