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WORLD AIDS DAY 2013 - Experiences of Universal Health
In the recent International
Congress of AIDS of Asia-Pacific/ICAAP in Bangkok I couldn't find traces of
concern around HIV-associated TB deaths except few ad-hoc basis discussions on
HIV related co-morbidities with TB being a small component. The speakers and
participants across the Congress spoke volumes on rights, stigma,
discrimination, legal issues, access and mobilization but kept mostly quiet on
the burning TB/HIV issues of the Asia-Pacific regions.
The statistics of South-East Asia[1]
say, every year more than 50,000 people die due to HIV-associated TB, less than
40% TB cases know their HIV status, less than 40% PLHIV get screened for TB and
access of PLHIV to INH prophylaxis is more than negligible.
Demand for newer diagnostics for
rapid diagnosis of TB/DR-TB was not heard in the voices of community networks
who otherwise made their presence strongly felt across ICAAP.
A prominent member of
Asia-Pacific TG network told me, ‘The problem of TB lies in your overall poor
advocacy.’
A known friend of the PLHIV network
of an Indian state commented, ‘I am really not bothered much about HIV now, but
TB scares me hell of a lot, almost every time.’
‘Why don’t you discuss about TB within
your group?’ I asked her.
‘I really don’t know what to say
except cough for more than 2 weeks.’ She replied pessimistically.
The ICAAP experience made of
aware of the fact that we are failing miserably to sensitize people, providers
and policy makers on TB and its implications in the background of HIV. It is a
grave problem and we must find the solutions.
Limited sphere of advocacy where
the advocates don’t really want to venture out of their comfort zone is a big
issue in TB. As far as international conferences are concerned the advocacy
efforts, in true sense are yet to cross the boundaries of the World Lung
Conferences.
Working with HIV community networks might be
highly challenging to many TB professionals and advocates, but the fact is 'need
for appropriate TB care' is maximum with those networks. When mobilization is their
operational expertise these networks need proper guidance to know the right
path for consolidating their mobilization and demand generation activities on
TB. That’s exactly where we are repeatedly failing to produce any impact.
It is important to bring TB in
the agenda and action plans of the international, regional, national and local
level HIV community networks (Sex Workers, IDUs, MSM, TG and PLHIV). Let
community people speak freely and firmly about their TB problems together with HIV and
demand for health facilities enabling rapid TB diagnosis and early treatment. Let
there be stronger demand from the community groups for ready access to 3 Is
(Intensified TB screening, INH prophylaxis and Infection Control), ART for all
HIV-infected TB patients and combined screening of the pregnant mothers for TB
and HIV.
TB/HIV collaboration in its true
sense can only happen when HIV community groups and networks will play their
advocacy cards of TB and HIV on the same table to ensure the right placement of
the right package of services for them.
This is the high time we, the not-so-visible
TB advocates in the AIDS Conferences, facilitate the process, with utmost sincerity and
dedication.
Sugata Mukhopadhyay
Universal Health
