Gender Mainstreaming in TB-HIV Response-A private sector response

Alice Tembe - CNS
In this years' event, the Swaziland Business Coalition on HIV-AIDS (SWABCHA) launched the integration and mainstreaming of gender in the HIV and TB response programmes in the workplace. The  US Ambassador to Swaziland, Ms Makila James, the guest speaker, said in her remarks that  the progress and milestones gained so far in the HIV and TB response will go to waste if due diligence is not accorded to the gender dynamics at play in the society. She noted that gender based violence, has undoubtedly contributed to new infections among the Swazi population. Further, these two epidemics,  have increased the burden of care on women and reduced the chances of women growing in the workplace as they are bound to withdraw from work to care for their loved ones.

The Swaziland business leaders gathered on the eve of  29th November 2013, to commemorate and celebrate the tremendous achievements that the organized response to HIV-AIDS and TB has made in the preceding year. This was the fourth dinner combined with an award ceremony organized by the private sector secretariat  of SWABCHA. Having witnessed much speech loaded World AIDS Day events previously, the SWABCHA board led by Mr. Nick Jackson,  Managing Director Royal Swaziland Sugar Corporation, decided that the World AIDS Day event should have tangible outputs and impact on the business sector. To this effect, four years ago, SWABCHA established a minimum package for workplace wellness, HIV and TB programmes against which  individual companies compete to do more than the minimum in response to TB and HIV. Consequently, Swaziland business sector wellness, HIV and TB programmes have improved and expanded in the past four years.

It is in acknowledgment that despite the fact that TB is curable and HIV is treatable, 320,000 people co-infected with the two diseases died in 2012.  An estimated 1.1 million people needed simultaneous treatment for both diseases in 2012 and 75% of them were in the African Region. According to the Global TB Report 2013 and the WHO TB-HIV Factsheet of 2012–13, 4.1 million enrolled in HIV care were screened for TB in 2012 while up from 3.5 million were screened in 2011, yet only 46% of TB patients knew their HIV status and this is the gap in linkage to care and prevention of new infections towards the UNAIDS theme, Zero new infections. The same report indicates that of the TB patients found to be HIV+ in 2012, 57% were enrolled on anti retroviral therapy (ART)-- a significant increase from the 49% in 2011. Of concern is that while  9.7 million people in low- and middle-income countries, where Swaziland is nested, are on ART, 16 million more are eligible under new guidelines and have no access to it.

The main obstacles to managing patients with TB and HIV infection are weak coordination between TB and HIV programmes and slow integration of collaborative TB-HIV services into the general health services.  Anthony Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease (The Union), says that, "HIV-associated TB can be controlled by better scale up and implementation of tools that are currently available. We need to get more HIV-infected people earlier on to ART as this is the most important way of preventing TB. In high HIV-TB burden areas of Southern Africa, TB preventive effects of ART can be further increased by the addition of isoniazid preventive therapy. We need to test all patients with TB for HIV, and those who are HIV-positive need to start ART and cotrimoxazole preventive therapy as soon as possible."

The Swaziland National Emergency Response Committee on HIV-AIDS (NERCHA) is initiating and advocating for the mainstreaming of HIV and TB in non-health government ministries. Possibly, a partnership of civil society organisations with parent ministries to encourage government ministries appreciate the link with grassroots communities and industries and benefit from spillover of lessons learnt through civil society experiences can be auspicious--in particular to improve early diagnosis, timely initiation of treatment for both diseases and careful monitoring which are essential to treat TB in people living with HIV and identify HIV infection in people with TB. With more than one million people needing simultaneous treatment for TB and HIV, it is essential that services for these patients be scaled up and coordinated within the general health system.

Alice Tembe, Citizen News Service - CNS
December 2013