[Ip-health] UNAIDS letter

[Vanessa Wu]

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Dear All:

   Below is a letter to the incoming Executive Director of UNAIDS from
those concerned about TB-HIV co-infection and the inadequate response
provided by UNAIDS thus far.  There are currently several leading
candidates and we all await word from the UN Secretary General about who
will be the next ED. Hopefully we can get lots of us on this letter to
greet her or him when they are announced.



PLEASE SEND *ORGANIZATION* Sign-Ons to Vanessa Wu (vwu@results.org)



Thanks

ARASA, HealthGAP, RESULTS, TAC & TAG



Dear _____,



Congratulations on your recent appointment to lead UNAIDS and the global
response to HIV and AIDS. On behalf of the undersigned, we are writing
to request your bold leadership and commitment to achieving universal
access to quality TB/HIV prevention, diagnosis, and treatment services
in the coming years in coordination with Universal Access on HIV/AIDS by
2010.

As you know, tuberculosis poses one of the greatest risks to people
living with HIV. Although preventable and curable in most cases, TB is
the biggest killer of people living with HIV (PLWHA). In sub-Saharan
Africa, up to 50% of people living with HIV will develop TB, and without
proper treatment, approximately 90% of them will die within months.

It is clear that the fight against AIDS will not be won without also
fighting TB--a reality the HIV community has known for over two decades.
Centrally important is the continued roll-out of ARVs for coinfected
people as one of the best strategies for reducing the burden of TB among
people living with HIV. We must reach the country-level targets of
Universal Access by 2010. However, we continue to see people living with
HIV dying unnecessarily of TB. A Universal Access approach that does not
include comprehensive TB services will continue to leave hundreds of
thousands of PLWHA to die of a disease that has been curable for over
half a century.

On numerous occasions over the last decade, UNAIDS, the World Health
Organization, and global leaders have committed to accelerating the
scale-up of critical TB/HIV interventions, but both action and impact
remain grossly inadequate. According to the World Health Organization's
2008 Global TB Report, less than 1 percent of people living with
HIV/AIDS were screened for TB. HIV/AIDS programs are also failing to
provide isoniazid preventive therapy to protect PLWHA from TB. ARV
clinics--which should be a symbol of life--threaten to become places
where people contract TB in high numbers without quality infection
control measures. Moreover, most programs continue to rely on passive TB
case finding, which translates to countless preventable deaths and
allows transmission to continue unabated. In the multisectoral response
to HIV, tuberculosis continues to be left aside--rarely incorporated
into workplace, harm reduction, youth services, etc. Globally, we do not
even have accurate data on the true scope of the TB/HIV pandemic and the
response to date.

All of these are areas in which UNAIDS and its co-sponsors should be
courageously leading the way. Collaboration between TB and HIV programs
is essential, not only for an effective AIDS response, but also to
bolster laboratory capacity, human resources, and other health systems
components.

According to the World Health Organization, full coverage of existing
screening, treatment, prophylaxis, and infection control tools could
reduce the number of TB-related deaths among HIV positive people by 80
percent--saving hundreds of thousands of lives every year--and would
cost $19 billion by 2015. This goal, as well as promoting the search for
new tools that work for PLWHA, should be a key priority for UNAIDS. We
acknowledge the recent work of the UNAIDS secretariat to highlight
TB/HIV and the Programme Coordinating Board's attention to these issues
at their meeting in April 2008 and the outcomes of the June 2008 HIV/TB
Global Leaders Forum, but so much more can and must be done to start
saving lives now. In your new role, we request your bold leadership to
develop and implement a concrete, funded plan of action for UNAIDS to
achieve universal access to quality TB/HIV services.

We offer our partnership and support to you in this effort and welcome
the opportunity to work together to ensure that UNAIDS, at the
Secretariat and country level, is advancing quality TB/HIV care for all
PLWHA as their right. We ask that as soon as possible, ideally within
your first year in the position, you:

*     Bring together a high level meeting of people within the UN,
governments, experts, civil society, and affected communities to craft a
plan of action to reach universal access to high quality TB/HIV services
and full adoption of the "Three Is." This plan must have clear
activities, milestones, a plan to fund scale-up, and must be coordinated
first and foremost at the national level.

*     Integrate TB/HIV into the central surveillance and reporting
mandates of UNAIDS to ensure that we have real and accurate information
and projections about the co-pandemics with which to plan a response.

*     Invest seriously in TB/HIV within UNAIDS by increasing the budget,
expanding the staff, and making TB/HIV roll-out among the central goals
in UNAIDS work plans in all regions.

*     Integrate TB into the multisectoral global response to HIV (e.g.
education, prisons, workplace, gender, children and youth, migration,
etc.)

*     Expand support for technical assistance to countries preparing
Global Fund grants to incorporate TB/HIV services while also working to
reach the goal of 70% success.

With your personal leadership and commitment, these and other key
interventions by UNAIDS will dramatically improve the world's response
to TB/HIV and save millions of lives. We look forward to supporting you
in this critical effort and working together to fight HIV/AIDS.



Sincerely,

[LIST IN FORMATION]



AIDS & Rights Alliance of Southern Africa (ARASA), South Africa

HealthGAP (Global Access Project), USA

RESULTS Educational Fund, USA

Treatment Action Campaign, South Africa

Treatment Action Group, USA