How acting fast is vital in the battle against advanced HIV...

HIV treatment is more and more available, but the number of deaths related to the disease is stagnating. Why?

HIV is a virus that attacks the immune system. People with advanced HIV, also known as AIDS, have severely weakened immune systems, putting them at high risk of life-threatening infections, such as tuberculosis or pneumonia.

Worldwide, huge progress has been made in improving patients' access to safe, effective medications which suppress the virus, allowing HIV-positive people to lead full and healthy lives.

However, while the numbers of people on treatment improves, hundreds of thousands continue to lose their lives to illnesses related to advanced HIV.

Severe consequences

In the MSF-supported hospital in Nsanje, Malawi, many of the HIV patients in the most critical condition are not people who didn't know their status.

Although they had previously begun treatment, for whatever reason, these patients may have stopped taking it, or found that a particular treatment is no longer effective for them.

The consequences are severe, and for many arriving at health facilities, the race to save their lives begins immediately.

Saving lives

Rapid tests at the local level ensure that health workers can quickly assess patients with advanced HIV, and get them started on vital treatments, fast.

However, these tests are almost never available in the communities where they are needed most.

On World AIDS Day, December 1, we are calling for this to change.  

Since MSF made the rapid tests available in Nsanje, the number of advanced HIV patients who die in hospital has dropped by more than half.

These are some of the people behind the statistics.


“I’m not feeling well at all. The challenge is that if I eat something, my stomach balloons.

I miss a lot from home – I miss my daughter and the food.

When I go home, I will take my medication every day. When the medication is finished, I will go back to the health facility for the refills.”


“My name is Gerrald and my daughter Lita is 25-years-old.

She started getting sick in July 2019, so we took her to the hospital. She was tested and found to be HIV positive.

Lita was advised to start taking antiretroviral drugs immediately. But when she was discharged, she went back to her husband and, unfortunately, stopped taking the medication.

As a result, she started getting sick again. I was really devastated. She is my first-born child. She made me a father and defines who I am.

Before we came to the hospital, Lita couldn’t walk without support. They had to drain the fluids from the stomach and she couldn’t sit down. 

But now there is a great improvement. She is able to walk on her own.

Lita and her husband are separated now. He left her the moment she started getting sick.

Together they had three children, but the eldest and the third-born passed away. The second-born, who is three, is alive. I want to bring her here to the hospital to be tested.

When Lita is discharged, I will make sure that she doesn’t have to do any heavy household chores. I will provide all the necessary support and love.

She will not default on her medication again, as I will be around.

All photos by Isabel Corthier/MSF

All photos by Isabel Corthier/MSF

All photos by Isabel Corthier/MSF


“I was admitted to the Nsanje District Hospital in October 2019. I had lost a lot of weight.

I have been taking antiretroviral medication since I tested positive for HIV three years ago. But then I decided to stop.

I quarrelled with my wife; I told her it would be better for me to die. I stopped taking my medication for three months and soon got worse.

After 12 days in hospital, I am happy to be going home.

I've also been diagnosed with diabetes, which the doctors say I will have to manage for the rest of my life, like HIV.

Now that I'm better, I want to be the voice of the change in my community.

I want to find people that are suffering from HIV and help this community become disease-free.”


“I come from Chitomeni Village and I am a fisherman.

During one of my usual fishing errands, I was having trouble breathing. I had chest pain.

When I realised that my health was deteriorating, I went to Ndamera Health Centre, where staff asked me if I had been tested for HIV and other diseases. I said ‘no’.

I was found to have two conditions: HIV and tuberculosis.

I was taken to Nsanje District Hospital, where I stayed for almost two weeks. During that time, the pain disappeared and my health improved.

I was discharged and went back to Chitomeni. But after nearly nine days, my condition started to worsen again.

I couldn’t speak. I couldn’t walk. Even drinking a cup of water was a struggle. I was coughing a lot and I couldn’t breathe.

I told my colleague at the fishing dock, ‘Joe, please find a bicycle and take me to the health facility’.

It’s a long way to the health centre, almost two hours by bicycle and on foot.

After assessments at Ndamera, an ambulance took me back to Nsanje District Hospital.

Now that I’m here, I am feeling better. I am able to breathe and speak again. After three days, my health has improved and I am now able to wash myself and my clothes.

Of course, I am not totally healed; I still struggle to breathe but what MSF is doing in collaboration with government is commendable.”

Soon after this interview, Manfred’s condition deteriorated. At the start of November, he sadly passed away at Nsanje District Hospital.


While fewer HIV patients are dying at Nsanje District Hospital since MSF made rapid tests available, Manfred's story shows that they are just one part of the puzzle.

Countries such as Malawi need support as they tackle advanced HIV.

MSF has released a report with three recommendations for improving the advanced HIV response and meeting global targets.

“We will not end the ravages of HIV by digging more graves, but by doing all we can to keep people healthy, no matter where they live and what their life circumstances are,” says Florence Anam, MSF’s HIV/TB Advocacy Coordinator and lead author of the No Time To Lose report.

“They must be supported mentally and medically as close as possible to where they live.”

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