Consumption brought him down to the grave

It's exactly ten years since I wrote my first article in the Jakarta Post about World TB Day - which falls today. I'd been fascinated by TB since I'd first got involved with HIV. It did seem like there was a connection, but I found it difficult to understand. How did TB suddenly become active and cause all the damage? Why do people seem so much more vulnerable to active TB in the first couple of years after they are infected with HIV, even thought their immune system is still relatively healthy? Perhaps all this is beyond the grasp of a simple engineer!

But it was clear to me even then that there was a real connection between the two diseases. Indeed, as a press release from UNAIDS on World TB day in 1998 (sadly no archived on their site) noted, "TB is the biggest killer of AIDS patients worldwide." The release also noted:

"A comprehensive response to the dual TB/HIV epidemic has not yet been implemented," Dr. Peter Piot, UNAIDS Executive Director commented. "Only a dual strategy of TB control and HIV prevention can reduce the TB/HIV burden." Dr. Piot believes that this strategy must be implemented worldwide "...if we are to break the lethal combination of HIV and TB, a partnership which is adding to the suffering of millions of people with HIV, shortening their lives and helping spread TB to alarming levels."

Sadly, Piot and UNAIDS then seemed to forget all about TB. Indeed, a search of their web site finds no pages on TB and HIV until May 2006, prior to the Special Summit of African Union on HIV/AIDS, Tuberculosis and Malaria. Even then, there is little effort made to connect the epidemics. As I think I have noted before, when I visited South Africa in 2004, for a pan-African workshop on Treatment Literacy, Treatment Action Campaign couldn't find anyone to speak on HIV and TB.

I attended a meeting of activists at the TB Conference in Paris in October 2005. Amazingly, that meeting focused strongly on HIV (when will an AIDS conference ever focus on TB?). Everyone was there. Except no one from UNAIDS! So we got together and drafted a letter to Peter Piot requesting action. Happily this triggered a response. The HIV-TB guru from WHO, Alistair Reid was moved to UNAIDS to take responsibility for a co-infection program.

The recent emergence of extensively drug resistant TB (XDR-TB) has demonstrated once again the fatal nexus between HIV and TB. I concluded my first article in the Post by noting that the best policies "...simply cannot have a widespread impact on the disease without political commitment. Clearly to develop and maintain such commitment in Indonesia at present represents a major challenge." Ten years on, this remains the challenge...

Babé