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HIV, TB, And The Battle For Global Health

Tuberculosis (TB), a formidable foe to global health for thousands of years, has joined forces with HIV, a relative new-kid on the block, and together the two have left a wake of destruction, destitution, and death in communities across the globe.
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By Shelley Garnham, TB Officer, RESULTS Canada

It's not a bird, and it's not a plane. Despite the similarities, it isn't another formulaic superhero, headlining a blockbuster movie coming to a theatre near you, and it hasn't taken in billions of dollars in box office receipts worldwide.

Though it should. It's a real-life battle between good and evil, not unlike many that we've seen before. We love watching heroes take on villains and come out on top -- seeing humanity (or our hyper-capable proxies) work together to defeat evil on behalf of our planet. But resemble as it might a comic book tale, life has yet to imitate art.

There are real life villains wreaking havoc across the globe, taking lives and fighting the forces of good at every turn, but a saviour has yet to truly emerge. The forces of evil I refer to are otherwise known as The Deadly Duo: Tuberculosis and HIV -- two infectious killers that have taken countless lives the world over.

Tuberculosis (TB), a formidable foe to global health for thousands of years, has joined forces with HIV, a relative new-kid on the block, and together the Deadly Duo has left a wake of destruction, destitution, and death in communities across the globe.

The two are ideal partners in crime: HIV breaks down the walls to the immune system and puts out a welcome mat -- sending out invites to whatever infection sees fit to make itself comfortable; and TB is the most deadly of all, killing 35% of people with HIV.

As a result, in 2015 TB claimed the lives of 400,000 people with HIV worldwide, and infected another 1.2 million.

Alone, TB is an opportunist. It moves through the air, indiscriminate in who it attacks, and like many villains has the capacity to take on various forms, depending on the environment, appearing as:

  • Drug Sensitive TB: TB in its most common form; infectious; deadly if untreated.
  • Latent TB: A patient and symptomless form of TB that cannot be transmitted but lies in wait until the immune system weakens, allowing TB to thrive and become active and infectious.
  • Multi and Extremely Drug Resistant TB: Two TB mutants that have developed the ability to defeat many of the most effective drugs used to fight TB; infectious; deadly and very difficult to treat.

HIV, meanwhile, is an undiscerning criminal, happy to team up with any of these TB characters for maximum damage. Together they are a perilously effective combination.

And yet, as always, there's hope! While the Deadly Duo has formed a strong and formidable partnership, it is one that we as the Global Community can and have the tools to defeat. Through years of painstaking research and with significant investment, we've developed weapons and strategies that can keep the Deadly Duo at bay, though we stand at a crucial point in history: like our onscreen heroes at the precipice of battle, we can choose to come together and fight, or become divided and fail.

Early diagnosis and treatment of HIV and TB is essential to winning this fight -- and we have treatment, preventative therapies and unique ways to diagnose TB in people living with HIV that can make a world of difference. The WHO recommends putting these to use in 12 collaborative approaches among TB and HIV communities to take the Duo down. It's not easy, but there exists a plan of attack.

However, the Global Community (our hero!) has yet to fully rally around the cause and implement the required tactics. A recent report examined the implementation of the WHO recommendations and found that many of the countries with the highest levels of HIV-TB coinfection rates in the world are failing to put the endorsed policies into practice.

People tested for HIV should be tested for TB, and vice versa, and they shouldn't have to travel between clinics to receive testing or treatment. Similarly, people living with HIV should be provided preventative therapy to protect them against TB. And yet, they aren't.

Governments need to adopt policies that entail this coordinated approach and that foster the required change within the system -- this includes education for health care workers and communities to reduce stigma.

In sum, if the Global Community is to meaningfully stop TB and HIV from their global assault, it must ensure that services are coordinated, that treatment is integrated when appropriate, and that governments implement the collaborative practices that effectively and collectively address the infectious villains.

In other words, there must be a shift in practice, from operating as two distinct communities -- TB and HIV -- each battling their own foe, and instead work as one to end the villainous reign of the Deadly Duo.

Our lack of unity is our Kryptonite -- we must work together, be collaborative and flexible and most of all, keep in mind that this enemy attacks communities, families, and individuals. No one is fighting harder against TB and HIV than those who are most immediately affected, and we must ensure that they have the tools and systems in place to defeat the forces of evil.

Will the Deadly Duo prove too strong? Or will the Global Community rise together and deliver the final blow to HIV and TB? Important questions, to say the least, and given the consequences we need to pay close attention to how it ends.

Shelley Garnham is the Tuberculosis Project Officer at RESULTS Canada, an advocacy organization that generates the political will to end poverty.

This blog is part of the blog series: Barometer Rising: No time to backtrack the fast track to ending HIV as a global health threat by 2030 by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (1 December). The series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on what they think needs to be done to strengthen our HIV prevention efforts at home and abroad in order for the world to meet the ambitious target of ending AIDS as an epidemic by 2030.

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

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