Confronting the Crisis of TB and HIV in Southern Africa

To address the current tuberculosis (TB) crises in Southern Africa, three non-governmental organisations (NGOs) in southern Africa - the AIDS and Rights Alliance of Southern Africa (ARASA), the Southern African AIDS Treatment Access Movement (SATAMO), and the Treatment Action Campaign (TAC) - convened an Emergency Southern African Advocacy Summit on TB and HIV in August 2007 in Johannesburg, South Africa. This report of the meeting looks at the current situation, identifies barriers to the effective control of TB in the region, and includes a practical agenda for action to be taken by governments, healthcare workers, researchers, civil society, and national and international agencies.

The more than 75 participants at the meeting included representatives from the countries of the Southern African Development Community (SADC), people living with HIV/AIDS and TB activists, healthcare workers, researchers, national TB programme officials, and representatives from donors and regional and international agencies.

The meeting had three objectives:

• to identify and highlight the current state of the programmatic and policy response to TB and HIV globally and in the SADC region;
• to identify the main barriers to an effective joint response to TB/HIV in the SADC region and discuss possible solutions to overcoming these barriers;
• to agree on joint short- and mid-term advocacy priorities to improve the joint response to TB/HIV in the SADC region.

The meeting was structured to identify a series of specific, measurable, achievable, relevant, and time-bound actions on TB and HIV that can be advocated for and implemented across the region in the near future. The four key areas of action identified were:

• Getting more people with HIV tested for TB
• Integrating and decentralising TB and HIV services
• Improving infection control
• Preventing and treating drug-resistant TB (MDR/XDR-TB)

Some of the barriers identified across three of the four areas of action require actions that involve a strong communication component:

Stigma was considered both a barrier to testing as well as a barrier to integrating and decentralising TB and HIV services as stigma drives people away from getting tested and seeking services. According to the report, the best way to fight stigma associated with TB is to educate communities about the disease and shatter the myths about what is largely a preventable and curable illness. The document recommends some concrete actions around this such as building large scale community education programmes and developing a SADC TB/HIV "myth-busters" information website. The report emphasises the need to use clear and simple messages in local languages and the need to adapt and share materials throughout the SADC region.

In order to support integrated and decentralised TB and HIV services, the report calls for advocacy at all levels - community level, programme and health service level, and government level. One action point cited in the document is the development, at community level, of advocacy and support groups to advocate for integrated and decentralised TB/HIV diagnostic and treatment services. Training of and collaboration with traditional healers to create a referral process with the public health system was also listed as an action point. At programme level, the report cites the need to document the successes and failures in integrating TB/HIV services for UNGASS 2008, International Treatment Preparedness Coalition's "Missing the Target" report. This can be achieved through "shadow reports" and the development of local, independent, civil society monitoring. At policy and government level the report calls for governments to advocate for an integrated and decentralised health service in all SADC meetings.

One of the main barriers identified in the document, related to infection control, is the lack of knowledge in southern Africa about the TB problem, the symptoms of the disease and how it is spread, the way HIV exacerbates the TB epidemic, and basic facts about treatment. TB treatment and prevention literacy is therefore essential and should target political, traditional, and religious leaders and should be integrated with HIV treatment literacy. One of the action points listed to increase treatment literacy is the establishment of TB clubs in districts in order to help educate communities and support people living with TB. The document also recommends developing a national coalition among HIV and TB programme staff and community partners to design and deliver a year-long national campaign to raise TB awareness. Another action point cited is the development of a SADC website to share TB literacy materials as well as materials from the STOP TB Partnership's Advocacy, Communication and Social Mobilization Working Group which can be adapted to each unique country situation.

Lack of political commitment is also considered one of the barriers to infection control as many countries have not adopted or implemented TB infection control policies. As an activity to build political commitment, the report recommends that activists, healthcare workers, researchers, and all citizens hold governments and clinic hospitals accountable for the spread of TB. Governments must be pressed to act quickly and thoroughly, which can be done through letters, petitions, meetings, and newspaper articles.