HIV: Still an epidemic

While HIV is treatable, the delivery of care remains challenging in Mozambique and other countries 

It has been one of those 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 anaemia. 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 human immunodeficiency virus (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 is 13 per cent of the population and young people are particularly affected. I am a doctor with the Médecins Sans Frontières/Doctors Without Borders (MSF) medical focal point for HIV and tuberculosis in the north of Mozambique in the Cabo Delgado district. MSF is currently the only organisation providing HIV care here.

Nowadays, HIV is easily treatable with antiretroviral (ART) drugs. 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 it can no longer be 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 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 travelling to the few health posts  available – 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.

The HIV situation in Mozambique and other countries is not under control and we are still battling an epidemic in many places

If left untreated, HIV is only the first disease

A HIV infection severely weakens the body and the immune system. People who carry the virus are therefore very susceptible to other diseases. And a patient suffering with other issues at the same time is more complex to treat.

One of my patients is HIV-positive 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 anew. So, we are treating her tuberculosis and her 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 stigmatisation of the infection in society. For those affected, 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. We send the children’s samples to the laboratory in the city of Pemba, 419 kilometres away. Sometimes it takes months to receive their results. Especially for children under 18 months, the World Health Organisation recommends a polymerase chain reaction 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 rarely 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 and petition to get the manufacturer to lower the prices of their GeneXpert tests.

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 centre 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. Take 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 to take their medication every day.