Time stands still for HIV treatment
In Southern Africa, HIV is no longer a death sentence but in countries such as the Democratic Republic of the Congo and the Central African Republic it’s as if treatment never happened
South Africa now boasts the world’s largest antiretroviral treatment programme. Of the almost seven million people estimated to be living with HIV in the country, 3.4-million are now on treatment, according to health department figures.
But in 2000, it was a very different story.
That year, Doctors Without Borders (MSF) opened the doors of the country’s first antiretroviral clinic in Khayelitsha. As news spread of the life-saving treatment being offered there, people living with HIV came en masse. We saw the sickest of the sick; people were brought into the one-room clinic on stretchers or wheelbarrows.
The patients who were carried or wheeled through our doors then were often extremely thin or dehydrated from persistent diarrhoea. They were suffering the unthinkable. Our doctors could not get patients on to antiretrovirals fast enough.
For the many in South Africa who were able to get lifelong treatment, this is a dark memory.
For our patients in West and Central Africa, this is their reality. In our clinics in countries such as Guinea, the Democratic Republic of the Congo and the Central African Republic, patients arrive showing signs of Aids — or the late stages of HIV infection — that have become relatively rare in South Africa. Their bodies’ immune systems have collapsed and deadly opportunistic infections have taken over.
MSF now supports advanced HIV units in national hospitals situated in the capital cities of Guinea, the Democratic Republic of the Congo and the Central African Republic. Often carried in by family or friends, our patients arrive extremely thin and in severely altered mental states. Our patients arrive so sick that a third cannot be saved.
At these centres, we partner with health ministries to provide free, high-quality care and treatment for people living with advanced diseases caused by HIV, including the HIV-related cancer kaposi sarcoma, as well as brain infections such as cryptococcal meningitis and cerebral toxoplasmosis. But even for the very sick, the huge stigma surrounding HIV adds to the many hurdles to seeking care openly.
When we began providing antiretrovirals in South Africa more than 15 years ago, stigma dropped steadily as people realised: it’s not only me, there are thousands all around who are HIV positive.
In Central and West Africa, the fewer who seek treatment, the higher the stigma. It is a vicious cycle.
Many HIV-positive mothers refuse to get their children tested, says one professor conducting paediatric HIV testing. Without antiretroviral treatment, a third of HIV-positive babies will die before their first birthday and more than half will never see the age of two, according to a 2004 study published in medical journal.
Many countries in the region have low proportions of people living with HIV. In Guinea, for instance, the Joint United Nations Programme on HIV and Aids (UNAids) estimates that 1.6% of the population is living with the virus. But low percentages hide huge numbers — 120000 of stock outs, a lack of money to pay for treatment or an inability to get to health facilities.
Those who develop resistance to initial HIV antiretroviral regimens because of these interruptions may never be diagnosed with treatment failure and switched on to appropriate medication.
In Guinea, the country’s few HIV testing services and treatment options are barely available to poor people because of crippling patient fees and chronic medicine stock outages, including those affecting