Médecins Sans Frontières - VIDEO: Dying of AIDS in 2017 (ENG)

Unique Identifier Code / URN MSF202854

Date taken / Date Recorded 11/07/2017 12:00 AM

Country Kenya

Commissioning section MSF-FRANCE

Photographer / videographer / producer Benoit Finck

Copyright MSF

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 7m57s

Maximum Size 1920px × 1080px 803.34 MB

Additional Information / Shotlist Script for the film Dying of AIDS in 2017.
Filmed and released July 2017.
Filmed by Benoit FInck. Written and directed by Armelle Loiseau.

Live : Winnie, managing for acute GE with treatment failure, RVD.
It’s a chronic one.

Dr Berna Gurer, MSF (in English)
Winnie is a typical patient who went from one facility to another and got lost in between. And finally came here to Homa Bay to get treatment.
Winnie was put on ARVs two years ago when she was pregnant of her child. Then she was sent to a facility. Due to private problems, it didn’t work out. Then, she should be switched half a year ago to second line. Because of managing her treatment properly at the facility, because of not presenting and changing facilities, she lost more or less two years and her condition got worse and worse.

COMMENTARY
Winnie was admitted to the AIDS ward in Homa Bay hospital in western Kenya with late stage HIV. This means the virus has attacked her immune system, leaving her extremely vulnerable to infection. She’s suffering from chronic gastro-enteritis.

Live: Is your right leg worse? How’s the pain?

COMMENTARY
In near-by beds are Kwonta and Molvine… and others like them, all in the same situation. Their stories are different, but together they reflect a largely ignored reality. At a time when antiretroviral drugs, ARVs, are in widespread use, AIDS continues to kill. In 2016, one million people died of the disease.

Dr Berna Gurer, MSF (in English)
HIV patients still dying to big extent like before introduction of ARVs. ARV drugs are available, diagnostics are available, so the question is: why HIV patients are still dying?

TITLE: Dying of AIDS in 2017

Dr David Maman, epidemiologist (in French)
With over 15 million people across the world now on ARVs, we’re seeing that AIDS-related mortality has a different profile to several years ago. It’s either due to people interrupting treatment or because their treatment is failing and it’s not being detected early enough.

COMMENTARY
For the medical team here in Homa Bay, patients whose treatment is failing need specially tailored care.

Dr James Abwao, Kenyan Ministry of Health (in English)
We see a majority of them who already know their status, and the majority of them are already on ARVs. Either they’ve been on ARVs for a long time and they’re failing, or they’ve been on ARVs and they defaulted, adherence problem. And therefore they got opportunistic infections. And this is a challenge in the ward.

COMMENTARY
The primary aim of most HIV programmes today is to put as many people as possible on treatment. This is based on the principle that once tested and treated, they’ll live for years without falling sick. But the reality is more complex: the journey ahead for people living with HIV is strewn with pitfalls.
Take this woman, for example. Her husband chased her from her home.

Patient (in Luo)
He 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 got back home in January, I started taking my ARVs again. I’d become disabled and I had no energy. I’m paralyzed from the waist down.

COMMENTARY
Psychological and socio-economic issues, stigma, lack of information on the implications of taking treatment for life… The reasons for treatment interruption or failure are numerous.

John (in Luo)
If you don't skip your medication, you can go about your business perfectly well.
Like me. I started on ARVs and got better, so I thought I was cured and could do my job.
When you get better, you imagine you’re completely cured and as healthy as everyone else.
You don’t know the drug has only weakened, but not eradicated, the virus.

COMMENTARY
Another obstacle: identifying patients whose treatment is failing. The main challenge here is to obtain test results as fast as possible. To facilitate this, some tests can be carried out at the patient’s bedside, ‘point of care’ tools that not only assess the treatment’s effectiveness but also detect infections that can develop when the immune system is weakened. It is these infections that kill people in the advanced stages of HIV.

Dr David Maman, epidemiologist (in French)
Firstly, the process of diagnosing opportunistic infections must be accelerated. This is why MSF is calling for new standardised tests to speed up diagnosis of tuberculosis and cryptococcal meningitis, the two most common opportunistic infections (…) and to treat patients as soon as possible.

COMMENTARY
As long as there are obstacles of this kind, the teams will continue to see gravely ill patients admitted to their wards… Many will die shortly after arriving. Medical care is a real challenge.

Dr David Maman, epidemiologist (in French)
We have three concurrent tasks. We’re working with people who are extremely weak, they’re malnourished and anaemic. We’re having to treat very severe infections as fast as we can. And at the same time, we have to work on rebuilding patients’ immune systems. And this is complex in extremely resource-poor settings. These issues are responsible for the appalling mortality rates we continue to see in hospitals today.

COMMENTARY
There’s another, hidden, side to AIDS: the sick, who don’t even manage to get to the hospital. Either they’ve never been tested for HIV or they’ve never had access to antiretrovirals. They remain out of sight, and will highly likely die in their homes
Such cases are found in countries where HIV is less prevalent, for example, in central and western Africa. Access to HIV treatment remains limited and people die of AIDS as much as 15 years ago, when antiretrovirals weren’t commonly available. In Central African Republic, there is very little access to testing and treatment for HIV.

Tanguy ANDYGBIA, MSF health promoter, (in French)
Patients come when the disease is in the advanced stages. But some prefer to stay home because of their poor state of health, while others can’t afford to go to the hospital. With insufficient inpatient capacity, we have to discharge patients doing a little better to make room for others in even worse shape.

COMMENTARY
In these countries, what’s most urgently needed is not so much identifying treatment failures and possible opportunistic infections as combatting (high levels of) stigma, setting up mass screening campaigns and providing widespread access to drugs.

Live : Most probably we have to put her on second line treatment.

COMMENTARY
To prevent and treat AIDS, medical strategies have to be adapted to include improved diagnostic tools and more effective affordable drugs, and to actively help people living with HIV to overcome the obstacles and constraints related to lifelong treatment.