PartnersGF - 2004-05-26
HIV-TB-Malaria TOGETHER
Nance
*****
IN FACT, IN AFRICA, IT'S OFTEN "THREE DISEASES, BUT ONE PATIENT"
It has been my perception from my involvement in Africa from the mid-eighties onward, that a lot more progress would have been made in the struggle against HIV AIDS, if we had had a combined approach to TB-HIV-Malaria as opposed to three distinct approaches, each said to be very specific.
As the saying goes: together we stand, divided we fall.
I was happy to participate in the launch of the STOPTB WHO TB/HIV International working group four years ago, glad to see the creation of a Global Fund with the purpose of dealing with all three diseases TOGETHER. Yet, I am disappointed that all people in charge (at all levels, UN, National and so forth) still seem to tackle each separately. Clearly, we are poised to distribute condoms, plus TB drugs, plus bednets, plus ARV now. But it still looks like attaching wagons on a train, and proposals to the Fund are rarely comprehensive.
Yet:
1) HIV testing and information and ARV can be very efficiently done as part of a program to identify and treat TB.
2) People at risk of malaria are simlutaneously at risk for HIV, and people with HIV have a risk of severe malaria.
3) TB identification and treatment are required among people identified as HIV+
4) People with malaria get more blood transfusion which places them at immediate risk for HIV
5) TB people who receive injections in run down facilities are at risk for contracting malaria and HIV from dirty needles (as was noted during the WHO -World Health Assembly session announcing the formation of the International alliance for Patient safety).
We could prolongue the list ad finitum.
In fact, in Africa, it's often "THREE DISEASE, BUT ONE PATIENT". The PWA [people living with HIV/AIDS] will at some point or another be affected with TB and Malaria and people at greater risk of TB or Malaria are often at great risk for HIV.
We need:
1) International advocacy for the THREE DISEASE TOGETHER
2) International IEC for protecting people from all three
3) Involvement of community people and community health care givers in all THREE
4) Prevention-Care and protection programs for communities INTEGRATING ALL THREE
5) Strengthening health systems and notably primary health systems to deal with all THREE simultaneously
Bringing the THREE together would empower the Fund itself.
In my view, this would de-multiply the GFATM's effectiveness, not three times but empower it, and this by more than a factor of exponent 3.
Nance
Email: nance@documentaliste.com
People's Health Movement, Geneva-International
(These views are my own and do not engage PHM-GI)