[procaare] South Africa: Treating HIV Among Township Poor

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South Africa: Treating HIV Among Township Poor
- IRIN Africa PlusNews reports, 6/2/2003
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CAPE TOWN, 2 June (PLUSNEWS) - 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.

[This Item is Delivered to the English Service of the UN's IRIN humanitarian information
unit, but may not necessarily reflect the views of the United Nations. For further
information http://www.irinnews.org ]
Copyright (c) UN Office for the Coordination of Humanitarian Affairs 2003
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