Nelson Mandela Foundation/MSF

 With 600 AIDS deaths per day and the imminent adoption of a national public sector antiretroviral treatment program, the question of implementing such a program in rural South Africa arises. Lusikisiki, a rural area located in the former Transkei, currently part of the OR Thambo municipality of the Eastern Cape, is home to approximately 300,000 people.

Most live in deep rural areas with limited sources of income, limited access to piped water and health care services. Most seek assistance from a fragile healthcare infrastructure in an area with one of the highest infant mortality rates in South Africa. Since January 2003, Medecins Sans Frontieres (MSF) and the Nelson Mandela Foundation have been working with the community and health sub-district of Lusikisiki within 12 primary health care clinics in and around Lusikisiki.

Collectively, this partnership has developed voluntary counselling and testing services with more than 500 community members accepting testing per month in these clinics including pregnant women accessing the mother-to-child transmission prevention program. Nurses in the sub-district have been trained in the management of HIV-illnesses and now provide follow-up medical care to more than 200 persons living with HIV/AIDS monthly.

Community mobilisation promoting the rights of people living with HIV/AIDS, HIV treatment literacy and openness has contributed to a sea change in how living with HIV/AIDS is viewed by the community of Lusikisiki. HIV treatment currently includes the management of HIV illnesses from the community clinics and will include antiretroviral therapy shown to be feasible as a health service in many parts of South Africa.