South Africa

An estimated 18 percent of adults in South Africa are HIV positive, and many urgently need antiretroviral (ARV) therapy. Tuberculosis (TB), including drug-resistant TB (DR-TB), is the main cause of death and illness among those living with HIV/AIDS.

Khayelitsha, a township on the outskirts of Cape Town, is home to half a million people and has one of the highest incidences of HIV/AIDS in the country. Since May 2001, Doctors Without Borders/Médecins Sans Frontières (MSF) has been running an ARV therapy program there in partnership with local health authorities. This was the first such program in the South African public sector and has prompted similar initiatives in other parts of the country. More than 11,000 patients are now benefiting from the ARV therapy services in Khayelitsha.

A high proportion of HIV/AIDS patients are co-infected with TB. The case notification rate for TB here is at least 1,500 per 100,000 people per year—among the highest incidence in the world. As in the rest of South Africa, increasing numbers of people are being diagnosed with drug-resistant tuberculosis (DR-TB). MSF has been piloting a project to provide decentralized care and treatment for patients with DR-TB in Khayelitsha. The project is based on the theory that more patients will be diagnosed and successfully treated if they are encouraged to follow treatment in their homes, rather than being isolated in specialized hospitals. This model of integrated care for HIV/AIDS and TB patients has been replicated in many other settings and is promoted by the World Health Organization (WHO) as a model for best practice.

The Simelela Center for survivors of sexual violence in Khayelitsha provides comprehensive services for rape survivors such as emergency medical care, counseling, and social and legal support. Links with community activist groups aim to reduce the number of victims of sexual violence by raising awareness and denouncing rape as a crime of violence. The clinic saw nearly 700 patients in 2008.

Medical and humanitarian assistance for Zimbabwean refugees

Since December 2007, MSF has been working in central Johannesburg and in Musina to provide displaced Zimbabweans with medical care. The projects provide general primary healthcare, mental health support, and referrals to hospitals and specialized medical facilities. MSF treats up to 5,000 Zimbabweans per month in these two projects, mainly for respiratory tract infections; sexually transmitted infections, including HIV; gastrointestinal and diarrhea conditions; and stress-related ailments. MSF teams are also treating an increasing number of people who have been subject to sexual violence, and are seeing a growing number of unaccompanied minors.

"Zimbabweans face significant risks, including those of sexual violence, physical and verbal abuse, and police harassment when crossing the border into South Africa," says Sara Hjalmarsson, MSF field coordinator in Musina, a town on the Zimbabwe border. "And these risks persist in South Africa, where many continue to be harassed by the police and are unable to find sustainable employment."

Between May and September 2008, there was an upsurge of violence aimed at foreign nationals, which led to 62 deaths and the displacement of more than 100,000 people across the country.

MSF responded to this emergency in more than 15 locations in Johannesburg, Pretoria, and Cape Town. Teams treated injuries such as gunshot wounds, head traumas, wounds resulting from beatings, lacerations, and burns. MSF provided primary healthcare to those who had been forced to flee, and distributed hygiene kits, blankets, and plastic sheeting.

In Johannesburg, where the violence was most extreme, MSF incorporated mental-health activities into the work of the medical teams. MSF also pressured the South African authorities to improve basic services such as shelter, water, and sanitation in temporary camps.

During the crisis, MSF provided 11,000 medical consultations and an additional 8,000 mental health consultations.

Cholera outbreak

In November, a cholera epidemic spread from Zimbabwe to South Africa. Authorities in the northern province of Limpopo declared Vhembe district, on the Zimbabwe border, a disaster area. MSF reinforced teams in Musina in Vhembe district and in Johannesburg, shifting from providing basic primary healthcare for Zimbabweans to prioritizing cholera diagnosis and treatment and hygiene promotion. During the outbreak, the MSF team in Musina referred more than 300 people with cholera via three mobile medical teams working on farms, villages, and in other high risk areas in and around Musina. At the Central Methodist Church in Johannesburg, MSF, together with local health authorities, managed to contain the spread of the disease through intensive health promotion, early case detection, treatment, and water and sanitation improvements.

MSF has worked in South Africa since 1999.

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