“I was first diagnosed with the disease in 2002,” Kasaye continues. “I received treatment and the symptoms disappeared. I thought I was cured.”
Disastrous co-infection
Once treated, patients usually become immune to the parasite. However, this was not the case for Kasaye who, one year later, was diagnosed with HIV. HIV can prevent patients from being fully cured of kala azar, exposing them to the risk of relapse.
To make things more complicated, kala azar and HIV co-infection is disastrous because both conditions weaken the immune system and reinforce each other, leaving a person vulnerable to other opportunistic diseases like tuberculosis, malaria, and dysentery. Ethiopia has a very high number of co-infected patients, with 20 to 40 percent of kala azar cases occurring in HIV positive people.
A vicious cycle of poor living conditions
“During the years, I suffered from 12 other kala azar infections and the time between relapses is becoming shorter,” says Kasaye. “I came to Amhara from Tigray as a migrant farm worker but kala azar has made me weak and I can’t work in the fields anymore. Now I live in the streets and I have no choice but to beg for money.”
Economic status seems to be a determining factor when it comes to kala azar relapse in HIV co-infected patients, as people in poor living conditions are more exposed to sand flies—the carrier of the parasite—and are further debilitated by the lack of food.
“Kala azar is endemic in the Abdurafi area and that’s why MSF decided to set up its intervention here,” says Dr. Ernest Nshimiyimana, medical team leader for the Abdurafi project. “In addition to providing treatment for kala azar and HIV, we also run a state-of-the-art laboratory for the diagnosis of visceral leishmaniasis.”