Prometheus 6   

Fighting AIDS on the cheap

In the Vanguard Fighting AIDS, an Army of Haitian Villagers
By CELIA W. DUGGER

CANGE, Haiti � In the cool mist of daybreak, hundreds of villagers fanned out across the forsaken reaches of this nation's remote interior, fording rivers swollen by torrential rains, slogging through muddy cornfields and clambering up slippery mountainsides to reach people sickened by AIDS.

At each home, they handed out the little white pills that have brought their neighbors, wasted by the disease, back to robust life.

"If the medicines weren't here, I'd be dead," said Manesse Gracia, 39, a mother of six who was plump in a workday dress the color of orange sherbet. "My children would live in destitution. My husband is a farmer, but the earth gives back nothing."

Mrs. Gracia is part of a pioneering program run here by a Boston-based nonprofit group, Partners in Health, that has become an influential model in the frenetic race to expand drug treatment in dozens of poor countries across Africa, Asia and the Caribbean.

More than two decades into the pandemic, 22 million people have died of AIDS, and 40 million people are infected with H.I.V., the virus that causes AIDS. Millions will perish next year unless they get the medicines.

"Bringing antiretroviral therapy to all who need it is the most medically challenging task that the world has ever taken on," said Dr. Richard Feachem, executive director of the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.

…The Spartan model of care used by Partners in Health was born of necessity, but its very spareness is now seen as a virtue by many experts who want the scarce dollars for treatment to stretch as far as possible. Doctors here grafted AIDS treatment efforts onto the existing program for tuberculosis control.

AIDS patients, who will have to take the drugs daily for the rest of their lives, are visited in their homes every morning and evening by a health worker who hands out pills and watches as they are gulped down. Ensuring the medicines are taken properly reduces the risk that drug resistant strains of H.I.V. will emerge.

One of the biggest obstacles to rapid expansion of treatment in poor countries is the extreme scarcity of doctors, nurses and high-tech equipment. And the program here has minimized reliance on them. Generally, there are no lab tests done once treatment begins. The only monitor is a scale to weigh patients monthly.

Peasants have been trained to dispense the medicines, draw blood, take X-rays, clean bedpans, measure vital signs and spread the word about condoms preventing H.I.V. infection. Most of the workers who visit patients' homes are paid a small stipend of $38 a month.