Tb.net 2002 was held in Kathmandu, Nepal from 22-24th February 2002. At this cutting edge conference issues of TB, HIV and the Media through presentations, technical workshops and role play were explored . The emphasis was on skill and capacity building. Some of the practical skills at the conference included the designing of posters, leaflets and press releases. 

Here are excerpts of the key presentations.

Dr. E. Pontali
WHO SEARO, New Delhi

[Tuberculosis and HIV: a Global and regional perspective ]

TB constitutes a major component of HIV/AIDS care

The entire South East Asian Region (SEAR) suffers from overlapping epidemics of TB and HIV/AIDS. This rampant co-epidemic will have a major impact on the health systems of the affected countries. The implications of this dual epidemic for National TB Control Programmes of these countries include: excessive morbidity and mortality due to TB, an increase in number of persons requiring care and attention, low TB cure rates and emergence and transmission of multi-drug resistant Tuberculosis (MDR-TB).

Thus prevention of HIV is crucial to controlling TB, as TB constitutes a major component of HIV/AIDS care.

SEAR puts up with 40% of global TB burden and 18% of world's HIV infection and 
30-40 % of TB patients are HIV positive in selected areas. TB is increasing in areas with high HIV prevalence and 55-70% of persons with HIV develop clinical TB.

The experiences from Tanzania demonstrate that a good TB control prevents long-term effects of HIV epidemic. Tanzania launched its TB control program in 1979. TB cure rates in the country have been rising steadily from 55% (in 1980) to 80% (in 1990), despite rampant HIV epidemic.

The devastating socio-economic impacts of TB are well known. In India alone 300,000 children leave school as a result of their parents suffering from TB. Families on account of TB reject more than 100,000 women. 

Directly Observed Treatment, Short-course (DOTS) is a comprehensive strategy that ensures cure to a majority of TB patients. DOTS coverage in SEAR has risen noticeably from 10% in 1997 to 56% in 2001. In India 42% population had access to Revised National Tuberculosis Control Programme (RNTCP -implementing DOTS) at the end of December 2001.

HIV fuels the TB epidemic by: promoting progression to active-TB in persons with recently acquired TB infection or latent TB infection (LTBI) and increasing rates of recurrent TB. The risk of TB transmission is also increased in cases with co-morbid TB and HIV.

The basic strategies for combating the dual TB/HIV epidemic should incorporate activities for HIV prevention; providing care and support for management of HIV related opportunistic infections and prevention of TB in HIV infected. This is possible only if we enhance capacities of nations for social mobilization and building partnership over a broad spectrum of framework.

We do not require only funds. We need a committed political leadership, strengthening of national health systems and training of all health care professionals in management of TB and HIV control programmes. We need to integrate these programmes at all levels. This is already happening in some countries of SEAR and there are successful examples from India, Myanmar and Thailand.

Mr. Kunda Dixit
Editor, Nepali Times
[Media as Communication]

If treatment becomes necessary-the prevention has failed

Our expectations from media as an instrument of change are rather high. There are limits to what the media can set right. The situation becomes more critical if the media spreads a wrong message-the consequences of such an action could be grave. This is a significant point when we discuss the role of media in propagating messages about communicable diseases. There is no denial that communication is our first line of defense against communicable diseases. That is why I say, " If treatment becomes necessary-then prevention has failed". This is particularly true in respect of HIV/AIDS; which is a sexually transmitted disease and a societal issue. It not only affects the health of individuals but also that of the economy.

We need to understand how to communicate with the media. For most organizations, achieving coverage in media means breaking new ground. In my opinion awareness generation is only half the answer, people have to be provided with alternatives. Our past experience has shown that many a times the media coverage of HIV/AIDS tends to be scandalous and does not address the core issues. These result in stigmatization and stereotyping of victims.

Here are a few tips on how to communicate with media:

It is not advisable to expect immediate changes. The way we approach and deliver the message is very important. The process of establishing a dialogue with media cannot be a one-time affair. Besides being sensitized about the issues we need to keep on refreshing their knowledge. Media personnel need to be handled very carefully, they carry an image of being lazy, arrogant and dislike being told what to write. For tabloids HIV is a sensational theme, which involves sex, blood and death. This kind of reporting ends up spreading panic and disgracing victims and serves only to scare the public. 

Diseases like TB and HIV/AIDS are not merely medical issues. They involve wider stakes, social inequalities, socio-economic issues, literacy levels and those of poverty leading to migration in search of jobs. These diseases do not deserve to be on the health pages of the news alone. These emerging "First Line" killers of mankind are in fact page one headlines. The earlier we establish a communication with journalists, the better; the media can act as a powerful instrument of informed debate and assist in policy decisions. 

To conclude we need not over estimate the potential of media. Journalists should be persuaded and not pressurized to write what we want. We must pick our medium carefully and choose a core group of motivated journalists and bring them to understand and propagate our point of view.

Peter Gill, 
BBC World Service Trust
[Experiencing the Media]

We need to be positive, more enabling in our approach


"We live in an increasingly media savvy world. In neighboring India there are 500 million TV viewers and the figure is growing rapidly. They watch on the whole because they want to be entertained and not educated, but here is our chance to interest them, to entertain them and thus to inform them and, we hope to change their behavior. In fact it is actually our only chance. "

"With 90% of the AIDS spread in the region by sexual route, condom an apparently low-tech device, represents the only hope we can get. Either that or abstaining from sex or keeping to one uninfected partner. Desirable, but not always possible." 

"Of course the problem with AIDS campaigning is that it is to do with sex, and all societies are coy about it to some extent. On no nation's TV you are going to get instruction on how to put a condom on - which is what people need to know."

"Part of the problem in talking about sex is thought to be promoting promiscuity and some people associate images of sex with porn as well as promiscuity. We know that our objective is behavioral change- to get people to change their conduct. And that means overcoming their embarrassment. You may have noted the AIDS question to Mr. Collin Powell last week, he got into trouble with American puritans for daring to say that sexually active young people even in Catholic countries should use condoms. "

"The overuse of drama in our advertising can be a problem. Especially when we are entirely negative in portraying AIDS, in demonizing and further stigmatizing the victims for example women commercial sex workers in particular as the source of AIDS , when they often take great care, in fact it is their clients who do not."

"We need to be more positive and more enabling in our approach. Fear arousing or fear based message alone do not actually make people change their behavior. A negative message should be coupled with a positive solution. To my mind there is no better countering than brining positive people on the screen. In our AIDS campaigns it is my ambition to get real live HIV positive people to appear on the screen, it does require a great deal of care. Some of our most remarkable results in this regard came in leprosy campaign in Orrisa."

"Unfortunately TB does not have the same glamour as associated with HIV/AIDS, it needs to infuse the glamour of HIV and ride its bandwagon." 

"To sum up the media is one of the few tools we have got for AIDS control we need to use the most modern media techniques and avoid negative stereotyping." "Bring real positive people to the attention of the public because it is prejudice and ignorance that stands most in way of changes in attitude and behavior."