Activists Lament Lack of HIV/TB Co-Treatment

by Miriam Mannak

CAPE TOWN, Mar 26 (IPS) – Despite repeated calls for integrated HIV and tuberculosis (TB) health services from medical experts and AIDS activists, most of South Africa’s public health facilities continue to treat the diseases independently. Co-infection presents a major risk to the lives of people living with HIV.

At the end of a march to Cape Town’s parliament buildings on World TB Day, March 24, AIDS activist group Treatment Action Campaign (TAC) and the TB/HIV Care Association handed a memorandum on TB, which highlighted the need for integrated testing and treatment of HIV and TB, to the South African Department of Health.

They urged government to invest more time, energy and money in developing strategies to tackle both illnesses. According to the TAC, only a quarter of HIV-positive persons are screened for TB during clinical visits.

World Health Organisation (WHO) standards stipulate that a country is a ‘TB emergency zone’ when 200 in 100,000 people are sick. South Africa is well beyond that limit with 940 in 100,000 people being infected with the disease, according to WHO estimates.

South Africa’s TB problem is directly linked to its high HIV prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 18.1 percent of South Africans aged 18 and 49, or 5.7 million people, were infected with HIV in 2008. According to statistics gathered by TAC, 54 percent of people who are HIV positive are co-infected with TB, a disease that mostly affects the lungs and is transmitted through coughing, sneezing and spitting.

“In some communities, this co-infection figure is as high as 75 percent,” said TAC spokesperson Lesley Odendaal.

People living with HIV have weaker immune systems and are therefore at greater risk to contract TB compared to those whose HIV status is negative. According to the Global TB Control Report by the WHO, 94,000 co-infected South Africans died in 2007. This is the bulk of the total number of TB related deaths, which is estimated at 112,000.

Co-infection risk

Although the South African government has made progress over the past few years in integrating HIV and TB programmes at some of the country’s hospitals, many co-infected South Africans are still forced to seek treatment and care for both illnesses in separate health facilities.

Lungiswa Mbanbani from Nyanga, a township near Cape Town, told IPS she recently asked for a TB test at her local was told go somewhere else. 
“I was worried about my cough and wanted to be screened for TB. I have seen many people die of TB because they were slack in getting a test and therefore received their treatment too late,” she said. “I did not want to be one of them.” 

Instead of being tested, Mbanbani was told to go to another facility because her clinic does not screen for TB. “Friends of mine have experienced the same,” she said. “This is a big problem, as not everyone can afford to travel from clinic to clinic. Most of us rely on public transport, as we do not have transport of our own. If it were up to me, all medical facilities in South Africa would be equipped to provide care and treatment for both diseases.”

Despite the fact that health experts and AIDS activists have been calling for linked HIV and TB services for the past few years, public health facilities in South Africa have not been adjusted to provide integrated services in one location. “Services dealing with either disease were initially established separately,” Odendaal explained. “Because they have been operating independently for so long, it is difficult to integrate them.”

Deputy director general of the provincial health department of the Western Cape, Joey Cupido, who received the memorandum on behalf of the national health authorities, promised the department will ensure that the activists’ demands – including the integration of TB and HIV programmes – will be met as soon as possible.

“HIV and TB are two of the main problems we face in South Africa, and the department is committed to address this and the related issues,” he said.

“We do recognise that better quality care is needed by those who suffer from both illnesses, but we cannot do it alone. We need to form partnerships with civil society organisations. We are not making empty promises because we have already started the journey of tackling TB and HIV.”

Rigorous diagnosis

Liz Thebus, who has been working a nurse in Cape Town’s public health sector for the past 30 years and is currently working as health care worker at the Desmond Tutu HIV Foundation, agrees that the situation needs to change drastically.

“Every clinic, hospital and other medical facility in South Africa should be able to test and treat people for both diseases,” she said. “TB and HIV go hand in hand. Everyone knows it. So many people who are living with HIV are dying of TB, despite the fact that the disease is completely curable.”

TB is usually treated with a six-month course of antibiotics, to which patients must adhere rigorously. Already after a few days on treatment, patients can no longer spread the disease.

Thebus highlighted the fact that TB diagnosis needs special skills when testing HIV-positive persons “Health care workers should receive proper training when it comes to diagnosing TB in people living with HIV. Many are not aware of the fact that people who are HIV-positive may test negative for TB, even if they are actually infected,” she said.

One of the methods to test for TB involves injecting a protein from the TB bacteria into the patient’s arm. If this causes swelling – a reaction of the immune system – it may be a sign that the patient has TB.

The swelling, however, does not always occur in people living with HIV. “Sometimes, their immune systems are too weak to respond to the test,” Thebus explained.

According to Thebus, it happens too often that patients, based on negative test results, are incorrectly sent home: “Healthcare workers should be taught to look further then the first test results, especially if a patient is symptomatic.” She recommends additional screenings, blood tests, chest X-rays and sputum smear tests.

“When it comes to TB and HIV, one has to exhaust all avenues,” said Thebus.