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In Rwanda, U.S.-Backed Program Improves Access to AIDS Drugs

November 6, 2007 at 6:40 PM EDT
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SUSAN DENTZER, NewsHour Health Correspondent: It’s often hard to comprehend the toll that HIV-AIDS has taken here in this beautiful land of the legendary 1,000 hills. About 4 percent of the adult population here in Rwanda is infected with HIV, the virus that causes AIDS. That’s added untold misery in a poor country, where per capita income is just $1,600 a year.

Before the widespread use of antiretroviral drugs, or ARVs, thousands with HIV were dying. But now all of that has changed, to the benefit of people like Fatumah Nyirasafari, a 24-year-old Muslim woman with HIV. We interviewed her outside the hospital where she gets her HIV treatment.

FATUMAH NYIRASAFARI, HIV-Positive Rwandan (through translator): I learned I was infected in 2001 after the death of my first husband. I started on antiretroviral treatment. I took it for eight months. Then I had my first child with my second husband.

SUSAN DENTZER: Thanks in part to drug treatment she underwent while pregnant, her now year-old son was born HIV-free. As is the case with tens of thousands of Rwandais with HIV, Nyirasafari’s treatment is paid for by U.S. taxpayers.

FATUMAH NYIRASAFARI (through translator): I know that it is funded by the American government, and we are very, very happy that they managed to bring that support to us. With the treatment, we are healthy. We are living like any ordinary person, and we are very, very grateful for that support.

GEORGE W. BUSH, President of the United States: Tonight I propose the emergency plan for AIDS relief, a work of mercy beyond all current international efforts to help the people of Africa.

SUSAN DENTZER: The program that pays for Nyirasafari’s treatment, proposed by President Bush in 2003, is the U.S. Global AIDS Initiative. It’s often called PEPFAR, the President’s Emergency Plan for AIDS Relief.

Congress ultimately voted to spend $15 billion on the five-year effort to fight HIV in roughly 120 countries. The goal by 2008 was to get 7 million people on antiretroviral drugs, prevent 10 million new infections, and provide care for 2 million orphans and other AIDS-affected people.

From the start, countless concerns were raised that the program was too costly; or, by contrast, that the U.S. wasn’t spending enough on it; that health systems in poor nations could never deliver the care; that Africans in particular couldn’t follow complex treatment regimens; that high-cost anti-AIDS drugs would be stolen or diverted.

But now, four years after the program got going, most of these concerns have been laid to rest, says Ambassador Mark Dybul. He’s the U.S. global AIDS coordinator.

MARK DYBUL, U.S. Global AIDS Coordinator: When President Bush started this, when he announced this, 50,000 people — 50,000 people — in all of sub-Saharan Africa were receiving antiretroviral therapy. Through last September, we supported treatment for 1.1 million people.

And that, I think, is the greatest thing about PEPFAR. It’s hope. It’s creating hope where there was no hope.

Providing antiretroviral treatment

John Dunlop
USAID - Rwanda
The treatment goal for Rwanda is 50,000 people on antiretrovirals by the end of the PEPFAR program. And, indeed, Rwanda is really moving very fast in terms of achieving that goal.

SUSAN DENTZER: Dr. Agnes Binagwaho heads Rwanda's National AIDS Control Commission.

DR. AGNES BINAGWAHO, Rwanda's National AIDS Control Commission: PEPFAR has been a great success in Rwanda. It has really adapted to what we are already doing, just gives us the capacity to go faster to fight the disease, and to bring very deep inside communities care and treatment services. And we are very grateful.

SUSAN DENTZER: The Global AIDS Initiative is making its greatest headway in getting HIV-infected people on antiretroviral treatment. The job has been made easier by rapidly falling prices of generic forms of the drugs.

A year's worth of treatment for one person used to cost thousands of dollars. But the U.S. program can now purchase a typical combination drug treatment for as low as $90 per person per year.

John Dunlop is the health officer for the U.S. Agency for International Development, who directs the AIDS initiative program in Rwanda. He says Rwanda may be the first of 15 so-called "focus countries" to reach its five-year treatment target about a year ahead of schedule.

JOHN DUNLOP, USAID Rwanda: The treatment goal for Rwanda is 50,000 people on antiretrovirals by the end of the PEPFAR program. And, indeed, Rwanda is really moving very fast in terms of achieving that goal. We expect to be close to or have achieved that by the end of this year, so it's very exciting.

SUSAN DENTZER: The results are evident here at Shyira Hospital in northwestern Rwanda. Patients with HIV who are trained as community counselors were meeting here the day we visited.

The U.S. program paid for extensive renovations and expansion of a hospital. Today, under a contract from the U.S. Centers for Disease Control and Prevention, Columbia University supports the hospital staff in delivering a range of anti-AIDS programs.

One is the effort to prevent maternal-to-child transmission of HIV. If pregnant or breastfeeding mothers and their infants are not treated with antiretroviral drugs, babies may acquire the virus up to 45 percent of the time. As a result, up to one million babies worldwide each year acquire HIV.

DR. RUBANZABIGWI THENESTE, Shyira Hospital (through translator): We have women who are already coming here for antiretroviral treatment under the program to prevent transmission from mother to child and then who come here to deliver.

Blocking mother-to-child spread

Dr. Rubanzabigwi Theneste
Shyria Hospital
I can say that, here at our hospital, we have reduced the rate of transmission from around 40 percent, estimated in places like this, to less than 5 percent.

SUSAN DENTZER: At Shyira, Dr. Rubanzabigwi Theneste described the protocols the hospital follows to block mother-to-child transmission.

DR. RUBANZABIGWI THENESTE (through translator): There are other women who arrive here. We do the test right here on the delivery table. They have never had treatment, so we have to give them the Nevirapine when they are in labor. After delivery, the babies also get medication, usually Nevirapine syrup and AZT. For AZT, the infant must receive the dose for 30 days.

SUSAN DENTZER: Theneste told us the hospital has cut transmission rates to levels close to those in the U.S., where today as few as 1 percent of infants born to HIV-infected mothers have the virus.

DR. RUBANZABIGWI THENESTE (through translator): I can say that, here at our hospital, we have reduced the rate of transmission from around 40 percent, estimated in places like this, to less than 5 percent.

SUSAN DENTZER: One of the babies who have been spared from HIV is the young son of Odette Mimukuza.

ODETTE MIMUKUZA, HIV-Positive Rwandan (through translator): Before this program, people were dying in the villages, or they would be brought to the hospital only to die.

SUSAN DENTZER: But today, Mimukuza and her husband are living with HIV, and their child was born HIV-free. Rwanda's experience has set to rest other concerns, such as that drugs paid for by the U.S. would be siphoned off or stolen.

Dr. Binagwaho of the National AIDS Commission points to a cell phone-based tracking system called TracNet. It allows monitoring of drugs given to every patient around the country.

DR. AGNES BINAGWAHO: Just go and see if you have one case of corruption that was reported and not tracked, me, I am paid to be sure that every single dollar spent in the fight against HIV-AIDS go in the right place to the right person and the right amounts.

Adherence to HIV treatment

Dr. Innocent Nyaruhirira
Government Minister, Rwanda
We have adherence which is beyond 90 percent. I have to say that I was impressed, too. And, really, the TracNet has answered that question.

SUSAN DENTZER: The concern that Africans could not adhere to rigorous AIDS drug treatment regimens has also eased. Lack of adherence to treatment not only harms the patient but can also spur the growth of drug-resistant strains of HIV.

Dr. Innocent Nyaruhirira is Rwanda's minister in charge of HIV-AIDS and other infectious diseases.

DR. INNOCENT NYARUHIRIRA, Government Minister, Rwanda: We have adherence which is beyond 90 percent. I have to say that I was impressed, too. And, really, the TracNet has answered that question.

SUSAN DENTZER: Global HIV experts say adherence rates that high exceed those found among some patients in the U.S. More than anything else, U.S. aid and the battle against HIV in Rwanda may be helping not to bury the past, but to move beyond it. These skulls belong to some of the ethnic Tutsis who were slaughtered 13 years ago by Rwanda's ethnic Hutus.

This is one of the many memorials to the genocide in Rwanda that killed upwards of 800,000 people in 1994. Memories of that unspeakable horror still haunt many Rwandans to this very day, but many also told us that the battle against HIV and the U.S. assistance in that effort have played a role in the nation's post-genocide healing.

Nowhere is that more evident than here at AVEGA, the Association of Genocide Widows in Rwanda. That's where we meant Winifred Mukagihana, now 48. Her husband -- like her, a Tutsi -- was killed during the genocide, as were two of her three children. Imprisoned in a church, she was repeatedly raped by her Hutu captors, so many, she told us, that she lost count.

WINIFRED MUKAGIHANA, HIV-Positive Rwandan (through translator): After about a month and 20 days, there came a soldier who wanted to rape me. And I told him, "Please, instead of treating me like this, why don't you shoot me so that I can at least get some peace?" And he said that he cannot waste his bullets on me. That's when he got a bayonet and pierced me in the groin.

Program helps save lives

Winifred Mukagihana
Genocide Widow
The truth is those drugs are very helpful for us. We really need to thank God for that, because if we didn't get those drugs, me personally, I would no longer be alive.

SUSAN DENTZER: Mukagihana was eight months pregnant with her late husband's child when the genocide ended. Her captors sliced her Achilles tendon so she could only crawl away.

WINIFRED MUKAGIHANA (through translator): I delivered the baby alive, but I couldn't move, and I couldn't help myself. There were dogs all over the place that came and ate my child. They ate my baby.

Just after the war, I tested positive for HIV, so I started coming just after the war, as soon as AVEGA was born. So they've been caring for me and providing me with treatment. They kind of became my parents.

SUSAN DENTZER: Mukagihana told us she's alive today because the U.S. is paying for her antiretroviral drugs, provided through the clinic here.

WINIFRED MUKAGIHANA (through translator): The truth is those drugs are very helpful for us. We really need to thank God for that, because if we didn't get those drugs, me personally, I would no longer be alive.

SUSAN DENTZER: By the end of next year, two million more people around the world who will have benefited from the U.S. program may be able to say much the same thing.

GWEN IFILL: Susan will have another story from Rwanda tomorrow night. You can ask questions about U.S. efforts to combat AIDS in Africa in our online Insider Forum. Find it at PBS.org/NewsHour. Also look online for Susan's slide show of photos and original footage, plus a lesson plan for teachers.