Open Letter to the Governments of the World:
As leaders gather in New York for the “Global Leaders Forum on TB/HIV,” we write as civil society groups, advocates, researchers, and groups of people living with TB and HIV from sixty five countries around the world to demand concrete action on TB and HIV.
We express our collective outrage that TB, despite being curable for over a half century, continues to be the leading cause of death of People Living With HIV/AIDS (PLWH/A). We call on governments and multilateral institutions to take bold and concrete action—and commit ourselves to the same—to ensure that every person in need receives high quality TB and HIV treatment, prevention, diagnostics and care.
Below you will find a call to action from Civil Society—as we add our voices to the leaders gathered in New York June 9th. In 2006, the UN Political Declaration on HIV/AIDS called for “accelerated scale-up of collaborative activities on tuberculosis and HIV, in line with the Global Plan to Stop TB.” Since then some nations have seen major scale-up, but the vast majority of people with TB/HIV co-infection still do not have access to coordinated services.
The world must treat TB/HIV as the crisis that it is. In Sub-Saharan Africa currently up to 50% of people living with HIV will develop TB—they are 30 times more likely to develop active TB. Multi-Drug Resistant (MDR) TB, including Extensively Drug Resistant (XDR) TB, is poised to become the next pandemic—and already has frighteningly high mortality amongst people with HIV. An effective response must be mobilized immediately.
We understand that, if universal access to existing high quality TB/HIV care and services were available by 2015, we could likely cut the current mortality rates by 80%--saving the lives of hundreds of thousands of people each year. As a matter of urgency, we call upon governments of the world to move beyond declarations and provide the plans, the resources, and the effective programs to stop these intertwined pandemics.
We demand that governments immediately and publicly announce:
UNIVERSAL ACCESS TO HIGH QUALITY TB/HIV CARE BY 2015: By 2015, in high burden areas, every person living with HIV should be screened for TB, every person with TB should be offered HIV counseling and testing, and treatment, prevention, and care must be universally available and coordinated for both diseases. This must be coordinated with a scale up to Universal Access on HIV by 2010.
FULL FUNDING: Donor and high burden country governments must announce specifically how they will fund the at least $19 billion through 2015 needed to ensure existing high quality TB/HIV care is available to all and that new tools are on the way.
REDUCE TB/HIV MORTALITY: Country plans should monitor progress to reduce mortality to no more than 90,000 by 2010 and 50,000 by 2015—an 80% reduction over our current course.
21st CENTURY DIAGNOSTICS & TREATMENT: A tangible global commitment must be announced to developing and ensuring access to 21st century diagnostic and treatment tools so that co-infected people are screened and treated more effectively.
CIVIL SOCIETY CALL TO ACTION
FOR THE “TB/HIV GLOBAL LEADERS FORUM”
We, as civil society groups, advocates, researchers, and groups of people living with TB and HIV, in anticipation of the first TB/HIV Global Leaders’ Forum meeting at the United Nations in New York on 9 June 2008,
Recalling the UN General Assembly Political Declaration on HIV/AIDS (2006) emphasizing the need for accelerated scale-up of collaborative activities on tuberculosis and HIV, and the World Health Assembly Resolution (2007) requesting countries to immediately address extensively drug-resistant TB and HIV-related TB as the highest health priorities;
Noting that HIV and TB are major constraints for socio-economic development and that investing in joint TB and HIV/AIDS interventions will contribute positively to the achievement of the Millennium Development Goals on health and poverty reduction by keeping people healthy and productive;
Dismayed that every twenty seconds a person dies of TB and that mortality rates have escalated over the past ten years, despite tuberculosis being a preventable and curable disease, and notwithstanding global commitments to halve TB mortality by 2015;
Particularly dismayed by the increasing proportion of people living with HIV who are infected by, and dying from, TB; and worried that this has not corresponded with sufficient scale-up of TB/HIV collaborative activities – in defiance of Universal Access targets;
Concerned that we, PLWHA, are placed at risk by poor infection control practices in healthcare facilities, that render health care workers and people living with HIV extremely vulnerable in the very settings where we are obliged to access and provide healthcare;
Alarmed by the devastating spread of multi-drug resistant tuberculosis and extensively drug-resistant tuberculosis, which are particularly lethal in people living with HIV;
Appalled that the standard diagnostic TB test has changed little in over a century and routinely fails to detect TB in people living with HIV and that systems for the diagnosis and early detection of tuberculosis in those living with HIV have not improved substantially in the past few years, in spite of commitments at the national and international levels to this effect;
Emphasizing the critical need for governments to empower and engage communities and wider civil society in the response to TB;
Concerned by the inadequate investment of resources – both at the national and international levels – in a comprehensive TB research agenda targeted at improving the prevention, diagnosis and treatment of TB;
Recognizing the need to examine and address our shortcomings in meeting global targets for the prevention, diagnosis and treatment of TB;
Confirming that saving lives among people living with HIV and cutting mortality associated with TB by at least 80% compared to current rates requires bold leadership and decisive, urgent action at all levels;
URGE all UN Member States, and CALL on Organizations of the United Nations system; intergovernmental and nongovernmental organizations, the corporate sector, foundations, donors, communities and the international community as a whole:
To reaffirm and evaluate their commitment to the global fight against TB/HIV and in country statements, during remarks, roundtables and discussions to:
Commit the resources necessary to ensure universal access to high quality TB/HIV care by 2015, which could reduce TB-associated deaths among people living with HIV by 80%.
Work toward cutting TB related mortality among people living with HIV to 90,000 by 2010 and 50,000 by 2015—an 80% reduction over our current course.
Commit the minimum $19 billion needed through 2015 including $14 billion necessary to universal access to high quality TB/HIV care and $5 billion for research required to yield new TB tools.
Critically evaluate the progress made in the response to TB/HIV, identify the major challenges herein, and develop and implement strategies to overcome these challenges;
Expand and accelerate the coordination between national TB and HIV programs in line with the WHO TB/HIV Collaborative Policies to achieve Universal Access to TB services for all persons at risk for or living with HIV/AIDS, as agreed upon by the 2006 General Assembly Political Resolution on AIDS;
Immediately act on the recent UNAIDS commitment to monitor TB mortality in people living with HIV by making this an integral part of TB/HIV indicators on the national level;
Prioritize education and mobilization around TB infection control and treatment in communities, health care facilities and other institutions – particularly for people living with HIV and other communities at high-risk for TB/HIV;
Expressly commit resources to research around development and promotion of better tools – including drugs, diagnostics and a vaccine – for prevention, diagnosis, and treatment of TB that are effective for those living with HIV.
Systematically include TB and TB/HIV in broader development and poverty reduction strategies, and strengthen health systems across the board to be able to effectively respond to the need; and
Actively pursue the involvement of communities and wider civil society in developing and implementing effective responses to TB/HIV.
Ensure TB and TB/HIV case detection and cure rates are indicators within health sector reviews.
REQUESTS THE UN SECRETARY GENERAL (through his Special Envoy to Stop TB):
To engage governments and civil society in resource mobilization and in ongoing monitoring, evaluation and strengthening of the global response to TB;
To report regularly on progress in addressing TB/HIV to the UN General Assembly Special Session on the HIV/AIDS Epidemic, High Level Meetings on HIV/AIDS and other important meetings convened by the United Nations System.
To report back on progress at the Stop TB Partnership Partner's Forum, to be held in March 2009 in Rio de Janeiro, Brazil.