5 minutes to understand. Why are people still dying of AIDS in 2017? (ENG)

This film explains why over a million people continue to die of AIDS every year despite ARVs being widely available.

MSF204192

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5 minutes to understand. Why are people still dying of AIDS in 2017? (INT)

5 minutes pour comprendre… pourquoi on meurt encore du VIH en 2017 ? (FR)

Subt. French

5 minutes to understand...Warum sterben Menschen 2017 noch immer an AIDS ? (DE)

Subt. German

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5 minutes to understand - July 2017. Why are poeple still dying of AIDS?

5 minutes to understand - July 2017. Why are people still dying of AIDS?

5 دقائق لفهم السبب: لماذا مازال الناس يموتون من الإيدز ARABIC SUBTITLES في عام 2017؟

Subt. Arab

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Unique Identifier Code / URN MSF204192

Date taken / Date Recorded 19/07/2017 12:00 AM

Country Kenya

Commissioning section MSF-FRANCE

Usage Rights (MSF) Advertising Campaign, External Media, MSF Fundraising, MSF Publications, Social Media

Formal Consent Copy available no

Editor's rating ★★★★★ (C)

Video format h264 (Constrained Baseline) (avc1 / 0x31637661)

Duration 5m57s

Maximum Size 1920px × 1080px 604.92 MB

Additional Information / Shotlist 5 minutes to understand
Why are people are still dying of AIDS in 2017?

Hello… Today I’m going to talk about HIV/AIDS.
As you probably know, with treatments now in widespread use, HIV has become a chronic infection people can live with for many years, in relatively good health.
So, a complete change to 15 years ago when we raised the alarm.

Maryline Mulemba, head of mission in Malawi, ARCHIVE / 2000 (in French)
“Patients just keep coming back … and we end up burying them all.

So everything’s ok now? That’s what people tend to believe, but not what we see in the places we work.

Dr Berna Gurer, MSF – TODAY (in English)
HIV patients are still dying to a big extent, like before the introduction of ARVs

So yes, huge progress has been made in treating HIV/AIDS. But people in Africa, for example, continue to die of it. I’ll explain why.
(On-screen text: Number of AIDS-related deaths – Number of people on treatment)

SLATE: The fundamentals

First, there’s a difference between the virus (HIV) and the syndrome (AIDS). You can be infected with HIV without having AIDS
(On-screen text: HIV = Human Immunodeficiency Virus) (AIDS = Acquired Immunodeficiency Syndrome).
If you’re diagnosed HIV-positive, take the drugs and have regular medical checks, you won’t get rid of the infection, but you can live with HIV without getting sick.
But without all three of these, the infection could develop, your immune system could weaken and you might get sick. This stage is called AIDS.
17 years ago, when Maryline, our head of mission in Malawi, was so frustrated, patients living with HIV/AIDS in Africa died without ever even seeing one single drug.

Maryline Mulemba, head of mission in Malawi, ARCHIVE / 2000 (in French)
“As a medical organisation, we have a duty to treat people”

18 million people across the world are now on antiretrovirals.

SLATE: So what’s the problem?

The problem is that being on ARVs isn’t enough to live a healthy life.
If that was the case, AIDS wouldn’t kill over one million people every year.
(On-screen text: ARVs = antiretrovirals)
In 2015, a team from Epicentre looked into what was happening in hospitals, first in Kenya, then in Malawi, the Democratic Republic of Congo and Guinea.
(On-screen text: Epidemiology & Research)
The conclusion came as a shock to everyone. Half of all hospitalised patients were HIV-positive, and half of them had had access to ARVs for several years.
So they should have been in good health. But they weren’t. They were in the advanced stages of the disease, and at risk of dying.

When you’re on lifelong treatment, you need both medical follow-up and psychological support.
If your treatment is failing, you need to be quickly put on what’s called second-line treatment. And if you’re having trouble taking to your treatment, you should talk to a counsellor. Counsellors, often HIV-positive themselves, have a crucial role in helping patients.
So that’s the ideal patient-carer scenario. But in reality, it doesn’t always work that way.

(On-screen text: OBSTACLES - ACCESS TO DRUG TESTING - INTERRUPTION OF TREATMENT - STIGMA - ACCESS TO SECOND-LINE TREAMENT)

So what’s not working? What can we do to improve the situation? And what are the challenges our teams have to deal with? These are the questions I’ll be asking David Maman, an epidemiologist with Epicentre. But before that, let’s hear from some of our patients in Homa Bay in Kenya.

SLATE: From the field

Patient 1 (woman)
My husband stood at the door and said he didn’t want to see me near the house. So I couldn’t get in to take my ARVs. I tried to dodge my way in, but he started hurling stones at me. When I returned home in January, I started taking my ARVs again. I’d become disabled and I had no energy.

Patient 2 (woman)
When we go to collect our drugs, we’re often really scared somebody will see us. We lose our nerve and put it off. So the virus gets worse and weakens our bodies.

SLATE: Understanding why patients interrupt their treatment is crucial to be able to adapt care to their needs.

Patient 3 (man at home)
I was using herbal medicine and not adhering to the set times for taking my ARVs. I went for counselling and you (MSF) told me I should drop herbal medicine.
And that I should take my drugs at a set time.

SLATE: Even without interrupting their treatment, some patients get sick.
We still don’t know how to detect these failures early enough. The consequences can be dire.

Patient 4 (Man in hospital)
I haven’t missed one dose. This pain in my back is excruciating. The doctor has told me I’ll have to stay on ARVs for the rest of my life. I don't know what to do.

SLATE: Now what?

C : Hello David. You’re one of the team that carried out the study on advanced HIV. Can you explain why people continue to fall sick?
D : It’s extremely hard to change treatment when patients become resistant. In order to change a patient’s treatment early on requires information on what’s called the viral load, which still isn’t possible everywhere in Africa.
(On-screen text: VIRAL LOAD = AMOUNT OF VIRUS IN THE BLOOD.)
It takes us a year on average to change a patient from first line to second line treatment, during which time they can get sick again.
C : What’s stopping us from getting what we need to help treat these patients?
D : What we could do to reduce this problem of resistance is to provide treatments with higher genetic barriers, which means drugs to which the virus will be less prone to developing resistance. Another obstacle is that in Africa we don’t have access to resistance tests.
C : So our teams are now working on studies to improve the situation?
D : In Zimbabwe, we’re going to start testing new first-line treatments that are far more robust. Then in the Democratic Republic of Congo and Kenya we’ll do studies to measure resistance in hospitalised patients. And next year we hope to trial new protocols in Malawi to be able to start patients on second-line treatment much quicker.
C : Thanks David—and thank you for following us. Please share our content on all your social media!

End credits

Keywords

Antiretroviral Therapy

Antiretroviral Treatment

HIV/AIDS

Person Living with HIV/AIDS