Treating HIV in Africa: case report from rural Congo.

Human immunodeficiency virus continues to devastate sub-Saharan Africa (Figure 1).1 Despite evidence to the contrary,2 many physicians still question whether AIDS treatment is even possible in resource-limited settings. Rural HIV-positive Africans are often tormented by fear of discrimination, fear of HIV-related stigma, and confusion from conflicting traditional and faith-based beliefs.3 Within this context, stories of survival—successful antiretroviral treatment (ART)—are powerful motivators for physicians, patients, and communities. Differential access to services, diagnoses and screening, practitioner factors, and patient adherence can affect the effectiveness of our clinical interventions.4 Success stories are emerging, however, as Médecins Sans Frontières (MSF) (Doctors Without Borders) and other medical organizations integrate HIV and AIDS care into basic health care programs in resourcelimited settings. We present this case report to raise awareness of integrated HIV care,5 which has implications for family physicians working internationally and for those working with African refugees in Canada. This case outlines the process of diagnosis and management of a patient who presented to a basic health program that had integrated HIV and AIDS care in a rural village in the Republic of Congo (ROC). It highlights the central role of psychosocial counseling and simplified single-pill ART, together with management protocols that integrate HIV care.