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Mar 2004 |
The opening of an AIDS clinic in Xiangfan city of Hubei province
in May 2003 marks a turning point for Médecins Sans Frontières activities
in China. Officially recognised as a pilot project, the program has the potential
to be replicated countrywide if it is successful. Hubei province has an estimated
45,000 people living with HIV/AIDS. Médecins Sans Frontières is
working closely with Chinese health authorities to treat HIV/AIDS patients. This
interview explores the relationship between Médecins Sans Frontières
and the Chinese government in this project.
Why did Médecins Sans Frontières choose to start a project
in Hubei but not in other areas in China?
Hubei is one of the provinces at the epicentre of China’s HIV/AIDS epidemic
and Médecins Sans Frontières started working there because of the
urgency of the situation in this region. Hubei is also one of the seven provinces
targeted by the Chinese National Treatment Plan, providing Médecins Sans
Frontières with the opportunity to work closely alongside Chinese health
authorities on tackling HIV/AIDS.
We are also starting another HIV/AIDS treatment project in Nanning, Guangxi.
It is important to note that in our projects we treat all HIV/AIDS patients, including
those infected by donating their blood.
How did the people in Hubei get infected with HIV/AIDS?
Hubei province is estimated to have around 45,000 HIV/Aids sufferers. Many of
them contracted HIV after selling blood to commercial blood banks several years
ago. The epidemic expanded as the virus was spread widely through sexual relations
and mother-to-child transmission.
How is the problem of stigmatization and discrimination towards AIDS
patients in Hubei?
The problem of stigmatisation is acute throughout China. In Hubei, as elsewhere,
people living with HIV/AIDS risk losing their jobs and being socially ostracised
if they reveal their HIV positive status to the community. Therefore, most choose
to keep their status secret from all but their close family in order to avoid
discrimination. Some don’t even dare to tell their families, for fear of
losing their support.
Part of the Médecins Sans Frontières programme will focus on
increasing understanding about HIV/AIDS amongst patients and their families and
organising mutual support groups.
What is the level of knowledge about HIV/AIDS of the general public
in China?
For the general public, the level of knowledge towards HIV/AIDS remains
low. Therefore, a long-term aim of the project is to increase the understanding
of the wider community about what AIDS is and how HIV is contracted. Awareness
and education projects are organised in collaboration with the health authorities
to reduce the problem of social stigmatisation and to encourage voluntary HIV
testing, especially amongst pregnant women. People are also informed about how
they can protect themselves from getting infected.
What is the relationship between Médecins Sans Frontières
and the Chinese government in the project?
The program is jointly run by Médecins Sans Frontières
and the Xiangfan Centre for Disease Control (CDC). Médecins Sans Frontières
runs its clinic in the premises of the District General Hospital. The Médecins
Sans Frontières expatriate and national staff work closely together with
local CDC doctors and medical staff to give consultations. Seriously ill patients
are referred to the Infectious Diseases Hospital for hospitalization.
The CDC also treats patients under the China Cares Project and refers to Médecins
Sans Frontières cases that are relatively difficult to manage, such as
patients on ARV treatment suffering from serious side effects, children, pregnant
women and patients with severe opportunistic infections and chronic diseases.
In addition, Médecins Sans Frontières supplies the CDC patients
with certain alternative first line drug treatments.
How many patients is Médecins Sans Frontières currently
treating and what’s the target?
Médecins Sans Frontières is committed to the challenge
of providing care for all HIV/AIDS sufferers, so we do not have a specific “target”
to achieve in terms of patient numbers.
By the end of February 2004, there were more than 120 patients being followed
up at the Médecins Sans Frontières clinic and we had started 47
patients on ARV treatment. Médecins Sans Frontières anticipates
being able to treat up to 500 people in the coming 5 years.
How are the patients selected by Médecins Sans Frontières?
Most of the patients are referred by Xiangfan CDC, but we also have patients from
other counties, prefectures and provinces coming to us on their own initiative.
Who staffs the project?
There are five expatriates, three local nurses and supporting staff.
How would Médecins Sans Frontières comment on the policy
and attitude of the Chinese government in tackling the HIV/AIDS epidemic?
We recognize that the Chinese government has recently taken a more active
approach to respond to the HIV/AIDS epidemic at a national level. The China Cares
initiative offering free treatment to 5,000 patients in rural areas, which was
introduced early last year, represents an important and positive first step in
tackling the crisis. However, it is a first step only. Much more needs to be done.
Whilst we are relieved to see that the Chinese authorities have now made a
start on confronting the challenge, we hope that we will quickly see the scaling
up of comprehensive treatment programs using high quality drugs, as well as prevention
initiatives. Simply providing ARV drugs on a large scale is not in itself a solution
for the HIV/AIDS crisis. There are other crucial components that must be included
in HIV/AIDS care, for example Voluntary Counseling and Testing (VCT); providing
prophylaxis drugs against opportunistic infections; and detecting and treating
opportunistic infections. Any comprehensive program must also foster patient support
groups and set up tools to ensure that patients actually take their treatment
correctly. Our past experiences have shown that if such a full “package”
of care is not provided, HIV/AIDS programs risk being far less effective. The
training of medical personnel will need to be a priority in China, since in many
rural areas there is currently a shortage of qualified medical staff to assist
patients.
What else should the Chinese Government do?
It is also extremely important that the ARV treatment protocols for HIV/AIDS
patients are of high quality. If people are given low quality drug cocktails they
may suffer from serious side effects, which may prompt them to discontinue their
treatment. Not only is this bad for the patient, it also increases the risk of
creating drug-resistant HIV strains in the future.
In China, the drug cocktail currently provided by the government comprises
four generic drugs that can be produced locally at a relatively low cost. Our
initial experiences in Xiangfan have suggested that a worryingly high proportion
of patients on ARV treatment are suffering from significant side effects and are
therefore discontinuing taking their drugs. It is therefore vital that before
China scales up its HIV/AIDS treatment programs, there is a thorough re-evaluation
of treatment protocols.
On a positive note, the opening of the clinic in Xiangfan illustrates the willingness
of Chinese authorities to invest in upgrading the existing medical services to
address the needs of HIV/AIDS patients. It has also adopted an open-minded attitude
towards the establishment of psychosocial/ counseling services for patients.
Will Médecins Sans Frontières treat patients with other
diseases?
Médecins Sans Frontières provides comprehensive care for
people living with HIV/AIDS. That means that as well as providing ARV therapy,
we also treat the “opportunistic infections” that attack HIV/AIDS
patients during the full onset of AIDS. Common opportunistic infections are tuberculosis,
hepatitis, pneumonia and sexually transmitted diseases.
The Chinese government has been criticized for covering up the epidemic.
What is Médecins Sans Frontières’ comment on this?
There now appears to be an increasing realization by the authorities
that the HIV/AIDS epidemic needs to be addressed urgently. This is a significant
step forward. The government must now prioritize preventing the further spread
of the epidemic and providing treatment on a large scale for those already infected.
It is crucial that the health authorities now ensure safe blood transfusions in
hospitals, prevent contamination accidents in health facilities and stop the illicit
blood transfusion trade.
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The peace process between northern and southern Sudan that has been underway since 2002 has renewed hopes for an end to Africa's longest-running civil war. The conflict has cost almost two million lives, mostly civilians who have died from hunger and disease. Yet amid talk of peace between the north and the south, the westernmost region of Sudan, Darfur, became the site of a growing catastrophe in the past year. For years, MSF has assisted people in both northern and southern Sudan, providing basic health care at hospitals or through networks of clinics and health centers. Its work has included treating people with tuberculosis (TB), kala azar (visceral leishmaniasis) and other diseases; providing food; and treating the severely malnourished. MSF also delivers clean drinking water and provides sanitary facilities in areas where displaced people have sought shelter. » More | 
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