World Aids Day: a surprising story of success

Dralinya* is a father in his forties. He lives on the South Sudan/Uganda border. He also has HIV, the now-infamous virus that weakens immune systems –and if left untreated, cuts short lives.

When he was first enrolled in Save the Children’s antiretroviral treatment (ART) clinic at Nimule hospital, in South Sudan, several years ago, Dralinya’s CD4 count – a type of white blood cell that helps to protect your body from infection – was dangerously low.

A father, sick, unable to provide for his family

The threshold for people living with HIV to start on ART, according to the World Health Organisation, is a CD4 count of 500.

Dralinya’s count was 192. He was weak – and unable to provide for his family.

A step forward… then a step back

Eight months after beginning the programme, he started to feel better. He began working again. But then his wife died. Her death devastated him. He wished he could die, and stopped coming to Nimule hospital for his treatment.

For thousands of people, the story would have ended there. Dralinya’s CD4 count would have plummeted, and eventually an infection would have set in and – his body weakened and unable to fight back – he would have died, leaving his family orphaned.

But that didn’t happen this time.

Reasons for default

The reasons people default are very varied, from suffering from depression through to needing to work long hours and being unable to take time off to visit the hospital.

Recognising the high default rate of patients enrolled on the programme, especially those who had to cross from Uganda to the South Sudan-based Nimule hospital, Save the Children’s  ART Programme Supervisor at Nimule Hospital, Emmanuel Males, had previously taken matters into his own hands, launching an innovative small-scale project cross-border.

An innovative and life-saving system

Emmanuel created support groups for people living with HIV, and then created a ‘buddy’ system, whereby people who are enrolled and successfully completing their treatment are buddied with those who are defaulting.

It’s a simple measure – and a successful one. ‘Buddies’ drop by the home of the defaulter and talk through the issues and the reasons it’s important to continue treatment.

Dralinya wasn’t convinced initially, but after his buddies shared their own stories of loss, treatment and how they cope, he agreed to re-start treatment.

That was two years ago, and Dralinya is still successfully enrolled on the programme and his CD4 count is rising by the month. He is also now a buddy for other potential defaulters.

Save the Children is looking at ways to expand the buddy programme. The success rate is extraordinary – the default rate prior to the scheme was 58% – more than one in every two people dropped out at some point. Now, the default rate is 1.8% – less than two people in every hundred default from the scheme.

A different kind of statistic

In our line of work, statistics usually outline the problem – it’s the percentage of the population facing starvation that prompts us to act, or the statistics of young girls forced into early marriage that demand international action.

Here, in a dusty border town between Uganda and South Sudan, the statistics are actually exciting. A dedicated team is gradually turning individual human tragedies into stories of hope, and that hope is slowly spreading.

Emmanuel’s HIV buddy system in Nimule hospital is a microcosm for all the change we want to see in the world, and for once, the statistics don’t dismay me. They galvanise me.

*Name changed to protect identity