In western Kenya, near the shores of Lake Victoria, a tuberculosis outbreak unfolds much like anywhere else in the world. A few dozen people fall ill, health workers scramble to locate and test those exhibiting symptoms, and efforts are made to ensure that patients complete their full course of medication. This six-month regimen is crucial to preventing the development of drug-resistant TB strains.
However, the fight against TB in this region is complicated by the high prevalence of HIV infections. People living with HIV are more than 14 times more likely to contract TB than those without the virus. This vulnerability extends to other areas, such as the Ugandan shores of Lake Victoria, Zambia’s Copperbelt Province, South Africa’s Eastern Cape Province, and Enugu State in Nigeria. These regions share a grim reality: TB and HIV co-infections pose a significant public health challenge.
Among the 30 countries identified by the World Health Organization as having a high burden of TB and HIV co-infections, 22 are in sub-Saharan Africa. The highest rates of co-infections globally are found in South Africa, India, Nigeria, Mozambique, and Kenya. These nations struggle to contain the dual epidemics, often relying on international partnerships and donor-funded programs to manage the crisis.
Unlike TB, which is curable with a long but effective treatment regimen, HIV remains incurable. While antiretroviral drugs help control the virus, they do not eliminate it. The weakened immune systems of people living with HIV make them more susceptible to infections like TB. In fact, TB is the leading cause of death among people with HIV.
Foreign aid has played a vital role in the battle against these diseases. International funding supports programs that identify and treat individuals living with HIV, providing them with the necessary medication to suppress the virus. Similar initiatives ensure that TB patients receive uninterrupted treatment, preventing further spread and reducing drug resistance. These interventions have saved countless lives.
However, the trend of reducing foreign aid now threatens to undo years of progress. Budget cuts could dismantle critical programs, leaving vulnerable populations at heightened risk. In regions like western Kenya, where TB and HIV remain widespread, funding cuts could lead to a resurgence of both diseases. The interconnected nature of global health means that outbreaks in one area can quickly spread beyond borders.
To combat TB and HIV effectively, the world needs new and improved treatments. Shorter, more effective TB treatment regimens would reduce the burden on patients, making it easier to adhere to medication schedules. Breakthroughs in HIV research could eventually lead to a cure, eliminating the need for lifelong treatment.
Preventative measures are equally important. The only existing TB vaccine, Bacillus Calmette-Guérin (BCG), was developed over a century ago and offers limited protection against pulmonary TB, the most common form of the disease. Meanwhile, there is still no vaccine to prevent HIV. Promising prevention methods are in development, but without sufficient funding, progress could stall.
Global investment in research for neglected diseases, including TB and HIV, has declined by more than 20% since its peak in 2018. In 2023, high-income countries provided 59% of all funding, but these contributions are expected to decrease further. Low- and middle-income countries are working to increase their own research contributions, but they are still in the early stages of developing homegrown solutions.
Today, progress against TB and HIV is at risk as governments face difficult budget decisions. Funding cannot be restored overnight if it is abruptly cut. The COVID-19 pandemic set back the fight against TB, with an estimated 700,000 additional deaths linked to disruptions in treatment and diagnosis. In 2023, less than half of all patients with drug-resistant TB received the necessary medication. Further funding cuts could erase the hard-fought gains made since the pandemic.
It is crucial for both the Global South and Global North to maintain collaborative efforts against these diseases. The world remains interconnected, and solutions that benefit one region ultimately benefit everyone. Continued investment in research, treatment, and prevention is not just a moral obligation—it is a necessity for global health security.
