The Power of Disclosure

Khulile Mamba is a 33-year-old office clerk living with HIV in Eswatini, a small nation that borders South Africa and Mozambique. A mother of five, Mamba was diagnosed with tuberculosis (TB) in November 2020.  

Previous to receiving her TB diagnosis, Mamba had missed some of her HIV follow-up appointments and had defaulted on her antiretroviral medication. She had only recently been brought back to care. With this medical history, both she and her healthcare workers feared she would struggle to effectively fight TB if she did not adhere to both TB and HIV medication.  

“Frankly speaking, I was afraid when I was told that I had TB, especially because I have had other people tell me that once you have TB and you are HIV–positive, you are more likely to get sick,” said Mamba. 

It always rings in Mamba’s mind that people living with HIV are more likely than others to become sick with TB, because of their weakened immune system. Because of this, she recommitted to adhering to her medication. 

Learning from her past experience, Mamba found that disclosing both her TB and her HIV status to her close family members and colleagues helped her continue with the medication. She says disclosing has bolstered her confidence and motivates her to alter some of her behaviors that might otherwise put her life and the lives of others at risk. 

Learning from her past experience, Mamba found that disclosing both her TB and her HIV status to her close family members and colleagues helped her continue with the medication.

To protect her children and others in her family from getting TB, Mamba stays in her own room and uses her own bed linen, bath towels, and utensils for food and other needs. Maintaining quality care for her 3-year-old child is the main challenge, but Mamba always wears a face mask when with the child and frequently cleans surfaces that the child might touch. It would be difficult, if not impossible, to implement these precautions had she been unable to disclose her status to her family.  

In addition to protecting others, disclosure helps people living with HIV and TB take care of their own health—after all, if an individual is hiding their diagnosis, they may avoid storing or taking medication where others can see it, which can result in defaulting on medication. 

Fear and shame are the greatest barriers to achieving good health for you and your family. Khulile Mamba

Having disclosed her status, Mamba feels she can take her medication when she needs to, regardless of who is around. This is helpful, as the treatments for HIV and TB can be difficult to navigate—each treatment system has a different number of pills and different timing. Deviating from the assigned timing can cause the medications to interact badly. Mamba says that it is essential that she feel comfortable taking medication throughout the day, without hiding it from other people.  

Mamba believes that taking both HIV and TB medication has made her stronger—and an ambassador to talk about TB/HIV co–infection. 

“One point for me to stress for others is that if you have HIV, it is very important to get a TB test. I wasn’t thinking of TB when I went to hospital because the pain was not in the chest, nor was I coughing. I just had a back pain,” Mamba says.  

Mamba emphasizes the need to resist fear and stop being afraid once one is diagnosed with both TB and HIV.  

“Fear and shame are the greatest barriers to achieving good health for you and your family.” she says. “Both HIV and TB are treatable and survivable, if we commit to our health.”