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The Number One Killer of People With HIV

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As advocates, we often like to use analogies to explain the scourge of pandemics like HIV: It's a runaway train with no conductor, a loaded gun in the hands of a madman, a tide that needs to be turned.

The problem with analogies though is that they have a way of detracting from the overarching, inevitable truth: People are dying. Real people.

By the end of 2012, there were 35.3 million people across the world living with HIV. That's more than the entire population of Canada. No analogies needed here.

Even more jarring is the fact that one third of those people also have tuberculosis (TB), and many of them will die before they even know that they have it.

TB is the number one killer of people with HIV worldwide, and modern science has only recently caught up enough to be able to accurately and efficiently test for this deadly co-infection. In December of 2010, the WHO first endorsed GeneXpert, a revolutionary new diagnostic tool that they heralded as a major milestone for global TB diagnosis. Not only does it cut the testing time down from weeks to mere hours, but it is the first tool to be able to detect TB in HIV patients.

So what makes TB so hard to find? For more than half of all HIV patients infected with the disease, their TB exists outside of the lungs, making it impossible for a standard sputum smear test to detect. Extrapulmonary TB can be found in bones, joints, lymph nodes and the central nervous system, just to name a few places.

"We cannot win the battle against AIDS if we do not also fight TB." - Nelson Mandela

The UNAIDS strategy for 2011-2015 is Getting to Zero. Zero New HIV Infections. Zero Discrimination. Zero AIDS-Related Deaths. What tends to get lost in the thinking, planning and support surrounding HIV is the specificity of the last part of that strategy: Zero AIDS-Related Deaths. For more than half a million people each year, their AIDS-related death is caused by TB, and yet the amount of attention being paid and funding being provided to TB prevention and treatment globally is continually falling short.

As grim as that sounds, we are not without hope. More and more, implementing agencies, donor governments and other governing bodies are recognizing the importance of integrating HIV and TB screening, testing, control and care programs, but there is still a long way to go. Stigma is something that both HIV and TB patients understand all too well, and that stigma often keeps HIV patients from being tested for TB, and vice versa.

As we near ever closer to 2015, it's time to stop addressing these global health issues in silos and join forces to combat them once and for all. The Global Fund to Fight AIDS, TB and Malaria has introduced a landmark strategy to address this ever-growing problem. Moving forward, any country that records high rates of HIV and TB must design its programs in a way that will address both in conjunction before they will qualify for funding from the Global Fund. This type of approach will help to streamline treatment programming at the country-level, and also contribute to combating the stigma of disease that the patients face on a daily basis.

Canada has long been at the forefront of funding for international TB control, most notably for its support of the Global Fund and its leadership in helping to launch TB REACH in 2009. An initiative of the Stop TB Partnership, TB REACH focuses on small, community-based projects aimed at the most vulnerable populations across the globe, and is currently being sustained almost entirely on funding from the Canadian government -- funding which is due to run out next year.

So what's next?

We must now switch from being reactive to proactive when it comes to TB. There is currently no effective vaccine for TB, and funding for research and development is hard to come by. But the proof is in the numbers: Humankind eliminated smallpox with the introduction of a vaccine, and we're on our way to eradicating polio thanks to cost-effective immunization and the tireless work of community health workers.

We won't get to zero AIDS deaths until we first eliminate TB. It's going to take the scientific community, health care systems, and governments coming together with a common goal of halting and preventing this epidemic from spreading further, because, as medical research champion Mary Lasker famously said, "If you think research is expensive, try disease!"

This blog is part of a World AIDS Day series produced by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (Dec 1). The series runs from Dec. 1-7, 2013 and will feature a selection of blogs written by our member and partner organizations. Each day of the week will address a specific, yet broad topic area, and offer different perspectives and insight on what must be done to achieve the UNAIDS campaign of "Getting to Zero." 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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