NEW YORK – At a “high-level” meeting of nations all confronting the impacts of a still incurable virus, it may seem strange that just one event and a scattering of mentions in a political declaration have been dedicated to the leading — and curable — killer of people with that virus. But for leaders of responses to tuberculosis who have gathered in New York this week, that represents both status quo and progress in a fight against a disease that hits the poorest and most ignored populations the hardest.
In a refrain that became familiar in the course of the one morning meeting alone, speakers wondered, in the advent of a six-month cure for HIV, if political and public health leaders would settle for the slow decline in incidence and death that represent advances in tuberculosis control and treatment.
At a discussion Wednesday morning, before the opening General Assembly talks at the 2016 High Level on ending AIDS, they also wondered at the disconnects that continue to surround efforts to address tuberculosis and HIV together, between medical and community responses, as well as within medical and community responses — keeping screening and diagnosis for the two diseases apart. After all, as one put it, “HIV doesn’t kill, tuberculosis does.”
Health ministers of Nigeria and South Africa were there, representing the nations with the leading tuberculosis burdens in Africa. The present, and past two leaders of the President’s Emergency Plan for AIDS Relief were there, with U.S. Global AIDS Coordinator Ambassador Deborah Birx joining her predecessor, now United Nations Special Envoy on Tuberculosis Eric Goosby, and his predecessor, now Global Fund to Fight AIDS Tuberculosis and Malaria leader Mark Dybul to speak to the deadly ties they’ve observed between the two diseases. Dybul noted continued failures to reach migrants, people living in poverty in urban areas and people who inject drugs, and pointing to increasing incidence of HIV among people who inject drugs in Eastern Europe, predicted that incidence of tuberculosis “will follow right behind.” Birx heralded success in Botswana, which she said, had seen 50 percent drops in TB incidence and deaths following the adoption of its “treat all” policy. The additional costs of HIV treatment were more than balanced by savings on tuberculosis treatment and impacts, she said. And Goosby, who ran the meeting, warned that unequipped, under-funded and unprepared health systems remain among many weak links in efforts to control tuberculosis.
Timur Abdullaev, a human rights advocate from Uzbekistan who lives with HIV also was there to tell the parable of a man who, after receiving a grant from a king with the deliverable that he will teach a donkey to talk in 10 years, does nothing but throw lavish parties, reasoning “In 10 years either I will die, the donkey will die or the king will die.”
Which could serve as a warning that it is the outcome of the most encouraging aspect of this event that will be watched most closely. That’s the mention, and target set in the Political Declaration nations agreed to on Wednesday, in which they:
“Commit to work towards the target of reducing TB-related deaths among people living with HIV by 75 percent by 2020, as outlined in the WHO End TB Strategy as well as commit to funding and implementing to achieve targets set in the Stop TB Partnership — Global Plan to End TB 2016-2020, to achieve the 90-90-90 targets to reach 90% of all people who need TB treatment including 90% of populations at high risk, and achieve at least 90% treatment success, including through expanding efforts to combat tuberculosis, including drug resistant tuberculosis, by improving prevention, screening, diagnosis and affordable treatment and access to antiretroviral therapy, and to 100% coverage of intensified TB case finding among all persons living with HIV, with particular attention to underserved and especially at risk populations, including children, utilizing new tools, including rapid molecular tests through joint programming, patient-centred integration and co-location of HIV and TB services, ensuring that national protocols for HIV/TBcoinfection are updated within two years to reflect the latest WHO recommendations . . .”
It will, as many have mentioned Wednesday and throughout the week be a difficult charge to keep without attending to the needs and obstacles confronting the most marginalized — the “Key” populations — of people who inject drugs, gay, bisexual and other men who have sex with men, sex workers and others who earn income through sex, transgender people, prisoners, and others largely left unmentioned in the same document.