UNAIDS News - March 22, 2001

"Not only is reducing the TB and HIV burden a health imperative - it is fundamental to human rights. TB and HIV are both enhanced by poverty, homelessness, substance abuse, psychological stress, poor nutritional status, crowded living conditions," Dr Brundtland added, referring to a new report on TB entitled "A human rights approach to tuberculosis".

The new report was released in the lead-up to World TB Day 2001, on 24 March. Its theme, 'DOTS: TB cure for all', calls for equitable and discrimination-free access to adequate treatment and services for anyone who has TB.

HIV and TB are closely linked. Testing in a number of developing countries shows that up to 70% of TB patients are infected with HIV. In addition, up to 50% of people living with HIV can expect to develop TB. Worldwide, 36.1 million people are infected with HIV and 95% of them live in developing countries, where TB rates are highest. About 13 million people are infected with both HIV and the germ that causes TB.

"People with both diseases suffer double discrimination," said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "HIV severely weakens the immune system, and makes people highly vulnerable to diseases such as TB. According to our latest figures, nearly two thirds of all people with HIV or AIDS were living in the countries with the highest TB burden in the world. The link between the two is inescapable, and TB is the first manifestation of AIDS in more than half of all developing country cases."

TB has serious human rights implications. Most major human rights treaties protect against discrimination in access to health care. However, TB hits hardest in areas of the world where access to treatment is an unaffordable luxury. The poor are made even poorer by TB as people fall sick and income is lost in marginal households.

TB, unlike HIV, can be cured, even in people with HIV infection. A simple strategy called DOTS cures most people with TB and the drug costs as little as US$ 10-15 per patient. Untreated, a single person with contagious TB can infect between 10-15 people a year.

In March last year, a ministerial conference in Amsterdam endorsed a global target to detect 70% of new TB cases and cure 85% of those detected by 2005. The G8 summit in Okinawa endorsed the commitment to reducing TB by agreeing to reduce the global burden of TB by half by 2010. In spite of the commitments and some significant successes, resources allocated to fighting TB remain insufficient.

"If present trends continue, the target of 70% case detection under DOTS will not be reached until 2013. It is shameful that with such a cheap and effective cure available, so many people must continue to die of TB," Dr Brundtland said. "Our campaign this year reflects the important role of governments and the private sector in providing TB drugs and services, and calls on civil society to create the necessary conditions for everyone with TB to seek treatment."

There were an estimated 8.4 million new cases of tuberculosis in 1999, up from 8 million in 1997. This increase is due largely to a 20% rise in incidence in African countries most affected by AIDS. If these trends continue, some 10.2 million new cases could occur each year by 2005.

"Effectively treating TB will not solve the worldwide AIDS crisis, but it will significantly reduce its burden," said Dr. Piot.

Globally, 12% of TB patients are infected with HIV. For those countries in Africa with high HIV prevalence, the estimate is 45%. HIV is also fuelling TB in parts of Asia, which has about 60% of all TB cases. Industrialized nations, once almost free of TB, are seeing a resurfacing of the epidemic. A danger facing all countries is the emergence of new strains which are resistant to many drugs and cannot be treated cheaply.

TB, like the common cold, is airborne. It spreads when an infected person coughs, spits or sneezes. It can attack a number of organs but mostly affects the lungs.

Last year, the UNAIDS Secretariat officially joined the 'Stop TB' initiative, a broad partnership spearheaded by WHO to halt the spread of tuberculosis around the world.
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