According to a 2008 UNAIDS report, an estimated 33.2 million people are living with HIV/AIDS. Africa has been the hardest hit by the HIV/AIDS pandemic, as the continent is home to an estimated 22.5 million (68 percent) of those infected. Antiretroviral drugs (ARVs), which significantly delay the progression of HIV to AIDS and allow people infected with HIV to live relatively normal, healthy lives, are available on average to only 44 percent of those who require the drugs. Because of the limited number of ARVs available, the AIDS epidemic in sub-Saharan Africa claimed the lives of an estimated 1.6 million people in 2007. These deaths left 12 million children orphaned.
The extent of the HIV/AIDS crisis is only now becoming clear in many African countries as increasing numbers of people with HIV are becoming ill. If larger numbers of ARVs are not made accessible soon, the AIDS death toll and number of orphans is expected to rise. Many African countries are losing their working class, adults age 15 to 49, to this devastating disease.
Antiretroviral Therapy
Direct Relief has partnered with OGRA Foundation in Kenya and the Ministry of Health and Child Welfare in Zimbabwe to distribute ARVs to more than 6,000 HIV-infected people annually. Since the beginning of 2008, almost 2.6 million pills—enough to treat 1,775 people for a year—have been delivered to Kenya. And in Zimbabwe, the more than 5.7 million pills sent to that country provide treatment for 3,905 people for a year. These people are not just statistics; they are parents, friends, breadwinners, and loved ones who will survive another year, thanks to ARV therapy. Our desire is to see this program expand in Kenya and Zimbabwe until all who required the life-saving drugs have access to them.
Determine® Rapid Test Kits
Every 48 seconds a child is infected with HIV. This is a profound human tragedy whose primary case is preventable. Without medical intervention, the chance that a pregnant woman will transmit the virus to her baby is as high as 30 percent, but with proper testing and treatment, this chance can be nearly eliminated.
Direct Relief and corporate partner Abbott are working to remove the barriers to HIV testing of pregnant women. In 2007, Direct Relief began distributing free, Abbott-donated Determine® HIV rapid testing kits in 32 developing countries. Between 2002 and 2007, Abbott has donated more than 9.8 million rapid HIV tests to prevention programs throughout the developing world.
In many developing countries, Direct Relief distributes the test kits through with Ministries of Health and other major healthcare networks running prevention of mother to child transmission (PMTCT) programs. The test is quick—results take 15 minutes—and requires no electricity or water, making it ideal for areas that lack reliable access to these resources. If a pregnant woman tests positive for the virus, the testing healthcare provider can take the necessary steps to help protect the baby from infection.
The Rwanda Ministry of Health, one of the first to subscribe to the program, has already tested 750,000 pregnant women. In Kenya, where UNAIDS estimates that 8.3 percent of adult females are HIV positive and 117,000 children younger than 14 are infected, Direct Relief partner Elizabeth Glaser Pediatric AIDS Foundation has tested 177,000 expectant mothers, 8,600 of whom were HIV-positive.
Hospice and Home-Based Palliative Care
Hospice and palliative care in Africa was adapted from the western hospice model to cope with an impossible clinical overload of inpatient facilities. The HIV/AIDS pandemic has crippled the hospital services that are underequipped, understaffed, and incapable of coping with large numbers of patients. Neither the hospitals nor the patients can afford the cost of inpatient treatment, so hospice and home-based palliative care providers have emerged as the only solution for patients who are too sick, poor, or isolated from the hospitals to receive the care they require.
African palliative care providers are using the WHO definition of palliative care: “An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” Palliative care aims to provide relief from pain and other symptoms so patients can live as fully as possible until death. The hospice networks use home-based support groups to enhance the patient’s quality of life while simultaneously helping the family cope with the illness and eventual death.
These home-based palliative care providers have proven essential in the fight against the HIV/AIDS pandemic. The February 28, 2008 issue of the Lancet reported that “the implementation of home-based care could significantly reduce mortality among adults living with HIV/AIDS in developing countries, as well as children within their families.” (BBC News, February 29, 2008) Many of these groups employ trained palliative care doctors and nurses who are directly involved in testing for and treatment of HIV and are authorized to dispense antiretroviral therapy (ART) treatment to enhance and prolong the lives of HIV-positive patients. They are also involved in preventing opportunistic infections and ameliorating the pain and discomfort that HIV patients live with daily.
Direct Relief International is providing home-based palliative care providers with the products they need to assist HIV/AIDS patients. These products include rapid HIV tests, pain relievers, antibacterials, antifungals, soaps, diapers, mattresses, vitamins, nutritional supplements, wheelchairs, and walkers. Direct Relief distributes these items to hospice sites approved and accredited through the African Palliative Care Association (APCA) or the Hospice and Palliative Care Association of South Africa (HPCA). We are currently supporting 16 sites in South Africa, Zimbabwe, Uganda, and Kenya, and are looking to expand our support.
The map below (source: South Africa Ministry of Health) illustrates the severity of the crisis in South Africa alone. It depicts the rate of HIV and syphilis infection among antenatal women in that country.
South Africa 2008 National Antenatal Sentinal HIV & Syphilis Prevalence Survey (Source: South Africa Ministry of Health)