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MSF in South Africa, 2010
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An estimated 5.7 million people are living with HIV in South Africa, which makes up approximately 17 per cent of the world’s HIV population, according to the World Health Organization.
HIV/AIDS and tuberculosis
In partnership with local health authorities, MSF conducts an integrated HIV and tuberculosis (TB) treatment programme in Khayelitsha, a township on the outskirts of Cape Town, which has the highest prevalence of HIV/AIDS in the country. Seventy-one per cent of MSF’s HIV patients in Khayelitsha are co-infected with TB. The project has been operational since 1999, and over the years has demonstrated increasingly innovative treatment integration of HIV and TB. Antiretroviral (ARV) treatment was introduced in 2001, and since then, more than 17,650 patients in Khayelitsha have begun ARV treatment.
Over its 12-year history, this project has contributed to the turnaround in South Africa’s stance on HIV/AIDS. Collaborations with local and national health authorities, as well as operational research partnerships with the University of Cape Town, have helped promote a change in approach. Civil society groups and a vibrant local community have all helped to reduce the stigma relating to HIV/AIDS, increase public awareness, encourage discourse and bring about tangible change in national health policy.
In 2011, MSF, the Ministry of Health and the community of Khayelitsha will mark ten years of free ARV treatment and a community-based model of care developed in MSF’s projects that has had local, national and global impact.
MSF’s community support groups for HIV, drug-resistant TB, and youth have helped people living with HIV enormously. Facilitated by peer counsellors and based in the communities where patients live, the support groups help members reduce the sense of stigma, find mutual comfort, adhere to complex treatment regimens, and encourage young people to have fun while taking active responsibility for their treatment. At the Zip Zap Circus School – a partnership between MSF, Zip Zap Circus, Cirque du Soleil and others – children living with HIV learn about teamwork, responsibility, community and creativity. They have fun, learn new skills, and improve their adherence to ARV treatment.
The term survival migrant was coined to describe people who leave their home country not merely in search of economic opportunities, but to escape circumstances that challenge their survival, such as economic collapse, a non-functioning healthcare system, enduring conflict and insecurity, or sexual and gender-based violence.
Over the years, millions of people have arrived in South Africa in search of a better life. The journey is often difficult and, after arrival, migrants can face violent xenophobic attacks. Vulnerable to exploitation from agents pretending to offer assistance, migrants do not qualify for refugee status and, undocumented, they live in constant fear of discovery and deportation.
Many migrants from Zimbabwe find work as informal agricultural labourers at farms around the border town of Musina. MSF teams travel to some of the largest farms, and provide free general healthcare and HIV and TB diagnosis and treatment. In 2010, teams carried out more than 16,400 consultations in Musina. More than 250 survivors of sexual violence received treatment. These patients had all been attacked on their journey to South Africa.
In central Johannesburg, MSF operates a free clinic located next to a church that has historically provided a safe refuge for migrants living in the inner-city slums.
Healthcare in the slums
There are an estimated 1,300 slum buildings in inner-city Johannesburg. Many of these are controlled by organised crime networks and, in many places, people live in squalid conditions. There is little or no provision of clean water or electricity, and residents are at risk of forced eviction by corrupt landlords or officials. Residents live in abject poverty, in cramped and unhygienic conditions that have an impact on health and personal security.
In 2010, mobile medical teams visited 40 of these buildings and carried out consultations with more than 26,100 patients. Teams also assisted residents in organising the clean-up of some buildings by providing materials and contracting waste management services.
MSF has worked in South Africa since 1999.