Voice of America - May 27, 2009
Howard Lesser
Washington, DC

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In sub-Saharan Africa, the AIDS death rate is seriously compounded by a high percentage of HIV-positive patients who also contract tuberculosis. Wednesday in Washington at the opening of the 36th International Conference on Global Health, medical experts, researchers, and advocates will discuss ways to coordinate and strengthen the fight against TB in combination with the campaign against HIV/AIDS.

Zambian-born Winstone Zulu became HIV-positive in 1990 and seven years later contracted tuberculosis. Four of his brothers died from TB, but with careful diagnosis and medication, Zulu survived TB and keeps his HIV in check with a regimen of first-line anti-retroviral drugs (ARV's). A participant in the Washington conference, he explains that the links between HIV/AIDS and tuberculosis are alarmingly high and require greater international attention.

"It's very, very important, especially in Africa, where the leading killer of people with HIV is tuberculosis. And basically what that means is that if you see all the statistics that talk about the number of people that have died in Africa from AIDS, and then you factor in TB and say, look, if we would have treated TB, then that would have changed the picture completely. And this is why it doesn't make any sense to me for anybody in Africa to do AIDS work without putting in TB," he says.

A growing body of evidence from sub-Saharan Africa points out that coming down with TB severely weakens immune systems and puts the lives of people living with HIV-positive conditions in great jeopardy. Describing himself as a global TB/HIV prescient advocate, Winstone Zulu notes that the unsettling experience of losing four brothers to the same disease is not as uncommon as it may seem in Zambia, where illness frequently claims the lives of multiple siblings within the same family.

Zulu claims it is urgent for healthcare providers to step up treatment and diagnosis of TB.

"I always challenge people and say, look, you can keep people living with HIV alive by treating tuberculosis. And because it's the leading killer of people living with HIV in Africa, that's a big achievement," he observes.

Zulu cites poverty and HIV as the main factors that account for two-thirds of HIV-positive Zambians also suffering from tuberculosis, which readily spreads among people who infect others within a community. Some of the main stumbling blocks in treating TB patients and stopping transmission are inadequate diagnosis and improper medication.

"TB is the only disease that if left untreated, someone can infect 15 others within a year. So treating it also works as a prevention so that others won't catch it,"

Zulu says the development of a reliable vaccine is the most promising way to eradicate the disease. Efforts are progressing to come up with a vaccine, but while the process is painstaking, there are other more challenging avenues that must also be pursued.

"At the moment, we talk about tools like new drugs to treat TB, which on its own is a preventive way, and then new diagnostics and an effective vaccine. But another way would be to improve the living conditions of people. But then, when you think of that and you think of the numbers involved, it looks like a tall one (a tall order): to have everybody in Zambia who is poor, and like 70 to 80 percent of the people live under one dollar, to lift them to a standard where everyone has ventilation in their house and clean water and a meal on the table when they need it. Personally, I feel that it would be like a real, real challenge, even more challenging than finding a vaccine, I guess," he points out.

Zulu credits the US PEPFAR initiative and global worldwide projects as the Bill and Melinda Gates Foundation campaigns against TB as preventing another genocide from rampaging across African countries because of the access to medicines and health professionals which have achieved proven records of success.

"I had TB in 1997, got cured of TB and then went on anti-retrovirals, and now for more than ten years, I'm still alive. But if I didn't have access to TB services, then I would be dead, just like my brothers died, and most likely, I would have gone as an AIDS statistic," he admits.

Three days of panels, workshops, and exhibitions begin Wednesday at the International Conference on Global Health and continue through Friday in Washington.

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