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Story Publication logo September 2, 2016

A Double Diagnosis: TB and HIV

Image courtesy of Misha Friedman.

According to all the latest reports, South Africa is making major steps in treating and preventing...


Every day Orianda came to a school building in Gugulethu, a township near Cape Town in South Africa. She would set up a make-shift stall and dozens of hungry students would line up to buy some "walkie talkies," barbecued chicken feet.

When she was 57 years old Orianda could no longer manage that. She was tired, feverish, lost weight and developed a cough. She went to the local clinic and found out she had tuberculosis. She also discovered she was HIV-positive. She was confused, shocked, in disbelief. After all, these diseases affect the young, while she managed to become one of the oldest people in her neighborhood—where average life expectancy is about 55 years old.

According to the World Health Organization, an estimated 80 percent of the South African population has latent tuberculosis, which means these people are not infectious but carry the malignant bacteria and can potentially develop the disease at some point in their lives. And hundreds of thousands do, every year, especially those with weakened immune system, such as people living with HIV.

Although tuberculosis is the leading cause of death in the country, in the past decade South Africa has dramatically improved its tuberculosis treatment strategies. Now more than 70 percent of those who develop the disease are successfully cured. Orianda may wear a corset to help her frail body and walk with a cane, but she was successfully cured.

Every fourth person in Gugulethu is HIV-positive. Most people do not get tested for HIV, unless they are among the key affected populations—young women and children, gay men, sex workers and drug users. At 60, grandmother Orianda still wonders how and where she got infected with HIV. If it wasn't for tuberculosis she would have never found out about her virus.

I spent the majority of my career as an aid worker and a journalist in the former Soviet Union, where most patients with HIV and tuberculosis co-infection knew about their HIV status by the time they got sick with tuberculosis. For me, it was startling to find out that in South Africa it was normal to discover one's HIV status at a tuberculosis clinic.


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