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Antiretroviral Therapy in Primary Health Care, the South African Experience

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Photograph by Peter Casaer

Southern Africa is one of epicentres of the worldwide AIDS pandemic. With more than 5.2 million people infected with HIV, South Africa has the highest number of people with HIV/AIDS of any country in the world. A comprehensive response to HIV/AIDS - including prevention of new infections, prevention of mother-to-child transmission (PMTCT), prophylaxis and treatment of opportunistic infections, dignified end-of-life care, and, critically, antiretroviral therapy (HAART) - is necessary to adequately tackle the epidemic.

In South Africa, the government has so far not introduced antiretroviral treatment in its government-run health facilities.

Since 1999, Médecins Sans Frontières (MSF) has been working in the Khayelitsha township, outside of Cape Town, with what was then the only government-supported prevention of mother-to-child-transmission project (PMTCT) in the country. Khayelitsha is a resource-poor township with approximately 500’000 residents. About a quarter of women at Khayelitsha antenatal clinics test HIV-positive. It is estimated that more than 50’000 residents are HIV-positive. More than 50% of the MSF patients are unemployed and the majority is living in informal housing (usually corrugated iron shacks).

In April 2000, in collaboration with the Provincial Administration of the Western Cape (PAWC), MSF set up three dedicated HIV/AIDS clinics within Khayelitsha’s primary health care centers. In May 2001, the HIV/AIDS clinics began to offer highly-active antiretroviral therapy (HAART) to people with advanced stage of HIV infection.