TB/HIV co-infection: Why is ICAAP silent?

Dr Sugata Mukhopadhyay - CNS
“I am infected with HIV and not scared of AIDS, but definitely of TB. I know TB can knock me down at any time.” Space to discuss crucial issues of TB/HIV co-infection and management appears to be extremely limited in the current ICAAP. Surprisingly, community advocates and activists are also not very vocal on what should be a burning issue for the region.

According to recently published Global TB Report (2013), 15.3% of all co-infected people (currently estimated to be 170,021) are from South-East Asia. Each of the high TB-burden countries of the region, such as like India, Indonesia, Myanmar and Thailand, carry almost all of this burden.

The estimated annual number of HIV-associated TB deaths in the region is more than 50,000. The figure might have been more if it were not for the fact that only 40% of people with newly diagnosed TB cases know their HIV status.

According to the same report, only 39% of the people living with HIV are screened for TB, overlooking a large proportion of potential co-infected cases. Drug-resistant TB (DR-TB) has already made its presence felt across the globe and Asia and the Pacific are not spared. China and India have the highest national numbers of DR-TB cases globally.

Early detection and early treatment of TB is key to reducing HIV-associated TB mortality. Dr Anthony Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease (The Union), insists that, “We need to get more HIV-infected people earlier on to antiretroviral therapy as this is a most important way of preventing tuberculosis. We also need to test all patients with tuberculosis for HIV, and those who are HIV-positive need to start antiretroviral therapy and cotrimoxazole preventive therapy as soon as possible. We have made good progress over the years in our fight against HIV-associated TB, but only by attaining universal coverage and meeting ambitious targets set by the international community will we achieve victory.”  

But with continuing stigma and discrimination, and when access to services and information is denied, early TB detection and treatment remains a real challenge. Low focus on TB sensitization in HIV programmes and regional networks, insufficient linkages between the two services, and a lack of sustained advocacy to strengthen TB/HIV collaborative initiatives – especially the absence of community voices demanding newer diagnostic techniques for early TB diagnosis – are major barriers that dilute efforts and disrupt the partnership between the old bacteria and new virus.

So where is the scope to achieve zero discrimination and zero-death without adequately addressing the issues of TB/HIV co-infection in the region? Is anyone in ICAAP listening?

Dr Sugata Mukhopadhyay, Citizen News Service - CNS
November 2013

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.