HIV@MSD - Benin - Feeding Body & Spirit

It's lunchtime at Action Plus Sida Santé (APSS), a caring center for people with HIV/AIDS in Porto Novo, the capital of Benin in West Africa. Six of the fortunate few who are receiving free antiretroviral (ARV) medication through a government-sponsored program have gathered together around the conference table to talk with the staff and enjoy a nutritious meal of stewed fish with rice, bread, avocado salad, and fried bananas for dessert.

Five months ago, my doctor told me to come here to the center," says Donatien, "mainly because the best way for us to have our medicines is to take them with meals, otherwise we don't assimilate them well." Indeed, to optimize the benefits of antiretroviral treatment, adequate dietary intake is essential, and the strong medications used in this therapy require that they be taken on a full stomach. Good nutrition helps patients cope with the powerful effects these medicines have on the body and fight off AIDS-related opportunistic infections more effectively. In some cases, physicians prefer to delay the initiation of ARV therapy until their patients have regained enough strength to tolerate the treatment.

Throughout the developing world, HIV, poverty, and malnutrition go hand-in-hand. Poverty not only makes it difficult to access treatment, but also to adhere to the challenging ARV drug regimen. Some doctors have observed that their patients who are too weak become less compliant with these medications, while others drop out altogether.

Here in one of the 18 poorest nations in the world, many of Benin's seven million inhabitants lack access to adequate food supplies. This deficit is particularly devastating to those suffering from the wasting syndrome associated with HIV/AIDS. And because of the stigma associated with this disease, many of those living with HIV/AIDS have lost their jobs and have been shunned by family and friends, leaving them without any means to feed themselves. By the time they find their way to Action Plus Sida Santé, located on a quiet, muddy street in the heart of Porto Novo, most have completely exhausted all financial resources and lost all sense of hope.

"I am from Togo," one woman told us, and when I was sick, people pushed me away. I lost my family and my friends, and I had to flee the country that's why I came to Benin. I was in such a state of despair. Things were so bad I even tried to hurt myself. I met a pastor here who told me to go and get tested, and I went to the hospital and discovered that I had HIV. I was put on ARV treatment. Since I have been coming here to the center, I have discovered that there is hope, and now I want to live again."

Action Plus Sida Santé has been rekindling hope and courage in Benin since 1999 when French AIDS specialist Prof. Christian Courpotin and Denis da Conce" founded this caring center. Denis was born and raised in Porto Novo and then studied biology in Paris where he met Dr. Courpotin and learned about HIV/AIDS. Upon returning to his homeland in 1999, Denis and Christian took a close look at the new ARV treatment initiative Benin's Ministry of Health was developing.

"We found that there were two components that were lacking," says Denis da Conce, Executive Director of APSS. "The first was communication and the other was nutrition. So we decided to put together a center to accompany the national ARV efforts. We built this center to be able to provide HIV patients and their families with essentials such as counseling and meals, knowing that many lacked the means to get adequate nutrition."

Compared to other sub-Saharan African nations, Benin's overall HIV prevalence rate of 2% is relatively low. Among particularly vulnerable groups, however, the infection rate is quite high, with 50% of commercial sex workers estimated to be HIV-positive.

Sandwiched between Togo to the east and Nigeria to the west, this former French colony lies at the center of the busiest trade route in West Africa that carries 3 million people a year from Abidjan in Cote d'Ivoire to Lagos, the economic capital of Nigeria. Health experts consider this the single largest transmission belt of HIV/AIDS in all of West Africa.

Believing that Benin could not afford to be complacent in face of this grave and growing threat, the founders of APSS contacted the government hospital in Porto Novo, and with the financial support of MSD, FSTI (Fonds de Solidarité Thérapeutique International), ESTHER (Ensemble pour une Solidarité Thérapeutique Hospitalié En Réseau) and Bristol Meyers Squibb, they provided training to the staff to instruct them about the basics of AIDS care and support and ARV medication. With the backing of President Matthieu Kerekou and his ministers, Benin then launched its national ARV treatment program in 2002. Since that time, Action Plus Sida Santé has worked closely with healthcare workers from the government program (Programme National de Lutte Contre le Sida) who refer patients to their center on a regular basis.

Today, the center in Porto Novo provides HIV education and counseling and one meal a day, six days a week, to 20 people on ARV therapy. Another 25 people come by when they can but lack adequate means of transportation to reach the center. Those who come to the center would prefer to receive two meals a day, seven days a week. "ARVs are very demanding in terms of calories," explains a patient named Happy. "After lunch I get hungry again, but I have to go back home and I cannot afford to have a meal at night. I fear taking the second dose because I know I won’t be able to assimilate it properly and it will make me even hungrier than I was before."

In addition, says Denis, "We are in need of psychologists to help these people get back to work, and increased funding to take care of their opportunistic infections, because the government supports the prevention but not the treatment of these infections. Today there are about 3,000 people on ARV therapy in Benin, and the Ministry of Health recently announced that this number would reach 6,000 by the end of 2005. That increase will bring even more patients to Action Plus Sida Santé, which has expanded its operations to seven sites across the country. Its mission of providing nutrition, counseling and support to patients in need will grow even more critical to the success of the national ARV treatment program in the days to come.

A.P.S.S: 01 BP 1713 Porto-Novo, Benin tel: (229) 95 60 52 07 75 03 / 88 46 80

Interview and photographs by Ms. P. Watson, USA