Carol Brown (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to discuss the global epidemic of tuberculosis, TB, and particularly its effect on women. While I will share with you some of the key achievements that have been made in the fight against TB, AIDS and malaria, I also want to frame the challenges we will continue to face in the future.

It is timely that I deliver this speech in the lead-up to World Tuberculosis Day, this coming Thursday, 24 March. It is a day that marks the anniversary of the discovery of the cause of TB and the first steps taken towards diagnosing and curing the disease. The World Health Organisation uses the annual World TB Day as an opportunity to promote the global plan to stop TB by 2015. The theme for World TB Day 2011 is transforming the fight towards the elimination of TB, with the aim to inspire innovation in TB research and care. To consider how we might transform the fight it is first important to frame the challenge before us.

Tuberculosis is a curable and preventable disease. The TB infection is spread by coughing, sneezing, laughing and even singing. Alarmingly, TB kills around 1.8 million people each year, and almost half of those fatalities are in the Asia-Pacific region. The most recent estimates indicate approximately one-third of the world’s population is infected with the bacteria that causes TB and there are 9.4 million new cases of TB each year. Additionally, TB is the leading cause of death for people with HIV-AIDS in developing countries. To compound that, only 4.1 per cent of people living with HIV-AIDS are screened for TB each year.

TB is the third-leading cause of death for women in developing countries. The disease is most prevalent in women in the 15 to 44 year age bracket—the time when they are economically and reproductively active. TB therefore disproportionately affects pregnant women. The prevalence of the disease heightens the risk of death during childbirth and infant mortality, and it perpetuates the transmission of the disease from mother to child.

Due to a range of socioeconomic and cultural factors, TB is more likely to go undiagnosed in women. This is partly attributable to the gender bias of some physicians who view TB as a male disease and partly because women are less able to access qualified health services. There is also evidence which suggests biological differences in women may produce different immune responses, symptoms, signs and outcomes to men, which may complicate diagnosis and treatment.

A lack of education, particularly patient education, also complicates diagnosis and treatment of TB. One study in Pakistan, for example, found that some women did not understand it was necessary to provide mucus for a sample for TB screening and instead just used saliva. This distorted the diagnosis of TB and thwarted timely access to treatment. In developing communities, women’s social role places them at a higher risk of contracting TB than men. Evidence suggests that, as a result of indoor cooking in confined spaces with biomass fuel, a woman’s respiratory system is weakened and they are therefore more susceptible to developing active TB. Women are further disadvantaged in the fight against TB by treatment options which are not gender sensitive. Women who are diagnosed with TB then face additional social and economic challenges as they battle to care for themselves and for infected and affected family and community members. As we continue to transform the fight towards the elimination of TB, it is vital that we work to support women in developing communities to combat this disease. We need to consider taking steps such as screening pregnant women for TB, improving patient education, investing in research on gender sensitive treatments and improving the diagnosis of TB in women. All of these form part of our future challenges.

Whilst there is always more that can be done, it is also important that we reflect on the significant progress that has been made in the fight against TB. In 2002, the Global Fund to Fight AIDS, TB and Malaria was established. The global fund operates as a partnership between governments, the private sector and affected communities to finance international health interventions to fight AIDS, TB and malaria, and in turn to reduce poverty and support sustainable development. Since the establishment of the fund we have seen significant progress in the fight against AIDS, TB and malaria. Recent data from the World Health Organisation’s Global tuberculosis control report indicates that incidence rates of TB are falling globally in all regions except for South-East Asia, where the rate has stabilised. Mortality rates fell by around 35 per cent between 1990 and 2009, and current projections indicate that the mortality target could be achieved in all WHO regions except Africa—and even in Africa mortality rates are falling.

The prevalence of TB is falling globally in all six WHO regions. There is the potential to reach the target of halving the 1990 prevalence rate by 2015 in the region of the Americas, the Eastern Mediterranean region and the Western Pacific region. We have made progress in case detection and treatment success and in raising awareness amongst TB patients of their HIV status. According to the 2009 report Scaling up for impact: results report by the Global Fund to Fight AIDS, TB and Malaria, comprehensive prevention, treatment and care programs have been supported in 137 countries. The data indicates that, as at December 2008, 3.5 million people who would have died of AIDS, TB or malaria were still alive as a result of the intervention supported by the global fund. Through 2009, six million people with active TB were able to access treatment, and 1.8 million people were supported to access combined HIV and TB services. All this presents compelling evidence that we are making significant progress.

Notwithstanding the progress that has been made, we do face significant challenges into the future, not just in the fight against TB but in our effort to eradicate poverty and promote sustainable development. We know that drug resistant strains of TB are emerging due to inadequate treatment and that cases of multi-drug-resistant TB and extensive-drug-resistant TB have been found in almost every country in the world. We therefore need to find ways to resource research into TB treatment. New breakthroughs in diagnostic testing that we should embrace in the fight against TB have also emerged.

As I have mentioned, World TB Day is on Thursday, 24 March, and a motion will be moved by Senator Louise Pratt and me as part of World TB Day. The motion will call for Australia to increase overseas aid to 0.5 per cent of GNI to ensure that the resources for TB, as well as for AIDS and malaria, are sufficient to achieve the goal of significantly reducing the number of people suffering from these diseases. The motion also calls for Australia to facilitate adoption of the new Xpert TB diagnostic testing tool in South-East Asia. The Xpert diagnostic tool is the first new diagnostic strategy in over 100 years. It cuts the time for diagnosis of TB from several weeks to less than two hours and is highly accurate—recent field tests have increased the number of correctly diagnosed TB sufferers by 30 per cent. The tool is able to identify multi-drug-resistant strains of the disease earlier and will be a vital resource in rural areas that have been further disadvantaged by diagnosis and treatment delays. Xpert was endorsed by the WHO in December last year, and it follows that such a breakthrough in diagnostic testing will significantly assist in the fight against TB globally.

Most significantly, however, the new tool will assist with diagnosis in South-East Asia, which, as I outlined earlier, is the only one of the six WHO regions in which the incidence rate of TB is stable rather than falling. Given how far we have come in the fight against TB, we should feel confident about facing future challenges. I hope that colleagues across the chamber will support the motion on World TB Day and help us play our part in contributing to the political pull to transform the fight against TB.