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The Director’s Corner

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A message from José Luis Castro, Executive Director, The Union, on World AIDS Day – 1 December 

On this day, it is important to review why, despite scientific evidence-backed policies and programmes, we are still failing to prevent tuberculosis (TB)-related deaths among people living with HIV (PLHIV).

The latest figures released by the World Health Organization (WHO) state that TB is the cause of one-third of the 1.5 million AIDS deaths each year and continues to kill an estimated 1.7 million people and infect over 10 million. According to the WHO, the risk of developing TB is estimated to be up to 27 times greater in PLHIV than among those without HIV infection. When someone has both HIV and TB, each disease speeds up the progress of the other – with catastrophic results.

What is to be done? The Union, along with other partners in the TB and HIV community, was an active advocate at last month’s WHO Global Ministerial Conference in Moscow, and we made it clear that we cannot accelerate progress towards the End TB deadline in 2030, unless we have the political will to enable us to do so.

National governments must be responsible for generating action for people living with HIV/TB co-infection. But unless individual countries have clear national targets for dealing with these epidemics (with budgets and resources similarly aligned to invest in the most affected communities), global TB targets cannot be met.

TB is a curable disease – and there are existing, proven diagnostics and treatment regimens that all countries should be encouraged and supported in adopting, increasing universal access. That is a basic, fundamental requirement in any End TB strategy.

Concurrently, worldwide investment in new drugs – and the essential research and development to make them possible – needs to be prioritised. Our communities urgently need new diagnostics and treatment regimens that are effective, safe, quick and accessible to all.

In 2016, of the almost half a million reported cases of HIV-associated TB, 15% were not on antiretroviral therapy (ART)*, as recommended by the WHO. A Union project in Myanmar (in collaboration with the National AIDS Programme) is integrated HIV care (IHC) for TB patients living with HIV, and has HIV/TB co-infection treatment strategy at its core. IHC patients are provided with ART, screened for TB, have their CD4 count and HIV viral load monitored, and receive expert counselling. The IHC model has become a key component of Myanmar’s national HIV strategy. There are now 44,000 people enrolled in the programme, across five regions of the country and supported by over 1300 volunteers. The office also runs the Prevention of Mother to Child Transmission of HIV programme, to reduce HIV incidence in babies. If HIV positive, women begin ART when pregnant and are also screened for TB. Similar projects for integrated HIV/TB care services are run by The Union in countries including Benin, Democratic Republic of the Congo, Uganda and Zimbabwe.

World AIDS Day is a reminder that ending TB is just as crucial to the survival of those with HIV. HIV/TB co-infection and the TB epidemic are global health emergencies – and the solutions lie in a mix of effective programme management, behavioural and human rights approaches. With the will and the resources, we can ensure that everyone has access to both the treatment and support services they need to enable them to live their lives. That should not be an impossible ask.

Access the recording of the CNS/The Union media webinar for World AIDS Day: When HIV virus and TB bacteria can work together, why can't we?

*Source – Global Tuberculosis Report 2017 – WHO: