At the end of the twentieth century, optimism prevailed. People said tuberculosis was on its way to being eradicated around the world. However, the disease, which in the past afflicted hundreds of thousands of "consumptives" in Europe with the most privileged seeking treatment in sanatoriums in the Alps, is coming back with a vengeance. From Swaziland to Kyrgyzstan, Médecins Sans Frontiéres (MSF/Doctors Without Borders) teams are fighting its resurgence.

Heaven on Earth. That's the first impression of a visitor arriving at the New Haven clinic, one of 17 health centres overseen by MSF in the Shiselweni region of Swaziland. At the top of a verdant hill, the clinic is not far from the village, a few dozen houses, a church, and a school surrounded by fields and prairies. In the shadow of a large tree, three women sell colourful fruits and vegetables.

[Claude Mahoudeau/MSF]

The heavenly scene is deceiving, however. Behind the clinic some 30 patients wait in line. Men, women, and children, all coming to renew their prescription for antiretroviral medicines or to be tested for tuberculosis (TB). Like most villages in Swaziland, New Haven is being ravaged by the double-edged sword of HIV/AIDS and TB. One adult in four here is seropositive and, more importantly, 80% of the thousands of people infected with TB each year also have HIV/AIDS.

"AIDS and tuberculosis have caused great sorrow in the community," remarks 62-year-old Sam Simelane, one of the few elders in the village. "Many people have died; many have lost their entire family."

In Swaziland, as in most countries in southern Africa, TB has become the leading cause of death for people with HIV/AIDS who have weakened immune defences. MSF has been intervening in Shiselweni Province since November 2007, helping to treat several thousand patients affected by HIV and/or TB. By the end of 2009, more than 2,700 TB patients were receiving treatment in centres overseen by MSF in Swaziland, including 105 patients with a drug-resistant form of the disease (DR-TB).