An Overview of MSF's HIV/AIDS Programs Around the World

June 1, 2001
An Overview of MSF's HIV/AIDS Programs Around the World
Pilot antiretroviral treatment projects launched in seven countries

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

"Is the world ready to lose one million people in Malawi and 30 million people in Africa? I don't know if we really can afford this.

"Of course we need to continue focusing on prevention, to try to reduce transmission and that less people get contaminated, but we need also to treat the ones who are infected because we can't afford to lose them all. And to be able to treat them we need to have the drugs in-and we need to have the infrastructure to be able to do it.

"If you would say tomorrow one million people will die because of an earthquake, everybody will rush here and bring help; but people will die slowly and in silence more or less; the help coming in is still very slow.

"If you want to do antiretrovirals, it has to start somewhere, and we need to learn how to do it in this context, because actually nobody has done it in this context."

— Maryline Mulemba, MSF Head of Mission in Malawi, from PBS' The NewsHour with Jim Lehrer, in a special report by Elizabeth Farnsworth, April 25, 2001

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.

"Treatment should be recognized as a cornerstone of prevention activities.

"Providing treatment decreases the stigma for HIV positive people, changing their ideological stereotype of a person 'sentenced to death'. It reduces fear in the general public by showing that people with HIV/AIDS can live quality and long lives with treatment, just as others do. For medical centers, providing treatment raises the motivation of HIV-infected people, especially from vulnerable marginalized groups, to come for medical care and especially for those who are not tested to come for testing."

— Konstantin Lezhentsev, MD, Ukrainian AIDS specialist working with MSF

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.