RI of HIV-TB coinfection threat

Tb. Arie Rukmantara, The Jakarta Post, Jakarta

Datuk, not his real name, who is HIV positive, is tired of watching his friends continue to die.

"I watch as my friends die one by one, not because they have AIDS, but because they are suffering from tuberculosis (TB)," said the 28-year-old, who also has TB.

"I wonder why no one does anything to stop these deaths," he said.

NGO activists and health experts share Datuk's concern, warning that ignorance of HIV-TB coinfection was raising the mortality rate among patients.

The executive director of the Coalition for a Healthy Indonesia (KUIS), Tom Malik, said the mortality rate for patients with HIV-TB coinfection should not be rising because the government provided medication to treat both HIV and TB.

"Medication for both TB and HIV is provided for free by the government, but each year the problem grows worse," he said during a recent discussion hosted by the coalition on the threat of HIV-TB coinfection in Indonesia.

According to data from KUIS, every year about 250,000 new TB cases are found in Indonesia, which now has the largest number of TB patients in the world after India and China.

There are almost 400 TB-related deaths recorded in Indonesia each day, or about 140,000 annually.

Tuberculosis is a contagious disease that attacks the lungs and is caused by the bacilli Mycobacterium tuberculosis, which are transmitted through aerosol droplets expelled when people with active TB cough, sneeze, speak or spit.

Additional data from the coalition indicates there are between 90,000 and 130,000 people with HIV/AIDS in Indonesia.

AIDS is a collection of symptoms and infections resulting from the depletion of the human immune system caused by infection with HIV, and can be transmitted through unprotected sex, blood transfusions and sharing needles.

Citing data from the World Health Organization, Tom Malik said TB was the number one cause of death for people who were HIV- positive.

"WHO says that over 50 percent of HIV-positive patients carry TB, meaning that one out of every two HIV/AIDS patients is likely to have TB, which could lead to his or her death," he said.

Tom added that three million of 14 million people detected as having HIV-TB coinfection were living in Southeast Asia.

He said regional administrations were not taking the necessary steps to treat these patients.

According to a 2003 study by the Ministry of Health in four provinces -- Jakarta, West Java, East Java and Bali -- many HIV- TB coinfection patients did not receive proper treatment.

"The study showed that regional administrations were not providing integrated health services or disseminating information to HIV-TB coinfection patients," he said.

Kartono Mohamad, a noted health expert, urged regional administrations to give this issue greater attention and to formulate regulations to ensure coinfection patients get the help they need.

"What is most important is to eradicate the stigma, in this case the double stigma, that HIV-TB patients do not deserve to be treated like other citizens. They have the same rights," he said, adding that there were still many doctors and nurses in the regions who were reluctant to treat HIV-TB patients.

Tom stressed for regional administrations to provide proper care for coinfection patients, they had to set aside sufficient funds.

"I found one regency that does not allocate any money in its budget for TB or HIV/AIDS," he said.