Rectal Microbicides Open New Frontier in Turning HIV Tide

By Chief K. Masimba Biriwasha | OpEd

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Microbicides are products designed to prevent or reduce the sexual transmission of HIV or other sexually transmitted infections when applied inside the vagina or rectum. Most vaginal microbicides are being tested as gels or rings, while rectal microbicides are primarily being tested as gels.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Although the rate of new infections is stabilizing in many countries around the world, HIV continues to disproportionately affect racial minorities and men who have sex with men. It is estimated that five to ten percent of the world’s population engages in anal sex.

Globally, men who have sex with men are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population.

For decades, the primary approach to HIV prevention for anal sex has been consistent and correct use of male condoms. Male condoms are an extremely effective method to prevent HIV, but many people are unable or reluctant to use them.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex.

If proven effective, rectal microbicides could protect against HIV in people who are unable or reluctant to use condoms. Unlike condoms, they could provide an alternative way to reduce risk that is not controlled by one’s sexual partner and possibly enhance sexual pleasure, helping to motivate consistent use.

Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. Such an alternative is essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools

Rectal microbicides research is in the early phase of clinical development due in part to scientific challenges related to the biology of the rectum, and cultural reluctance to address anal sex.

Most critically testing the safety and acceptability of microbicides designed specifically for rectal use is key to ensuring their effectiveness in preventing HIV infection among people who engage in anal sex.

Researchers need to first be sure rectal microbicides are safe and then conduct additional studies to find out whether they are effective against HIV.

In Zimbabwe and Africa Cigarette Smoking Grows Despite Health Dangers

By Chief K.Masimba Biriwasha | iZiviso Global Editor At Large

HARARE, Zimbabwe – A man slowly crosses a busy street in Harare, Zimbabwe’s capital, puffing away at a cigarette, and then nonchalantly flicks the cigarette butt onto the tarmac.

The butt rolls away to the edge of the tarmac as the man gets swallowed by the crowd, a trail of smoke hovering behind his head.

In Zimbabwe, as in many parts of Africa, cigarette smoking is growing. According to experts, Africa is expected to double its tobacco consumption in 9 years if current trends continue. The surge in smoking is seen in young people under the age of 20 that constitute the majority of the continents population.

Zimbabwe – as one of the world leading producers of tobacco – has been more focused on te dollar sign over and above the negative consequences of smoking to te public. The government has been reluctant to put in place anti-smoking legislation. Tobacco has long figured prominently in the Zimbabwean economy – tobacco exports bring in a significant share of the country’s export earnings.

Cigarettes can be found everywhere – at street corners and in shops – at ridiculously cheap prices. Alex Madziro lives in Harare. He smokes an average of ten cigarettes a day. He says he has tried to quit but without success. “I just buy single cigarettes at street corners; it helps me to keep the habit in ccheck. I wish I could quit but it’s now very difficult,” he said in an interview. Cigarette companies can still advertise in the media. While the adverts contain health warnings, these have not been sufficient to stem smoking in the country. To put it bluntly, none of the adverts make note of the fact that smoking harms nearly every organ of the body.

According to a 2008 World Health Organization (WHO) survey, twenty-one percent of men in Zimbabwe smoke cigarettes.Across Africa, it is estimated men constitute of 70-85 percent of smokers. For many, smoking starts at a young age. It starts with peer pressure, being exposed to second hand smoking, having parents and best friends who smoke. While it’s almost taboo for women to smoke, the habit is slowly picking up among young women who regard it as a fashion statement.

Globally, tobacco kills more than 14,000 people each day – nearly 6 million people each year. Included in this death toll are some 600,000 non-smokers who are exposed to second-hand smoke. In 2004, children accounted for 31% of these deaths. Almost half of children regularly breathe air polluted by tobacco smoke. There are more than 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful, and more than 50 are known to cause cancer.

Without urgent action, deaths from tobacco could reach 8 million by 2030. 63% of all deaths are caused by non-communicable diseases, for which tobacco use is one of the greatest risk factors. A jarring statistic is that around half of all smokers alive today will be killed by tobacco. Tobacco is the single most preventable cause of death in the world today.

On the streets of Harare, smoking continues unabated: how much it is a public health problem is yet to be known. In fact, it is regarded low in the priority of public health issues affecting the country today. The death rate from smoking in Africa where treatment options are absent is high but smoking is not a priority in African public health strategies.

“Tobacco is way down in the public health concerns we have. There is malaria, malnutrition, HIV-AIDS, and tuberculosis. So, tobacco comes as something we know to be harmful, but we are not ready to handle at this time because of the limited resources that are available,” Dr Adamson Muula, a senior lecturer of public health at the University of Malawi was quoted by Voice of America in an interview on the ravages of smoking in Africa.

Just like Zimbabwe, very few countries in Africa have tobacco control acts to protect citizens from adverse effects of smoking, second hand smoking and the rate of new addictions.

TB in Children: Why Zimbabwe Must Act Now

By Chief K.Masimba Biriwasha | iZiviso Editor-in-Chief

Harare, Zimbabwe – Tuberculosis (TB) is a major public health problem in Zimbabwe yet very little is known about the impact of the disease on children. Without a functional health-care system and research into pediatric TB, Zimbabwe is likely to continue losing its children to this hidden epidemic.Image

Among African nations, Zimbabwe is one of those most heavily affected by TB. The 2009 Global Tuberculosis Control Report from the World Health Organisation (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.

Zimbabwe had an estimated 71 961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 people. While, Zimbabwe has fought TB fairly successfully since attaining statehood in 1980, in the past few years the disease has re-emerged as a leading killer, especially among people living with HIV, who are often not identified through long-established TB tests. Put simply, the TB control programme has been adversely affected by a lack of adequate financial, human and material resources.

As it is, there’s very little epidemiological data on the extent of TB among children in the country. Experts say that child TB is widely under-reported and can represent as much as 40% of the TB caseload in some TB high burden settings such as Zimbabwe. Children are at high risk of TB, are prone to disseminated disease and the diagnosis of paediatric TB may be difficult, since complaints often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously, as it has adults. It has increased the risk that infants and young children will be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to HIV-uninfected children. It also makes diagnosis and treatment more complicated and increases the risk of TB-related death about 5-fold.  The HIV epidemic has also orphaned many children (with or without TB-HIV themselves).

Unfortunately, Zimbabwe’s national tuberculosis programme has historically not given child TB high priority because of diagnostic challenges (e.g., children under 10 have difficulty producing enough sputum for microscopy and the majority are smear-negative); children are not a major source of the spread of the disease; resources are limited; recording and reporting forms did not include boxes for recording ages 0–4 and 5–14 until 2006.

“Our ability to even assess the magnitude of the problem is severely hampered by the lack of diagnostics in children. The problem is that diagnostic tools, both current and in development, do not adequately take into account the special requirements for assessing children,” said Dr Steve Graham, chair of Stop TB’s Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than adults for developing active TB disease, as well as of having the TB disseminate throughout the body, including to the brain, where it causes meningitis. This type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as ‘difficult cases’, especially with regard to diagnosis. Children are thought of as needing specialised care.

Against this background, TB case-finding efforts should target children under 5 years of age living in a household with a sputum-smear positive adult. If the children are well, they should receive isoniazid preventive treatment (IPT) to help prevent their developing active TB disease.  If they are not well, TB treatment should be considered and a clinical examination is recommended.

Suggestions for national tuberculosis programmes include:

  • Establish a dedicated child TB working group that includes National Tuberculosis Control Programme (NTP) staff and national child TB experts.
  • Use the working group to set practical priorities and goals, develop guidelines, implement activities for child TB, support health workers managing child TB and raise awareness through advocacy and health education.
  • Include the needs of child TB in routine NTP activities, such as training, drug procurement, strategic plans and recording and reporting.

OpED: TB Is A Women’s Issue Too

By Chief K.Masimba Biriwasha | iNamibia Contributor

Harare, ZIMBABWE – Today is March 8, and across the world the International Women’s Day is being commemorated. Coincidentally, March is the global tubercolusosis (TB) awareness month. The disease, which is caused by a mycrobatrium, has a major impact on women’s sexual reproductive health and that of their children.

For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth. The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality. Unfortunately, there is little to no attention to women’s vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women’s health needs at the core.

More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fuelling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world’s population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women’s specific needs.

Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.

Even with the availability of TB drugs women’s socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.

For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives. (CNS)

TB/HIV poses challenges for Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a nearby hospital but the bacteria was not detected in his sputum.

Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.

“I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.

After two years, Raradza started coughing again. He went to get tested for TB again.

“At the hospital, it was discovered that I had TB, so I was given 60 injections and tablets – its was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

In 2005 Raradza said he went to a Voluntary Counseling and Testing centre to get tested for HIV.

“It was unheard of then for anyone to go and get tested but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.

After noticing Raradza’s poor response to the AIDS drugs, Raradza said that a doctor-friend of his recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets.

According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.

“Diagnosis of TB is usually straightforward, the best test is sputum microscopy. But HIV changes the way the body reacts to infections. That’s why X-ray is now required but it is very expensive technology and the country cannot afford it at the moment,” said Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB unit.

Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.me

TB is a leading cause of illness and death for people living with HIV—about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. The risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.

According to UNAIDS, TB places a heavy burden on people living with HIV including significant illness that requires at a minimum six months of treatment, with the associated economic costs to the individual, his or her family and the health-care system.

Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population.

For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.

An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.

In Zimbabwe, the TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated.

To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Leck of medical practitioners coupled with obsolete machinery has also worsened the problem.

According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the health ministry is a key hindrance to an effective response to TB and other diseases.

“The Ministry of Health and Child Welfare has received paltry funding – only 7 percent of its projected budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the health ministry adequately,” she said.

15% Now Campaign Targets Africa Health Budgets

Imagine four African countries without any living soul – Botswana, Namibia, Lesotho and Swaziland – all because of deaths to preventable, treatable and manageable diseases.

Across Africa, public health systems are in a ramshackle state, as a result, over 8 million African lives are being lost annually to diseases, because people have little or no access to public health services.

“That figure of 8 million people dying annually is easily the combined populations of Botswana, Namibia, Lesotho and Swaziland dying in one year. At this rate, many countries will run out of burial space. Consequently Africa’s fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria – at 130 million – Africa’s most populous country,” said Rotimi Sankore, coordinator of the Africa Public Health Rights Alliance which is promoting the 15% Now! campaign to push African governments to adopt appropriate health policies.

“Investment in health is key to resolving this situation”

Maternal and child mortality, HIV/AIDS, malaria and tuberculosis are the main diseases affecting the populations yet governments are doing little to reverse the ide of deaths.

“It is clear that the vast majority of African governments have under-invested in health systems and there has been no long-term planning and understanding of health needs of citizens by government,” said Sankore

Heads of State African Union (AU) meeting in Abuja, Nigeria in 2001 agreed to commit at least 15 per cent of national budgets to health. But, six years later, only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge.

“To say it is tragic that in 2007 only two out of fifty three AU member countries have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy,” said Sankore.

Since the pledge was signed in 2001, Africa has lost a staggering 40 million lives due to a failure by African governments to develop, implement and fund comprehensive public health policies.

Worryingly, many of the governments are relying mainly on external efforts and donor funding to resolve their numerous public health problems.

“The leadership of most of the governments have not had to depend on the health systems of their countries for treatment and are therefore not committed to resolving the problem,” said Sankore.

According to the 15% Now Campaign, African governments must urgently implement their 2001 Abuja Declaration pledge to dedicate 15% or more of annual budgets to health care within three years. Commensurate to this must be a commitment to dedicate a significant chunk of the money to resolving the brain drain of health care workers, and addressing key concerns such as reproductive health, child mortality, HIV and TB.

“If you look at countries where health systems can meet the needs of citizens, anything from 15 to 30 percent of budgets have been spent on public health. In Africa, the lion’s share of budgets goes to military and defense spending,” said Sankore.

“The consequence is that once a higher percentage of citizens need health services, it becomes impossible for grants to deliver services.”

Currently, the doctor per patient ratio in Africa is appalling.

For example, the Democratic Republic of Congo (DRC) with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the France’s 203,000, Italy’s 241,000 and the UK’s 160,000.

Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years.

“To come anywhere near meeting the WHO recommended health worker to patient ratio or meeting the health based millennium development goals (MDG), these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years,” states the 15% Now! petition. “This is Africa’s priority.”

The 15% Now! campaign urges African governments to make the adoption of comprehensive health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress.

Some people argue that funding the health sector is not the solution, but if all the people are dead, what will the other sectors be for, said Sankore.

The loss of health care workers to developed nations is also a major factor contributing to the poor state of health care system in Africa. Some developed countries maintain domestic public health policies that promote the recruitment of health care workers from Africa.

Improving health care systems in Africa will require developed nations to abandon such practices. Because developed countries have benefited from poaching African health care workers, they have a moral responsibility to promote the training of healthcare workers to improve Africa’s health care workforce.

However, ordinary citizens in Africa are not informed enough to lobby their governments to adopt proper public health policies.

“The citizens are not adequately informed and it’s the job of organized civil society to inform and mobilize ordinary people to campaign for their right to health and life,” said Sankore.

Given the critical importance of good health to national development, an obvious question is why African governments pay little attention to the matter.

“There’s phenomena that health is a private matter, but the truth is every single citizen’s health issue when brought together presents a collective challenge. We may die individually of TB or HIV, but collectively our deaths impact society as a whole,” Sankore commented.

“Ordinary citizens in Africa have two choices – either they campaign for governments to accord their right to health, or they will die.”

But the fact is that if African governments do not meet their obligations, they will soon find themselves presiding over countries without people, added Sankore.

Implementing the agenda of the 15 percent Now! campaign, coupled with international donor support and policy change, offers the best chance for African governments to address the health needs of ordinary citizens.

“Doing nothing is not an option because if the situation persists, some countries in Africa will cease to function,” said Sankore.

Why Tuberculosis Matters to Women’s Health

Tuberculosis (TB) has a major impact on women’s sexual reproductive health and that of their children.

For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth.

The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality.

Unfortunately, there is little to no attention about women’s vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women’s health needs at the core.

More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fueling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world’s population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women’s specific needs.

Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.

Even with the availability of TB drugs women’s socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.

For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives.