Tuberculosis (TB) is the single greatest killer of people living with HIV, yet is unaddressed and unrecognized within the HIV/AIDS community (i.e among patients themselves, politicians/policy makers, activists).  Among women of reproductive age, TB and HIV are the leading causes of morbidity, i.e “dual burden.” Gender, cultural and social factors contribute to the lack of awareness/attention being paid to TB, including co-morbidity of TB and HIV.

Within Zambia, TB is often thought of as a “man’s disease.” Women oftentimes go undetected as a result of not receiving a diagnosis and this may be due to a lack time to receive test due to household responsibilities, taking care of family or they may be unaware of infection.  Additionally, TB messages conveyed via public media campaigns are thought to be too technical and not easily understood by those who are mainly infected/affected by TB.  TB and HIV services are oftentimes offered in separate clinics, making accessibility difficult and contributing to lack of TB detection among people with HIV. There is a call for greater community involvement in promoting awareness surrounding this issue and the need for simple TB targeted messages.

For South Asian countries, specifically India, stigma and discrimination against people with HIV/TB remains an issue, particularly for women (due to caste system/traditional patriarchal society). India has 1/5 of the global incidence of TB; women are disproportionately affected.  Factors identified as turning the tide for HIV and applying these to TB would involve commitment from all levels (government, donors, researchers, pharmaceuticals, civil society, patients), access to information (i.e helpline), access to testing/treatment (easy, locatable), and empowerment of affected communities.

Lighthouse Clinics in Malawi has employed an innovative approach offering HIV, TB and other services simultaneously within the same clinic. Specifically, it has integrated HIV testing/ ART treatment services with TB screening/testing and cervical cancer screening for women. Challenges arising with this approach involve managing multiple partnerships, bombarding patients with too much/complex information and “one stop shop” not being enough.

Track D: Turning the Tide: Women, Children and HIV-Associated Tuberculosis
Chair: Mandy Slutsker, United States tbc and Stephen Lewis, Canada

Scaling up care for women and children with HIV-associated tuberculosis-C. Nyirenda, Zambia

Stigma as a barrier to HIV-associated tuberculosis services in women in India-B. Kumar, India

Progress towards integrating TB, HIV, and MCH services in Malawi-S. Phiri, Malawi

Youth Response to HIV-associated tuberculosis-H. Hess, South Africa

TB is the leading opportunistic infection in HIV infected patients and often the first indicator of immune deficiency (AIDS defining Illness). Tuberculosis accelerates the progression of HIV infection and HIV increases the likelihood of active TB disease. Despite high mortality among women and children from HIV related TB every year, little attention is paid to HIV-associated tuberculosis in women and children. This leaves a number of women and children, undiagnosed and untreated. Panelists from Malawi, Zambia, South Africa and India highlighted experiences, successes and challenges, and considered how each of us can turn the tide to eliminate HIV-associated tuberculosis in women and children. Major themes that emerged were that lack of knowledge on TB, lack of political will, inadequate financing, and stigma and discrimination and lack of activism remained barriers to addressing HIV-associated tuberculosis in women and children. A model program from Malawi illustrated the process of how a community could integrate TB, HIV, and MCH services.

Major areas of consensus were that there was need for integration of TB screening, diagnosis, treatment and care in HIV and MCH services; integration of TB in of TB for all pregnant women; provision of IPT treatment to prevent active TB disease among HIV + positive people; and increased TB/HIV/MCH activism; fighting stigma and discrimination within the cultural context; utilizing lessons learned from HIV prevention, treatment and care to inform TB integration. The session contended that Commitment, Provision of information, Access, Empowerment and Involvement of affected communities by key populations would turn the tide.

            “Turning the Tide: Women, Children, and HIV-Associated Tuberculosis” focused on the accomplishments that have already been made for women and children dually diagnosed with HIV and tuberculosis, as well as the steps necessary for progress to continue. Opening the session was an activist  who is currently working to improve TB diagnostics and treatment for Zambian women and children. Her motivation to fight for change springs from her own struggles to receive diagnosis and treatment for tuberculosis. She disclosed how her dual diagnosis of TB and HIV came as a surprise to her as she was not previously aware that she was at risk for either disease. She blamed her own and other women’s lack of awareness on her culture’s incorrect belief that tuberculosis is a “man’s disease.” In order for TB services to reach more women and children, she argued, TB screening must be integrated with prenatal and pediatric services for HIV positive women and children. Next to speak was an activist from India, the country with the highest global burden of tuberculosis. She discussed how gender inequality and stigma are barriers to care for women dually diagnosed with HIV and tuberculosis. Quoting a HIV/TB patient who said ” If the doctor speaks to me kindly, I can bare everything else!” she emphasized how the elimination of stigma among healthcare providers is key for to preventing loss to follow-up among patients. The last presentation featured a speaker from Malawi, who explained how integration of TB treatment with ART services had decreased mortality among those with AIDS in his country. He asserted that moving forward, TB clinicians should be trained in ART in order to correctly counsel patients about medication adherence, and that an electronic system should be created for better management of HIV/TB co-infected patients.