Maputo’s antiquated airport comes as a shock after the shimmering consumer seduction of Johannesburg International airport’s duty-free zone, a mere 50-minute flight away.
On the drive into town, the power of the donor dollar is evident in the large billboards proclaiming what donors are doing for the country.
Ten years ago Mozambique emerged from civil war as one of the world’s poorest nations. Three years later its economy was growing by a healthy 10%. But in 2000 it was knocked flat by devastating floods.
The economy has slowly picked itself up again and now has a growth rate of 4,4%. But the government is heavily dependent on donors to deliver basic social services to its citizens.
It is thus surprising to learn that this impoverished country is already a step ahead of South Africa when it comes to HIV/Aids treatment. Mozambicans have been able to get free anti-retroviral drugs at two sites since the beginning of the year.
Funding for Mozambique’s ambitious HIV/Aids programme is coming largely from the Clinton Foundation ($330-million), a $54-million Global Fund grant, and $55-million from the World Bank.
Mozambique’s national Health Director, Dr Alexander Manuel, told the recent Metropolitan Aids conference that his country had an HIV prevalence rate of 13,5%. South Africa’s HIV prevalence is 11,5%, according to a Human Sciences Research Council survey conducted last year.
“We are seeing lots of deaths, especially in strategic sectors such as health and education,” said Manuel. “This is having dramatic consequences for families and the economy.”
Ironically, economic progress has brought with it a greater risk of HIV. The country’s most developed Central province has the highest prevalence rate at 17%, almost triple the 6% prevalence of the rural north.
One possible reason is that the Maputo Corridor, which runs through the Central province, has provided easy access to the country with many truck drivers now moving between South Africa and Mozambique.
Other developments that pose potential risks are the aluminium smelter, Mozal, and a gas pipeline being developed by Sasol. These developments mean that very poor communities are coming into contact with workers with money.
“Unequal social relations is a risk factor for HIV/Aids,” says Metropolitan Aids strategist Stephen Kramer. “What impact [are these developments] having on the spread of HIV/Aids?”
However, the Mozambican government is well aware of the dangers and has already formulated a comprehensive HIV/Aids plan. But it is seriously short of resources to implement the plan.
“Mozambique only has 461 doctors in the whole country to treat a population of 18,5-million people. This is one of the lowest figures per capita in the world. So this is a very ambitious programme,” says Dr Marc Biot, country representative for Médécins sans Frontières (MSF).
Unlike South Africa where relations between the government and the MSF are frosty, MSF is in partnership with the Mozambican government to address HIV/Aids treatment.
The Mozambican model is similar to that being envisaged for South Africa’s anti-retroviral roll-out. It is built around “integrated health networks” with day hospitals at the heart of these.
HIV-positive people are referred to day hospitals that manage whatever treatment they need, including anti-retroviral therapy. Doctors see patients every three months, while nurses see them monthly.
Since January, two integrated health networks have been set up, one in Maputo and the other in Tete. Remarkably, these have already tested 17 000 people, 32% of whom were HIV-positive. The two centres manage the treatment and care of 4 000 patients, 282 of these are taking anti-retroviral drugs.
“Patients were very sick to start with, with an average CD4 count [measure of immunity] of 85,” said Biot. Most healthy people have CD4 counts of over 500.
“Seven patients have died in the past 50 days, and a quarter of patients had to adapt their treatment programmes to feel better,” said Biot. “But the good thing is that most had to adapt their doses because they gained weight.
“The vast majority of patients [89%] are taking the drugs properly. “Only 7,3% had severe side effects. Average weight gain is 8kgs and the average CD4 count has jumped to 148,” said Biot.
The painful part about weight gain is that patients start feeling hungrier and ask their health workers for food — something that the programme cannot afford to give.
Hunger is a constant enemy of HIV prevention. Nyeleti Mondlane from Vida Positiva, an organisation for people living with Aids, says it is very difficult to warn communities about a virus that could kill them in the next few years when they have no food to eat in the next few days.
Before being given anti-retroviral drugs patients have four sessions of treatment training, which teaches them how the drugs work and what side effects to expect.
“Patients also have to sign an adherence contract in which they promise to take their drugs properly and they choose a treatment buddy, someone close to them to give them moral support,” said Biot.
Over the next five years, 129 integrated networks are planned and the country aims to have 132 000 people on anti-retroviral treatment.
Biot is optimistic: “Although Mozambique has a very poor health infrastructure, the vaccination rate of children by the age of a year is 88% and 75% of TB patients finish their six-month treatment.” — Health-e News Service