BIPAI: Taming the monster of AIDS
By Ruth SoRelle, M.P.H.
In the mythology of the country of Lesotho, a terrible monster devoured the people and the animals, leaving only a pregnant woman behind. When she gave birth to a son, Senkatana, he asked her why they were so lonely in a beautiful land. She told him there were once people and animals, but that a huge monster had eaten them. Senkatana himself grew to match the size of the enemy. He armed himself, killed the monster and freed his people from the belly of the beast.
Today, a monster of smaller size but even greater lethality – HIV/AIDS – is devouring the people of Lesotho, but an army of Senkatanas, armed with potent anti-viral drugs, knowledge of medicine and a desire to care, is marching into battle again.
In August, the Baylor International Pediatric AIDS Initiative (BIPAI) announced a dramatic strengthening of its childhood AIDS initiative in the tiny kingdom of Lesotho, increasing the number of Pediatrics AIDS Corps physicians in the country from 10 to 14 and adding 10 satellite clinics to the Baylor-Bristol-Myers Squibb Clinical Center of Excellence – Lesotho already operating in the capital city of Maseru. The expansion of services (see map) is possible through the support of Baylor College of Medicine, Texas Children's Hospital and the Bristol-Myers Squibb Foundation.
Time to fight for children
"For too long, children have been on the outside looking in," said Mark Kline, M.D., president of BIPAI and a professor of pediatrics at BCM. "It is time we insured that children have the same access to life-saving therapy that their mothers and fathers have."
"Lesotho is fortunate indeed to have these partners in its fight against HIV/AIDS," said the nation's Prime Minister Pakalitha Bethuel Mosisilli, during a visit to Houston, where the expansion was announced. "BIPAI will restore the health of our children. The work of BIPAI has been possible because of a strong collaborative partnership with the government of Lesotho. It is indeed a true and enduring partnership in the fight against HIV/AIDS."
Mosisilli and a team of Lesotho government officials visited Baylor and Texas Children's a day after ceremonies in Washington, D.C., in which the U.S. government's Millennium Challenge Corporation announced $362.5 million in support to Lesotho. The MCC was established in 2004 to help some of the poorest countries in the world.
HIV problems are grave
The problems in sub-Saharan Africa are grave, said Dr. Mphu Keneiloe Ramatlapeng, Minister of Health and Social Welfare for Lesotho. In almost any nation in that region, at least 20 percent of adults in their most productive years are infected with HIV.
"We know this is the time to reach every single child," she said. "If we miss reaching them now, then their numbers will grow smaller. We must reach every available child now, and we must stop new infections transmitted from mother to child."
"With a population of less than 2 million and a prevalence of HIV of over 23 percent, every single person in our country has been touched by HIV/AIDS," said Mosisilli. "It is difficult to stay in denial when you have lost half your siblings to the disease, in a nation where pregnancy is associated with death. We are not in denial because we realize we have to act."
Importance of satellite clinics
The opening of the Senkatana Center, an adult HIV/AIDS clinic attached to Maseru's Queen Elizabeth II Hospital, in May 2004 was an important launching point for care in the small kingdom. However, said Ramatlapeng, treatment for children was slower for many reasons. Physicians to treat children were in short supply. Fixed dose drugs (rather than syrups for which doses must be figured and carefully measured) have made giving the drugs easier.
"Now we have this wonderful news about the Lesotho Expansion of Rural AIDS Treatment and Outreach (LERATO)," she said. Putting satellite clinics in all parts of the kingdom will help eliminate barriers related to transportation, bringing treatment closer to those who need it. LERATO is not only an acronym for the new program, but it is also the word for "love" in the indigenous language of Lesotho.
The establishment of satellite clinics is a new part of the BIPAI program. The new satellite clinics will provide lifesaving HIV/AIDS care and treatment to thousands of children and families residing outside main urban areas, extending the reach of the Centers of Excellence.
Protecting the next generation
"We have made pediatric HIV/AIDS our entry point into treatment and care," she said. She said the country plans to require that pregnant women be tested for HIV and offered treatment to prevent passing the disease to their infants.
"We are protecting the next generation. We really can't afford to have any more people becoming positive or being born positive," she said. The health ministry also plans to test children who come to clinics for vaccinations against childhood diseases.
Mosisilli said that such activities are critical to the future of the nation. "Only through the prevention of new infections among our children can we possibly hope to realize the dream of an HIV-free generation and promising future for Lesotho."
BIPAI plays a prominent role in that future, he said. "I wish to thank each doctor (in the Pediatric AIDS Corps) for the sacrifices he or she is making and for his or her courage and commitment to this struggle. They are indeed our modern and legendary Senkatanas. Through them, we will be able to overcome this monster that is swallowing our people mercilessly."
BIPAI's first center of excellence was opened in Romania in 2001. Since that time, the effort has expanded to programs in Mexico and the African countries of Botswana, Burkina Faso, Kenya, Lesotho, Malawi, Swaziland, Tanzania and Uganda.
