Science and social justice: the lessons of HIV/AIDS activism in the struggle to eradicate tuberculosis.

The global social, political and health emergency presented by the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) has also once again propelled tuberculosis (TB) into a global public health emergency. The examples I will use to show how activism and social mobilisation can assist in overcoming TB are primarily from my home country, South Africa. Despite significant differences in health systems, culture, politics and history, there are lessons that could be used to advocate for TB prevention, diagnosis, treatment and care globally. Our country experiences globally significant HIV and TB epidemics. I will return to the epidemiology of TB-HIV and the crisis of illness and death. Early in April 2005, one of my closest friends, Ronald Louw, a professor of law at the University of KwaZulu-Natal, a human rights lawyer and activist for more than 25 years, suffered a persistent fever and cough. While on sabbatical, he was taking care of his mother who had been diagnosed with cancer. He assumed his illness was stress-related and went to a doctor who diagnosed bronchitis. After 4 weeks' treatment with antibiotics, his illness was worse-he had a raging fever, night sweats and was becoming disoriented. He requested an HIV test. Within 24 hours Ronald Louw knew that he had been infected with HIV. His mother died on the same day. He also knew within 24 hours that his CD4 count was below 100. They could not diagnose his lung disease and concluded that it was Pneumocystis carinii pneumonia. Four weeks later his doctors diagnosed TB through a lung biopsy. Ronald Louw had been desperately sick under medical care with TB and HIV for more than 8 weeks. He died 3 days after receiving a definitive TB diagnosis, and a week after treatment for presumptive TB had commenced.