Here in the waiting room of Helen Joseph Hospital, a cough never sounds like just a cough. It’s more like the audio accompaniment for a glimpse at what may be the most sustained medical catastrophe of our time. A throng of new patients are spectral figures, the latest victims of what public-health officials dub a “co-epidemic” of tuberculosis and HIV. The patients’ off-white masks flutter whenever they break into that distinctive guttural bark, followed by a raspy rattle in the throat. Linger long enough in this room and you’ll hear prayers offered: “Please, Jesus, let this be a case of ordinary tuberculosis.” Rising numbers of patients are infected with strains of Mycobacterium tuberculosis resistant to commonly used medications. Treatment, then, will be longer, more punishing, and less effective.
Although largely unnoticed by the public in the United States and Western Europe, where TB and HIV are relatively well-controlled, the co-epidemic rages on across great swaths of Asia, Eastern Europe, Latin America, and Africa. In 2013 alone, these twin scourges took the lives of an estimated 2.6 million people, who died of one infection, or the other, or both.
Nine million people contracted TB in 2013 (1.1 million of them also HIV-positive), and nearly half a million new infections that year involved drug-resistant strains, according to the World Health Organization. The ongoing, uncontrolled spread of multidrug-resistant tuberculosis (MDR TB) also threatens to upend the public-health systems in South Africa and 21 other counties.
Against this grim backdrop, there’s a $1.7 billion shortfall worldwide in funds needed for the prevention, diagnosis, and treatment of TB. Investment in research on vaccines and new treatments remains at paltry levels. The scale of suffering and dying is alarming enough, but public-health advocates worry about the potential for wider consequences, since one in three of us hosts a latent, or inactive, form of tuberculosis, and 37 million are HIV-positive.
“You know, Ebola is only a plane ride away,” one of the doctors at the hospital told me shortly after I arrived for a visit on a cool autumn morning. “Like Ebola, untreatable TB is only a plane ride away, too. So I’m quite surprised by the apparent lack of a sense of urgency about this everywhere but here.”
In a corridor that links the hospital’s HIV clinic to its TB treatment center, I met a patient who has been fighting both illnesses for the past six years. “This sickness has been hunting me,” Babsy Raphoto told me. “TB, you know, it eats your strength.” She’s a 45-year-old black woman with a pleasant, oval-shaped face, dressed in a bright pink-and-blue blouse. “And there’s been so many TBs!” Raphoto exclaimed. “I’ve had it three times so far.”