"Africans can't take medicine properly"
25 years ago, MSF introduced treatment for people living with HIV/AIDS in Malawi and silenced critics who said adherence wasn't possible.
Photo: © Francesco Segoni
“In those days (1990s-2000s) it was very bad; people were dying. I lost my brother and my sister to AIDS. When I was sick, I had no hope. At that time no one was receiving Antiretroviral Treatment (ART) until MSF began providing it,” says Fred Minandi, the fourth patient to receive ART in the MSF Chiradzulu project on 16 August 2001 at the age of 41.
MSF first began HIV/AIDS prevention and control activities in Chiradzulu, Malawi, in 1997, where 20% of the district’s adult population was estimated to be HIV-positive. In August 2001, we started a programme to provide free access to ART at Chiradzulu’s district hospital. Before this, no HIV treatment was available in the country.
“In 1999, I tested positive for the virus,” Fred says. “Later, I met with MSF counsellors who told me they were going to begin ART. After a month, I was able to start work again.”
The story of the project in Chiradzulu is not just about providing drugs to patients. It proved it was possible to tackle HIV in poor rural settings and that patients would comply with the strict HIV treatment routine, an idea met with significant cynicism at the time.
In July 2002, Fred was invited to speak at the 14th International Conference on HIV/AIDS where MSF’s presentation on access to ART included the Chiradzulu experience.
“I am one of the first patients to benefit from free treatment in Malawi and if I am here to talk to you about it today, it’s because I am receiving treatment. Some of you will say that Africans cannot take medicine properly because we don’t know how to tell time. I don’t have a watch, but I can tell you that since I began my triple therapy, I have never forgotten to take a single dose,” Fred told the conference.
- By the end of 2003, more than 2,000 patients were on ART in the Chiradzulu programme, at an average rate of 200 new patients per month.
- By 2009, every health structure in Chiradzulu district was able to provide the whole range of services for HIV/AIDS patients, from testing to prevention of mother-to-child transmission, and treatment of tuberculosis (TB) co-infected patients.
- An MSF study in 2013 showed that 65.8% of people needing ART in the region were receiving the appropriate medicines, and there was a very low level of new infections.
Such progress was not only made possible by the partnership between MSF and local health authorities but by the patients themselves. Patients such as Fred formed support groups and were employed by MSF as peer counsellors to encourage people to get tested and help patients comply with their treatment. Over the years, this has enabled thousands of patients to live comfortably with the disease.
“When I go for viral load testing nowadays, the virus is undetectable. In 2001, when the counsellor said ART could prolong my life, I thought it would be two to three years but here I am, 22 years later,” says Fred.
After over 20 years of collaboration with MSF, Chiradzulu district health authorities and their partners fully took over all patients and activities between 2022 and 2023, ensuring the continuity of HIV treatment and care.
Fred Minandi - one of the first MSF patients to receive ART at Chiradzulu. Photo: © Pascale Antoine