Winning the fight against TB: combining efforts of the research and civil society community

Burning this mask was very important to me. I wore it for several months and it was very painful. My peers did not know what my face and smile looked like. When I burned the mask, it was like getting rid of the stigma, I felt free. - Rachel, Border Voices and Images of Tuberculosis Project participant.

What's the issue? TB in the US-Mexican border region

Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person-to-person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to "wall off" the bacteria. The symptoms of active TB of the lungs are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats.

Tuberculosis is treatable with a six-month course of antibiotics. About one-third of the world's population is infected with TB, a contagious disease that causes nearly 2 million deaths annually, according to the Centers for Disease Control and Prevention.

TB continues to be a concern for border areas in both Mexico and the United States. Both countries report approximately 15,000 cases of all forms of tuberculosis on a yearly basis. In 2005, the tuberculosis incidence rate in Mexico was 15 per 100,000, while the United States reported a rate of 4.7 incident TB cases per 100,000 population. What is more troubling is that the U.S.-Mexico border states reported a tuberculosis incidence rate higher than the national average, with rates of 7.9 in U.S. border states and 26.3 in Mexican border states.1

Research to Practice: Improved Research combined with civil advocacy

TB Research has been fundamental in developing effective treatment for acute TB infection. In February 2010, Indiana University School of Medicine researchers identified a mechanism used by the tuberculosis bacterium to evade the body's immune system and identified a compound that blocks the bacterium's ability to survive in the host, which could lead to new drugs to treat tuberculosis and significantly shorten treatment times.2

On the other side, there have been crucial steps by civil society to convey the message that TB is preventable, treatable and curable. An impressive example is the TB Photovoice which presents photographs taken by TB affected community members (survivors, caregivers, friends, family). The photographs and accompanying narratives each represent a life story that serve as a point for discussion about what can be done to change the present situation in regards to TB, stigma, education and related issues.

Another remarkable initiative is Nuestra Casa, a three-dimensional movable house representing the life stories of persons affected by TB, their messages of reality and hope and the surrounding conditions of TB not only at the U.S.-Mexico Border. Ten  participants from across Mexico have been available at Nuestra Casa to share their personal stories and photos. It gives clear messages how to prevent and get treatment for TB. Nuestra Casa is a tool for advocacy, communication and social mobilization promoting awareness among decision makers, health care providers, and the public in general to get involved in concrete action to prevent the spread of TB, reducing the number of cases and deaths caused by it.

What next: Improved detection through integrated cross-sector approaches

Although medicines to treat TB are available, they must be taken for at least six months to fully eliminate all TB bacteria from the body. People who do not follow the lengthy treatment regimen can become sick and infectious with a more virulent form of the disease that is resistant to standard medicines. As Rachel puts it: "We are told that recovery will take place after a full course of treatment. That's not always easy when jobs and life's daily demands take priority. It's not long before your life-saving medication becomes a daily intrusion—especially without warning that interrupting treatment increases drug resistance and furthers TB infections."

Further, detection of TB remains a huge challenge. Lack of widespread diagnostic tools hinders patients from starting early treatment once the disease is active. At 35, Rachel was diagnosed with diabetes. Since susceptibility to TB is higher with diabetes, hepatitis, HIV/AIDS, smoking and other addictions, malnourishment, and pregnancy, her latent TB infection developed into the active disease within a year. For three agonizing years, Rachel was misdiagnosed with flu, colds, allergies, respiratory infections, pneumonia, and asthma. Her 3-year-old niece also suffered through surgeries to remove a recurring cyst. Only after Rachel was correctly diagnosed was her removed tissue tested and found positive for TB. They both started the daily medication treatment for active TB disease. Rachel's case shows the need for upscaling TB detection to allow correct diagnosis and early treatment.

What does this show? There is an urgent need to combine efforts by the scientific community and civil society, so that they become linked in a way that is synergistic. The research community should cooperate with civil society initiatives to promote TB prevention and treatment. Civil society should make use of the newest research advances for better decision-making. With regard to the US-Mexican border, implementing effective control, prevention and treatment for TB is particularly difficult. Efforts to control tuberculosis in the United States—Mexico border are reflected in the 2005—2010 Strategic Plan of Ten against Tuberculosis, a binational initiative created by the health officers of the 10 U.S.-Mexico border states in June 1995. However, more efforts are needed to face the lack of coordination among a myriad of actors and stakeholders. Health prevention communication methods are often insufficiently adapted to the border-specific context.

Our team would like to give special thanks to


  1. Fig. 1. US—Mexico border map (Institute for Public Strategies, 2003)in: Collins-Dogrul, Julie; Managing US—Mexico "border health": An organizational field approach, Social Science & Medicine 63 (2006) 3199—3211, Elsevier, Maryland Heights, USA.
  2. Cf. (accessed February 25, 2010)

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