HIV: still an epidemic
I work for Doctors Without Borders/Médecins Sans Frontières (MSF) in Mozambique and am the focal person for HIV and tuberculosis in the district Cabo Delgado.
It has been one of these weeks. We admitted three children as inpatients at the same time. The youngest is just one year old and is severely malnourished. Of the other two (six and seven years old), one is seriously ill with malaria and the other suffers from anemia. The grandmothers who brought the children to our hospital in La Palma in the north of Mozambique report that they have lost their mothers. When we tested them for HIV, it turned out that all three are HIV-positive.
Despite good medication, treatment is a challenge
Here in Mozambique, 2.4 million people are living with HIV, that’s 13 per cent of the population – and young people are particularly affected. I am a doctor and Doctors Without Borders/Médecins Sans Frontières (MSF) medical focal point for HIV and tuberculosis in the north of Mozambique in the Cabo Delgado district. MSF is currently the only organization providing HIV care here.
Nowadays, HIV is easily treatable – with antiretroviral drugs (ART). However, it is important that people stay on ART for the rest of their lives. The level of virus is then reduced to such an extent that the virus can no longer be sexually transmitted and those affected can lead a relatively unrestricted life.
This may sound simple, but it is a challenge here in Mozambique, as in so many other countries. My colleagues in Guinea, Pakistan, Malawi, Uzbekistan, India and the Democratic Republic of the Congo face the same or similar challenges in treating people living with HIV as we do here in Mozambique.
On the one hand, there is a lack of adequate healthcare in many places. In remote regions in particular, people spend hours traveling to the few health posts – or there is no medical care at all. On the other hand, recurring armed conflicts in many regions make it difficult to guarantee continuous care. And the violence prevents people from accessing medical care structures.
If left untreated, HIV is only the first disease
An HIV infection severely weakens the body and the immune system. People living with HIV are therefore very susceptible to other diseases. And a patient suffering several diseases at the same time is correspondingly more complex to treat. Like, for example, a woman I have been accompanying for a long time, let us call her Amina*.
Amina* is living with HIV and lost her son to the virus last year. She had started treatment with ART but did not manage to take the medication continuously. Now she also has tuberculosis. Being pregnant again, she is motivated to start her treatment.. So, we are treating her tuberculosis and HIV – if things go well, the child will be born HIV-negative.
When treating our patients, we are not only fighting against a virus, but against a whole range of factors: there is still a lot of misinformation circulating about HIV. Our country’s culture also plays a significant role here, as many patients first go to a traditional healer before turning to conventional doctors. Adding to the challenging situation is the stigmatization of the infection in society. For those living with HIV, it often means being shamed and excluded, which in turn can have serious consequences for people’s mental health. We therefore put a focus on health promotion, working closely with the communities and have also established relationships with traditional healers.
In the beginning is the test
Before any treatment a diagnosis is needed. Even though there would be a quicker and simpler solution, we send the children’s samples to the laboratory in the city of Pemba, 419 kilometers away. Sometimes it takes months for our little patients to receive their results. Especially for children under 18 months the WHO recommends a PCR test, such as the GeneXpert test from pharmaceutical manufacturer Cepheid. These tests are easy to use and provide an accurate result for HIV, tuberculosis, hepatitis and many other diseases very quickly. However, they are hardly available here in Mozambique, as in many other low- and middle-income countries, because the tests and the machine that runs them are very expensive.
The HIV situation in Mozambique and other countries is not under control and we are still battling an epidemic in many places. But how can we contain the virus if we can’t even test everyone for it?
We do what we can
To change this, we at MSF have launched a campaign to get the manufacturer Cepheid to lower the prices of their GeneXper tests. You can support us in this: Sign the petition now!
Meanwhile, my team and I are doing what we can. Together with our colleagues from the Ministry of Health, we are treating people at the health center in Palma. We test people and distribute drugs. We carry out follow-up examinations, provide information about the disease and offer psychosocial support. And we locate people whose ART treatment has been interrupted in order to provide them with ongoing HIV care.
I am lucky and privileged to work with a highly motivated team that tackles the many challenges and saves lives every day. And I focus on what is possible – what can still be done. Like the three children who have just arrived here. Once their malnutrition, malaria and anaemia are under control, they will be put on ART and their grandmothers will be given all the information they need to ensure that they continue their HIV treatment when they return home and take their medication every day.
*Names changed to protect identity.
