The first sign of hope for a community devastated by the overwhelming effects of the AIDS pandemic came with the opening of a first-of-its-kind treatment facility in Durban, South Africa, Aug. 30.
The clinic is the product of an international partnership between two AIDS organizations and will work to establish the first long-term treatment of AIDS patients in that country's hardest-hit region.
In the presence of two U.S. Congresswomen and numerous AIDS advocates, the clinic, known as Ithambalabantu (Zulu for "people's hope"), opened its doors along with the hearts of those whose vision had become reality. School children waved American and South African flags, belying tensions that still exist from Apartheid, as the Premier of KwaZulu Natal committed the government to treating people with AIDS.
"Even though it's a small project, there's a feeling of hope," said Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation (AHF). "There's a feeling that the voices of the people of South Africa need to be heard."
The idea for the clinic started with a plea for help during the 13th International AIDS Conference held in Durban, the largest city in KwaZulu Natal Province, in July 2000. Nomaswazi Mlaba, director of Network of AIDS Communities of South Africa (NetCom, SA), a nongovernmental organization (NGO), heard that Weinstein was speaking at the conference about the difficulties associated with AIDS treatment in that country. Desperate for the support she was sure he could provide, she tracked him down and had a friend slip a note under his hotel room door.
"She told him South Africa was ready to work with AHF and other NGOs," said César Portillo, chief of public affairs for AHF. "Had she not pursed that, this whole partnership would never have happened."
The partnership between NetCom, SA and Global Immunity, the international division of AHF, was solidified last November when delegates from several NGOs in South Africa, including Mlaba, came to the United States on an AHF-sponsored visit. The delegates told stories about a difficult fight against a crushing epidemic in a country where there is little government support and few resources. At the end of the two-week visit, the two organizations decided to facilitate a community-based demonstration project in Durban, where it is estimated that one in three people are HIV-positive, the highest infection rate in South Africa.
The Ithambalabantu clinic is the first real attempt at implementing treatment using the AIDS cocktail--highly active anti-retroviral therapy, or HAART--in a resource-scarce environment. Many obstacles had to be overcome to open the clinic, which will address several important issues so that widespread treatment can begin.
"Before we can build a big system, we have to have an example of what we can do," Weinstein said. "We hope that in six months we'll have enough data so that this can be duplicated."
In the first year, the demonstration project will gather clinical and behavioral data by treating an initial 200 patients. Problems with adherence, drug combinations, and determining when and how to initiate therapy will be worked out. Additionally, a financial analysis will establish what it costs to treat patients in that community.
In the second year, the addition of 300 patients will expand the research and analysis while incorporating lessons learned from the first year to maximize treatment success. In its third year, the clinic will transform from demonstration project to full-fledged outpatient health care center--a hopeful sign in a community still dealing with a powerful stigma around AIDS.
Opening a clinic of this type in South Africa was an intimidating task, said Terri Ford, director of prevention programs at AHF. Not only did they have to deal with the prejudice of white contractors and suppliers, who refused to come to the predominantly black township where the clinic is located, they had to assure the clinic's volunteers that AHF would not leave them unsupported after it opened.
After weeks of searching for a site, Ford chose a space in a strip mall in the Umlazi Township of Durban, where she had to convince the landlord it was a good thing.
"The clinic is in a perfect location to become part of the community," Ford said of the socially centralized shopping center. "They [NetCom, SA volunteers] are so dedicated. They don't even have salaries, yet they show up everyday. They would do anything to get this clinic. For them it's life or death."
The next big struggle was picking the criteria to qualify the first 200 patients. In a country where those who reveal their HIV-positive status often face rejection by family and friends, adherence to drug regimes can be a problem. During a community forum held by NetCom, SA and AHF to ask potential patients what they thought the criteria should be, many said they should not be allowed to hide their HIV status.
But one woman begged them not to impose that requirement as it would mean certain rejection by her family. Her commitment to adherence and compelling argument for hiding her status was very enlightening, Ford said. As a result, the clinic may not specify openness in the qualifying criteria.
In an effort to attract such stigma-wary HIV patients, the clinic will offer a variety of health services including STD treatment and education to meet the needs of the entire patient community. HIV-positive patients can then enter under the guise of seeking general health care.
Having traveled to Africa not just for the opening, but to get a sense of the overall AIDS crisis, the delegation of AHF members and U.S. congresswomen visited hospitals, talked to officials and met with a variety of agencies and businesses.
"It was a mission to view firsthand the AIDS pandemic in South Africa," said Burt Hammond, legislative director for Rep. Diane Watson, D-Calif., who joined Rep. Barbara Lee, D-Calif., in representing the U.S. government at the event. "She was there to discuss the whole AIDS issue."
Watson, Lee and other delegates met with officials at the DaimlerChrysler auto factory, where the company is trying to implement its own program to fight AIDS. Having lost countless workers to the epidemic, the automaker wants to work with AHF and others to form partnerships with public and private businesses to develop treatment.
The delegation also went to a hospital in Durban where 600 (50%) of the patients had AIDS. Hammond said that they simply have no treatment for those patients, adding that "the level of infection is incredible. If something isn't done soon, the devastation will be unbelievable."
Some of the delegates were surprised by the awareness of AIDS in a society that has struggled with accepting it.
"You can't pick up a newspaper without a red ribbon on it," Portillo said. "The South African government is not unique in some of the mistakes they have made in prevention messages, but I was struck with how much awareness there is with AIDS."
South Africa's progress in addressing the disease is not indicative of what is happening across the continent. While there are similar infection rates--26 million total cases in sub-Saharan Africa--most other countries do not have the infrastructure found in South Africa, making treatment a virtual impossibility. In countries like Uganda, prevention programs have significantly reduced the prevalence of HIV/AIDS, but a lack of money and hospitals makes treatment there difficult. According to Weinstein, who traveled to Uganda after the opening of the clinic, if 15% of infected people could be treated, the death rate might go down as much as 80%.
While Weinstein and others do not anticipate treatment to become widespread in Africa in the near future, they are encouraged by an activist spirit there.
"The activists remind me of us 15 years ago," Weinstein said, "believing they can make a difference."
He added that our own resolve and success with the AIDS issue in the United States is translating into increased help for Africa. "A lot of the core activists in the United States are turning their attention to this," he said.