Mandela Tells of TB's Peril
AIDS Groups Urged To Tackle Disease
By Ellen Nakashima
Washington Post Foreign Service
Friday, July 16, 2004; Page A15
BANGKOK, July 15 -- Nelson Mandela was in prison in 1988 when a test showed he had tuberculosis. Fortunately, he said, the condition was diagnosed and cured before "holes in the lungs" developed, a sign of advanced disease.
Mandela chose to tell the story of his four-month bout with the disease during the 15th International AIDS Conference because tuberculosis, which kills almost 2 million people each year, is the leading cause of death for people with AIDS. The icon of South Africa's struggle against racism urged Thursday that the fight against AIDS be extended to conquering tuberculosis as well.
"We are all here because of our commitment to fighting AIDS," Mandela, 85, said at a news conference. "But we cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS."
On Friday, he was to deliver the closing address at the week-long conference.
Mandela, who was released in 1990 after 27 years of confinement for challenging South Africa's racist policy of apartheid, recounted the reaction of members of his political party, the African National Congress, when he told them he had tuberculosis. "There were long faces drawn. My friends objected to me sharing my personal affairs," he recalled, referring to the stigma of tuberculosis in many countries in the developing world, where it is seen as a disease of the poor.
"But I consoled them and told them that the doctors and hospital staff knew about my status and I therefore had no reason to hide this information from those close to me." He said speaking openly brought support that helped him heal.
After Mandela left the podium, a panel of experts discussed efforts against tuberculosis and HIV/AIDS.
People who have HIV, the virus that causes AIDS, are 50 times as likely to develop tuberculosis, because their weakened immune systems provide a "fertile environment" for the tuberculosis bacteria to breed, said Jack C. Chow, assistant director-general for HIV/AIDS, tuberculosis and malaria at the World Health Organization.
An estimated 50 percent of people with HIV in the developing world contract tuberculosis, officials said. And up to 35 percent of deaths among those with AIDS -- a condition in which the immune system is damaged -- are attributable to tuberculosis, Richard E. Chaisson, director of Johns Hopkins University's Center for Tuberculosis Research, said in an interview. Most of those deaths are in sub-Saharan Africa.
In the developing world, the World Health Organization has developed a tuberculosis strategy called DOTS, or directly observed treatment, short-course, which relies on a health care worker or family member to make sure a patient takes each dose of medicine and completes the entire treatment, which usually lasts six months.
But Chaisson said many affected regions must use other strategies. One is "massive preventive therapy," or giving the anti-tuberculosis drug isoniazid to large numbers of people. Another is actively identifying tuberculosis carriers who are transmitting the disease but don't know it.
On Thursday, the Bill and Melinda Gates Foundation announced a $45 million grant to the Consortium to Respond Effectively to the AIDS-TB Epidemic to research strategies to control tuberculosis in areas with high HIV rates. The foundation also announced a $50 million donation to the Global Fund to Fight AIDS, Tuberculosis and Malaria, adding to an earlier gift of $100 million.
"As HIV continues to spread throughout the world, the impact of tuberculosis will only increase," said Helene Gayle, director of the foundation's HIV, TB and Reproductive Health program. "So it's critical that we find strategies now that help us reduce the further spread of tuberculosis."
© 2004 The Washington Post Company