Integrating HIV/AIDS and TB Efforts: The Challenge for the President’s AIDS Initiative

February 1, 2004

In his 2003 State of the Union Address, President Bush pledged $15 billion over five years to fight the HIV/AIDS pandemic. A significant portion of this funding will go to an initiative known as the President’s Emergency Plan for AIDS Relief (PEPFAR), which will prioritize efforts in 14 highly affected African and Caribbean countries. The PEPFAR initiative offers a singular opportunity to focus U.S. bilateral funds to make a significant impact in these countries. Lessons learned will inform future efforts elsewhere. Most notably, it will be the first large-scale effort by the U.S. government to treat people living with HIV/AIDS.

The PEPFAR initiative is a welcome addition to the global response to HIVAIDS. However, it does little to address the fact that too little attention is being paid to the relationship between HIV/AIDS and tuberculosis. These two diseases are inextricably linked: as rates of HIV/AIDS have risen, TB rates have also skyrocketed. An estimated 2 billion people worldwide are infected with the TB bacterium, and TB is the most common opportunistic infection and number one cause of death for people with HIV/AIDS.

This paper surveys the current state of HIV/TB co-infection in each of the 14 PEPFAR target countries. It outlines the benefits of better integrating TB and HIV/AIDS efforts through expanding TB programs to reach all those HIV patients with TB and linking TB programs to HIV/AIDS voluntary counseling and testing (VCT). It also calls on the U.S. government to lead efforts to ensure a robust response not only to the HIV/AIDS, but also to the TB/HIV co-epidemics.

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