With the advent of AZT and the various drug cocktails used to treat the symptoms of HIV, we have become accustomed to thinking of AIDS as a manageable disease, rather like tuberculosis, seemingly well on it's way to eradication. But more ominous parallels between these two great epidemics of the 20th century are now coming to light, as well as a disturbing new connection.
An artist, photographer, and activist, Linda Troeller has been involved in Aids education for over two decades. Her award winning photo-essay, TB-AIDS Diary, which premiered in 1988 and was exhibited widely in the U.S. and Europe throughout the nineties, has recently been receiving renewed attention, and was the subject of a show at Ryerson University in Toronto, Canada this November. TB-AIDS Diary tells, in thought-provoking words and visceral images, the parallel stories of two patients, one with TB--Linda Troeller's own mother, who spent time in a sanatorium in the 1930s--and one with AIDS, focusing on how the stigma attached to the respective diseases affects the patients' treatment, with an eye to using the lessons learned from the earlier epidemic to inform our perceptions of the later.
Linda is a petite, red-haired woman with a friendly manner and an intelligent gaze. Talking with her in her room at New York's Chelsea Hotel, she explained the various medical and social parallels between AIDS and TB. Among the medical parallels, both TB and AIDS are diseases that attack people with compromised immune systems. There is a lot of TB in the hospitals, and among the homeless and drug abusers. People with HIV often also contract TB once their immune system becomes too weak to fight it off. Furthermore, both TB and AIDS are life-reducing diseases: "They really wipe you out," Linda says, "really put you to bed," severely decreasing the quality of life. From a social standpoint, both diseases are often seen as diseases of passion: TB is associated with artists and poets living in drafty garrets, while AIDS is seen as a disease transmitted by sex, and a "gay" disease. Related to this, both diseases have a stigma attached to them. Applying for public housing decades after her bout with TB, Linda's mother sought to hide the fact of her TB from the officials for fear they would deny her application. And, as Linda says, "The gay population caught AIDS in the major metropolitan areas, went back to the Midwest for care, and found there was a stigma attached to the disease that made it difficult to get the proper care. This contributed to the problem, and to the spread of the epidemic."
Linda's work has proved sadly prophetic, for a new connection between AIDS and TB has arisen. Steven Lewis, UN special envoy for AIDS, reports that up to 75% of people infected with HIV in some countries also contract TB. While AIDS patients in the past have often succumbed to TB, the extent of the correlation is now becoming increasingly alarming, especially since new strains of drug-resistant TB have also been surfacing. Although at the present time TB is largely confined to developing countries; however since TB is an air bourn disease, communicated via breath, it's even more easily spread, and this could increase the stigma that AIDS patients face, further affecting their care.
Because of these recent developments, health care professionals are starting to wake up and take a new look at the connection between AIDS and TB. "People think that you can just take an antibiotic and it will go away," Linda says of TB, "But that's never been the case, and it's even less so now." In fact a cure involves quite a regimen. "You have to take the drugs for six months," Linda says, "and sometimes people drop them because they're feeling better or they can't get them easily. You have to rest and eat three square meals a day, and in parts of Africa it's unrealistic to expect people to do this. For one thing, they just don't have enough food." And when TB is not properly treated, it can further the development of drug resistant strains of the disease.
The solution, Linda says, is more research, and especially more education. "The two diseases are closely aligned," Linda says, "and we need to see how they interact. They are two simultaneous and interrelated catastrophes. We must reeducate ourselves about TB in both its medical and social dimensions. It's a wakeup call. We can arrest this, but we need to take action now. We need to provide the education, and have nurses there to assist people with their medication."
In addition to the medical problem, it's important to change the perception of the diseases. "What's happening now," Linda says, "is that AIDS will invade some new region of the globe, and with it will come TB. If we have the money we can send books, and nurses who understand the problem. But the stigma of these diseases still exists in developing countries." AIDS certainly isn't as bad as it was, but it's still affecting many populations, and if there is more of a stigma attached to it because of its association with TB, people will be more reluctant to seek treatment.
Often the artist is the first to sound the alarm. Linda's aim in her TB-AIDS Diary is to catch the attention of the media and the researchers. She believes that it's important for the diseases to stay in the public eye so we're not tempted to get complacent. AIDS wasn't brought under control by accident. There had to be activists lying down in the streets of our major cities every weekend to call attention to the problem. Let's hope it doesn't come to that again. You can learn more about Linda Troeller's TB-Aids Diary project at www.tbaidsdiary.com