The Director’s Corner

The Director’s Corner

Integrated approach critical to ending TB-HIV 

A message from José Luis Castro on World AIDS Day, 1 December 2016

This World AIDS Day, I want to reflect on why this date is as significant for the tuberculosis (TB) community, as it is for raising awareness of HIV and AIDS.  

TB and HIV are an interconnected conflagration. In statistics released last month, the World Health Organization (WHO) stipulates that out of the 1.4 million deaths caused by TB in 2015, 400,000 of those were among people living with HIV (PLHIV).  Out of 10.4 million new TB cases worldwide, PLHIV accounted for 1.2 million – that’s 11 percent of cases. HIV weakens the immune system, therefore a person who is HIV-positive is between 26 and 31 times more likely to develop active TB than someone who is HIV-negative.  It is clear from these figures that, to quote Nelson Mandela, we cannot win the battle against AIDS if we do not also fight TB. 

In 2016, The Union and its partners have made progress on an integrated agenda to ensure the issue of TB-HIV co-morbidity is front of mind, at both community and government level.  

Earlier this year, the International AIDS Society (IAS) convened its first TB summit – TB2016 - immediately prior to AIDS2016.  In my opening address at that event, I underlined the importance of this very public recognition of a burgeoning crisis and how the TB and HIV communities must join together in an approach to beat TB-HIV. The Union and the IAS later issued a joint commitment calling for more effective, accessible and sustainable solutions to address the issue.   In light of the WHO statistics, this is more urgent than ever. 

Community solutions are integral to the success, or otherwise, of any public health programme.  In Durban, The Union convened the first faith community meetings to accelerate an effective response.  Working with the Desmond Tutu HIV Foundation and Reverend Nicholas Bhengu of KwaZulu-Natal province, we invited over 70 religious and community leaders to debate how their trusted networks might be utilised to reach isolated communities, encourage testing and treatment, and spread positive messages about TB and HIV.  “I believe in the transformative power of people of faith,” said Reverend Bhengu. “We will work together through places of worship to turn the tide against TB.” The results from these meetings will inform The Union’s community programmes and build effective outreach methodologies. 

Work on the ground within affected communities is crucial. The Union is committed to a collaborative care approach known as Integrated HIV Care for Tuberculosis Patients Living with HIV/AIDS (IHC). This system aims to build capacity into health systems to aid the delivery of high-quality HIV and TB care.  Between 2000-2014, the WHO estimates that 8.4 million lives have been saved through integrated TB-HIV activities such as these.  

The Union office in Myanmar provides antiretroviral (ART) therapy to over 24,000 patients – that is 22% of all cases in Myanmar - including 1,790 children, through the integrated HIV Care (IHC) Programme, which has been offering health and social support to patients since 2005. 

The office also runs the Prevention of Mother to Child Transmission of HIV (PMCT) programme, to help reduce HIV incidence. Up to June 2016, this initiative has put 988 mothers on antiretroviral (ART) therapy and has prevented HIV infection for 605 children who had been exposed to HIV through their mother. Thanks to these treatments, patients have survived and gone on to live healthy lives. This testimony from one of the mothers underlines the impact of this work: “At first, I felt sorrow and dread after being diagnosed with HIV infection, but now I realise that I can survive and have a healthy life with my family, thanks to the ART provided by The Union.”

As well as an opportunity to reflect on progress made, World AIDS Day also serves as a reminder that the job is not done, that there is still much to do.  The statistics tell us that ending TB is crucial to the survival of those with HIV. The stories behind those statistics are real-life tragedies that can and should be averted. Let’s make the year ahead the time when this becomes reality. 

José Luis Castro
Executive Director
The Union 


Read José Luis Castro’s opening address to TB2016 

Read The Union/IAS joint statement 

Learn more about The Union’s work on IHC 

Full story on The Union’s PMCT programme in Myanmar