Anxiety as MSF plans treatment pullout

Five years ago, medical humanitarian agency Medecins Sans Frontieres (MSF) began providing people with anti-AIDS drugs when full-scale treatment in Africa was still a distant reality. But now, with over 45,000 people receiving antiretrovirals (ARVs), the time has come for MSF to start transferring their ARV services in some countries to national treatment programmes – a decision that has shocked some delegates at the ICASA international AIDS conference underway in Nigeria this week. Isaac Tita, a Cameroonian activist who has been involved in MSF's ARV project in his country since its inception in 2000, told delegates attending an MSF satellite meeting: "when they come, they don't come to stay". In Cameroon, MSF is in the process of handing over their treatment projects to the government, a process which Tita said was generating concern among patients that the over-burdened public health sector would be unable to absorb them. Back in the conference meeting room, the possibility of MSF's withdrawal was also met with considerable anxiety by Nigerian treatment activists. One recipient of MSF's treatment programme in Lagos expressed concern over the huge gap in the quality of service between the government and MSF. "If MSF goes now, a lot of my brothers and sisters living with AIDS will [suffer]," he pleaded. But with the Lagos programme still relatively new, talk of pulling out of Nigeria was still premature, said MSF. However, in South Africa's case, where the MSF project has been operational since 2001, the time has come. In April 2006, MSF will officially hand over the three Khayelitsha treatment sites to the provincial health department. Since 2004, MSF has been preparing the government to take over the responsibility for the treatment about 3,600 HIV-positive people in the Cape Town township. In view of the overall shortages of health-care workers in sub-Saharan Africa, this might be easier said than done. Dr Eric Goemaere, head of South Africa's MSF mission, acknowledged the frustration of HIV-positive people benefiting from their treatment projects. With some governments having failed to successfully implement primary health-care, would a national ARV programme be sustainable? "It's difficult to answer...but the programme can only be sustainable with pressure from patients and activists," he suggested. According to MSF regional press officer James Lorenz, MSF was an emergency organisation that did not work on long-term programmes. “MSF is never going to pullout of situations and leave people without treatment. That would be ethically and medically unacceptable,” he insisted, adding that the agency would continue providing ARVs until they felt they could hand over treatment programmes to a capable partner.