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TB and HIV / AIDS

HIV/AIDS advocacy, prevention and care have been fundamental to Doctors of the World – USA’s (DOW) health and human rights mission since the organization’s founding in 1990.

As the late Dr. Jonathan Mann, one of DOW’s founders and the former director of WHO’s Global Programme on AIDS, said, “discrimination, marginalization, stigmatization and, more generally, a lack of respect for the human rights and dignity of individuals and groups, heighten vulnerability to HIV/AIDS.”  Recognizing that Tuberculosis (TB) and HIV/AIDS are twin pandemics, DOW takes a multifaceted approach to address and treat both diseases while advocating on behalf of affected people and serving vulnerable populations.

A deadly combination.  HIV/AIDS and TB are devastating epidemics, which, when combined, prove particularly lethal.  In November 2007, UNAIDS/WHO reported an estimated 33.2 million people living with HIV.  The disease targets mainly young and middle-aged adults at the prime of their ability to provide for their families, thus stunting economic growth and exacerbating poverty.  Women, discriminated against and exploited in many parts of the world, are disproportionately affected.  In Sub-Saharan Africa, young women are four times as likely as young men to become infected.  Many of these women are mothers and caregivers and their disease strongly impacts their children and families, and by extension, entire societies.

Due in part to the HIV pandemic, TB infection rates have skyrocketed in recent years.  The WHO reports that approximately one-third of the global population is currently infected with TB.  One of the leading infectious causes of death in the world today, TB is responsible for nearly two million deaths annually, mostly in poor communities.  Linked with HIV, TB is even deadlier, causing up to one third of HIV-related deaths.

Diseases of poverty & stigmatization.  The HIV/AIDS epidemic and the lack of or collapse of public health infrastructure in many countries have fueled the resurgence of TB.  Control of the disease is further complicated by the fact that it is a disease of poverty, primarily affecting populations lacking access to social services and health care.  TB control lags behind global targets set by the WHO’s DOTS program, particularly in developing nations in Africa and in many countries of Eastern Europe and the former Soviet Union.

TB and HIV/AIDS strike hardest at society’s most vulnerable segments: ethnic minorities, women, infants, the poor, and the displaced.  Stigmatization and discrimination exacerbate the TB and HIV/AIDS pandemic.  Viewed as deserving of their condition, people suffering from TB or HIV are often isolated by friends and family, communities, and even health care providers at a time when they most need support.   Such discrimination and stigmatization discourages the sick from seeking diagnosis or treatment, and can put them and those close to them further at-risk.  Stigma also enables impunity for human rights violators, allowing government leaders to ignore abuses against and the needs of marginalized groups.

Building capacity and improving access to care.  In the rural and impoverished West Pokot District of Kenya, DOW is working with local partners to develop systems and provide training that improve HIV/AIDS care, facilitate access to care, raise community awareness, and reduce stigmatization.

Reaching out to marginalized communities.  In the poor, rural state of Chiapas, Mexico, DOW works with indigenous communities to provide community education on TB, developing systems and training health workers to strengthen the coordination for TB control between communities and the health system.

Serving the at-risk groups.  In Russia, DOW works to adress the world’s fastest growing HIV epidemic by providing services to street and at-risk children and youth, and to HIV-positive mothers.  The clinical and psychosocial services for women and families provided through the MAMA+ Project combat the alarming rate of babies abandoned by HIV-positive mothers, working to keep these children in the birth family environment.  DOW has replicated the successful MAMA+ model in Ukraine, which also faces one of the fastest-growing HIV infection rates in Europe.  

Combating discrimination with education and community mobilization.  DOW, a member of the Stop TB Partnership, utilizes a rights-based approach to combat TB and HIV/AIDS, building the capacity of local systems and service providers and addressing the needs of marginalized and at-risk populations.  In each of its projects, DOW works with local organizations to develop enabling systems that empower people to control their health, such as training community members to advocate on their own behalf, and building the capacity of local health workers to provide care.  DOW also educates health care providers to identify and remedy barriers to treatment completion and engages them as advocates for vulnerable groups.  By incorporating advocacy, communications, and social mobilization into our TB and HIV/AIDS projects, DOW ensures lasting and effective solutions that can be implemented at regional and national levels.

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TB and HIV/AIDS PROJECTS:

KENYA: HIV/AIDS Prevention, Treatment, and Care

KENYA: TB Control

KOSOVO: TB Control

MEXICO: TB Control

ROMANIA: TB Control

RUSSIA: Access to HIV Testing, Prevention, and Care for Street Youth

RUSSIA: MAMA+ Project for HIV-Positive Mother and Their Children

UKRAINE: MAMA+ Project for HIV-Positive Mothers and Their Children

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