‘€œI think TB leadership have made a career out of poverty. They have done everything with the 10th rate drugs, fifth rate diagnostics for the longest time ever. You never see a TB person standing up and saying: ‘€˜Why can’€™t I have better diagnostics? Why aren’€™t there better drugs?’€ (With) HIV, we toyi-toyi until we get what we want. (With) TB, it’€™s like, ‘€˜oh, no, it’€™s too expensive’€™. A disease that kills almost half of all South Africans and causes massive lung morbidity. You’€™ve got a whole generation of people with destroyed lungs entering the medical system at the moment. But ‘€˜TB is curable’€™, is the mantra that comes out. It’€™s a dreadful illness and yet, people still are trying to do it on the cheap. I think that we’€™ve saved money at the expense of the public good’€, said Professor Francois Venter, head of the Southern African HIV/AIDS Clinicians’€™ Society.

Professor Venter said what the fight on TB needs is a civil society response that is equivalent to what characterised the fight on AIDS in the 1990s.  

‘€œThe HIV programme is not flawless. But HIV has drawn civil society together in this country in a way that nothing else has. And I think we need to acknowledge that. People who are standing up for TB now are not the TB people. It’€™s the people coming from the HIV world and the people with an understanding of systems’€, he said.

Head of Litigation and Legal Services at Section 27, formerly the AIDS Law Project, Adila Hassim, agreed.

‘€œWe haven’€™t seen the type of mobilisation that we saw in relation to HIV and we need to be doing more in relation to TB. And I think it’€™s going to be inevitable that it’€™s the HIV community that picks it up. The reason for that is because that’€™s where the infection is felt the most. The other reason for that is that the HIV community, as a result of the years of activism, has become very well versed in health, the right to health, health systems, how health is budgeted for and treatment literacy. So, I think it’€™s a good thing for the TB activism to reside there’€, Hassim said.

Health Minister, Dr Aaron Motsoaledi, who is a member of the international Stop TB Campaign board, a grouping of 22 countries with the highest burden of TB, added that:                    

‘€œWe have been able to make public hysteria about HIV/AIDS. (With) TB, we have not been able to. We have agreed that next year in April we will meet in Washington for a special session where we decide what public hysteria do we make about TB’€¦ the same hysteria as we made about HIV/AIDS. And I’€™m accepting here’€¦ out of the Millennium Development Goals, we are not doing well on three Millennium Development Goals. And all three of them by 2015 South Africa will never achieve if we don’€™t face HIV/AIDS and TB head-on’€.

The emergence of drug-resistant tuberculosis makes it hard to control the TB epidemic. But pushing up the infection rates is the scale of HIV that we have in the country. This has resulted in what is now known as the twin epidemic of HIV and AIDS.

‘€œThe co-infection rate is 73%. It’€™s the highest in the world, by the way. Our distant second is Zimbabwe. Countries which have (a) very big TB load, like China and India, only have a co-infection of 1.3% and 5%. But we’€™ve got 73%, meaning that 73% of people who have got TB are actually HIV-positive’€, the Health Minister said.

Head of the Southern African HIV/AIDS Clinicians’€™ Society, Professor Francois Venter, said the HIV/TB co-infection rate was ‘€œastonishing’€ and is ‘€œnot understood’€. He described this as ‘€œa scientific failure’€.    

‘€œThe degree of vulnerability of people with HIV and the way it contributes to the spread within the communities is far greater than we’€™ve anticipated. And I think that the TB leadership, specifically, haven’€™t recognised their failure in this. I like to tease the HIV prevention people and say, ‘€˜you know, if you were a company, they would just fire you all for results because even though you are very dedicated to your job, you’€™re not getting the results that you’€™re supposed to have’€™. Now, tThe same thing can be said for the TB programme. We’€™re getting absolutely astonishing bad results, despite pouring in more resources than any other African country into our TB programme’€, Professor Venter said.

For more than four decades, TB treatment has remained unchanged because scientists have not produced new treatment regimens. A new strain of drug-resistant Tuberculosis which cannot be treated using the available drugs has emerged. Diagnostics for TB have also not improved. Those are some of the challenges that fail TB control programmes around the world.