Hope in small doses: MSF new AIDS programmes in Mozambique

The reason for Graca's improvement is the drugs she has been taking daily for the last six months. She is one of the first people in Mozambique to be placed on a course of anti-retroviral (ARV) medicines, which bolster the immune system and suppresses HIV levels.
Graca's name suits her: she walks with an easy, languid grace, gestures slowly as though moving her fingers through water, smiles with white, white teeth. She is still painfully thin and looks breakable, but she shows me a photo of how she looked only six months ago. The difference brought me a sharp intake of breath. "I used to weigh 36 kilograms and I was very sick, I had skin lesions and tuberculosis, everything was so hard. Now, I feel much better. And look at me, I've put on weight: I now weigh 50 kilos!", she told me with some pride as we sit in a dark room looking over photos of her and other patients at this clinic. Graca quotes to me proudly the results of her latest CD4 count - CD4 cells are a type of white blood cell which is part of a body's immune system, and they are a primary target of the virus which is attacking Graca's body: the human immunodeficiency virus, HIV. CD4 counts are a major indicator of the progress of the disease. At its lowest point, Graca tells me, her CD4 count was 150, not quite at death's door but far too close to it; now it has reached 360; still below optimal but a massive improvement. The reason for Graca's improvement is the drugs she has been taking daily for the last six months. She is one of the first people in Mozambique to be placed on a course of anti-retroviral (ARV) medicines, which bolster the immune system and suppresses HIV levels. ARVs are not a cure for HIV/AIDS but HIV people who take them should be able to live healthy, full lives for many years. The problem is that, while the availability of ARVs has almost reduced HIV to the status of just another chronic disease in the West, in the developing world ARVs have for a long time been far too expensive for someone in Graca's position to afford. It is estimated that, in the developing world, some six million people with HIV need anti-retrovirals right now but simply cannot access them. To address this lack of access in a small but meaningful way, Médecins Sans Frontières (MSF) has, in the last two years, started ARV programs in 10 different developing countries and now provides antiretroviral therapy free of charge to approximately 2,300 people living with HIV/AIDS. In 2003, MSF will double patient intake in existing projects and plans to open additional projects in another 10 countries. Mozambique, where 13% of the population is HIV , is among those countries. Here two antiretroviral treatment (ART) projects have been established, in the districts of Mavalane and Chamanculo, both in the capital Maputo. A few patients, such as Graca, have already been in the program for some time but enrolments began in earnest in January: the Chamanculo project, for example, will take in 20 new patients each month over the next 24 months, to a total of 500 people. Once admitted into the program, patients will be put on triple therapy; a rigorous regime of three different but complementary medicines. After much testing and following final approval by the authorities, MSF medical staff in Mozambique have settled on a first-line (d4t/3TC/Nevirapine) and a second-line (AZT/ddI/Nelfinavir) treatment which they believe will be medically effective, simple to administer and have few side-effects. The regime will require patients to comply with a strict and exacting schedule of dosages - if a patient starts missing doses, the risk is not just that the patient will weaken but also that the virus itself will develop a resistance to the drugs. But if they do comply, the results can be rapid and confidence-restoring, as they have been for Graca. Graca now works for MSF at the Primero da Maio hospital in Mavalane district. When HIV patients come in for their regular check-ups, she talks with them, tries to soothe their obvious nerves, shares her stories, sometimes teaches them some safe sex techniques. Listening to her telling her stories, trying to connect with people who are desperately afraid of what lies ahead of them, her bravery is startling. She tells of the price she has paid for being public about her status; how mobs have surrounded her house chanting "AIDS, AIDS"; how conductors have thrown her off buses; how neighbours have told their children not to play with her 11-year-old son and how she tries to console him. And she shrugs and continues. These little pills, she explained, will have more than health benefits for the people who take them. They will also give people some added hope, some added help in fighting against the disease which they must face every day of their lives. "So often, when people hear they have HIV, they say to me 'I want to die'. But now people see me and they say 'You have AIDS, why are you looking so good?' and I can explain it to them. Already, there are many people who come in who want to take the tablets. They think, 'Maybe I will still live'."