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MSF in South Africa, 2006
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South Africa has the largest number of people with HIV in the world, with about six million infected. Since 1999, MSF has provided care and treatment for people with HIV in poor areas of the country. In 2001, the first patients were enrolled into antiretroviral (ARV) therapy in Khayelitsha, the largest township near Cape Town and eventually the first site in the country to provide ARVs at the primary care level.
By July 2006, the Khayelitsha HIV/AIDS clinics — run in partnership with the Western Cape Department of Health — were providing care to 8000 patients and ARV therapy to 4000 people, enrolling more than 200 new patients monthly. With plans to scaleup ARV treatment to 15,000 people by 2010 and a high demand for services, the model is being further decentralised. Intense efforts of clinics’ organization, triage of patients, redefinition of staff roles and referrals are being implemented.
Given the extremely high incidence of tuberculosis (TB) in the township and the high level of TB-HIV co-infection (about 60 per cent), an integrated response to the TB and HIV epidemic has been developed at the Ubuntu clinic in Khayelitsha, now the busiest primary care clinic in the province.
Central to the Khayelitsha program in 2005/2006 has been the transfer of clinical responsibilities from MSF staff to human resources recruited by the provincial government. Drugs, including ARVs, are fully procured by the government whilst MSF continues to provide managerial and technical support.
In Khayelitsha, MSF has also catalysed the establishment of services dedicated to vulnerable groups. The Simelela rape survivors center is a response to the high degree of sexual violence against women and children in South African townships. Simelela provides medical care and psychosocial support and has integrated with other service providers to offer forensic examination and police assistance to rape survivors in a single location.
After four years of presence in Lusikisiki, one of the poorest areas in the Eastern Cape, the handover of MSF’s HIV/AIDS program to the Eastern Cape Department of Health is expected to be finalised by the end of 2006. This highly decentralised, nurse-based model is a good example of how to provide HIV/AIDS care to a scattered rural population with a high prevalence of infection. Currently 2,100 patients receive ARV treatment through a central hospital and 12 feeder clinics.
Coupled to all MSF’s clinical interventions is a strong community component implemented in partnership with the Treatment Action Campaign (TAC). TAC volunteers provide intense community education about HIV/AIDS, developing treatment literacy and generating greater awareness about available support and the rights of persons living with HIV.
MSF first worked in South Africa in the mid 1980s and returned in 1999 to respond to the needs of people affected by HIV/AIDS.