Jeanne Tabaro is one of the chosen ones. She has Aids, she is poor, she lives in Africa, which is to say she should soon die. But her smile indicates a different fate: Jeanne expects to live.
”I think I have all the luck in the world. For me it’s like Moses parting the Red Sea and leading the people of Israel to safety,” she says. The 41-year-old mother of four recently started receiving free treatment with anti-Aids drugs which could keep her alive and healthy for decades, an option denied to all but a handful of the 30-million Africans with HIV.
What makes her so unusual is that she lives in Bukavu, a town in the Democratic Republic of Congo’s war-torn province of South Kivu. The relief group Médecins Sans Frontières has rewritten the rule book by providing anti-Aids drugs to impoverished communities in Cambodia, Ethiopia, Zambia and South Africa, but doing so in a conflict zone like Congo is more radical.
Starting with seven patients in October, Bukavu’s pilot project added another eight in November and expects to have 150 by late next year, after which it will be reviewed. The idea is to show that almost every corner of the planet can use the drugs effectively if given the chance, thus creating, MSF hopes, momentum for precisely that.
”HIV/Aids is a situation that demands a response and for Congo this is where it’s starting,” said David Tu, a Canadian doctor working with MSF. The drugs, known as anti-retrovirals, once cost $10 000 a year but imports of generics from India now cost MSF in Bukavu $29 a month for each patient. In some places, prices are now as low as $140 a year.
Ten years ago the town’s isolation — it is deep in the bush with few roads – kept HIV infection rates well below those of nearby Rwanda and Uganda. But an influx of some one million Rwandan refugees into eastern Congo in 1994, followed by invading armies and militias, who committed numerous rapes, means that up to one in five adults is thought to have the virus which leads to Aids.
Antoinette Mbonegabe (35) is one of them. Too sick for anti-retrovirals, she was being given the last rites when the Guardian visited Bukavu’s main hospital. The trickle of deaths is likely to surge as those infected since 1994 develop Aids, said Dr Tu.
Despite campaigns for abstinence, fidelity and condoms, new infections continue. Prostitutes in Chez Cikiza, a slum brothel, said most clients wanted and paid extra for unprotected sex. Most of the women are so poor they agree. But just as the need for drugs is great, so is the risk that MSF’s project could backfire. If patients do not take the drugs properly — which means two pills a day every day for the rest of their lives – the virus could become resistant within a few years.
The pills can have harsh side-effects, which makes it tempting to skip some once the Aids is under control. It is tempting to share some with sick friends or relatives, or sell them.
”It would be a disaster if a drug-resistant [virus] emerged and anti-retrovirals were being sold on street corners. I’m very concerned about that,” said Carlos Cordero, who counsels Bukavu’s patients about treatment. Sceptics say the money would save more lives if spent on HIV prevention rather than treating a chosen few.
But Cordero says that only by offering the hope of treatment do you encourage people to be tested for HIV.
Charged with keeping patients on the pills, his most powerful tool is his existence: a former model who was in a wheelchair after being diagnosed with HIV in 1992, he is today a vision of health.
The first batch of patients have yet to skip a pill, said Cordero. Jeanne Tabaro is among them. She knows the contents of her wicker straw bag are her only chance of seeing her youngest child, Joel, eight, grow up. Blotches on her skin are kaposi’s sarcoma, a skin cancer, and her legs are swollen, another sign of Aids, which doctors expect soon to disappear.
Without treatment she would probably die within months. Sitting in the two-room shack she shares with her sister and five of their children, she does not see drug adherence as a big challenge. ”I want to live,” she says. – Guardian Unlimited Â