By Gina Olivieri, RESULTS Grassroots Engagement Consultant

In September 2009, I was lucky enough to meet with Dr Akhtar Hussain, Head of the Antiretroviral Program at Prince Mshiyeni Memorial Hospital in Umlazi. I arrived at the hospital under a blanket of grey clouds and drizzling rain. The weather seemed to highlight the mood of the hospital from the outside – dark, shabby and desperate, with people lined up to get inside. Once inside it was very busy, with a constant stream of people treading a path past the reception where I waited nervously for Dr Hussain. People walked, limped and were wheeled past. People wore face masks; whether due to Tuberculosis (TB) or the new threat of swine flu I wasn’t sure.

Dr Hussain emerged from the throng of people, beaming a warm smile. He had a relaxed and friendly demeanour, no mean feat for someone with a no doubt highly stressful and busy job. He immediately offered a tour of the hospital. He took me first to the hospital’s crisis centre. Called ‘Place of Comfort’, it is a place where rape victims can be treated, tested for HIV, and report the crime to police. The centre has 5 to ten people per day report to the centre for help, with victims ranging from 2 month old babies to adults. I was also shown around the small TB clinic where a few people waited and watched TV. We then headed to Vusithemba Clinic, the hospital’s HIV/AIDS clinic. On the way a trolley was wheeled past and a pair of anonymous feet poked out from under the sheet. The head was covered.

On the way across the car park to Vusithemba Clinic Dr Hussain remarked that today was a quiet day. The people lining the entire length of the veranda suggested otherwise, but Dr Hussain told me that usually the line extends to the other side of the car park. This line begins forming at 5am, and people will often wait all day to be seen. Men, women, teenagers and children all wait patiently with simple red numbered stickers indicating their place in line. I saw a girl with number 168 on her hand, a sticker marked 225 lay abandoned on the floor. The waiting room and hallways were all packed with people. On the day I visited it looked as though about 80-90% were women, and indeed Dr Hussain confirmed that men face increased stigma and are reluctant to seek help.

The name Vusithemba roughly translates to ‘building hope’. The hospital had to find an alternative to calling it the HIV/AIDS Clinic, due to the stigma surrounding the disease. The name also acts as a form of encouragement to patients, reminding them that they can live long and healthy lives whilst being HIV positive. The Vusithemba Clinic started its HIV program in about 2004, without access to any antiretroviral drugs (ARVs; HIV-treating medications). Initially staff would only be able to offer testing, counselling and education. In the early days patients would sell their test results, as they could be used to get food parcels, but Dr Hussain believes this problem has been overcome. In 2005, the clinic had about 60 patients. Now that number stands at 8,500. Considering the national HIV rate is officially estimated to be about 18% and Umlazi has a population of 1.6 million people, the clinic treats a maximum of 3% of the Umlazi’s HIV positive population. Dr Hussain estimates that Umlazi’s HIV rate is more like 40% based on compulsory testing of pregnant women in the hospital. Between 60% and 70% of people reporting to the hospital have HIV-related sicknesses such as TB. Seeing the crowded waiting room and calculating these figures highlighted the enormity of South Africa’s HIV/AIDS pandemic.

The clinic is under-resourced and limited in the patients they can treat. Until recently patients needed to have a CD4 count of less than 200 to receive treatment. A CD4 count is a measure of how many immune cells are left in a person’s body. The lower the count, the more HIV has attacked the immune system and the sicker the person is. If a person comes to the clinic with a CD4 count above 200 they are encouraged to stay healthy and called back every three months. Recently the CD4 cut-off was changed to 350, meaning more people can access treatment and stay healthy for longer.

The clinic faces a big problem in staff shortages. New guidelines from the Department of Health require more work from the same number of staff, so burnout is common. The staffing requirements of the clinic are significant; the clinic doesn’t just need doctors but also cleaners, security and clerks to keep the clinic clean, safe and organised. Despite the challenges, Dr Hussain tries extremely hard to put all mothers on ARVs, regardless of their CD4 count, to try and protect their children from the disease. The clinic does a lot to educate people and empower them to live healthy lives. There is a three day training program for patients to learn to take their medication properly, and a big emphasis on helping them find support. Inside the training room I saw a piece of cardboard stuck to the wall with various pills taped on it to show the daily regimen of medication for patients.
The stigma surrounding HIV/AIDS remains a significant barrier to people seeking treatment, and Dr Hussain even says ‘I think some die of their stigma’. Umlazi is thought to be in a stage of denial, and within the community people avoid speaking to Dr Hussain publicly as he is well-known as the HIV/AIDS doctor. The stigma means HIV/AIDS isn’t spoken about openly, fuelling myths and misinformation. Even a medical intern recently asked Dr Hussain if HIV was introduced to Africa by American scientists. Zulu people will often see a traditional healer for muthi (traditional herbal medicine) instead of or as well as their doctor. Muthi can cause problems such as liver damage and can interfere with the effectiveness of ARVs. Sometimes people will stop taking their ARVs altogether.

For Dr Hussain, this is but one challenge. He says his greatest challenge in his work is seeing people so incredibly sick with HIV/AIDS every day. His greatest reward comes from seeing people getting better enough with treatment to return to work. About 70-80% of patients treated at Vusithemba return to work. Seeing children become well enough to go to school is also a great reward.

Preventing the spread of HIV further is a huge public health concern in South Africa, and one that has attracted considerable attention. Dr Hussain believes that there is a greater need for more VCT (voluntary counselling and testing) and empowering young people through sex education. He says that simply distributing condoms does not work. He believes young people have a vital role in stopping the spread of HIV, saying ‘young people must understand HIV, get tested, and change their behaviour. They must understand ABC (Abstain, Be faithful, use a Condom) and not get trapped by HIV/AIDS. They must be young leaders and stay HIV-negative’.

I wrote this piece in 2009 after visiting Prince Mshiyeni Memorial Hospital in Umlazi as a volunteer with The Oaktree Foundation’s Schools4Schools program.. Stats and facts undoubtedly have changed since then. What hasn’t changed, is the need for countries like Australia to increase their contribution to the Global Fund to Fight AIDS, TB and Malaria to prevent future illness and deaths. In November 2013 the replenishment conference is taking place where donors will decide how much they give the Global Fund for the 2014-2016 period.

Australia must commit $395million for this period. We can end AIDS, TB and Malaria if we make smart, strategic decisions now.

Join the conversation and show your support by tweeting #thebigpush to @RESULTS_AU

Or visit theglobalfund.org/en/thebigpush