Positive lives: ART care brings new hope in Mozambique

Sean Healy

Beatriz Mangate discovered she had HIV when pregnant with her second child. Today she is fit, healthy and taking good care of herself. She is now working as a receptionist in the MSF clinic at the maternity hospital and is participating in a weekly self-help group of HIV people.

Tajardo had been sick for some time but Beatriz only suspected something was wrong when she told him she was pregnant with their second baby. Suddenly, he started becoming aggressive, but would not explain what was wrong. Eventually he threw her out of the house - it just wasn't like him.

Beatriz took herself to Médecins Sans Frontières' clinic to be tested for HIV. It was what she feared - she had contracted HIV from her husband. And if she didn't get help, it was likely the disease would claim her baby too.

In the waiting room of the overcrowded Alto Mae health centre, David Evans, a doctor from Newcastle in Australia, explains a job which some days must surely resemble holding back the tide: containing Mozambique's HIV epidemic.

Thirteen percent of the people in this south-east African country have HIV: approximately 1,100,000 people. Close to 500 people are newly infected each day. An entire generation of Mozambicans is in mortal danger.

Comprehensive care

"What we're trying to do is offer comprehensive care," said David, who is MSF's medical coordinator in the country. "We provide voluntary testing and counselling. Then, if someone is HIV , we offer them early diagnosis and treatment for any of the opportunistic infections, like tuberculosis, which are brought on by their weakened immune system. If the patient is pregnant, we have a clinic aimed at preventing transmission to their babies. If a patient is too sick to come in to the clinic, we offer a nurse and home-based care."

MSF runs five such HIV-identification projects in Mozambique: two in different districts of the capital, Maputo, and three in the far-northern Niassa and Tete provinces.

Starting this month (January), MSF will open a new service in the country: treatment with anti-retroviral therapies; medicines which, although not able to eradicate the virus, can prolong the lives of HIV people for many years by effectively suppressing it. Hopefully, by providing such medicines, not only will people be able to live long and healthy lives but the air of hopelessness that surrounds the disease can also start to be lifted.

The Alto Mae clinic is proving very popular: it is right next to the main bus stop in Maputo and its waiting rooms seem to always be full. Over 7,000 patients have come in for testing and counselling since the centre opened in May 2001, and over 1,700 HIV patients have attended medical consultations. To cope with the demand, MSF has had to build two brand-new buildings on the grounds.

While they might feel overwhelmed, David and the other medical staff are obviously doing something right.

"Look, I'm a doctor, this is just what I do," he said. "We're all well aware that there's an enormous problem here and that our operation is only small. But in the end for us it's about helping the person in front of us, hoping that our assistance can help them fight the disease."

Still fighting

Beatriz is certainly fighting. After finding out she was HIV , she checked into MSF's clinic at Chamanculo Maternity Hospital and was put on the prevention of mother-to-child transmission (PMTCT) program.

Just before she gave birth, she was given a dose of nevirapine, a medicine which reduces the chance of HIV transmission; just after birth, her baby was given the same drug. Since then, she has been feeding her baby daughter on formula - provided free by MSF - as breast milk can transmit HIV. Her daughter will not get the all-clear for another few months, but the midwife says she is healthy and hopefully free of the virus.

With new hope, Beatriz has put her life back together again. She is fit, healthy and taking good care of herself. She is now working as a receptionist in the MSF clinic at the maternity hospital and is participating in a weekly self-help group of HIV people.

"What I now know is that I'm not alone", she said.

As for Tajardo, when MSF staff heard Beatriz' story they went to find Tajardo and found him in a hospital suffering from TB. He was alone and sure he was going to die. He was placed on a treatment programme, at the Alto Mae hospital, for opportunistic infections.

She and Tajardo are now back together again and are happy. Tajardo also is improving: he is responding well to treatment and is gaining weight again.