People Living with HIV Not Being Tested for Tuberculosis

TB Is the Biggest Killer of People Living with HIV/AIDS, Yet HIV Programs Are Screening Only One Percent for TB

Washington, DC (August 7, 2008) — A mere 1 percent of people living with HIV/AIDS are reported to have been screened for TB, according to the most recent global data available from the World Health Organization. Health experts and activists at the International AIDS Conference are calling upon HIV/AIDS programs and international donors to ensure universal TB screening of every person who has tested positive for HIV.

Data collected from South Africa in 2006 and Nigeria in 2007 show that only 1.83 percent and 2.25 percent, respectively, of the total estimated number of people living with HIV had been screened for TB. Earlier this year, the World Health Organization estimated that among the 33 million people living with HIV worldwide, approximately 314,394 had been tested for TB; an alarmingly low 0.96 percent.

"One of the great tragedies of this epidemic is that people who are living with HIV after hard-fought battles for access to antiretroviral treatment, go on to die needlessly from TB," said Dr. Jim Yong Kim of Harvard University. "It is a crime that most HIV/AIDS programs can't even tell you how many people they have tested for both HIV and TB. Effective TB testing for people living with HIV is more difficult and we need new diagnostic tools, but we can do much better with what we have and we simply must scale-up TB testing for PLWHA (people living with HIV/AIDS)."

Approximately half of all PLWHA will develop TB in their lifetime. TB is a death sentence for people living with HIV/AIDS — up to 90 percent of people living with HIV/AIDS will die within a few months of developing active TB if they do not receive proper treatment.

On January 21, 2004, the World Health Organization unveiled plans to expand collaboration between national tuberculosis and HIV/AIDS programs, promising that "TB case-finding will be intensified in high HIV prevalence settings by introducing screening and testing for tuberculosis into HIV/AIDS service delivery points."

Since WHO issued these guidelines, dual testing remains virtually non-existent. Since 2004, nearly 1 million PLWHA in Africa — including many on antiretrovirals (ARVs) — have died from TB.

"We're facing a preventable plague inside a devastating epidemic," said Michel Sidibe, UNAIDS Deputy Executive Director. "The theme of this conference is 'Universal Access Now.' We must provide universal access to ARVs. But ARVs alone are insufficient to protect people from TB. The recent advent and scale-up of ARVs may have left some people with the false impression that ARVs provide immunity from TB, which they do not. We must also provide universal access to high-quality TB diagnosis, treatment, and care services."

None of the three leading funders of HIV/AIDS programs — the Global Fund to Fight AIDS, TB and Malaria, the World Bank, and PEPFAR — have required TB testing to be provided universally for PLWHA in the HIV/AIDS programs they fund.

"Such neglect on the part of HIV/AIDS programs and international donors is outrageous," said Vuyiseka Dubula, Secretary General of the Treatment Action Campaign (TAC). "It has led to thousands of unnecessary deaths and undermined the entire goal of getting access to ARVs, reducing mortality and increasing the quality of life of people living with HIV/AIDS."

To mobilize attention to this issue, a group of HIV/AIDS and TB civil society organizations are collecting personally-signed postcards, over 10,000 of them, addressed to key decision-makers who have the power to correct this situation. In addition to universal screening of PLWHAs for TB, activists are demanding global leaders commit to universal access to high quality TB-HIV care by 2015, including the treatment, preventative therapy, and infection control needed to keep people alive.

The postcards are being sent the heads of the Global Fund, World Bank, and PEPFAR, as well as the Ministers of Heath of four countries with extremely high burdens of both HIV/AIDS and TB: Nigeria, Kenya, South Africa, and Botswana.

"I'm pleased that we are finally recognizing that millions of people like myself are living with not just one major disease, but two. Now, these words need to get translated into action at country level so that PLWHA have their right of TB access," said Lucy Chesire, a TB-HIV activist for the ACTION project in Kenya. "I'm very moved that AIDS conference participants have not only attended workshops here to learn about the issue, they have also chosen to make a difference and appeal to important decision makers to take action. I hope these officials receiving their cards will also turn their knowing into doing."