Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Support communities to tackle TB


Talk given on TB by Arulagam health educator, Palaniswamy © Gideon Mendel/Alliance

A lack of involvement in the development and implementation of tuberculosis (TB) policies by civil society organisations and communities affected by HIV and TB is resulting in an absence of government accountability for TB policies and quality services.


Tuberculosis (TB) is a major cause of death for people living with HIV but adequate measures to control TB infection are still not implemented in most settings that provide HIV care and treatment.

Of 33 million people living with HIV barely 20% know their HIV status, only 2% are screened for TB and just 29,000 put on isoniazid preventive therapy.

HIV weakens the immune system and so people living with HIV who are infected with TB bacteria are 20 times more likely to become sick with TB than someone infected with TB who is HIV-negative.


Efforts to tackle TB and HIV have largely been separate despite the overlapping epidemiology. Thankfully, this is now changing as it’s recognised that the achievement of universal access to HIV treatment, care and prevention remains elusive unless HIV/TB co-infection is addressed. But civil society and communities are still rarely consulted or involved with HIV/TB co-infection responses.

The Alliance works in 15 of the 22 high burden TB countries. Over the last year we have been systematically looking at the work we’re doing integrating TB into HIV programming and we are capitalising on our grassroots experience and outreach to marginalised groups to address TB/HIV co-infection.


In India, LEPRA Society, a health and development organisation and a partner of the International HIV/AIDS Alliance in India, is working with the Andhra Pradesh State AIDS Control Society to spearhead a HIV/TB co-infection coordination outreach project, funded by the Global Fund.

146 community workers work in nine districts of Andhra Pradesh, a state that contributes 40% TB-HIV co-infection cases managed in the country.

The project aims to strengthen the referral system among TB, HIV and other healthcare providers, improve the follow up of cases and strengthen the links between service providers and communities.

It is the community workers who map out where available healthcare services aren’t utilised or patients don’t return for follow up services and they identify new cases by engaging with communities through personal counselling or group awareness meetings.

Community workers will focus on personal health, treatment adherence, diet, safe sex practices and preventative measures. They also engage with local leaders to leverage support in organising awareness meetings to help reduce the stigma and discrimination.


In Zambia, stigma and discrimination often means that many people don’t recognise they have TB until they are very sick so work is being done to decrease the burden of stigma for people living with TB and HIV. With approximately 70% of people in Zambia with TB co-infected with HIV it is a significant public health challenge.

The HIV/AIDS Alliance Zambia and Zambia AIDS-related TB Project (ZAMBERT) have developed a stigma toolkit in consultation with ex-TB patients, people living with HIV, nurses and young people. The result is a toolkit that clearly explains transmission through diagrams to help dispel fears; provides exercises to support children facing stigma and for health workers to reduce the stigma in health settings.

The toolkit has been distributed to trainers working in 13 districts in Zambia, and is now also being used in South Sudan, Kenya, South Africa and Burkina Faso.


“Communities are finding innovative ways of combating the challenge of HIV and TB co-infection. They need support both financially and technically to help tackle this issue and the Alliance will be working hard to make sure that these voices are heard,” said Taline Haytayan who is supporting the Alliance’s HIV/TB work.

The Alliance is a member of the Stop TB Partnership.

    Of 33 million people living with HIV, only 2% are screened for TB