Nuturing Hope

MOZAMBIQUE:
“AIDS Sharply Cuts Life Expectancy in Mozambique”
Reuters (09.03.04)::Mateus Chale
Life expectancy in Mozambique has dropped sharply due to HIV/AIDS, threatening the government's ongoing reconstruction following the 1992 end of its 16-year civil war, Health Ministry officials said Friday. This year, life expectancy at birth is estimated at 38.1 years, compared to 46.4 years without the presence of HIV/AIDS, a Health Ministry report said. By 2010, life expectancy could drop to just 35.9 years. “We need to act to reduce the speed of the growth of HIV/AIDS, which is a huge development challenge,” said Health Minister Francisco Songane. “These are figures… that remind us of how serious we should face this fight.”
The report called for “immediate and effective” action to control the AIDS epidemic
in Mozambique, where 1.4 million of the country's 18 million people are
HIV-positive. HIV prevalence in the key 15- to 49-year-old group jumped to 14.9
percent from 13.6 percent in 2002, the report said. It projected that figure
will reach 16.8 percent in five years and would likely stabilize around those
levels.
Health Ministry officials noted that HIV prevalence was much higher
in urban centers than in remote areas of Mozambique. In the port city of Beira,
HIV prevalence is around 35 percent, compared with 8.0 percent in northern
districts on the Tanzanian border.
Songane said that about 8,000 of the 218,000 patients in need of AIDS medicines could benefit from the government's program to distribute free antiretroviral drugs. The number receiving drug therapy will rise to 58,000 patients in 2006 and 132,000 by 2008, he said.

Most of the images and stories we receive of Africa in the US can be divided into two categories: the exotic and the dismal. Between the depictions of tribal ceremonies and distended bellies, it’s nearly impossible to get a good idea of what African life is really like from the US media. I could write hundreds of pages on what I’ve already seen and learned, but I’ll try to give you a taste that fills the void between the hopelessness and the sensationalism that characterize the media coverage.

Over the past three weeks I’ve been to 6 of the country’s 16 day hospitals for HIV treatment. Invariably, they are overflowing with expectant patients hoping to finally get life-saving treatment. The Mozambican Ministry of Health began making drugs available at no cost only a few months ago. Widespread HIV Testing has been available for just over a year. Estimates are that only about 1% of the population has been tested so far, but now that treatment is available, numbers are slowing increasing. The whole health system is being retooled from offering only solace to providing hope. At 8 am at the Beira Day Hospital, there is barely room to move through the narrow waiting room. Every available seat is occupied and some sit cross-legged on the floor. On one of the wooden benches, a man lies curled under a capulana, the brightly colored fabrics that are used as skirts, shawls, baby-carriers and blankets. He is too weak to lift his fragile, wasted frame. But most of those quietly waiting in the concrete-walled room are not obviously ill. Almost half of the 50 or so people here this morning are women with babies, some breastfeeding as they wait for their CD4 results.

Treatment is based on a protocol which depends heavily on CD4 counts (CD4s are the type of white blood cell attacked by HIV). Those with counts under 200 get triple drug anti-retroviral therapy, those with higher counts are given prophylactic medications and told to follow up in a few months, or if they develop symptoms. Higher counts are a good thing, it means the virus hasn’t yet ravaged the immune system and the drugs aren’t needed, but it’s proving hard to explain. People are often disappointed to leave the day hospital empty-handed.

I’ve also spent a good bit of the past few weeks making the rounds with all the institutions and agencies that are here to help. So far the list includes the CDC, USAID, The World Bank, UNICEF, WHO, MSF, and various and sundry other NGOs and US academic centers. Each one has its own modus operandi and its own concept of what’s needed. In the middle of it all, the Mozambican Ministry of Health has to balance the competing political interests and keep the donors happy without getting bowled over--all while working to build a complex health care and drug distribution system with scarce resources. So far, they’re proving an example for many other African countries. Health Minister Songane was featured in a recent New York Times article for standing up to USAID and refusing to buy expensive brand-name drugs in place of the generics that cost thousands of dollars less. The cost difference can be easily measured in lives saved. One year of the generic, twice-a-day triple therapy pill is only $140. Brand name regimens can cost 10 times as much or more.

This weekend, back in Cleveland, many of you will be at the AIDS walk in Edgewater Park. Keep the Mozambicans in mind. I’ll be having my first weekend off since I arrived, probably sitting on a beach watching fishermen paddle their dugout sailboats (called dhows) out to sea in the morning and sail back in the late afternoon. Maybe I’ll even convince one of them to give me a dhow sailing lesson.