We Can Only End TB and HIV By Reaching Vulnerable Populations

Mandy Slutsker is one of ACTION's HIV and TB gurus, based at the Secretariat in Washington D.C. Her post is part of Blog Action Day 2013. Let Mandy know what you think in the comments below or on Twitter @Mandy4Action, @ACTION_Tweets.

When notorious bank robber Willie Sutton was asked why he robbed banks, he simply said “because that’s where the money is.”

It’s a rather sound argument: If your goal is to steal money, you might as well go where the most money is. The Willie Sutton principle can also be applied to epidemiology. If you want to end disease, you need to focus on people who are most at risk of getting sick.  In the case of TB and HIV, this includes vulnerable populations such as sex workers, prisoners, migrant populations, men who have sex with men, and people who inject drugs.

Usually we justify this from a human rights perspective, the idea that everyone is entitled to a set of fundamental freedoms, including the right to health. While focusing on vulnerable populations is important for ethical reasons, it also makes scientific sense. Unfortunately, science and human rights fail to guide many governmental disease-fighting strategies. Despite having higher infection rates than other groups, vulnerable and marginalized populations are often ignored by health programs. For example, needle exchange programs are banned in Russia under the government’s “zero-tolerance” approach to drugs, despite evidence that these programs are extremely effective in reducing HIV infection.

That is why the Global Fund to Fight AIDS, Tuberculosis and Malaria plays such a critical role in fighting disease. Operating as a partnership between states, civil society, and the private sector, the Global Fund has managed to dramatically scale up the response to TB and HIV for those in greatest need, saving millions of lives.

Instead of ignoring evidence, the Global Fund embraces it.  Executive Director Mark Dybul recently explained that “by better identifying and locating those at greatest need of becoming infected because of where they live or who they are…we can dramatically improve our ability to control the spread of these diseases.” To fight TB and HIV among vulnerable populations the Global Fund supports programs targeted on the most vulnerable groups including HIV prevention and education to support sex workers, needle exchange programs for people who use drugs, and preventing TB in prisons.

We are at a critical moment. One in which scientific advances, epidemiological data, and implementation experience enables us to truly turn the tide on HIV, TB, and malaria. This December, countries from around the world will meet in Washington, D.C. for the Fourth Global Fund Replenishment Conference to secure funding for the next three years, enabling the Global Fund to support programs to fight the diseases effectively and save the lives of millions of people. A fully-resourced Global Fund can maintain its successful programs while scaling up the most effective interventions to beat back these epidemics.

If our goal is to fight TB and HIV, then we need to scale up services for those who are most at risk.


Check out these videos from our friends at the Here I Am Campaign on the Global Fund and ulnerable Populations and the Global FUnd