Feature - Treating HIV among township poor

Babalwa Tembani was diagnosed as HIV-positive after being raped by her uncle. She was only 14 years old at the time and knew nothing about AIDS. After being admitted to Cape Town's Groote Schuur hospital, a nurse told her she had four days to live and must "look for a place to die". "I was waiting for my day and the day didn't come until today," she said. Addressing a group of journalists at an event marking the two-year anniversary of the Medecines Sans Frontieres' (MSF) antiretroviral (ARV) therapy pilot programme in a Cape Town township, 21-year old Babalwa is nowhere near ready to die. She's a bubbly, ambitious young woman, planning to study medicine. Tembani is one of 400 people receiving ARVs from the MSF project in Khayelitsha, a poverty-stricken township just outside South Africa's second city. The NGO started providing ARVs in May 2001 and is currently in the process of extending the service to rural communities in the Eastern Cape province. Findings from the programme have demonstrated that treatment campaigns are possible in poor communities, and AIDS activists hope that the national government will take note of the project's experience when they introduce ARVs through the public health sector. According to the head of MSF in South Africa, Eric Goemaere, after the medical relief group began supporting the Western Cape's prevention of mother-to-child (PMTCT) programme in 1999, the discussion over whether to provide ARVs become more than just an "intellectual debate". "At delivery of the children, the women were asking 'What about us?'" he said. MSF has established three dedicated HIV clinics inside the township's existing public health facilities, where most HIV patients are treated for opportunistic infections. A limited number of these have been placed on the ARV programme. Patients with HIV/AIDS will only receive treatment after careful selection, based on medical criteria such as their CD4 cell count (cells that orchestrate the body's immune response) and their clinical status, as well as a "patient-centred adherence approach" in which patients take responsibility for their treatment. This approach requires patients to have been on time for their clinic appointments for the past three months and have a supportive home environment, including a treatment assistant. The beneficiaries receive a triple cocktail of generic drugs and visit the clinics every week during the first month, followed by monthly visits. The cost of the treatment is around US $1.50 per-patient per-day. Up to 83 percent of the patients on ARVs remain in the programme after being on treatment for 18 months. In most cases, their viral load drops dramatically to undetectable levels after no more than three months on the drugs, Dr David Coetzee, a clinic doctor, noted. High levels of treatment adherence have been attributed to the support structures in place. However, Miliswa Galada, a counsellor at one of the clinics admits that patients find it difficult to stick to their treatment regimen, particularly in the first month. When Babalwa went back to school, even her teachers would remind her when it was time to take her tablets. She carries her pillbox and some fruit "everywhere I go, so that I don't forget," she told PlusNews. But stigma and discrimination still make it difficult for people to come forward and disclose their status. Consequently, members of the AIDS lobby group, the Treatment Action Campaign, have embarked on the "Ulwazi" (meaning "awareness" in Xhosa) project, through which they explain to Khayelitsha residents the link between HIV and AIDS, and how the disease can be prevented and treated. The results are encouraging. In 1998, up to 500 HIV tests were conducted in the township, which has now risen to between 12,000 and 14,000 tests a year. "Khayelitsha has become a place where people living with HIV/AIDS are able to talk freely ... bringing dignity and hope back to the people," Nomfundo Dubula, coordinator of the Ulwazi project said. The MSF programme hopes to reach 600 people this year and is making plans to increase the number to 1,500 by the end of next year. As Dr Coetzee points out, the Khayelitsha project is not out to prove that ARVs work - but it has demonstrated that people like Babalwa and the rest of the programme's beneficiaries can stick with, and benefit from, ARV treatment when it is provided free of charge.