07/07/2006

UN Special Envoy Visits Dream Centres

In 2002, Ana Maria was approaching death.

She weighed 29 kilos, and could scarcely walk.

It seemed that she was in the terminal stages of AIDS. Her CD4 count was down to a vanishingly small 24. (CD4 cells are the part of the human immune system attacked by the HIV virus - a healthy person should have between 500 and 1,000 of them per cubic millimetre of blood).

Ana Maria was taken to the general hospital in the Maputo suburb of Machava - which accommodates one of the DREAM (Drug Resource Enhancement against Aids and Malnutrition) centres set up by the Italian NGO, the Sant'Egidio Community.

She did not die: she was put onto a cocktail of anti- retroviral drugs, and today looks as healthy as any other Mozambican woman.

She was among a group of AIDS activists at Machava who met with Stephen Lewis, the special representative on HIV/AIDS of UN secretary general Kofi Annan, when he visited the DREAM centre on Friday, accompanied by Mozambique's former first lady, Graca Machel. Today Ana Maria is an outspoken woman who mobilises others.

She is one of an association of HIV-positive women who travel around Maputo province speaking to other women about the disease, how to prevent it, and how to treat it.

Her life has not been easy. "My husband left me when I fell ill", she told Lewis. "He left me to look after seven children".

Officials from the Sant'Egidio programme told Lewis that the DREAM centres now provide anti-retroviral therapy for 8,000 people - which is almost a third of all those undergoing this treatment in Mozambique.

A further 16,000 HIV-positive people, in whom the disease has not reached the clinical stage where anti-retrovirals are appropriate, are being monitored, and receive nutritional support, and treatment for opportunist infections).

The DREAM experience over the past four years has proved that in Africa, just as in the rich countries of the north, AIDS no longer need be a death sentence, and activists like Ana Maria are the living proof of this. The anti-retroviral drugs convert the disease into a chronic, but manageable condition.

It has also given the lie to the claim that Africans, because of poverty or illiteracy, will be unable to follow the strict regimen necessary for success. Fears were once expressed that Mozambican patients might not take the drugs regularly, and that slipping off the regimen might lead to strains of the virus developing immunity to the drugs.

But 95 per cent of the DREAM patients have adhered to the treatment. Sant'Egidio says this is the highest figure in sub- Saharan Africa, and as good as, or better than treatment schemes in Europe or the United States.

A couple of kilometres away, Lewis visited a maternity ward in the city of Matola. Here the DREAM programme tries to ensure that every child born is HIV-negative, regardless of the HIV status of the mothers.

Half a dozen healthy children, all born to HIV-positive women, were among the welcoming party outside the ward.

Health staff confirm that nowadays all babies born to women in the DREAM programme are HIV-negative. Sant'Egidio has achieved this by abandoning the use of just one anti-retroviral, nevirapine, for pregnant women.

Instead, all HIV-positive women, regardless of their CD4 count, are given the full cocktail of three drugs (contained in a single pill) as from the 25th week of pregnancy. This is continued until six months after the birth - unless the woman's CD4 count is already down to 200 or less, in which case she will be on the drugs for the rest of her life.

To make quite certain, the new born infant is given a single dose of nevirapine.

Here 1,500 babies have been born free of HIV to infected mothers. Lewis noted that, even on a nevirapine only treatment, let alone no treatment at all, several hundred of these infants would have developed AIDS and would have died.

Currently there are 13 DREAM centres in Mozambique, including three molecular laboratories (in the Maputo, Beira and Nampula central hospitals) which can carry out the CD4 count, and measure viral loads.

Sant'Egidio staff put the full cost of the programme (much of it met by the World Bank, and by Italian companies) at three million US dollars a year. "It's a very small amount", commented Lewis.

After his visits, Lewis described DREAM as "one of the most intelligent and advanced projects I have ever seen".

"Mozambique faces a serious AIDS crisis, but there are pockets of hope, and this is one of them", he told reporters.

"The country is in serious trouble because of lack of treatment.

But Sant'Egidio shows that treatment can be made available, if they can expand fast enough".