04/08/2004

ANTI-RETROVIRAL DRUGS: FROM DREAM TO REALITY

Maputo, 4 Aug (AIM) - The largest AIDS treatment programme in Mozambique, that funded by the Italian NGO, the Sant'Egidio

Community, claims a spectacular success rate, with 95 per cent of its patients still alive, and enjoying a good quality of life.

Paola Germano, the coordinator of the Sant'Egidio programme,

called DREAM (Drug Resource Enhancement against AIDS and Malnutrition), declared on Wednesday that the DREAM patients, treated with anti-retroviral drugs, had proved that "AIDS is no longer a death sentence".

She was speaking at the opening of a three week pan-African

training course on AIDS treatment, organised by the Sant'Egidio

Community. In addition to Mozambicans, the course is attended by health staff from Malawi, Tanzania, Angola, Guinea-Bissau, Guinea-Conakry, Ivory Coast, Rwanda, Togo and Equatorial Guinea.

The DREAM programme began in Mozambique in March 2002, with 50 patients. Germano recalled that these were people "who had nothing to lose. They were desperate, they had the illness written on their faces, and so had been abandoned by everyone".

Within two or three months, "these patients began to be transformed", she said. "We witnessed real resurrections. We saw women who had been abandoned on mats in their huts regain their weight, rising from 29 to 70 kilos, and begin looking after their children again".

"We saw extremely ill men, who could no longer walk, prostrated not only by the disease, but also by the humiliation of their inability to do anything for their families - we saw them stand up, begin walking again, and regain their dignity. Today, for many of them, their problem is finding a job", she said.

Furthermore, fears that Africans would find the regime of anti-retroviral drugs too difficult to follow proved unfounded.

Compliance with the drug regime in the DREAM centres, Germano said, is higher than with patients on similar therapy in Italy or the United States.

In two years, the DREAM centres had tested 11,000 people, 5,600 of whom had proved HIV-positive. Of these, 2,250 are in need of, and receiving, anti-retroviral drugs.

As for pregnant women, the DREAM programme opted to try to

save, not merely the baby, but the mother as well.

"The objective is to ensure not only that the baby is born without AIDS, but also to keep it healthy through breast milk substitutes (since the mother's milk can carry the virus), and

above all to save the mother's life", stressed Germano. "In Africa orphans, even if they don't have AIDS, have a short life expectancy. It's the mother's survival that makes the difference".

So instead of the standard treatment of only one drug, nevirapine, given to the mother just before, and to the baby just after birth, the DREAM centres also give the mother the three-in- one generic anti-retroviral, and continue this treatment after the birth.

Obviously this was more expensive, said Germano, "but how much do the 800,000 AIDS orphans that everybody talks about cost in economic, social and human terms ?"

654 children had been born to mothers in the DREAM programme. 97 per cent of these babies were born free of HIV. And despite the HIV status of their mothers, these children enjoyed better health than the average Mozambican baby.

Infant mortality in Mozambique stands at 212 per thousand live births. But among the DREAM babies it has fallen to 50 per 1,000. (It should be added, however, that the sample is too small to make definitive conclusions. Also the fact that the DREAM programme also provides poor households with food supplements and water filters doubtless contributes towards keeping children alive.)

The DREAM programme has now expanded into Malawi. Germano said that treatment began six months ago for 350 patients in Blantyre and Lilongwe.

Germano criticised past attempts by international agencies to devise AIDS strategies that were "exclusively preventive". But

these had failed to check the spread of the disease. Furthermore some 30 million Africans were infected with HIV: prevention could not be the only response, she stressed, for, if it were, then those 30 million people were condemned to death. One of the Italian specialists giving the course, Prof Carlo Perno, tackled the cost argument. In 2003, he said, the average cost of a DREAM patient was 400 euros (about 500 US dollars) -and this included the drugs, staff costs and food supplements.

But without AIDS treatment there are all sorts of other costs - notably the expensive treatment of opportunist infections for patients in the terminal stages of AIDS, and the fact that patients in this condition occupy an increasingly large percentage of Africa's hospital beds. There were also huge costs to the economy as workers sickened and died.

One man who has come to symbolise DREAM's success is Isaias Joao. He was close to death when he began anti-retroviral treatment. A video shown on Wednesday depicted Isaias wasting away, scarcely able to move, lying on what he must have imagined was his death bed: the film then flashed forward a few months to show a fully mobile, healthy and smiling Isaias, living witness to the effectiveness of the three-in-one anti-retroviral therapy.

Isaias was also present at the opening of the course. He received a round of applause from the participants and a warm embrace from Joana Mangueira, executive secretary of Mozambique's National Council for the Fight against AIDS (CNCS).

Isaias, she said, enshrined the spirit of hope and struggle, and "the determination that life not be defeated".

"Today, DREAM is not just a dream, it's a reality" Mangueira declared.

Dr Mouzinho Saide, head of the Health Ministry's national AIDS programme, also welcomed the DREAM programme which he

described as "fitting into the Ministry's plans".

The Sant'Egidio Community, Saide said, was playing an

important role "in successfully improving the health status of

our people".

He stressed that the government was committed to greatly expanding the numbers of AIDS sufferers receiving anti-retroviral therapy. By 2008 the numbers should have risen to 132,000 (the target for the end of this year is just 8,000).

Paul Fauvet