Can we find cure to these scourges?

It is a strange contradiction that while India celebrates being home to the world’s leading corporate giants and wealthiest persons, she is also home to one third of the world’s tuberculosis (TB) population and to the world’s second largest population suffering from HIV/AIDS. The latest report by the WHO states that TB is the leading cause of death among HIV patients in India, who number about two million, out of whom nearly one million have active, spreadable infection.

Moreover, India also has the largest multi-drug resistant tuberculosis (MDR-TB) cases, which reflect both poor medical management strategies and patient compliance issues. MDR-TB occurs when the tuberculosis bacteria develop resistance to one or several antibiotics. This grave condition makes treatment virtually impossible. But for the Bill Gates Foundation which has taken up the cause of HIV-related TB patients in this country in a big way, these statistics might have been even more startling.

Yet, however scary this scenario may be, it is not impossible to contain it with proper understanding of the relationship between AIDS and TB. It is well known that the HIV weakens or completely destroys the immune system, making way for the onset of other serious infections like TB.

Vicious cycle

The twin infections of HIV and TB also results in victims becoming carriers who can infect others and spread the virus. Thus, a vicious cycle is established where a latent TB patient contracts HIV, which in turn can make him an active TB patient who, in turn can become a dangerously infectious person to his surroundings. Unless the progression of the two diseases is understood, prevention and treatment become impossible. Our health authorities must prioritise their efforts in the eradication of HIV first if they wish to also eradicate tuberculosis in the country.

In the case of TB, there are several combinations of antibiotics available to treat and even cure the disease. It is only when these are misused that patients acquire drug resistant bacteria. More recently, a new threat has arisen from the infection of patients with Extremely Drug Resistant Tuberculosis (XDR-TB), which medical practitioners have to be aware of, and guard against.

One of the sad things about HIV and TB is that they both target the younger generation, especially women. The reasons are not hard to divine. Young women who have to sell their bodies to eke out a living are the saddest victims. We may not succeed in eliminating prostitution altogether. But, we can certainly reduce the risks suffered by sex workers who could be the carriers of infection. Our health policies need to be drastically changed to meet this impending disaster. Multiple studies worldwide have clearly revealed that the persons most vulnerable to contracting HIV infection are commercial sex workers, their clients, homosexuals and intravenous drug users. Careless medical practices (like blood transfusions with HIV-contaminated blood) can also result in HIV infection.

Instead of indulging in moral policing, why not take up the education of all those potential victims of AIDS on a war footing? Since active and potentially lethal TB infection can flare up when the person is also afflicted with HIV, all the more reason why this is necessary.

The Centre for Disease Control and Prevention (CDC) in Atlanta, USA, has established an office in India to assist the Indian government in fighting this ‘concentrated epidemic’ (HIV) by targeting those who are most at risk. Working in seven states which include the three southern states of Tamil Nadu, Andhra Pradesh and Karnataka, besides Maharashtra, where HIV/AIDS is rampant, the CDC aims at building up a team of workers who will identify and educate those who are infected. It is also in the process of strengthening laboratory systems in the country so that evaluation and diagnosis are made easy and quick. According to CDC, sexual transmission is one of the main causes of HIV/AIDS in the southern states. 

If TB and HIV/AIDS can be addressed through proper detection, diagnosis and timely treatment, they can surely be controlled. This can be achieved by a government that has the motivation to do so. But, if we merely rest on our laurels and boast of our achievements in other fields that have placed our country on the map of the world, the day will not be far off when we will also be on the world’s map as the poorest nation in terms of health and well being. The WHO report should act as an eye opener to a country that has allowed two preventible diseases to reach epidemic proportions.