In order to cope with the scale of the need and develop local capacity, MSF has gradually integrated employees of the Kenyan public health system into its teams in the Kibera South centre and the Silanga dispensary.

In 1997, MSF undertook an evaluation of Nairobi's Mbagathi District Hospital and found a veritable twilight zone. Numerous HIV/AIDS-infected patients were being left without adequate care. As a result MSF decided to open an HIV/AIDS clinic within the hospital to serve as a referral centre for primary health care clinics situated in the vulnerable areas of Nairobi.

In 2001, MSF created its own health facilities, opening two "patient support centres" in Kibera and Dandora. The centres focus on the management of HIV/AIDS patients, including voluntary HIV testing and psychological support. MSF also offers medical treatment, trains medical personnel on patient care and helps with the safe management of hospital medical waste.

In May 2003, MSF put the first patients on antiretroviral (ARV) treatment in the hospital. The team noticed that most of the patients were coming from the Kibera slum.

"There are 1.24 million people infected with HIV/AIDS in Kenya," explains Christine Jamet, MSF Head of Mission in Kenya. "In Kibera, the prevalence of HIV/AIDS is estimated to be around 15%. There is a real need for care and treatment for this vulnerable population."

Three facilities in the heart of the slum

In response, MSF opened its own specialised HIV/AIDS centres in the slum: Gatwekera dispensary in the west, Silanga dispensary in the east and a health centre in Kibera South.

"Working in partnership with the Kenyan Ministry of Health, MSF developed a public health centre in the heart of the slum: Kibera South," explains Jamet. "We aim to show that it is possible to integrate HIV/AIDS care into primary health care. These three medical facilities deliver highly technical care and treatment ranging from simple HIV testing to putting patients on ARV drugs."

In order to cope with the scale of the need and develop local capacity, MSF has gradually integrated employees of the Kenyan public health system into its teams in the Kibera South centre and the Silanga dispensary.

Originally a base for following up patients needing palliative HIV/AIDS care at home, the Gatwekera dispensary now offers a "package" of free care for HIV/AIDS-infected patients. This includes HIV testing, psychological support, care and treatment for opportunistic infections and ARV treatment.

A new building for the Silanga dispensary was inaugurated in June 2005. As well as offering the same package of care as Gatwekera, it also provides mother-child health services, family planning and vaccinations as well as treatment for sexually transmitted infections.

The Kibera South centre offers the Kibera population basic health care as well as specific care for HIV/AIDS patients. It also treats victims of sexual violence. It has a pharmacy and laboratory facilities for following-up patients on ARV drugs.

"All in all," explains Ian Van Engelgem, MSF's medical coordinator in Kenya, "the three health facilities in Kibera receive nearly 1,500 patients - about 1000 at Gatwekera, 225 in Silanga and 200 in Kibera South. Nearly 500 of them are on ARV treatment - about 360 at Gatwekera, 105 in Silanga and 19 in Kibera South. We aim to triple the number of ARV beneficiaries in 2006."

Mbagathi District Hospital

The midnight-blue walls of the clinic can be glimpsed through the trees. The HIV/AIDS centre is situated in a leafy, open area exuding a certain serenity. In the packed waiting room, a television hanging in a corner above the reception desk is showing a demonstration of how to use a female condom.

The HIV/AIDS clinic is in the grounds of Mbagthi District Hospital - the only public health facility in the entire Nairobi Province. This is an area stretching well beyond Nairobi itself, with a population of about three million. The hospital is located only a few hundred metres away from the Kibera slum, yet it runs on a "cost recovery" system: the patients must pay for their health care.

MSF currently treats nearly 2,000 patients infected by the virus here and gives a hundred consultations a day. The clinic provides a 'package' of comprehensive care and treatment for HIV/AIDS: from testing and counselling, including psychological and social support, to nutritional care and back-up laboratory support.

"Since May 2003, MSF has offered ARV treatment to more that 1400 patients at Mbagathi," says Van Engelgem. "The HIV/AIDS clinic focuses on patients who have reached an advanced stage of the disease."

Whilst the Kenyan government recognised the AIDS epidemic as a national disaster in 1999, the Mbagathi District Hospital only opened its own, paying clinic in November 2003. The increasing cooperation between MSF and the Nairobi health authorities permitted a fusion of the two clinics in February 2005, using the MSF building.

The clinic is staffed by personnel from MSF and the Kenyan Ministry of Health. The two teams treat a total of 5,000 patients, of whom nearly 2,000 are on ARVs. They give 150 consultations a day.

The MSF team is currently working on implementing an efficient referral system between the HIV/AIDS clinic and other services in the hospital. The detection and care of tuberculosis (TB) - the opportunistic infection most developed by HIV/AIDS patients who have a weakened immunity system - also needs improvement.

The links between the HIV/AIDS clinic and the hospital's TB service have been reinforced, allowing patients co-infected with HIV/AIDS and TB to receive optimal care. In time, these patients will receive their treatment for HIV/AIDS and TB within the same, unique service.