How do antiretroviral medicines actually work?

The HI-virus attacks the so-called CD4 cells in the blood, which are part of the immune system. Their number declines and, because of that, the body becomes susceptible to infections such as tuberculosis, pneumonia or encephalitis. We begin with the antiretroviral therapy when the number of CD4 cells sinks below 200 per microliter. Although the medicines cannot heal an HIV infection, they can slow the multiplication of the virus. As a result, the number of CD4 cells rises again and the immune system is strengthened. In order to achieve the best possible results and to hinder a build up of resistants, three different medicines are administered simultaneously. For this reason the therapy is called a triple therapy or an aids cocktail.

How do you ensure that patients take the medicines reliably?

In Chiradzulu our Malawian co-workers, who we have trained as educators and counselors, play an important role. In thorough and sympathetic discussions they explain to the patients that they have been admitted to a treatment in which they will have to take their medication regularly and reliably their whole lives, otherwise the medicine is ineffective. The Indian generic drugs producer, Cipla, produces the therapy now in the form of a single tablet which contains three compounds. So the patients must swallow only one tablet each morning and evening. Our experience shows that the patients in Chiradzulu take the therapy very seriously and they take their tablets at least as reliably as the patients in western countries.

What does this treatment mean for the patient?

Most of them gain weight and their general condition clearly improves after only a short time. Most of them can work again and take care of their children. It is impressive how completely weakened people get a second chance and can then lead a fairly normal life again. Here in Chiradzulu there is, for example, a therapy group of HIV infected patients. Many of them came to us very sick. Now they are doing so well that they present theatre pieces in villages once a week in addition to their regular work. In these pieces they educate people about HIV/Aids.

How many people are treated in Chiradzulu and where does the medicine come from?

At the moment we are treating about 500 people for free, among them children and pregnant women. New patients are added daily and by the end of the year 1,000 patients should receive antiretroviral medicines. The generically produced medicines come from India and cost 25 Dollars per month per patient.

In light of the high rate of infection in Malawi, those are only a few patients. Doesn't more have to be done?

Of course. Chiradzulu has shown that it is also possible in poorer countries to introduce antiretroviral medicines. Most positive of all is that the Malawian government is prepared to act: they recently applied to the Global Fund for supplies for the treatment of Aids, malaria and tuberculosis for 25,000 HIV infected persons in the next five years, and the funds have been granted to them. Médecins Sans Frontières supports the government at the moment by writing the protocol for the national HIV treatment. So the experience from the pilot project in Chiradzulu will hopefully be of help to many people.