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AIDS-RWANDA Nov-22-2005 (920 words) xxxi
In rural Rwanda, antiretroviral drugs give hope, life to HIV patients
By Evan Weinberger
Catholic News Service
MUHURA, Rwanda (CNS) -- Xavier Mdengo's body was racked with repeated bouts of malaria, and lesions covered his face. His illnesses seemed abnormal even in this destitute corner of northern Rwanda. So in March, Mdengo made his way to the Muhura health center, where he received an HIV test and bad news.
If there are better times than others for a person to hear he or she has contracted the virus that causes AIDS, then last March in Muhura was one of them. That is when the Muhura health center, which is staffed by Oblate Sisters of the Holy Spirit and is one of 80 clinics affiliated with the Rwandan branch of Caritas Internationalis, received its stock of antiretroviral drugs.
The drugs, which delay the onset of full-blown AIDS, are a rarity in rural Rwanda, far from city and district hospitals. The Muhura health center is one of only two rural health centers in Byumba province capable of distributing the medications.
In the past, the Muhura health center was only able to treat the infectious diseases -- like tuberculosis and malaria -- that preyed on the weakened immune systems of people living with HIV, said Oblate Sister Laurence Niyireba, the center's pharmacist.
Mdengo, who is 50 and the father of six, began his daily regimen of two pills in April after taking part in a training course. He said he does not enjoy thinking about what his test result would have meant without the medicines.
"I would already be dead," Mdengo told Catholic News Service, as he sat in a small, dark room receiving a month's supply of his medicine.
Before distribution of antiretroviral medicines began in Muhura, there were few opportunities for poor rural Rwandans to get the drugs.
Andre Gihanza, coordinator of AIDS relief for the U.S. bishops' Catholic Relief Services in Rwanda, said some people with resources have gone to Kigali, Rwanda's capital, for the medication that CRS is also distributing. He noted that few people can afford to make the trip.
Muhura's distribution of anti-AIDS medicines is part of a government effort to increase the number of Rwandans receiving the drug therapy. Over the last year, the number of recipients has jumped from 1,000 people to 13,000, while 250,000 Rwandans were tested voluntarily, said Dr. Louis Munyakazi, director of Rwanda's Treatment and Research AIDS Center. In addition, the number of pregnant women who undergo tests has also increased.
But the number of people getting the antiretroviral medications in rural areas is still low; the vast majority of people receiving the drug cocktail live in a city or near a district health center, Munyakazi said.
Rural Rwanda is rugged terrain. Muhura, at the top of one of the rolling mountains, is nearly two-and-a-half hours north of Kigali. Most of the people in the area are subsistence farmers living in dusty shacks with corrugated metal roofs. Banana trees line the winding red dirt roads. Travel is difficult in the summer dry season, and during Rwanda's seemingly endless rains it is even worse, said Oblate Sister Eugenie Mukankwiro, Muhura health center's director.
"We cannot jump into the community without having the supporting structure that is sustainable," Munyakazi said. "So that is the reason why it has been a little bit slow."
But Muhura seems to have found a model that works. Here, all pregnant women are tested for HIV, and people of all ages and both sexes come in for voluntary testing. If a person tests positive, the patient and a noninfected partner come in for training on how to take the drugs and prevent the disease's spread. They also receive counseling from a social worker. A doctor visits once a week, and patients come for a checkup and drug refill monthly.
Since distribution started in March, more than 70 people, including seven children, have received prescriptions for the drugs. Four of the original antiretroviral recipients have died.
Along with the doctor's visits and drug distribution, community health volunteers visit patients once a week to make sure they are taking their drugs every day.
One of the volunteers is Denys Nkurunziza. A mix of fatigue, a persistent abscess in his mouth and the loss of both his parents to AIDS sent him to the center about a year ago. When Nkurunziza first found out he had contracted HIV, his white blood cell count was 16. A noninfected person would normally have a count in the hundreds, and a count below 350 calls for the immediate use of antiretrovirals. He was in the first group to go on the drugs in March.
Nkurunziza, 27, is now chairman of an association of people living with HIV/AIDS. The 50-member group is called Mpore, which in Kinyarwanda -- the chief spoken language in Rwanda -- means to bring hope. Nkurunziza takes care of his four younger brothers and sisters, ages 12, 14, 16 and 18. He also visits 15 families a week, pedaling his bicycle down the ragged roads, through the mud when it rains and brutal sun when it does not.
Without the drugs, he would not have survived this long, Nkurunziza said. He said he plans to return to school, if he can find someone to help care for his siblings. He said patients like him, and the right medicines, provide hope to HIV patients and help combat the fears of those who are not infected.
"People don't accept them in parts of the village," he said. "I fight the stigma."
END
Copyright (c) 2005 Catholic News Service/USCCB. All rights reserved.
This material may not be published, broadcast, rewritten or otherwise distributed.
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