Opening remarks by Dr Hans Henri P. Kluge, WHO Regional Director for Europe, on “Shaping the future: a look beyond 20 years of scale-up of collaborative TB/HIV activities” at the 25th International AIDS Conference in Munich, Germany
21 July 2024
Excellencies, dear colleagues,
Guten morgen. I want to start with 3 simple words: preventable, treatable, curable. Tuberculosis (TB) is all of these things. And the global medical community has made extraordinary progress in getting us there.
This is an issue very close to my heart. I spent years treating people with TB, many of whom were also HIV positive, in some of the most challenging contexts globally. At the time, many had to endure long, toxic treatments – multiple pills per day for months, sometimes years. Daily injections. The side effects were excruciating.
Thankfully, today’s treatments are far shorter, far safer and far more effective. We now have fully oral treatments for TB and drug-resistant TB that are just 6 months long. There are fewer pills to take. Diagnosis can be made in a matter of hours. A decade ago, we could not have even dreamed this was possible.
But we are still not getting this lifesaving care to everyone who needs it. And as we have just heard, TB is still the biggest killer of people with HIV around the world.
I want to zoom in on the WHO European Region, where in 2022 some 28 000 newly diagnosed people with TB were also HIV-positive; where we have the treatments I’ve just mentioned – the preventive care, the technology and the tests that can diagnose quickly, and the innovative digital health solutions necessary to reach those in need; but where people are just not receiving them in time.
In many countries, HIV and TB care systems still exist in silos. Comprehensive, collaborative, integrated care is still more of a dream than a reality. We see delayed diagnosis. In the European Region, more than half of HIV diagnoses are made too late, with serious impacts on peoples’ immune systems.
The uptake of WHO-recommended TB preventive therapy among people living with HIV is woefully insufficient. This is therapy which can improve health and save lives. Today in our Region, 1 in 3 people living with HIV go without it.
We must urgently make every effort to close this gap. This will require 4 concrete steps. First, we need to reach people before it’s too late. Let’s stop talking about the lifesaving innovations and start using them at scale.
Second, national policies and commitment to collaborative approaches don’t matter if they are not being implemented. We must ensure that TB and HIV services deliver – together – the best outcomes for all people.
Third, we need to boost investment into truly putting people at the centre of care. This includes community-based support that addresses not only HIV and TB, but also mental health, substance use, and the social and financial issues that thousands of people face.
Fourth, and perhaps most importantly, we need to get over the final barrier to ending HIV and TB: stigma. It is dangerous, it is pervasive and it steals lives, with many too afraid to even seek care in the first place.
Dear colleagues, we have all the tools to end HIV and TB by 2030. As the inspirational Timur Abdullaev, a former WHO colleague and HIV/TB activist from Uzbekistan, perfectly sums up: “We can’t justify our inability to follow the science by system flaws and limitations.”
Let’s nurture the incredible progress we have made so far with stronger leadership and political will, more investment, more research, and more innovation. We owe nothing less to all of the people around the world living with HIV and TB.
Vielen dank.