Some medicine

As much fun as it has been learning about a new culture the main reason I came here was for the medicine. So far it has been mostly ups and a few downs- but the obvious place to start is with the HIV programme where I spend most of my time. The background as many people know is that there is an epidemic of HIV/AIDS in Southern Africa. The good news is that there is effective treatment for HIV and there is money available from various sources to pay for it. The challenge therefore is effectively distributing the drugs. The first challenge is for people to test for HIV and part of the programme is a ‘Voluntary Counselling and Testing ’ approach which uses various methods including attending public gatherings to encourage testing.

Once tested people can join the programme but of course this is also voluntary and not everyone joins. Once selected as needing the drugs the main problem is how to get people to take the medicines properly. Basically, people need to take tablets twice a day 12 hours apart every day and more than likely for the rest of their lives. If they take the tablets chaotically the HIV will become resistant to the drugs and will become difficult or impossible to treat and people will go back to square one. Patients with resistant HIV may also pass this to other people who themselves will be difficult to treat from the outset which would be a disaster. If you read the Daily Mail this would be like developing the ‘HIV super-bug’.

It is difficult for most people to finish a course of antibiotics let alone comply with these measures and in particular many of the patients are illiterate and have never used a clock or a calendar before. To address this problem the programme has formed a series of support groups; they are run by local people and involve a gathering, usually once a week, when they talk about and are educated about these issues and also get something to eat and drink. Anyone without a clock is given one, everyone has a treatment partner to help them and they are strongly encouraged to disclose their status to their family because keeping the drugs hidden from people in their tiny houses would only lead to chaotic drug taking.

The programme is exactly 2 year old, so far about 700 people have been put on medication and there are a further 700 who are on the programme but so far don’t need the drugs. There is no waiting list to start drugs and currently we are starting about 10 per week. This is scratching the surface of the problem but it is a good start. As you can gather it is a major undertaking and in some ways is more like a business than a hospital but there are no half measures. People are either taught how to take the drugs correctly and are supported so that they can continue to do so or we are wasting our time. So far the results have been really good, only a handful of people have been lost to follow-up and less than ten have developed resistant virus. The challenge ahead then is to sustain the early success and to allow the programme to grow without compromising on quality.