The Challenge of HIV and TB co-infection

Opening statement, Minister of Int. Development Erik Solheim
Research seminar: The Challenge of HIV and TB co-infection
University of Oslo, 010307

• Hippocrates – the father of medicine - said “For extreme diseases extreme strictness of treatment is most efficient”

• We are here to discuss two infectious diseases. Together they form an extreme and mortal combination. How to achieve the necessary strictness of treatment for everybody, regardless of social or economic status is a challenge to us all.

• One-third of the 40 million HIV-positive are also infected with TB. In sub-Saharan Africa, two-thirds of individuals with TB are co-infected with HIV. • Without proper treatment, approximately 90% of HIV-positive patients die within months of contracting tuberculosis. With adequate treatment patients may fully recover from TB.

• The mortal combination of multi-resistant TB and HIV is now a growing problem in Southern Africa, as it is in Eastern Europe.

• Our challenges with these diseases go way beyond medical science. We cannot fix this situation with medical means alone.

• We have to face deeply rooted social justice issues if we are to fight the spread of these diseases efficiently. And the issues at stake here are not only individual lives. We are dealing with a threat to many societies ability to perform fundamental tasks like education, health systems and security.

• When fighting diseases like TB and AIDS, a major challenge is to combine the medical response with strategies to combat the stigma linked to these diseases, to deal with capacity issues and promote and secure the basic rights of those affected.

• Malawi is an example of how collaboration between TB and HIV programs can produce concrete results, and help control and minimize the impact of this dual epidemic.

• Malawi has historically been at the forefront of TB program development While Malawi’s health system as a whole is in deep crisis; its TB program is considered a model TB program in Africa.

• The Malawi TB program history demonstrates an example of extremely dedicated personnel, ready to innovate and adapt and ensuring continuity in access in spite of adverse circumstances.

• A key strategy since 2002 has been the implementation of a plan for joint TB and HIV/AIDS services.

• Malawi may become the first country in the world to implement routine counselling and testing of all TB patients. The percentage of TB patients tested for HIV rose from 44 percent in 2004 to 60 percent in 2005.

• TB is therefore not seen as just part of the HIV problem in Malawi, the TB programme is an important part of the solution to HIV/AIDS scaling up. Of course many challenges remain, the main one being the human resource crisis in the health sector.

• Malawi is also an example of the importance of working with non-state actors to respond to the dual epidemic. 40% of health services in Malawi are provided through the Christian Health Association of Malawi (CHAM).

• The Ministry of Foreign Affairs issued in November last year a position paper on Norway’s HIV and AIDS policy in development.

• We point at stigma and discrimination as two of the main barriers to effective prevention with focus on women, vulnerable groups, young people, legislation, local communities, health personnel and health systems and prevention of mother to child transmission

• We are spending most of our financing for these diseases through the multilateral system and the Global Fund to Fight Aids, Tuberculosis and Malaria; now using about NOK 1.3 billion per year. 

• Early next week The Global Fund will hold the first meeting of their second Replenishment Cycle in Oslo. The aim of this meeting is to give the Fund adequate financial strength for its role as a major instrument financing the fight against the three diseases. The Global Fund is today financing 67 present of the total TB-programmes world-wide and 21 present of HIV/ AIDS programmes. Norway is committed to contribute our share to make the Fund successful, increasing allocations to match the capacity to respond at the country level.

• Supplementing our efforts with the Global Fund is the participation in the new drug facility, UNITAID, based on solidarity tax contributions from a growing number of countries, also among the developing countries themselves. The strength of its purchasing power can leverage price. Working closely with the TB drug facility and its partners has made it possible for this new facility to get into operation rapidly, already with significant contributions to access and price of drugs for the two diseases...

• The problem of stigma and of course a number of other relevant issues will be high on the agenda of the new National Aids Council which is now established in collaboration with the Ministry of Health. We find it important to bring together people in Norway working on HIV/ AIDS related issues and make sure that we can learn from each other and stay updated with regard to what is being done nationally and internationally. Later today - the first meeting of the Council. Building credibility and trust through partnerships at home and abroad, is on top of this agenda, with the aim to make an even more effective, efficient and inclusive response

• Let me conclude like I started, with the man who nearly 2500 years ago transformed medicine from ritualistic and philosophical practices into something similar to how medicine is practiced today. Hippocrates said “Prayer is good, but while calling on the gods a man should himself lend a hand”.

• Let me assure you that Norway is still committed to lend a hand in the struggle to ensure everybody access to health.