The Shadow Plague

The XIVth International Conference on AIDS in Barcelona last month put the global HIV epidemic back in the spotlight--justifiably so. The UN estimates that the number of HIV/AIDS sufferers, currently at 40 million, will rise sharply in coming years, and 25 million children under age 15 are expected to lose one or both parents to the disease by 2010. But the continuing spread of HIV is closely linked with the growing resurgence of a much older killer.

Tuberculosis (TB) is an air-borne disease, transmitted the same way as common flu, by coughing or sneezing, although it is much less infectious. But, unlike flu, TB bacilli can survive in the lungs for years, surrounded by a "protective" wall built by the human immune system. These latent bacteria can be activated when other factors reduce the body's immunity to infection. This is why, over the centuries, poor living conditions, malnutrition, and diabetes always accompanied TB outbreaks.

During the past twenty years, the spread of HIV has dwarfed these historical accomplices in fuelling TB infection to an alarming rate worldwide: 8.7 million new cases per year and 2 million deaths. The vast majority of TB deaths occur in the developing world--largely induced by HIV. Indeed, more than 25% of preventable deaths in developing countries are due to TB. Because the young and economically productive age groups are the hardest hit, the disease's overall impact is even more destructive--condemning poor countries to generations of grinding despair.

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