Unequal Treatment: Reconciling Approaches to HIV and Tuberculosis in the Context of South Africa's National Strategic Plan for HIV, STIs and TB, 2012-2016

Abstract

South Africa faces among the world's highest burdens of both HIV and TB. These diseases affect not only the same populations, but often the same patient; HIV/TB co-infection has a compounding effect that creates a greater public health problem than the sum of its parts. In recognition of the need to address HIV/TB co-infection, South Africa is integrating the responses to both diseases under the National Strategic Plan for HIV, STIs and TB, 2012-2016. However, the two diseases have previously been addressed in very different ways, particularly when it comes to human rights considerations. Rather than a reconciliation of these two approaches, the NSP more closely resembles the ongoing response to HIV; while this approach may yield some benefits when applied to TB, it also risks undermining the unique characteristics of TB as well as its overall role in the co-epidemic, with potential repercussions for the effectiveness of the NSP. Through examining the historical roots of these approaches, both in South Africa and internationally, this paper explores how different factors, including the way different stakeholders have engaged with each, have influenced the development of the NSP, and what the implications are for its effective implementation. It is hoped that by focusing attention on TB, the stakeholders charged with monitoring and implementing the NSP will recognize the necessity of giving due consideration to both diseases in enacting a unified response to the co-epidemic.