Agenda 4 – intervention by Trevor Stratton, North American delegate

Thank you, Madam Chair.

Tuberculosis is a global crisis that kills over one and a half million people every year. It is the leading killer of people with HIV. Based on the Political Declaration resulting from the High Level Meeting on TB in September 2018, General Assembly President María Fernanda Espinosa Garcés from Ecuador said tuberculosis claimed 1.6 million lives in 2017, despite being a preventable, treatable and curable disease. Yet, collectively we have failed to respond effectively to TB, because it mainly affects poor people including criminalised and marginalised communities such as people who use drugs, prisoners, indigenous people, migrants and their communities. Sounds familiar?

We have built a quite robust HIV response globally, but we have neglected TB. The International Treatment Preparedness Coalition, and many other groups, highlights the need to recognise our collective and individual failures. It is time we realise that HIV and TB are two sides of the same coin – difficult living conditions, vulnerable life-styles and stigma.

At the 49th Union World Conference on Lung Health took place in The Hague, in October, this year, I joined a panel presentation with members of the global Indigenous Stop TB Working Group, highlighting where systems work in recording and reporting well, it showed that the large burden of TB carried by indigenous populations compared to non-Indigenous population. Identified barriers included HIV syndemics and antimicrobial resistance, but more challenging, is the lack of community engagement and social interventions. Delivery of programs in remote regions and isolated communities within large urban areas must be appropriate to the community, culturally appropriate and safe, community owned, evaluated, and used to improve HIV and TB co-infections’ outcomes locally and globally.

It is paramount that we develop multi-pronged strategies to support marginalized people (indigenous populations, migrants, etc.) living with HIV and are co-infected with TB.

It is essential that we, in line with the proposed decision points:

  • Ensure the rapid rollout of lifesaving new diagnostics such as LAM testing, and better and safer medicines such as bedaquiline. We need to commit to stop using medicines that do not work or worsen health outcomes for people with TB.
  • Ensure high-TB burden countries modify their Global Fund-funded TB and TB-HIV programs to reflect the newest WHO treatment and prevention guidelines rather than old and outmoded approaches.
  • Ensure access to better and safer TB health technologies, and through funding the bold expansion of contact tracing and active case finding campaigns.
  • Commit to implementing and aggressively scaling up access to the latest evidence-based health technologies and policies in our countries. In short, we must commit to ensuring that every single person who has TB receives the best available testing, treatments, and support – irrespective of their ability to pay or in which country they may live. In pursuit of this goal, we place human rights, and particularly the right to health, ahead of private interests and short-term political considerations.
  • Ensure that better, more tolerable treatment regimens and co-formulations are developed

We cannot continue to act as if TB occurs in a separate world from HIV, particularly in the global south where TB affects the poor and marginalized. We need to be proactive, bold and innovative in dealing with the intersection of two diseases when they intersect, and leave no one behind, otherwise it won’t be possible to achieve the SDG Goals by 2030.

43rd PCB

Agenda item 4. Follow-Up to the Thematic Segment from the 42nd Programme Coordinating Board Meeting

Delivered by Trevor Stratton, NGO North America

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