Feature story |

Fighting HIV/AIDS: A long battle with an uncertain outcome

In Mozambique, the fight against HIV/AIDS is one being fought every day. There is still a long way to go in overcoming the stigma surrounding carriers of the virus and providing medical care for those that need it. Here we meet up with Médecins Sans Frontières teams who support the employees of the Mozambique Ministry of Health in their work with HIV/AIDS.

The audience is listening intently: In the Accident and Emergency waiting room in the local hospital of the town of Lichinga, in the north of the country, around fifty people are present at Jaime Fernando Aime’s impassioned speech. Aided by sweeping gestures and a picture book, this man – his voice deep and his posture proud like a gladiator – informs everyone that he is HIV-positive and has been receiving antiretroviral treatment for four years. Out of his pocket he takes a box of pills: “Look, there’s nothing to it, it’s just medicine, and it means I can live and work normally... I even cycled here today!”

For three years Jaime has been employed by MSF to spread the good word and convince the inhabitants of Lichinga to get tested for HIV/AIDS. “The difficult first step is breaking the silence and daring to tell others that you are HIV-positive,” he explains. “Things are easier now; there is less shame surrounding the issue – the people I address feel more able to ask questions about the disease.”

Thanks to the work carried out by Jaime and dozens of other activists, HIV/AIDS is no longer the taboo it once was in Mozambique, albeit there remains much progress to be made. Proof of this can be found in the substantial increase in the number of patients under the watch of MSF-supported health structures. In Chamanculo, a district of the capital city Maputo, more than 18 000 people were receiving antiretroviral treatment at the end of 2010, an increase of 58% on the previous year. “These figures do not signal a new peak in the epidemic, but rather an increase in awareness among the population. More and more people are coming forward to get tested, which increases the number of patients,” explains Gaël Claquin, coordinator of the MSF project in Chamanculo.

Nonetheless, the figures remain a cause for concern, revealing that the rate of HIV/AIDS among adults aged 15 to 49 in Mozambique currently stands at 11.5%. In urban areas, this rate is as high as 15.9%. 18% of pregnant women are infected with the virus.

It is 7.30am and a busy crowd is thronging in front of the reception desk of Chamanculo hospital. A quarter of them, approximately 200 to 250 every day, have come for a consultation relating to a chronic illness – usually HIV/AIDS. For many of them, it is their first visit following a positive HIV/AIDS test. Behind the reception desk there are large metal drawers packed with thousands of HIV-positive patients’ files. One of the first steps for these patients in their care programme is to meet up with an MSF consultant.

Hope for a long and healthy life for HIV patients

In a small, poorly-lit room in Chamanculo hospital, two female MSF consultants talk to six patients sitting on wooden benches. A man wearing a yellow woolly hat asks if he has to come back every month to collect his medicine. He works in South Africa and doesn’t want to lose his job. Margarita, an MSF “expert patient”, who is herself HIV-positive, confirms that he will receive proper treatment there as well, with the same drugs. “This first discussion is very important as it allows people access to answers about what their lives will be like, meaning the medical staff that see them later on can concentrate on the consultation,” explains Amélia, a nurse who has worked for MSF since 2002. “A few years ago the patients would cry a lot at the first consultations. These days they are more philosophical when they find out they are HIV-positive; they know they can be treated and live a long and healthy life if they follow their treatment, especially if they have been screened early.”

This encouraging news does not mean that the battle against HIV/AIDS in Mozambique has been won. 1.4 million Mozambicans are HIV-positive. Of the 650 000 who are in need of antiretroviral treatment, only 250 000 have access to it. This is due to poor access to healthcare, and in particular a lack of medical staff.

Training nurses to take over from doctors

Médecins Sans Frontières has for several years tried to convince the Mozambican authorities of the necessity to invest more in human resources and to adapt certain protocols in order to allow more patients to receive care. “For example, we are proposing that nurses, having undergone sufficient training, could prescribe antiretroviral treatments for uncomplicated cases, which can currently only be done by doctors and técnicos de medicina ,” explains Mariano Lugli, MSF’s team leader in Mozambique. In anticipation of such a decision being made, MSF has set up a training programme for nurses, which will allow them to begin the work quickly. “We are well prepared and will be able to start providing treatment as soon as the law changes,” explains Alberto Zefarias, an MSF nurse in Chamanculo hospital. “Some of us are now even helping less experienced técnicos de medicina. But we are already inundated with work. On some days I see up to 60 patients who have come to the hospital to renew their treatment.”

The fact that hundreds of thousands of patients do not yet have access to the treatment they need to survive is also down to a lack of financing. HIV/AIDS care accounts for almost half of the Ministry of Health’s budget (78 million dollars from a total of 138.7 million). MSF teams observe frequent stock shortages of drugs, due to technical reasons or a lack of funds. “International funding, from the Global Fund in particular, is becoming more and more limited, be it for Mozambique or for other countries affected by HIV/AIDS and tuberculosis epidemics, which are often linked,” explains Mariano Lugli. “Sadly, despite its noteworthy efforts, Mozambique cannot make it without further commitment from international backers.”

By Phillipe Latour, Communications Officer