MORIJA, Lesotho — Medical workers are increasingly concerned that the lethal combination of HIV infection and tuberculosis may become the world's next major health crisis.
To mark World TB Day on Wednesday, Medecins Sans Frontieres drew attention to Lesotho, which has the world's third-highest prevalence of HIV, the virus that causes AIDS, and the fourth-highest prevalence of tuberculosis. Here, poverty and dependence on migrant labor complicate treatment in a country where life expectancy is about 40, according to the U.S. State Department. This places Lesotho among the five countries in the world whose citizens have the shortest average life spans, according to U.N. and U.S. government figures.
In a report citing State Department figures, the medical aid agency said life expectancy in Lesotho had dropped to 36, but updated figures on a State Department Web site show it is roughly 40 years.
Michel Sidibe, head of the U.N. AIDS program, fears the double infection could become the next new epidemic.
"I'm calling for serious attention to TB, and serious attention to TB-HIV co-infection," he said in an interview.
In this mountainous kingdom surrounded by South Africa, some patients battling HIV and tuberculosis must walk five hours to reach a clinic for their medication.
"It is a problem for us to come to the clinic because sometimes there are gangster men waiting down by the side of the river ... and yes, sometimes women are raped," said Tlalane Tsiane, a 21-year-old woman infected with TB and HIV.
Many men in Lesotho travel to South Africa to work in the mines and some return with HIV and a form of tuberculosis that is resistant to multiple antibiotics. The World Health Organization believes drug-resistant strains present a major challenge to the global effort to control the disease.
Helen Bygrave, a medical coordinator for Medecins Sans Frontieres, also known as Doctors Without Borders, estimated that between 80 to 90 percent of Lesotho's TB patients are infected with HIV.
"HIV/TB co-infection is the major driver of the massive decrease in life expectancy in Lesotho. In HIV-infected patients TB is definitely the most common cause of death we have seen," Bygrave said.
A person whose immune system is compromised by HIV is particularly susceptible to tuberculosis, which is caused by bacteria that usually attack the lungs. The disease is spread through the air when an infected person coughs or sneezes.
There are nearly 9 million new cases of TB worldwide and the disease kills more than 1.5 million people every year, according to the World Health Organization, even though it can be cured with a six-month course of antibiotics that costs only $20.
Sera Thoola, a retired miner of 47, believes that he contracted TB in South Africa. It is also where he first tested positive for HIV. He has multi-drug-resistant TB, and is currently taking an average of 49 pills a day to control his diseases.
Most clinics in Lesotho were set up through partnerships between the government and international groups. In seeking ways to make the most of scarce resources, Medecins Sans Frontieres is helping to support and run a program in which nurses are given training to take on roles doctors might have carried out. Community health workers later make sure patients are sticking to their treatment regime.
(This version ADDS updated figure on life expectancy to correct it is 40 instead of 36, which was from an older report cited by the medical aid agency)