SA has a chance to lead the world in realising Madiba’s dream this September as the United Nations convenes its first high level meeting on TB.
Former president Nelson Mandela would have been 100 today. One of the best ways that President Cyril Ramaphosa can honour his legacy is to join with the leaders of other countries to end the twin epidemics of HIV and tuberculosis (TB).
It was at the 2004 International Aids Conference in Bangkok, Thailand where Mandela spoke the words that still resonate among those of us striving to end the TB epidemic: “We are all here because of our commitment to fighting Aids. But we cannot win the battle against Aids if we do not also fight TB. TB is too often a death sentence for people with Aids.”
It was a simple observation, but the words galvanised an international response that viewed the two epidemics as an integrated co-epidemic. South Africa later became one of the first countries in the world to implement a national strategy for battling TB and HIV together.
As Archbishop Desmond Tutu has written: TB is like kindling and HIV is like a match.
TB spreads through the air and once infected a person can live for years — even decades — without symptoms, as the TB infection stays latent inside the body. About one in four people worldwide are living with a latent TB infection, according to a 2018 World Health Organisation (WHO) fact sheet.
When HIV weakens the body’s immunity, that latent TB infection can quickly develop into active, contagious TB — and then spread to others.
For this reason, TB skyrocketed in South Africa after HIV began to spread. It explains why UNAIDS data shows TB is still the leading cause of death for people living with HIV globally. It is also the leading natural cause of death in South Africa generally, according to the latest Statistics South Africa report.
Through the Sustainable Development Goals, however, South Africa and virtually all of the world’s other countries have stated their commitment to work together to end TB and HIV by 2030.
It’s an ambitious goal — but it’s achievable. In fact, Ramaphosa and other national leaders face a historic opportunity to accelerate progress to get the job done.
South Africa and other countries are currently preparing for the world’s first-ever high-level meeting on TB. At the United Nations General Assembly in September, presidents and prime ministers will gather, for the first time, to announce an international political framework for ending the TB epidemic.
Those leaders are likely to endorse measurable targets for reaching all people with TB with diagnosis, treatment and prevention, as well as commitments for accelerating research and development of new TB diagnostics, medicines and a vaccine.
These targets will help government and advocates establish national, measurable milestones for ending the TB epidemic — and in a way that promotes accountability for sustaining progress.
As a country where rates of TB and HIV are among the world’s highest, it is fitting that South Africa will be represented by Ramaphosa at the UN High Level meeting. In keeping with Mandela’s legacy, it is equally as critical that South Africa champions human rights as the foundation of the global response to TB.
We know first-hand how essential human rights are to saving lives from TB. Children with TB have been neglected for decades, as limited resources have been used to deliver care to people with TB who are the most infectious — this almost always happens to be adults. In the process, children with TB have become a much lower priority in fighting TB.
That strategy has left children with TB to fate. About a quarter million children die from TB around the world each year — nine in 10 of whom were left without treatment, 2017 research published in The Lancet Global Health medical journal found.
Human rights have always been the driving force behind the response to HIV and Aids. We must do the same for TB.
Madiba was a TB survivor. He was cured of the disease in 1988. As we honour his life and celebrate his legacy, let us recommit to realising his vision of a nation and a world in which human rights are universally honoured and where no one must fear a life cut short from HIV or TB.
José Luis Castro is Executive Director of the International Union Against Tuberculosis and Lung Disease. Follow him on Twitter @JLCastroGarcia