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Why We Need to Stop Tuberculosis to End AIDS

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After more than 30 years and over 30 million deaths, we finally possess the tools and tactics to effectively chart a course to end AIDS. And so this year, a gathering chorus of advocates will mark World AIDS Day on December 1, by calling for policies to achieve the ambitious, bold target of "zero AIDS deaths."

But nothing threatens to reverse the gains won in the fight against HIV/AIDS more so than the spread of tuberculosis. Long since forgotten by the international community, this deadly bacteria claims the lives of more than 1.4 million people each year, and is a leading killer of people living with HIV-killing up to half of HIV patients worldwide.

HIV positive individuals have an estimated 20-30 times greater risk of developing active TB than people without HIV infection, and without adequate treatment approximately 90 per cent of people living with HIV die within months of developing active TB. This is particularly tragic when the cost for a full regimen of TB drugs can be as little as $20, and in 95 per cent of cases is curable. However, despite the fact that TB is responsible for a quarter of all HIV/AIDS deaths, globally only 48 per cent of people living with HIV/AIDS are actually being tested for TB.

It is a reality that Banza from Zambia knows all too well. In early 2005, Banza's health started deteriorating. Feeling chest pains, he suspected he may have tuberculosis, but after visiting three clinics in Lusaka, none were able to diagnose him. As his weight fell from 68 kg to 47 kg, his wife took him to see his brother, a doctor in the Democratic Republic of Congo. Banza discovered there that he had both TB and HIV. Fortunately, he was able to immediately access treatment for both diseases through a health initiative supported by funds from the Global Fund to Fight AIDS, TB and Malaria -- the largest international financier for AIDS,TB and Malaria.

It is lives like Banza's that are at stake in the global fight against TB and HIV. Despite yielding significant results, like the dramatic reduction in TB mortality rates from 1.8 million in 2003 to 1.4 million in 2010, internationally, TB investments are at an all-time low. The World Health Organization has identified a USD $3 billion dollar per year funding short-fall for global tuberculosis control and is reporting a 73 per cent decline in investments in overall TB research and development since 2005. To date, there remains a persistent vacuum of leadership on global TB control, particularly to address the TB-HIV co-epidemic at the practical level of policy, funding, programming and monitoring and evaluation.

Canada, once heralded as a global leader on tuberculosis, and a current champion on maternal and newborn child health, can help fill this void in leadership on TB-HIV by supporting innovative mechanisms with a proven track-record of success, like the TB-REACH facility and the Global Fund to Fight AIDS, TB and Malaria. Established in 2009, with a generous Canadian contribution of $120 million over 5 years, TB-REACH aims to increase case detection of TB among people living with HIV and other vulnerable populations. To date TB-REACH has committed US $50 million to 75 projects in 36 countries which aim to aim detect and treat an additional 140 000 TB cases.

Additionally, since 2001, the Global Fund to Fight AIDS, TB and Malaria has helped save eight million lives, provided 3.6 million people with anti-retroviral treatment, detected 9.3 million cases of tuberculosis and delivered 2.4 million TB-HIV health services.

These global mechanisms are achieving dramatic results in the fight against TB and HIV. But, without an infusion of renewed global support, they cannot scale up their activities to ensure that all people living with HIV are screened for TB, and all TB patients, and those suspected of having TB are provided HIV counselling and testing followed by access to appropriate treatment.

Canada has a long and proud tradition of leadership in the fight against global poverty. On this World AIDS Day, it has an integral role to play in achieving zero AIDS deaths by strengthening the global community's response to the TB-HIV co-epidemic, and increasing its support for key mechanisms in the fight against TB-HIV.

We can achieve "zero AIDS deaths" but only if we stop TB as well.