One million adults and children are estimated to have HIV/AIDS in Malawi and life expectancy has fallen below 40 years of age. In this country where most people live in rural areas and have little or no access to health care, MSF provides medical care to people living with AIDS in the districts of Chiradzulu and Thyolo, including treatment with life-saving antiretroviral medications (ARVs).

MSF also responds to nutritional emergencies and disease outbreaks such as cholera. Since 1996, MSF has been working to provide healthcare to those who live with HIV/AIDS in the Thyolo district of southern Malawi. An estimated 50,000 people are HIV-positive in Thyolo out of a total population of about 475,000.

In coordination with partners in both civil society and the government, MSF has developed a continuum of care network to meet the needs of those living with HIV/AIDS. Through activities in two hospitals, ten health centers, and multiple clinics, as well as schools, churches, and community groups, MSF is working to provide an integrated, multi-sector approach to HIV/AIDS prevention, care, treatment and support.

Volunteers, traditional healers and birth attendants are an important part of the network.

Activities include voluntary counseling and testing services, care and treatment for opportunistic diseases (including tuberculosis), prevention of mother-to-child transmission, and home-based care. MSF staff also hold monthly mobile sexually transmitted infection clinics for commercial sex workers. In this mostly rural district, bicycle ambulances have become an important means of transportation to health centers and hospitals; 60 bicycle ambulances are currently part of the MSF continuum of care.

As of March 2004, the team had carried out 8,603 consultations with people living with HIV/AIDS and more than 500 patients were taking life-extending ARVs.

In the nearby district of Chiradzulu, another MSF team is caring for people with HIV/AIDS. MSF staff carry out daily HIV clinics in Chiradzulu's central district hospital and bimonthly clinics in eleven district health centers, seeing an average 400 newly diagnosed patients per month.

The MSF team also carries out direct patient care for hospitalized HIV/AIDS patients. In August 2001, the comprehensive program in Chiradzulu began providing treatment with ARVs. By the end of 2003, more than 2,000 patients were taking ARVs, at an average rate of 200 new patients per month.

MSF also works to provide education and information to fight the stigma associated with HIV/AIDS. By visiting villages, traditional authorities, peer groups and patient groups, MSF staff work both to share knowledge and to learn about the constraints faced by their patients. In many villages, patients meet once a week to support each other and share their experiences.

While AIDS was a taboo subject in Chiradzulu as recently as 2001, it is now discussed much more openly. In Malawi, as word spreads about MSF's free AIDS treatment, many people are traveling long distances to reach the MSF clinics. In Chiradzulu, staff estimate that half of those receiving care live outside the district. With such immense needs, MSF staff are working to reach as many people as possible.

However, the success of the MSF AIDS projects in Malawi go beyond those who directly receive medical care, their families and their communities. The effects of MSF's efforts in Chiradzulu and Thyolo are part of a larger global debate on the use of ARVs in developing countries.

By demonstrating that ARV treatment is possible in these poor, rural settings, MSF is fighting to bring ARVs to the millions who desperately need these medicines now. Each life saved in Thyolo or Chiradzulu further supports the reality that ARV treatment can and must be put into place in Africa.

Recently, Malawi submitted a successful application to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Despite the pending influx of resources, the challenges involved in implementing ARV treatment to all those who need it is daunting, particularly in a country which lacks medical personnel. Partner organizations are looking at the pilot ARV projects in Thyolo and Chiradzulu as examples of how to bring ARV therapy to the rural poor of Malawi.

MSF hopes to provide training to medical staff from other parts of the country in preparation for the Global Fund project. In Malawi, MSF also responds to nutritional emergencies and outbreaks of diseases such as cholera when needed.