International Activity Report 2002
Treatment starts now: Increasing access to HIV/AIDS treatment in resource-poor countries

There is no cure for HIV/AIDS, which now affects 40 million people worldwide. Antiretroviral (ARV) medicines used in combination, however, help extend and improve quality of life for people living with the disease. But only a very small number of the 36 million people living with HIV/AIDS in developing countries have access to these essential drugs. The drugs are available in industrialized countries at high prices that have till now made them an unaffordable luxury for resource-poor countries for whom prevention was long seen as the only "cost effective" way to curb the pandemic.

MSF now runs HIV/AIDS programs in almost 30 countries (including testing, counseling, prevention, palliative care and treatment for opportunistic infections). Refusing to choose between prevention and treatment, and in line with our successful campaign (as part of the Access to Drugs Campaign) to reduce the price of ARVs, MSF began offering them in some projects in 2001. In November 2002, about 2,300 people in Cambodia, Cameroon, Guatemala, Kenya, Malawi, South Africa, Uganda, Ukraine, Honduras and Thailand were receiving them and the number is increasing steadily. We also work to prevent pregnant mother-to-child transmission (MTCT) of HIV in South Africa, Ukraine, Honduras and El Salvador.

MSF offers ARVs free of charge using the most affordable combinations of drugs available, a mixture of brand-name products and generics. In Khayelitsha, South Africa, the government has authorized the use of Brazilian generics, thus allowing us to treat three times the number of patients for the same cost.

MSF selects patients for treatment after consultations to determine their suitability. If the white cell count is below a certain level, there are clinical signs of the disease and patients can comply with the drug regimen, they qualify for treatment. But with limited resources, difficult choices have to be made.

Initial results after six months of ARV treatment are extremely encouraging: patients gained an average of 5kg and the cell counts improved significantly, with the virus undetectable in over 90% of cases. Clearly, patients in developing countries comply with treatment as rigorously as those in Europe and North America, removing another argument against ARV treatment in such settings.

MSF trains and works with local health staff. We also try to dispel the stigma surrounding AIDS in most countries, such as Malawi where as many as one in ten people are HIV infected, yet society is in collective denial. However, attitudes change with the availability of treatment, information and counseling, leading people to use protection and prevent further transmission. Hurdles have to be faced when treating HIV/AIDS patients in resource-poor settings, but MSF is helping to show these can be overcome when individuals and communities are involved in planning and implementing projects.

If ARVs in developing countries are to be given nationally, patient follow-up must be adapted, simpler monitoring tests developed and resistance risks monitored, all of which MSF is engaged in. We also advocate, with local activist groups, for cheaper, more available ARVs and greater international funding. With 3 million deaths and 5 million new HIV/AIDS cases in 2001, widespread access is essential.

Mary, 32, walks eight hours for her weekly appointment at Chiradzulu hospital, Malawi, but has no complaints. "I found out I was HIV-positive in July 2000. I was doubly affected because it turned out my daughter was positive as well. I knew I was going to die, so I started selling my things and stopped working." In August 2001, when the Malawi government registered several ARV drugs, MSF began offering treatment to some patients in Chiradzulu hospital, including Mary. A month later, her hope returned: "I feel stronger, and I can start my business again and look for work on a farm to have a steady income." A year on from the interview, Mary is taking her ARVs regularly and training to be a community AIDS counselor. Her six-year-old daughter is also being followed up as a potential candidate for treatment.