South Africa: Treating AIDS patients and rape survivors

Sexual abuse is one of the major problems facing poor South African communities. Nevertheless, its magnitude is hard to estimate since it remains largely unreported.

In cooperation with the Western Cape Department of Health, MSF has been working since 1999 at three HIV clinics within primary health care centers in the impoverished township of Khayelitsha, located on the outskirts of Cape Town. The township, home to almost 500,000 people, was created during the late years of apartheid. Its inhabitants suffer from high unemployment, poor living conditions and a staggering HIV infection rate of 29 percent.

The clinics' staff members provide HIV care including ARV treatment for those with advanced AIDS and care for opportunistic infections. A pilot project to integrate TB and HIV care is being conducted at the Ubuntu clinic, (see page 16). By August 2005, the Khayelitsha HIV/AIDS clinics were providing ARVs to 2,600 people and conducting more than 8,000 medical consultations per month.

A partnership between MSF and Cape Town health authorities led to the opening of a youth center in mid-2004. The center aims at providing medical care, psychosocial support and life skills to youngsters living in the township. Its services include family planning and care for sexually transmitted infections and HIV including voluntary HIV counseling, testing and education. It also hosts activities such as debates, dances and planning meetings.

Sexual abuse is one of the major problems facing poor South African communities. Nevertheless, its magnitude is hard to estimate since it remains largely unreported. Since 2003, MSF has supported the Simelela Rape Survivors Center in Khayelitsha, which is run in partnership with provincial health and social services authorities, the police and a local organization specializing in rape crisis work. Simelela offers medical, psychological and social care - including post-exposure prophylaxis for HIV - a police service and ongoing monitoring of patients.

The center's scope of activity expanded in August 2005 to include forensic examinations, and its hours have increased to 24 hours a day, seven days a week. In the month of August alone, Simelela's staff provided assistance to more than 130 rape victims - about half of them children under the age of 14.

Since early 2003, MSF has run another HIV project in Lusikisiki, in partnership with provincial health authorities of the Eastern Cape province. Lusikisiki, one of the province's poorest regions and a former homeland, has an HIV prevalence rate of 30 to 40 percent.

Since MSF established its program in the central hospital and 12 clinics, more than 600 people have been tested for the virus each month. Three MSF mobile teams provide medical care to those with HIV-related infections. MSF began offering ARV treatment in November 2003, and by August 2005, 1,000 people were receiving these medicines through the program.

Central to all of MSF's activities in South Africa is a strong, fruitful partnership with the Treatment Action Campaign, a grassroots movement, to advocate for better access to HIV care and treatment. At community level, both groups support patients' adherence to treatment, fight stigma and discrimination against people with HIV and promote prevention of new infections. Joint campaigns are also developed at the national and international levels.

MSF first worked in South Africa in the mid-1980s and returned in 1999 to respond to the needs of people affected by HIV/AIDS.