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An Overview of MSF's HIV/AIDS Programs Around the World
Pilot antiretroviral treatment projects launched in seven countries
June 1, 2001
This article is part of the Summer 2001 issue of the MSF Alert newsletter.
Doctors Without Borders/Médecins Sans Frontières (MSF) currently operates or is implementing nearly 50 HIV/ AIDS projects in over 25 countries. Projects provide a range of services, including HIV prevention and general health education, condom distribution, management of sexually transmitted diseases (STDs), harm reduction programs, mother-to-child-transmission prevention programs, voluntary testing and counseling, screening for transfusions and diagnosis, psychological and social support for people with HIV/AIDS, direct medical care for people with HIV/ AIDS, and technical assistance and training for HIV/AIDS care programs in hospitals, health clinics, and homes. Medical care includes symptomatic and palliative treatment, treatment of common opportunistic infections, tuberculosis programs, and, increasingly, antiretroviral (ARV) treatment.
INTRODUCING ANTIRETROVIRAL (ARV) TREATMENT IN RESOURCE-LIMITED SETTINGS
In 2001, MSF began to implement small-scale "demonstration projects" which provide treatment with antiretroviral drugs, (also known as combination therapy because treatment regimens usually involve a combination of several drugs) as part of a broad continuum of care in seven countries: Cambodia, Cameroon, Guatemala, Kenya, Malawi, South Africa, and Thailand. These projects aim to reduce morbidity and mortality, improve the quality of life of people living with HIV/AIDS, provide appropriate case management in field conditions, and demonstrate the feasibility of providing ARV therapy in poor countries. MSF believes that demonstrating the effectiveness and feasibility of ARV programs in resource-limited settings will inspire local health authorities to invest in national programs, and will also encourage wealthy governments to contribute the necessary resources to fight the AIDS pandemic.
A SNAPSHOT OF MSF TREATMENT PROGRAMS
In Malawi, over one million people are living with HIV/AIDS and approximately 350,000 people have already died from the disease. In Thylo, MSF treats HIV patients who have developed TB, and runs prevention activities and a large home-based care program. In Chiradzulu, prevention activities focus on education on condom use and acceptability among vulnerable populations, including sex workers, police, and young people. In Chiradzulu Hospital, MSF treats opportunistic infections in HIV/AIDS patients and has opened an HIV clinic to help provide follow up for approximately 100 patients. MSF also runs a voluntary HIV testing program and has launched a mother-to-child-transmission prevention program in Chiradzulu Hospital. MSF has just received permission to launch an ARV treatment program in Chiradzulu and will begin enrolling patients this summer.
In Thailand, MSF has run HIV/AIDS care and treatment programs in central Bangkok and three surrounding districts since 1996. Since 1998, the project has also joined Thai activist groups and non-governmental organizations in pressing for more affordable AIDS drugs. In Bangkok, in Bang Kruai District Hospital and MSF's home-based care program, MSF launched a comprehensive care program, which includes voluntary testing and counseling, treatment of opportunistic infections, palliative care, and treatment with antiretroviral combination therapies. The project is currently exploring ways to more closely involve the community and people living with AIDS. The goal is to overcome reluctance to ARVs because of a lack of confidence in the long-term supply of AIDS drugs and difficulties in managing drug side effects.
At another HIV/AIDS program in the eastern province of Surin, MSF treats patients with opportunistic infections, provides home-based care, trains staff, and runs a mother-to-child-transmission prevention project. The project in Surin will introduce triple therapy with ARVs this year. MSF is hoping to expand its treatment programs in Thailand to children infected with HIV and to more rural areas of the country.
In Ukraine, MSF is battling poor information, lack of infrastructure and diagnostic testing capacities, as well as the high price of ARVs. MSF activities include running an AIDS information center and supporting 17 harm reduction projects aimed at the 46,000 HIV-positive Ukrainians, 80 percent of whom were infected through intravenous drug use. In June 2000, MSF launched a pilot program to prevent mother-to-child transmission of HIV.
In Guatemala, MSF runs HIV/AIDS programs in Guatemala City and Quetzaltenango. In Quetzaltenango department, MSF offers HIV education to women and youth as well as to sex workers and health-care workers, and provides technical support to health services in the care and prevention of people with HIV/AIDS. MSF launched its first treatment program in Central America in 2001 with the beginning of an ARV treatment program for HIV-infected adults in Guatemala City with plans to provide treatment for parents of infected children and those most in need because of their health status. MSF also launched the Campaign for Access to Essential Medicines in Central America with special interest in Guatemala, Honduras, El Salvador, and Nicaragua where the teams in the field will develop other projects related to AIDS prevention and treatment.