Tuberculosis kills 1.6 billion people every year© WHO

South African leader Nelson Mandela and officials of the Bill and Melinda Gates Foundation have launched a $44.7 million project to fight HIV and tuberculosis, which together kill 400,000 people every year.

The foundation also announced that it is awarding $50 million in new money to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds projects in poor countries. The Gates Foundation has already given $100 million to the Geneva-based fund.

"The world has made defeating AIDS a top priority," Mandela said today at the XV International AIDS Conference in Bangkok. "But tuberculosis remains ignored. Today we are calling on the world to recognize that we can't fight AIDS unless we do much more to fight TB as well."

Mandela suffered from tuberculosis while he was in prison for protesting against apartheid in South Africa. However, he was successfully treated, and he called on more tuberculosis sufferers to seek treatment for the disease.

Tuberculosis kills 1.6 billion people every year, and is the leading cause of death in people with AIDS. Doctors currently treat tuberculosis in AIDS patients either by treating the symptoms of AIDS, or by using a strategy called 'directly observed therapy short course', or DOTS. But the lead researcher on the new HIV-tuberculosis project, Richard Chaisson of Johns Hopkins University in Baltimore, Maryland, said that this strategy isn't working. He said patients with HIV and tuberculosis often don't seek care until they are very ill.

"The overlap of tuberculosis and HIV forms a catastrophic collision," Chaisson said, because tuberculosis accelerates the progress of HIV. And HIV often activates the bacterium that causes tuberculosis, but which does not usually cause disease in healthy people.

Chaisson said a better strategy would prevent people carrying the tuberculosis bacterium from becoming sick with the disease. The project he will lead is called the Consortium to Respond Effectively to the AIDS-TB Epidemic, or CREATE. It will test whether doctors can prevent more cases of tuberculosis in AIDS patients by searching for tuberculosis sufferers in communities, and, if they have HIV, by giving them treatment to prevent tuberculosis developing.

Winstone Zulu, a Zambian activist with AIDS, said that many of his friends and four of his brothers had died of the disease because they were unable to get drugs to treat it. Zulu called on governments and other funding organizations to do more to provide patients with the drugs. And he called on the Global Fund to give more money to tuberculosis projects.

Cash shortfall

The Global Fund has spent only 10% of its funds on tuberculosis. However, it faces a $100-million cash shortfall this year, together with a shortfall of nearly $2 billion on its expected budget of $3.6 billion next year.

In making its second donation to the Global Fund today, the Gates Foundation said it hoped to alleviate the fund's financial crisis. The foundation also hopes to encourage more donations from others, said Helen Gayle, director of the foundation's HIV, TB and reproductive-health programme.

"We urge governments, the private sector, and other donors to dramatically increase their contributions to the fund," Gayle said. "Their generosity can help save millions of lives."

Protesters at the AIDS conference have demanded all week that leaders of rich nations make more donations to the fund. They have been especially critical of the US pledge to give $200 million to the fund for next year. According to the Gates Foundation, the maximum allowable US contribution next year is $547 million.

Mandela also called for more support for the Global Fund, which will distribute $1 billion to 200 projects by the end of this year.

"It is going to take much more than the resources of the Gates Foundation to achieve the scale-up required to fight AIDS, TB and malaria," Mandela said. "We challenge everyone to help the fund now."