Maputo — Hundreds of HIV-positive Mozambicans and their supporters marched through the streets of Maputo on Monday in protests against the decision by Health Minister Ivo Garrido to close the "Day Hospitals" that catered exclusively for HIV/AIDS patients.

They marched for two kilometres down one of Maputo's main thoroughfares, Eduardo Mondlane Avenue, singing and waving placards against the measure, in force since March 2008. The march ended at the Health Ministry, where a message was delivered to Garrido.

"We want to express our indignation at the closure", said Cesar Mufaniquice, coordinator of the Movement for Access to Anti-Retroviral Treatment in Mozambique, who read out to the crowd the message delivered to the Minister.

There used to be 23 Day Hospitals, operating out of health units across the country. In March 2008, Garrido ordered their closure, and the integration of HIV/AIDS patients into ordinary hospitals. At the time, the Minister argued that the Day Hospitals were counter-productive, because they worsened the stigma against HIV-positive people, and became "foci of discrimination".

But the AIDS activists say that this was a mistake, and that in reality they are suffering more stigma now than previously. Furthermore, when they are mixed with patients sufferings from other diseases, they find that the health professionals do not have the patience to care for them appropriately.

They say that with the transfer to normal hospitals, medical files have gone missing, which has led to several HIV-positive patients interrupting the life-prolonging anti-retroviral treatment.

Others say that, although they are receiving treatment, this is far below the level of care at the Day Hospitals, where they had benefited from personalised treatment, and had been able to accompany, step by step, progress in their viral load.

The activists accuse Garrido of failing to consult with anybody about the advantages and disadvantages of the measure. They called him "a dictator, because he decided to close the Day Hospitals without prior consultation with civil society, or with the patients, and much less with the medical staff".

Speaking to AIM, Percina Narsone of the DREAM programme of the Italian NGO, the Sant'Egidio Community, one of the main organisations providing anti-retroviral therapy, said that the closure of the Day Hospitals had made the problem of access to anti-retrovirals more serious, particularly for those patients transferred from the Day Hospitals to the ordinary hospitals.

"The patient has no information about his health status, and often the medical staff don't have it either", she said.

Worse still, the state-of-the-art molecular laboratory that the DREAM programme used to run in Maputo Central Hospital, which carried out tests on patients' viral loads, has been closed. Currently the tests are done abroad, with longer delays and thus less efficiently.

DREAM has been able to keep its own Day Hospitals operating, but their managers do not know what their future will be. Many AIDS patients have been trying to join the DREAM programme, but some have been turned away because the programme managers do not know how long it will continue.

"The Day Hospitals were a genuine centre of excellence, a centre of human dignity", said the message to Garrido.

After receiving the message from the activists, the Minister said it was always his intention and that of the government to care for sick people, and never to damage their interests.

Garrido said that in 2005 there were just 6,000 HIV-positive people receiving treatment in 12 Mozambican health units. Now the number had risen to over 145,000 patients treated in more than 200 units.

"In the shift from 6,000 to over 140,000 patients, it's normal that problems happen", said Garrido. He promised that his team will continue to care for HIV-positive people, and will work to find a solution to the problems raised by the activists.