Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
Sunday Times - Sunday, 7 December, 2003
Claire Keeton
Every morning and evening, he was reminded by his girlfriend to take the life-saving drugs. Says Damane: "Antiretrovirals have changed my life."
His life-long commitment to taking the drugs is shared by most of the 650 people receiving treatment in Khayelitsha, Cape Town, as part of a M decins Sans Fronti res (MSF, or Doctors without Borders) project. Patients' adherence to the drug regime after three months has exceeded 95%.
The project has proved that it is possible to provide treatment successfully in an impoverished community, using a model that could be followed elsewhere.
This signals hope for South Africa's national treatment programme, approved two weeks ago, which will have to rely on the primary healthcare system to reach some half a million people who need the drugs.
When the project began in May 2001, nothing like it existed despite a huge demand for antiretrovirals. Critics said destitute Aids patients would not be able to follow the strict treatment regimens.
Dr Marta Darder of MSF said: " We never said it would be easy; we just had an obligation on medical grounds. We believed it was right and we had to go for it."
About a tenth of Khayelitsha's population of half a million is HIV-positive. About 70% of those enrolled for the project were already at a late stage of Aids and very sick. Patients were identified through MSF's three HIV/Aids clinics, which operate within government primary healthcare clinics and offer HIV/Aids services to about 1,800 patients a month.
MSF involved the local community in the highly sensitive decision of which patients to select for the project. The rigorous selection process has contributed to the project's results: after 18 months, 84% of patients had survived and opportunistic infections had dropped sharply.
From the lessons it has learned in Khayelitsha, MSF makes several recommendations on offering effective treatment. These include that antiretrovirals be part of a package of HIV/Aids care; that HIV/Aids services are decentralised to the primary care level; and that community education is a priority.
The value of this approach has been demonstrated in MSF treatment projects in other developing countries. In its 10 largest treatment projects, it found that 87% of over 6 000 patients were still taking their drugs.
031207
ST031201
Copyright © 2003 - The Sunday Times. Reproduction of this article (other than one copy for personal reference) must be cleared through the Sunday Times Permissions Desk.
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Elton John AIDS Foundation UK, the National Library of Medicine, AIDS Walk of Orange County, and donations from users like you.
Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .