Demedicalizing AIDS prevention and treatment in Africa.

303 province, 27,800 patients are receiving their HIV treatment through adherence clubs, and the approach is being adopted in other parts of South Africa. The program offers a model for treatment in countries with far fewer resources.1,4 Similar community models of care have been adopted in Mozambique and are being piloted by MSF in Malawi and Zimbabwe, countries with even broader treatment coverage for their HIVinfected populations but with similar challenges when it comes to maintaining patients in treatment for a lifetime. Effective, widespread treatment of HIV in Africa was once thought to be logistically and economically impossible. Programs in multiple countries are showing that it can be done. But the problems involve attitudes as well as economics and logistics. After the adherence-club meeting in the small home in Khayelitsha, we gather outside. Someone asks our gracious host if she can take her picture for an article in a local magazine. She pauses, and for the first time she seems uncomfortable. Then she says yes to a picture but asks that her name not be used. She has worries about her employment outside Khayelitsha. “These things can get around. You cannot trust what some people out there might do.”