Malawi has one of the world’s highest rates of HIV/AIDS, with 10.6 percent of people between 15 and 49 today affected by the virus1 . HIV/AIDS is the main cause of death in what should be the country’s most productive age group. The epidemic is the leading cause of death amongst adults, reducing life expectancy to just 43 years. The majority of HIV infection occurs amongst young people, and the rate of HIV prevalence is higher amongst women than men.

In 1997, MSF started its programme in the rural district of Chiradzulu, in the south of the country, which is home to more than 290,000 people (NSO, 2006), and where today 14.5 percent of the population between 15 and 49 is infected with the HIV virus (17.5 percent of women and 11 percent of men). At that time, as no ARV drugs were available in the country until 2001, MSF was focusing on the treatment of opportunistic illnesses and palliative care at the district hospital and on prevention of infections.

In 2001, MSF began providing antiretroviral (ARV) treatment and follow-up at the district hospital, giving priority to the sickest patients in danger to die. The first patients were placed on ARV drugs in August 2001.

The programme was designed to demonstrate that ARV drugs could be provided in low-resource rural contexts, where they would prolong life and allow people to regain their autonomy. The aim was also to show that those patients are able to follow a life long treatment. Although no one believed this could be achieved, MSF took up the challenge. Since MSF’s ARV treatment programme began in 2001, more than 52,000 patients were followed by MSF teams. Today, more than 55% of the patients who started treatment in 2001 are still actively followed as well as alive and healthy

By September 2011, MSF is still following 30,000 HIV positive patients in the project. Not all patients are eligible for treatment, only those with a severe reduction of their immunity need to start treatment. Today 22000 patients are receiving ARV treatment in Chiradzulu, 12.5 percent of whom are children. Over the last three years, approximately 3,000 new patients were integrated in the project annually.

The Chiradzulu programme is one of MSF’s largest HIV progammes, with an average of 175,000 medical visits and 50,000 counselling sessions held every year.

MSF was a pioneer in this fi eld, and MSF’s patient cohort is the most long-standing in the country. The project has already shown that when treatment is adapted to local conditions and supported by human and fi nancial resources, rural health systems can effectively provide comprehensive HIV/AIDS care. The project has allowed many more people who were bedridden to get back on their feet and resume productive lives.