The importance of our response to Tuberculosis

My name is Gracia Violeta Ross, I am from Bolivia, a social anthropologist and an advocate openly living with HIV. Today is World Tuberculosis Day and I want to send a message for people living with HIV about the needed actions and advocacy to respond to Tuberculosis (TB).

Often in the community of people living with HIV, we do not hear much about TB. Some of the wrong ideas are that it is not a problem where we live or that antiretroviral medications take us off from the risk of getting active TB. It is also difficult to diagnose TB if our health system uses obsolete diagnostic tools. TB and HIV work together very well with serious consequences for several people living with HIV. We must discuss the issue with the importance that it has.

First, we have to acknowledge that people with HIV are still dying with AIDS related diseases. The last update of UNAIDS reports that in 2021, despite of good tools and strategies for HIV prevention and care, 650 000 people with HIV died. Tuberculosis is one of the leading causes of death among people living with HIV. The WHO Global TB Report says that among all incident cases of TB in 2021, 6.7% were people living with HIV; this proportion has been steadily declining for several years. The proportion of people with a new episode of TB who were co-infected with HIV was highest in countries in the WHO African Region, exceeding 50% in parts of southern Africa.

Therefore, what can us, people living with HIV do to respond to TB?

1. Stay adherent to antiretroviral treatment. The WHO global report says that provision of TB treatment and antiretroviral treatment to people living with HIV who were diagnosed with TB is estimated to have averted 74 million deaths between 2000 and 2021.
2. Ask your health provider to perform a triage and test you for TB, more if you have any of these symptoms cough, fever, night sweats and weight loss.
3. If you have a positive TB test, you must take treatment and complete it correctly, this means, not abandoning it as soon as you feel better. According to the Global Fund/WHO State of Inequality Report[1], in 2020 an estimated 9.9 million people developed TB, about 8.0% of new cases were among people living with HIV and multidrug- or rifampicin-resistant TB (MDR/RRTB) which are more difficult to treat.
4. If you have a negative TB test, WHO recommends TB preventive treatment for household contacts of people with TB, with an emphasis on children aged under five years and people living with HIV.
5. Advocate at local level for integrated TB/HIV programs and for extra efforts to reach out to children living with HIV who might have active TB as well.
6. Advocate at national level with the official delegation of your government. United Nations member states agreed to have a High Level Meeting[1] on TB on Friday 22nd September 2023 at UN Headquarters in New York, during the UN General Assembly High-Level Week. There will be a UN Multi-stakeholder Hearing on TB, taking place no later than June 2023. What will the reports of your country say about TB/HIV collaborative actions?
7. Challenge the stigma and discrimination around HIV and TB. We understand the HIV stigma in our context but we have to understand the stigma for TB as well, and challenge it because the combination of these stigmas is seriously limiting the uptake of services and adherence to TB treatment.
8. Fight against inequalities. TB/HIV co-infection is in fact one area of the intersections of inequalities, which has been exacerbated by the COVID-19 pandemic and the reassignment of human and economic resources for HIV and TB. The most vulnerable populations among people living with HIV are again the most affected by TB, some of them will be trapped in a dual or triple stigma, with challenges of sexual gender based violence, lack of respect for human rights and miss understanding of social economic factors of the person and the communities. This has to change.

TB is one of the last challenges people living with HIV must face. It is my wish that the upcoming World TB Day, we people living with HIV join the fight against TB and we do it in a consistent and dedicated way.

Gracia Violeta Ross

(Anthropologist and advocate openly living with HIV)

graciavioleta@gmail.com