Mozambique: Addressing the growing AIDS crisis

Mozambique has a desperate shortage of medical personnel and a health budget of less than US$8 per person per year. Life expectancy has already begun to be affected by the AIDS epidemic. MSF has HIV/AIDS projects in the capital city of Maputo and in Niassa and Tete provinces. Other activities in Mozambique include cholera response. MSF recently began a cholera vaccination project in Sofala province. Since 2001, MSF has worked to provide comprehensive care to people living with HIV/AIDS in Maputo city. MSF teams support the Alto Maé health center and one unit of the Chamanculo Hospital, both located in the Chamanculo health district. Activities include voluntary counseling and HIV testing, prevention of mother-to-child transmission and treatment with antiretroviral medicines (ARVs). Together with local NGOs, MSF staff also provide home visits for those too sick to leave home. As of January 2004, 313 patients were receiving life-extending antiretroviral therapy in Chamanculo district. More than 2,000 AIDS consultations were conducted during the month of January alone. The MSF team hopes to increase the number of patients using ARVs in Maputo city by at least 80 per month. In March 2002, MSF began a second project in Maputo city, in the Mavalane health district, home to an estimated 478,000 people. MSF staff work at the Primeiro de Maio health center providing comprehensive AIDS prevention, treatment and care services primarily to a low-income urban population. At the end of 2003, 200 patients were receiving ARVs, an average of 2,000 consultations were being performed each month in the day clinic and 6,200 women had benefited from the prevention of mother-to-child HIV transmission program. The MSF staff hope to expand ARV treatment to an additional 700 people in Mavalane district during 2004. MSF has also been running an AIDS awareness program in Maputo since 2001. The initial objective was to "break the silence" surrounding HIV/AIDS by focusing on a number of activities (recording and distributing a music CD on HIV/AIDS, a nation-wide "Positive Lives" photo exhibition, close cooperation with Mozambican media, etc.) to bring the epidemic to the public's attention. Since 2003, the project has also focused on assisting the patient support groups that have grown out of MSF's HIV/AIDS projects. In 2004, we will work on a program of support for several associations of people living with HIV/AIDS. MSF began working with HIV/AIDS patients in Lichinga city (Niassa province), where nearly 180,000 people live, in 2001. MSF supports two voluntary counseling and care clinics (one in the provincial hospital and one in the city health center) and one hospital in this isolated city in the north of the country. Activities include comprehensive HIV/AIDS care and education and training within health structures to reduce transmission. As of January 2004, 27 patients were receiving ARVs. A campaign to reduce stigma and discrimination through street theater, radio programs and other education and awareness-raising activities recently began here. MSF also runs two HIV/AIDS projects in the province of Tete, one in Tete town and the neighboring district of Moatize and another in the northern district of Angonia. Angonia is the most heavily populated district of Tete province, with more than 300,000 inhabitants. Tete has a high concentration of displaced people who arrived during Mozambique's period of civil conflict. The country witnessed large population movements during and after the war. The most recent epidemiological surveillance showed an HIV infection rate of 20 percent. As in Maputo, MSF is working to improve the care and treatment of people who live with HIV/AIDS in Tete and Angonia by implementing the "Integrated Health Network", the Mozambican national strategy to respond to the AIDS epidemic. The network approach includes comprehensive HIV/AIDS prevention, treatment and care activities. Information, education and counseling, prevention of mother-to-child transmission, voluntary counseling and testing, a day clinic for the treatment of opportunistic infections and the administration of ARVs are the principal elements of this strategy. In Tete, the program is centered in Provincial Hospital, but a number of services have been decentralized to the peripheral health centers. A similar approach is being employed in Angonia, where HIV/AIDS services are provided in the district hospital and two outlying health centers. In 2005, MSF hopes to expand the program to a third health center and possibly, start the use of ARVs. Combating cholera Cholera is endemic in Mozambique, and outbreaks can be devastating. In an effort to help the government cope with this recurring health problem, MSF began a cholera vaccination project in December 2003 in the city of Beira, Sofala province. This is the first large-scale, field test of a cholera vaccine, and is being carried out in cooperation with the World Health Organization, the International Vaccine Institute of Seoul and local health authorities. The vaccination campaign is intended to enhance other preventative activities, including improving access to clean drinking water, construction of latrines and sanitary education. An evaluation of the vaccine's effectiveness will be carried out in the coming months. MSF teams also responded to cholera in Mozambique's capital city, Maputo, between January and March 2004. At the request of local health officials, MSF helped support a cholera treatment center where hundreds of patients were receiving care. Activities included the installation of tents, latrine construction and the donation of material. MSF teams were also involved in prevention activities in parts of Maputo, organizing water trucking, water chlorination and awareness-raising on cholera prevention. In mid-2004, MSF will hand over another cholera prevention program to a local association with which it has worked for the last three years; the project focused on water and sanitation activities.