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
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
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
"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.
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
"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
"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."
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
"When it comes to TB and HIV, one has to exhaust all avenues,"
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