Introduction

In the late 1990s, the introduction of antiretroviral (ARV) treatment transformed AIDS from a death sentence to a chronic lifelong disease. However, the extremely high cost of ARV drugs meant that treatment was restricted to people in richer parts of the world, and the millions of people suffering from the disease in places like Africa remained untreated.

National and international decision makers actively refrained from embarking on the fight against HIV/AIDS, believing that an insufficient budget and a scarcity of both technical means and human re- sources would lead to inadequate HIV care and manage- ment. Their fear was that this would ultimately lead to the emergence of widespread drug-resistant strains of the virus, which would exacerbate an already dire situation.

Médecins Sans Frontières (MSF) – determined that the plight of people with HIV/AIDS in African countries would not be ignored – has been working with HIV in Mozambique since 2001, where it has been helping the Ministry of Health develop a comprehensive plan for widespread provision of ARV treatment. During the first few years, around half of all patients on treatment were supported by MSF.

MSF’s objectives were to demonstrate that it was feasible to provide ARV services in low-resource settings, to explore possible modes of operation and to help cre- ate a national capacity for treating people with HIV/AIDS. At the time, the organisation of the Mozambican health system needed to be adapted to allow the development of comprehensive ARV treatment programmes, in terms of human resources (both numbers and skills), laboratory capacity, technical means, and the overall management of HIV/AIDS. MSF has spent a total of 58 million Euros on its HIV/AIDS activities in Mozambique since 2001, of which the majority comes from private funding.

The number of patients on treatment has risen dramati- cally over the last few years. At the end of August 2010, more than 200,000 patients were on ARV treatment in Mozambique1, of whom more than 33,000 were being treated with the assistance of MSF. The growing number of patients on treatment shows that the scale-up and pro- vision of ARV treatment is indeed possible in a country like Mozambique. MSF has helped to put HIV/AIDS firmly on the national health agenda and, along with the Minis- try of Health, has developed innovative strategies for HIV care and management.

This report details MSF’s work and achievements in Mozambique in the field of HIV/AIDS over the last ten years, as well as pointing to the challenges that lie ahead.