Khayelitsha - Community, activists, people living with HIV, health professionals, and local government workers have mobilised themselves over the last two years in Khayelitsha to provide adequate medical care for people living with AIDS - and to break the silence around HIV/AIDS.

Two years ago, in May 2001, the three day hospitals in Khayelitsha - Michael Mapongwana, Site B and Nolungile - started providing antiretroviral therapy to people infected with HIV who need it. The ART took place in HIV/AIDS dedicated clinics run by MSF.

These two years have been full of challenges and experiences, from which we all have learned many lessons: We have observed very good clinical results. People who start taking antiretroviral drugs respond very well to the therapy. In most cases, their viral load drops dramatically to undetectable levels after no more than three months on the ARVs.

Their CD4 count - measuring the strength of their immune system - gets stronger again. They gain weight and feel in general strong enough to carry on with their normal lives. You, the people who take the AIDS treatment, have accepted it very well, and have taken a brave attitude to improve your health. You have taken your treatment, educated your family to assist you, attended support groups to help yourselves and others.

You have also shown an incredible courage to explain your experience to others, to your community and to visitors. You have said loudly that ARVs have worked for you. And that if they work for you, they can work for anyone who faces a similar situation.

The community of Khayelitsha in general, and a growing number of people living with HIV have shown an enormous courage to face the huge burden that HIV imposes on our families and on our friends. Khayelitsha is now more ready to speak loud and clear: "We need to fight HIV together.

And because it is a hard and often painful fight, we need openness and determination. We need to break the silence." The availability of medical services in Khayelitsha that properly care for people with HIV, and that include ARVs as part of the service, has fuelled the effort of the AIDS fighters in and outside of Khayelitsha.

People after receiving medical attention feel cared for, and are more willing to speak about their own experiences. We have built this programme on the stories of many people who felt very sick, sometimes also very lonely, and came to the clinic seeking proper medical care and a caring environment.

Our strong partnership in the fight against HIV has achieved a clear impact on openness and has reinforced responsible behaviours: the number people attending support groups in Khayelitsha has increased dramatically, as well as the number of people willing to be tested, and the number of people willing to use condoms.

We have also learned that the high cost of the drugs can no longer be used as an excuse, and that ARV drugs can be made much much cheaper. Using quality generic drugs, MSF has managed to cut the price of the daily dose of ARVs more than 4 times.

This has shown to us that the prices of the ARVs in the pharmacy are abusive, and that our government should show its commitment to the people of South Africa by buying the drugs for the lowest possible price. The Khayelitsha ARV programme is not only a model of implementation of AIDS drugs for South Africa, it is also a model for the world.

This programme has been described last week by the World Health Organisation as one of the best examples of successful implementation of ARVs in a poor environment. And the most remarkable point, what makes this programme unique is the engagement of the beneficiaries, and the participation of the large community with it.

As we review all these achievements, we need to look forward to the many challenges that remain ahead: Many people in Khayelitsha still feel sick and lonely, but don't come to the clinics. We have learned that people often wait too long to seek medical care. This only shows that many people are still frightened to face their HIV status, and that fear of discrimination still plays a role.

We need to work together to fight discrimination and encourage openness. It is mostly women who openly face the challenge of HIV, for themselves and their families.

Men are very often reluctant to come forward. We need to face this as this struggle belongs equally to all, men and women. We also witness with pain the agonising reluctance of the national government to expand access to ARVs for all the people in SA who need it. 600 people die to AIDS every day in South Africa. People are being punished for being poor, and they pay with their own lives.

Only those who can afford to pay for the drugs can buy life; those who cannot are left to die. In Khayelitsha we are privileged. And we can only enjoy our privilege if at the same time we fight intensively to make change in South Africa, and ensure that ARVs are made available to all those who need them.

We need your commitment and the commitment of all the partners of the Khayelitsha ARV programme to face the challenges ahead, and make sure that AIDS stops destroying our families, friends and our societies. Forward to treatment !! Phambili !! Dr Eric Goemaere Head of Mission MSF South Africa