Sub-Saharan Africa is the region worst-affected by HIV and AIDS

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The End of AIDS in Africa? | American Council on …

The ability of African health care systems to respond to, manage, and contain the growing number of cases of tuberculosis is constrained by limitations of funding, facilities, personnel, drug supplies, and laboratory capacity. Although the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria have donated large sums of money to help address Africa's health problems, most of the money has been earmarked for HIV, with a lesser focus on tuberculosis.

Botswana seems an unlikely place for an AIDS epidemic

The emergence of drug resistance has been a largely neglected aspect of Africa's epidemic; although multidrug-resistant (MDR) tuberculosis has been present for some time, the number of cases was thought to be low. A 2006 outbreak of extensively drug-resistant (XDR) tuberculosis in South Africa, however, has highlighted this serious problem. In KwaZulu-Natal Province, half the XDR cases in patients with HIV infection were acquired in hospitals or clinics, and several occurred in health care workers. Mortality exceeded 95% — chilling evidence of the critical importance of preventing the nosocomial spread of tuberculosis. XDR tuberculosis will undoubtedly continue to emerge elsewhere in Africa: Botswana's first two cases were reported in early 2008.

The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several factors, the most important being the HIV epidemic. Although HIV is Africa's leading cause of death, tuberculosis is the most common coexisting condition in people who die from AIDS (see ). Autopsy studies show that 30 to 40% of HIV-infected adults die from tuberculosis. Among HIV-infected children, tuberculosis accounts for up to one in five of all deaths.