When Amare Truneh got sick, he left home. He’d been working as a teacher, but was worried he might have AIDS and was so afraid his reputation could be ruined that he left town and travelled more than 100 kilometers to Addis Ababa. He fixed his hopes on a renowned holy shrine where he went to pray for a full recovery.

It’s a long steep climb up to the community of Entoto in the eucalyptus-filled hills just outside the capital city. Many of the pilgrims who have gone to seek solace at the shrine have tuberculosis - the most common disease in the country. The faithful visit the natural spring to pray for good health, drinking and bathing in the holy waters presided over by Ethiopian Orthodox monks.

Amare’s condition did not improve on arrival at the shrine; camping outdoors on the chilly mountainside and struggling to survive on alms contributed to a decline in his health. His cough got worse and the monks advised him to seek medical attention in addition to his spiritual devotion.

St Peter’s TB Clinic, Addis Ababa

St Peter’s TB clinic is located opposite the entrance to the shrine. The clinic monitors the health of the shrine’s congregation, encouraging people with a nasty cough to undergo medical examination. TB tests are financed by the Global Fund, as is treatment if TB is confirmed.

The Patriarch of the Orthodox Church encourages the faithful to use modern medicine. He has publicly decreed that faith and holy water are not the only cures for disease – “Drugs are also works of God”.

Amare was diagnosed with TB, hospitalized at St Peter’s during the contagious phase of his illness and put on a course of treatment. He could return to his home town to continue his course of drugs because TB treatment, financed by the Global Fund, is available at all health clinics across the country. But TB is not the only health problem he has - Amare was counseled to get tested for HIV. 

Co-infection of HIV and TB is high in urban areas

Amare agreed to be tested, as most patients do. Many HIV test sites will only advise testing in response to a direct request, but given the high correlation between TB and HIV it is recommended the test be offered as a matter of policy to TB patients in areas of high HIV prevalence - a practice known as provider-initiated HIV testing and counseling.

Amare was diagnosed as he suspected – HIV-positive. The virus had weakened his ability to fight TB. In urban areas of Ethiopia, around half of TB patients also have HIV. The Global Fund pays for testing and for antiretroviral drugs (ARVs) if the patient is found to be HIV-positive, as well as vitamin supplements to counter the toxic effects of high doses of medicine. TB treatment comes first, until the patient is no longer contagious.

Amare is no longer considered a critical TB case and is taking ARVs. Amare says that when he is better he wants to go back to being a teacher - but with a difference: he wants to teach preventing and curing disease thanks to the modern miracle of medicine.