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percent. New York had the largest increase of tuberculosis in the country, but nationwide rates also increased, as they did in much of Western Europe.
There were three reasons that tuberculosis began to thrive while public agencies slept. One was the difficulty of taking the drugs for so long. In New York City, a sharp rise in homelessness increased this problem. Not only were the homeless vulnerable to contracting tuberculosis in crowded shelters, but their unstable living arrangements and poverty made it especially difficult to follow a complicated drug regimen. This already difficult situation was made much worse by the worldwide spread of HIV, the virus that causes AIDS. An HIV-weakened immune system was less able to arm the macrophages to kill off new tuberculosis infections and also had a hard time keeping old dormant infections in check. Around the world, wherever HIV infection rates were high, tuberculosis rates began to soar. By the year 2000 there were two million new cases of tuberculosis occurring per year in Africa south of the Sahara.
New York City is one of the places in the world that have actually turned around their tuberculosis epidemic: since 1993 rates of tuberculosis infection have dropped there. The key to beating back tuberculosis has been a program known as Directly Observed Therapy Short-Course or DOTS, which means having someone watch while patients take their tuberculosis drugs. Imagine thousands of people with tuberculosis scattered across New York City being tracked down and watched every day while they swallow their pills. This is time-consuming and expensive, but it works, and not just in New York. In Africa, the countries of Ethiopia, Congo, Mozambique, Kenya and Tanzania found they could ure more than 80 percent of cases of the disease by using DOT. In Asia, home to two thirds of people suffering from tuberculosis, China, India, Indonesia, Vietnam, Bangladesh, and the Phillipines started very successful DOTS programs.
Another innovation that has made a difference for tuberculosis sufferers at the beginning of the twenty-first century has been the availability of new sources of money to fund programs to fight TB. Wealthy donors have begun to finance projects through non-government funding agencies that have modeled themselves after businesses. These funding groups - such as the Soros Foundation, the Gates Foundation, and the Global Fund to Fight AIDS, Tuberculosis and Malaria - strive to fund only projects that promise to be effective. They do not do the work; they only give the money to people with the expertise to do the job. They make people compete for the money by first proving that they can be effective. And they focus on programs that are based in the com-