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MSF in South Africa, 2009
Field Staff: 158
Reason for Intervention:
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In 2009 the new South African government completely reversed its stance on one of the country’s biggest health challenges, and is now addressing HIV/AIDS and tuberculosis (TB) as major health priorities. On World AIDS Day, President Jacob Zuma announced a number of long-awaited changes to strategies on HIV/AIDS treatment, including the use of higher-quality drugs for initial treatment, and a new model of care to address the deadly HIV/TB co-infection directly. Treatment will also be available for pregnant women and more nurses will be trained, which will give patients greater access to care. MSF has been continuing to provide HIV/AIDS and TB care to those in Khayelitsha and healthcare to refugees from Zimbabwe.
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, MSF has been running a program there in partnership with local health authorities offering antiretroviral therapy (ART). The Khayelitsha program was the first in South Africa to provide ART free of charge to the public. By December 2009, more than 13,550 patients were benefiting from the service.
But challenges remain including the lack of specific HIV/AIDS medication to treat children and adolescents, and the need for further integration of HIV/TB treatment to cope with the high numbers of patients who are co-infected. There are also increasing numbers of people being diagnosed with drug-resistant TB (DR-TB). MSF hosts a pilot project in the country offering DR-TB treatment through regular health-center visits, rather than in specialized isolation 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 as a model for best practice. The program has enrolled 582 patients in the last three years.
Zimbabweans seek refuge in South Africa
MSF has been continuing its work in central Johannesburg and in Musina, a town on the border with Zimbabwe, to provide Zimbabweans seeking refuge in South Africa with medical care and mental-health services. In 2009, MSF also made regular mobile healthcare clinics available to the farms along the border where many migrants work. Since April last year, MSF has been focusing on HIV/TB care and on improving services for victims of sexual and gender-based violence.
In these two projects, MSF treated more than 5,000 Zimbabweans a month, mainly for respiratory tract infections, sexually transmitted infections, gastrointestinal conditions and stress-related ailments. Almost 4,000 HIV tests were carried out across the two projects. In Musina, close to one third of people tested were found to be HIV-positive, 64 per cent of whom were women.
More and more migrants are being sent back to Zimbabwe from Musina by the authorities. But they often attempt to re-cross the border into South Africa at unofficial border crossing points, where they are sometimes attacked or raped by violent gangs.
In 2009 MSF medical staff treated more than 140 adults in Johannesburg who had been sexually abused, and more than half of these victims had been abused while crossing the border.
Andile Madondile, HIV-positive patient at MSF clinic in Khayelitsha
‘When I arrived in the support group I was able to see that there are other people living with HIV, who share their stories, who talk about it. That’s when I started telling myself “No, man ... HIV is not the end of the world ... maybe I should just stand up and look towards the future ... maybe God has something here for me.”’
MSF has worked in South Africa since 1999.