AIDS treatment starts in poor part of Lima, Peru

Months of preparation and negotiation preceded Monday's launch. "It was a very emotional occasion," says MSF's Dr John MacRae. "For years we have seen our patients die around us. Of the group of two years ago, almost nobody is left. Now, finally, we can give them hope that they can continue their lives in relative health." Significantly, 15 patients received their first anti-retroviral medication. Medecins Sans Frontieres (MSF) has launched an HIV - AIDS treatment project in Villa El Salvador, a poor suburb on the southern side of Lima with a population of 350,000. The project will offer comprehensive care to 300 people and aims at providing an alternative model for fighting AIDS in Peru. Though the prevalence of HIV is relatively low in the country - 0.3 per cent according to official figures - it is sharply concentrated in the capital city. "Everything points at an explosive situation," said Cedric Martin, the MSF Head of Mission there. "AIDS is likely to become a big problem over the next ten years. By piloting a model for simplified and decentralised treatment, we can assure free access to treatment for the poorest and alleviate the load the health authorities have to deal with." The project was launched August 16 with a modest ceremony. People gathered in the waiting area, a tent put up in the angle of an L-shaped container construction that serves as the MSF clinic in the compound of the Centro Materno Infantil San José, and listened to speeches by the Director of the Health District and the MSF Head of Mission. More significantly, 15 patients received their first anti-retroviral medication. In addition to comprehensive treatment, which includes treatment of opportunistic diseases, MSF is developing a number of complementary activities. There is the option of home-based care, for those who cannot come to the clinic for whatever reason. A range of technical support activities guarantees the smooth running of the treatment; they include laboratory activities and waste management. The patients receive not only medical but also social and psychological support. In addition, they can get free and rapid testing close to their homes. MSF is creating a range of tools for informing patients and their caretakers of what is needed for successful AIDS care and treatment; this is hardly a straightforward task given the high level of illiteracy in Villa El Salvador. Months of preparation and negotiation preceded the launch. "It was a very emotional occasion," says MSF's Dr John MacRae. "For years we have seen our patients die around us. Of the group of two years ago, almost nobody is left. Now, finally, we can give them hope that they can continue their lives in relative health." The negotiations with the AIDS National Program, in which MSF has brought in its expertise in fighting the disease in other parts of the world, have resulted in the opportunity to start a comprehensive AIDS project which differs from the centralized 'dots' (directly observed treatments) national protocols. "We will use simplified drug regimes that make it easier for patients to stick to their course and providefree care for opportunistic infections," said Martin. "We will implement much simpler, and cheaper, methods for testing and analysis. Through our decentralized approach we will be better able to follow how patients are doing, not only medically but also socially, and trace defaulters. And we will continue our fightfor reducing the price of HIV-related medicines andfor making inexpensive medications available in Peru." MSF will work closely with a multidisciplinary team from the Ministry of Health in the Centro Materno Infantil San José who will benefit from the experiences in the new project. The start of the MSF project coincides with the launch of the Ministry of Health's national AIDS treatment program. But the poorest patients still face obstacles to access the treatment. Though the scale of the project is modest, its potential significance remains huge.