As an infectious diseases doctor-in-training, I have the following conversation with my ID colleagues on an all-too-frequent basis. “What was that other physician thinking?” we say to each other, our eyebrows raised.
This case was a doozy. “Jonathan” was a young man who had been seen in clinic several times over a span of months with fever, cough, and other symptoms, yet he had never even been tested for HIV. Eventually he was tested, found to be positive, and diagnosed with AIDS and advanced tuberculosis (TB).
I wasn’t surprised that the diagnoses of HIV and TB had been so delayed. I had seen it before. These diseases are out of sight, out of mind for many clinicians. With increased access to life-saving HIV drugs, fewer “Jonathan’s” are out there. But HIV and TB still lurk in the shadows of our cities and towns. Because of stigma, a lack of education, and a host of other factors, these diseases remain hidden, yet transmission continues.
I’ve been interested in HIV and TB since I was a college student. In 2002, I had the good fortune of meeting Dr. Hamza Brimah, an HIV doctor working in the Mississippi Delta. In his Greenwood clinic, Dr. Brimah told me of the challenges his patients faced – poverty, discrimination, and unemployment. His clinic was underfunded, as well. “I think we should spend less money on war, and more money on ‘viral terrorists’ like HIV,” Dr. Brimah had told me.
Since then, I’ve devoted my career to taking care of patients with HIV and TB in Philadelphia, San Diego, Mozambique, and Boston. I’ve also worked on HIV and TB at the Centers for Disease Control and Prevention (CDC). And I feel chastened. HIV only pops up in the public’s eye once a year, on December 1st (World AIDS Day). TB only pops up once a year, on March 24th (World TB Day), to a smaller audience.
Take a few minutes and watch the PBS documentaries, “The Forgotten Plague,” about the history of TB in the United States, and “TB Silent Killer,” about drug-resistant TB and HIV in Swaziland. These diseases are frightening, but they are aren’t going away. Although researchers have been trying for decades to develop vaccines for HIV and TB, the scientific barriers are enormous, and we shouldn’t expect effective vaccines anytime soon.
It’s not all hopeless. New diagnostics tests and drugs have been developed for TB. In addition, the scale-up of lifesaving HIV treatment continues around the world. Yet if I’ve learned anything from my work, it’s that local people are far more important than technology or medications. Only local people, like community leaders, health workers, and patients are the ones who can make the changes that needs to be made. This is the same in Boston as it is in Mozambique.
Let me give you an example. In Cape Town, South Africa, an inspiring group of health workers have formed an organization called “TB Proof.” Their goal is to counter the stigma surrounding TB and make their hospitals and clinics safer by reducing nosocomial TB transmission. On World TB Day 2015, they are making progress. Yet TB and HIV are formidable adversaries and they need your help.
As for “Jonathan,” he got started on TB and HIV treatment and has done well. But I hope his story reminds you that these diseases are forgotten but not gone.