Only 4% of South Africans living with HIV in South Africa are receiving preventative therapy for tuberculosis and only 1% are being screened for TB.
This is despite the fact that TB remains the leading cause of death in South Africa and that deaths from the disease have tripled in the past 10 years.
HIV infection is a key factor in the growing incidence of this curable disease. In some communities the HIV and TB co-infection rate is as high as 85%, while at least half of HIV-infected people in South Africa also have TB and vice versa.
These are shocking statistics in a country where political leaders constantly claim to be doing their utmost to protect the health of the populace.
Health activists have achieved great success in mobilising against Aids denialism and pressuring for effective government policy. Why, then, are we not screaming from the rooftops about TB and TB-HIV co-infection and implementing novel approaches to offset the dire public health consequences?
The silence is deafening.
Of particular concern is drug-resistant TB, where in some settings HIV co-infection is also at about 75%. This cannot be treated with the strongest TB drugs and the cost of treating it with special medication can be up to 100 times higher than when using the standard drug treatment.
Drug-resistant TB can develop when TB patients fail to complete their full regimen of treatment. Such patients can infect thousands of others with the same drug-resistant pathogen. Far more people in South Africa catch drug-resistant TB in this way than by not completing treatment.
The recorded number of multidrug-resistant (MDR) TB cases has grown from about 3 500 in 2004 to almost 10 000 patients. Even more deadly is extensively drug-resistant TB (XDR), which has increased from 74 to 535 cases in the same period.
The lack of capacity and infrastructure for diagnosing and treating MDR and XDR-TB and the high death rates associated with these strains of tuberculosis, combined with the effect of HIV co-infection, means that this has become one of the direst health emergencies facing South Africa today.
It is only relatively recently — after hype in international circles surrounding drug resistance — that there has been some movement towards confronting the crisis.
There have been some good results with regard to drug development, proving that with the necessary resources new treatments and diagnostics are possible.
But the real challenge does not lie in the range of drugs South Africa has at its disposal — it is about how it gets these drugs to the people and about how it diagnoses the disease in the first place.
Barbara Hogan may be a dedicated and efficient health minister, but that doesn’t change the fact our health system has been badly eroded. Our primary healthcare approach is failing, with people regularly arriving at hospitals close to death.
NGOs, researchers, clinicians, activists and patients must collectively focus on this tragedy.
World TB Day passed on Tuesday and the chances are that very few of our citizens were aware of it — despite the fact that scores of South Africans will have died of TB on that very day.
This week HIV clinicians, researchers, activists and students will come together at the fourth South African Aids conference in Durban.
Important though they may be, South Africa should not focus on the latest scientific developments and engage in congratulatory back-slapping of leading scientists for new discoveries.
The centre of our endeavour should be about how we plan to implement the science to revolutionise our public health system to prevent thousands of unnecessary deaths.
Lesley Odendal is a member of the Treatment Action Campaign