Bill & Melinda Gates Foundation

Perspectives: Reaching and Treating People with TB and HIV

March 23, 2014

This year, the theme of World TB Day on March 24th is “Reach the 3 million.” Advocates, researchers, experts, and communities around the world are rallying around a call to reach the 3 million people who have tuberculosis (TB), but do not receive the care they need.

TB is the leading killer of people living with HIV. To reach the 3 million, it is therefore essential to address this deadly co-epidemic.

ACTION spoke to advocates and experts from Kenya, Malawi, South Africa, Tanzania, and Zambia on the challenges and opportunities surrounding efforts to find, treat, and cure everyone with TB and HIV.

TB and HIV Integration

Dr. Raymond Chimatira (@Selektarj) , Programme Manager, TB/HIV Care Association (South Africa)

TB is still the leading killer of people living with HIV, so we cannot divorce the two. There are a lot of documents with guidance on why and how TB and HIV planning and services must be integrated, but strangely, on the ground, these policies are not being implemented. Funding streams for these two diseases are often separated. At the national level, there are different TB and HIV departments that barely talk to each other, and that use different indicators and tools. If you go into communities, it’s the same – there are strictly TB screening programs and strictly HIV screening programs. In my lifetime, I need to see a stage where we don’t just talk about integration, where we just do it. This requires a mindset shift that starts with global organizations and trickles down to national programs. 

Stigma

Nathan Nhlane (@MNNhlane), National Coordinator of the Zambia National Anti­retroviral Support Programme 

The same levels of stigma that are there on HIV are there on TB. If a person has TB in a family, only the closest of relatives will know. The rest will be told it is pneumonia. That’s it. It’s because a simple message has gone out that TB is airborne, so even in households where the person with TB is being taken care of, you will see discrimination at its highest. If someone in that household who has TB uses a cup, others will try to find another cup, and let the first cup dry out. Stigma is there, and it’s high. We must make it more socially acceptable to seek treatment, and change the language of ‘confidentiality’ that surrounds TB and HIV.

Increased Domestic Funding

Maureen Milanga, Project Associate with the AIDS Law Project (Kenya)
People know about the Abuja Declaration from 2001, when African Union countries pledged to increase government funding for health to at least 15% of their overall budget. But 2001 was a long time ago, so now we must ask: How can countries in Africa get to 15%? And when you tell governments that you want 15% you have to tell them what it’s for. For instance, in Kenya, only about 300,000 people are on treatment for HIV. We also don’t have enough doctors.  So there’s more work for us as advocates to follow up on that pledge and make sure something actually happens.

Clara Banya (@ClaraBanya), Malawi Network of People Living with HIV/AIDS (MANET+)

As a person living with HIV, I’ve had the privilege of accessing treatment and having quality of life. I’ve been able to contribute to my family, but also to my country in a positive way. But I’ve seen a lot of women in my country, who are in the rural communities, who are facing many problems. Some, even until now, can’t access treatment. Increased domestic funding for TB and HIV is a part of solving this gap. Malawi has done a lot, that we have to appreciate, but as a country, I think there is more that we can do. Increased domestic funding for health will help to bridge gaps and also create a feeling of ownership. If we have that feeling of ownership, we can create sustainability. We will be able to ensure funds are being used in the right way, and we can monitor and evaluate efforts. People at all levels – from grassroots to implementers – would also feel that they are doing something for their country.

Community Involvement

Olive Mumba (@LivMumba), Programmes Manager, The Eastern Africa National Networks of AIDS Service Organizations (EANNASO)

There are national policies out there that impact treatment, care, and support, and affect how people in communities access services. My role at EANNASO is to make sure that when policies are being made, that they are community-friendly. Often, in decision making, the voice of national organizations represents communities. But why can’t people from the communities sit at the table? Communities should be part of decision making at national and regional levels, and the people living with these diseases should be the ones to voice their concerns. I have seen there is a big gap –people at the community level don’t know what is their right and responsibility. As part of their health budgets, governments should set aside a portion to support the capacity of communities to participate.

 

 
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