International staff: 16
National staff: 98
Forty-five percent of Peruvians live in poverty, many in extreme poverty. People living in urban slum areas are vulnerable to transmission of sexually transmitted diseases (STDs), HIV/AIDS and cholera outbreaks. They are affected by social and family violence and environmental deterioration. And, although Peru is more politically stable now than it was during the peak period of unrest and guerrilla warfare in the 1980s and early 1990s, current efforts to liberalize the economy have left many Peruvians either politically alienated or economically adrift.
In Lurigancho prison, a high risk of AIDS
Some of the most marginalized people inhabit the country's prisons. In April 2000, MSF launched a three-year STD/HIV/AIDS control project in overcrowded Lurigancho prison, in northern Lima. The prison, primarily a holding center for men who have been accused of common crimes, houses more than 6,600 people - 25% of the total Peruvian prison population.
The social characteristics and behavior patterns of the inmates, coupled with poor and overcrowded living conditions and lack of access to condoms, put both the prisoners and those around them at great risk for TB, STDs and HIV/AIDS. The prison's high turnover rate also makes it a catalyst for the spread of these diseases to other prisons and the prisoners' home communities.
In an attempt to reduce risky behavior, education activities emphasize prevention. For those already infected with HIV, MSF has set up a counseling service and introduced comprehensive care for HIV/AIDS patients (including adequate TB treatment). There is a self-help group for prisoners living with HIV/AIDS. In addition, MSF is training prison health staff to improve infection control procedures.
MSF also works to control STDs and HIV/AIDS among the wider population. An estimated 40,000 - 70,000 people are living with HIV/AIDS in Peru, with a significant recent increase among 20-24 year-olds due to sexual transmission of HIV during adolescence.
MSF works in four marginalized districts of Lima: San Juan de Miraflores, Villa MarÃ?a del Triunfo, Villa El Salvador and Chorrillos. Part of the Ministry of Health's (MOH) national STD/HIV control program, the MSF project seeks to prevent infection (especially in adolescents and young adults) and improve care for those already infected.
MSF has held training workshops for public health personnel on subjects such as individual counseling, current approaches to STD management, and comprehensive care for people living with HIV/AIDS. MSF is also training adolescent and adult community health workers to organize STD/AIDS prevention education activities, and to detect and refer STD cases to appropriate health care services. Since November 1999, an MSF doctor specializing in infectious diseases has been working to establish an infectious diseases department, and organize comprehensive care for AIDS patients in the reference hospital MarÃ?a Auxiliadora in Lima.
Focus on young people
In Villa El Salvador, MSF, along with the MOH and other Peruvian organisations, educates young people about reproductive health and provides prevention activities focusing on violence and abuse.
Teams provide medical, social and psychological care and support to pregnant teenagers, abused children and adolescents. The activities are carried out through the multi-disciplinary consultation service "Entre Amigos" (Among Friends), and through home visits and cooperation with teachers, community health workers, adolescents and their parents.
Care for isolated communities
MSF also works in rural Peru, far away from the country's urban centers. In remote areas of the Amazon jungle and the Andes, health care is limited. Along the Ucayali river, in the Amazon region of Pucallpa, MSF provides primary care to scattered indigenous communities in the Masisea and Iparia districts.
Two other rural primary health care projects, one in the Amazon jungle province of Satipo, and another covering the Andean provinces of Angaraes and Acobamba, were handed over to the MOH in 2000.
An extensive mission to assess health, water and sanitation needs in Belén, a district in the northern city Iquitos, was carried out in early 1999. The findings were turned over to local health officials for possible intervention. During the second half of 1999, MSF vaccinated about half a million people in and around Iquitos and in San Martin province against yellow fever.