ARV project brings improved health and renewed hope

A pilot project providing antiretroviral (ARV) therapy to HIV-positive people in Mozambique has had a constructive effect on the quality of life of its beneficiaries. One such beneficiary is 31-year-old Graça Neves, who rejected assertions that it would be difficult for Mozambicans, many of whom are poor and uneducated, to maintain the drug regimen. "I always take my tablets on time and even my daughters remember them. They always ask [me if I] have taken [the] tablets," she said. Neves' doctor, Alice Roussaux, of Medecins Sans Frontieres (MSF) Luxembourg, pointed out that the drug regime is simpler these days, now that three of the ARVs have been combined into a single tablet contained in a pill box designed to show how many tablets have been taken each day. "They have to take one in the morning and one in the evening. Even if people aren't educated, they know what is the morning and what is the evening," Roussaux told IRIN. Neves, a mother of two girls, aged 11 and 13 years, learnt of her HIV-positive status 10 years ago. At the time her body was covered with open sores, she suffered from tuberculosis and only weighed 37 kilos. After her husband left her, Neves tried to support herself and her young daughters by selling fish. "But my neighbours used to bring back the fish they bought from me when they heard that I was HIV-positive. They told others in my neighbourhood not to buy my fish," she said. Since starting the ARV regimen, Neves has kept healthier and gained over 10 kilograms. She now works with Roussaux in an HIV/AIDS clinic at the Primeiro de Maio Health Centre, in the Mavalane district of the capital, Maputo. Neves educates people about safer sex and living with HIV while they sit in the waiting room. "I tell them that there is hope, and that I have lived with the virus for 10 years." The clinic, run by MSF-Luxemburg in cooperation with the Ministry of Health, offers a range of support services - including counselling and treatment of opportunistic infections - to over 2,600 people. Since December last year, some 150 people have been selected to receive ARVs through the pilot project, which will cost an estimated US $900,000 this year. The criteria for inclusion in the ARV programme are that the individual should regularly attend the clinic; manifest an AIDS-related opportunistic illness; and have a CD4 count (T4 cells are responsible for fighting off infections) of less than 200. Similar MSF-run projects are also underway in the northern provinces of Tete and Niassa. Roussaux said the ARV project had brought about "amazing changes". "I've been working here for over a year. Before the ARV project, those people who are now on the treatment were looking very sad. Now they are getting fatter, they laugh again ... and many have returned to work. They tell me that they feel like they have been plucked from the grave and been given life." The patients are monitored closely, especially for signs of any side effects like liver toxicity. MSF counsellor Rafael Mavota said the most challenging part of his job was counselling children. "It is not easy to explain to children that they have to take these tablets for the rest of their lives," he observed. Pregnant women are also benefiting from the provision of ARVs which, apart from prolonging their own lives, also significantly reduce the chance of transmitting the virus to their babies. Each month between 20 and 25 new people are placed on the ARV programme. But Roussaux added that MSF "would like to help many more [people]". Mozambique is one of the world's poorest countries. It is also one of 10 countries in the world with the highest HIV/AIDS infection rates - over 12.2 percent of Mozambicans aged between 15 and 49 years are HIV-positive. There are some 500 new infections daily. The MSF coordinator of the HIV project in Mavalane health centre, Christina Kabanda, said while the ARV programme has had a huge impact on individuals, its national impact was minimal. "You need to sometimes measure work by human impact, not always by numbers. But our aim is to scale up the ARV programme, which at the moment is 100 percent funded by MSF," said Kabanda. They were hoping that other organisations would assist with scaling up the ARV programme, Kabanda concluded.