Residents from one of South Africa's poorest townships have destroyed the myth that Africans cannot be trusted with AIDS drugs in the most dramatic way -- by staying alive.
Dozens of adults and orphans with the HIV virus have set a precedent by following a medical regime that some governments and pharmaceutical firms said was not feasible in Africa.
Pilot projects in Cape Town that have dispensed treatment usually limited to the West have reported extraordinary results, boosting the case for an extension of the treatment across the continent.
PHOTO: NY TIMES
Sceptics have long argued that poor Africans, many of whom lack watches and literacy, would break the strict regime of taking certain pills at certain times, risking the emergence of a drug-resistant strain of HIV.
But some of Cape Town's most destitute and sick have disproved this by adhering to the treatment better than patients in the West and returning from the brink of death.
The authorities in Western Cape now hope to extend the treatment across the province in what could become a model for the rest of South Africa -- which has five million sufferers and sees at least 600 deaths a day.
Among those included in the pilot project are orphans at an AIDS hospice sponsored by singer Elton John, British Prime Minister Tony Blair and his wife, Cherie. Providing the drugs was the initiative of the One To One Children's Fund, a British charity, and the non-governmental organization Medecins Sans Frontieres (MSF). Known as anti-retrovirals, combinations of the drugs need to be taken twice a day.
Since launching in May 2001 in Khayelitsha, a crime-ridden and impoverished township outside Cape Town, the MSF project has put 360 people on treatment. Concerns that patients would drop out or share pills with sick relatives have evaporated, with more than 90 percent following the regime.
`Incredible' response to drugs
Within six months of treatment the average patient gained 8.8kg in weight and their viral load -- the level of HIV in the blood -- dropped below the rate of detection.
"The response has been incredible. These adherence rates are better than you would get in the US or the UK," said an MSF spokeswoman.
"I think the reason is two-fold. People in Khayelitsha know how lucky they are to get treatment; and they've seen people die of Aids," she said.
To receive anti-retrovirals a patient must live in the township, have a stable home environment and have disclosed their HIV positive status to at least one other person.
One of the new patients was Esther, 34, who sat in a hallway clutching a plastic bag. When she recovers she hopes to resume work as an office cleaner.
"Earn money, have a good life, I can have it back," she smiled.
Building on existing state-run clinics, MSF hopes to expand the treatment at Khayelitsha and start a rural scheme in the Eastern Cape.
Controversial
project
The pharmaceutical industry, under pressure to lower prices in Africa, has argued that the continent's health systems are too basic and patients too uneducated to use the drugs responsibly.
South Africa's government has cited the same excuse for not rolling out anti-retrovirals, but many believe the real reason is President Thabo Mbeki's controversial view that the drugs are toxic.
MSF is breaching patent law by importing generic drugs from Brazil, but neither the government nor the pharmaceutical industry -- fearing bad publicity -- has intervened.
Project workers have also found anti-retrovirals to be viable in the treatment of children, with only 10 out of 94 of the youngsters being treated at Cape Town's Groote Schuur hospital dropping out.
"We used to have mothers in the ward rehearsing for the death of their child but that doesn't happen any more," said Paul Roux, a pediatrician. "There is no reason, with anti-retrovirals, why these children could not grow up to see their own children graduate from college."
Some of the mothers with HIV have also started receiving treatment, fleshing out what had been skeletal frames. Cradling her two-year-old son, Nomava, 20, said: "I thought we would both die soon, but now I want to become a civil engineer and watch him grow."
For Nazareth House, a home for orphans with HIV, things will never be the same. Sister Agnes Abrahams pondered the implications: "We will have to learn to talk about the future -- even to talk to them about sex."
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