Pregnant with her first baby, Jackie Ampire discovered that she was HIV-positive after a visit last July to the Hope Clinic Lukuli, in the outskirts of Uganda’s capital Kampala. She had stepped inside this local NGO for the first time to receive a prenatal examination and was encouraged by a counselor to have an HIV test.

“I was so hurt and worried about how I could tell this to my husband,” Mrs. Ampire recalled. “I didn’t want to lose my baby. But a counselor told me how I could give birth to a healthy baby and continue my life with HIV treatment.”

While HIV could easily have been a death sentence for mother and baby alike only 10 years ago in Uganda, treatment is available today that can both sustain life and help HIV-positive mothers deliver healthy babies. A large increase in international donor funding has brought these treatments, known as “antiretrovirals,” to patients in developing countries. MASSIVEGOOD was created to support one such international funding program, UNITAID, which has saved thousands of lives by purchasing affordable medicines and diagnostics, helping patients like Mrs. Ampire access free HIV treatment.

Yet it is through the work of facilities like Hope Clinic that these drugs actually reach those in need – one patient at a time.

Councilors at the Hope Clinic put Mrs. Ampire on anti-retroviral treatment when she was 6 six months pregnant. She eventually gave birth at the clinic without complications – to a completely HIV-free baby. “I am still taking antiretrovirals, my baby is healthy and I have resumed work” she said, now 27 years old. “My husband was also tested and found negative but he has been very supportive together with the staff of clinic. We now attend sessions at the clinic together to learn how to live with each other.”

The Hope Clinic Lukuli (see photo, right) is a primary health care facility, providing essential medical services to the village of Lukuli and its surrounding population of around 50,000. Residents can come in for outpatient care, including immunizations and fever diagnosis, providing a discreet way to offer quality HIV diagnosis and treatment in a community where HIV stigma can still be strong. Over 5,000 people are tested for HIV each year at the clinic, important for an area where around 12-13% of the population is infected with the disease. All HIV services are free of charge.

“We use the experienced patients to reach out to other patients,” said Angella Baitwabusa, the lead counselor at the clinic. “Jackie’s story and those like it encourage other people to test. Last year 84 pregnant mothers tested positive for HIV and with appropriate treatment there were 84 HIV-negative babies born in the clinic.”

Until recently, much of Hope Clinic’s funding for HIV treatment came from PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, created in 2003 and widely celebrated for having distributed treatments to about 2.5 million Africans infected with HIV. In Uganda, PEPFAR funding has helped bring the number of those on treatment from 10,000 to around 200,000. As an outreach center of the Joint Clinical Research Centre (JCRC), the Hope Clinic received PEPFAR-funded medicines, providing almost 300 patients at the clinic with treatment.

In March of last year, things changed for the worse. The Hope Clinic received a letter that JCRC funding was being “flat-lined” in Uganda, a worrying sign of belt-tightening in global health budgets throughout the Western world.

 “The situation was dire,” said Philip McMinn Mitchell, director of the clinic. “After March 2009, those that tested positive for HIV were given mosquito bednets and water purification kits. But they were told that they had to cross town in order to get free antiretroviral treatment.” Delivering complete HIV services to the community is at the heart of the clinic’s mission and the PEPFAR “flat-lining” meant that new patients could not be put on anti-retrovirals that they could afford.

Luckily, Mr. Mitchell had already begun searching for alternative sources for HIV treatments and Hope Clinic (already accredited by the AIDS Control Programme of Uganda in 2006) was allowed to access the government drug stocks in March 2009. With this new line of supply, the Clinic today has put 100 additional patients on antiretroviral treatment, Mrs. Ampire included, using drugs provided by the National Medical Stores, an autonomous government body.  The testing and drugs for the prevention of mother to child transmission is entirely reliant on the government testing and drug stocks. In Uganda, UNITAID purchases drugs in bulk and delivers them to the National Medical Stores via their “implementing partners,” the Clinton Health Access Initiative (CHAI) and UNICEF.

This multi-tiered funding model has proven quite successful and efficient. UNITAID’s bulk purchases of powerful “second-line” medication (for those who become resistant to treatment), child-friendly antiretrovirals and special drug kits to prevent mother-to-child transmission of HIV have significantly brought down the prices of these previously expensive medications. In 2009 alone, UNITAID supplied a powerful antiretorival drug, tenofir, to nearly 50,000 patients in Uganda and Zambia alone.

“UNITAID is large in the scale of the response, but you can see the funds going all the way down,” said Mr. Mitchell. “A tiny proportion of what we spend on an iPhone in the West can make a real difference in my community – UNITAID works and we hope it will continue.”

When Mr. Mitchell founded the Hope Clinic in 2000 with his wife and six Ugandan friends, a sole midwife was delivering babies out of a tiny two room facility. Today the clinic has a functioning lab, a confidential space for consultations and a wide range of services to help its community. Importantly, the dedicated staff of the clinic is using a community-focused approach to save lives and educate about the importance of HIV testing and treatment. HIV-positive patients like Mrs. Ampire are able to lead productive lives and contribute to their community thanks to the commitment of the Hope Clinic. 

Yet as the budget of PEPFAR and other international programs prove difficult to increase in today’s economic environment, new forms of financing are needed. The appropriate treatments must be made available to health providers across the developing world, so places like the Hope Clinic can continue to provide to their communities.