Creating Hope


Photographs: Gideon Mendel

"As we progressed I saw a whole lot of change in my patients" says Tryphina Madonsela. "Those who felt that they were dying when we initially met now had a positive attitude. They were going back to school. They said 'I'm getting married, I have found a new job. I'm alive'..."


Madonsela is a nurse at Chris Hani-Baragwanath Hospital in Soweto providing treatment to HIV-positive people in Africa. The centre in which she worked was part of the MTCT-Plus initiative, started in 2002 by HIV specialists at the Mailman School of Public Health, Columbia University, New York.

Creating Hope is a narrative account of the world's first multi-country HIV treatment programme.It describes the early years of the MTCT-Plus initiative and is based on interviews with secretariat staff, including Dr. Wafaa El Sadr, Dr. Elaine Abrams, Dr. Patricia Toro, and other participants and partners of the project, including, Dr. Kevin De Cock and Stephen Lewis.

Creating Hope (2010) is an online publication, written by Lesley Lawson for the International Center for AIDS Care and Treatment Programs (ICAP).

Part 1: Beginnings

"Should we not be giving serious consideration to finding ways to offer women treatment simply because they are infected with HIV, not just because they are pregnant? In other words should we not value saving women's lives as an equal priority to decreasing transmission to infants?"

Dr. Allan Rosenfield, 2001

The MTCT-Plus Initiative, the world's first multi-country HIV treatment program, was announced at the 14th International AIDS Conference in Barcelona in July 2002. Its aim: to demonstrate to a disbelieving world that it was possible to provide care and antiretroviral treatment in resource-limited settings, using programs to prevent vertical transmission of HIV (or PMTCT) as an entry point.

"We were trying to bridge the gap," says founding director Dr. Wafaa El-Sadr . "The world had divided into people who said you've got to do prevention, treatment is not an option and you are going to have raging resistance in Africa; and the few people who were advocating for treatment, saying it was completely unethical not to treat people."

Within four years the MTCT-Plus initiative of Columbia University's Mailman School of Public Health was providing HIV care and treatment for more than 16,000 people at fourteen sites in nine countries. By 2010 the International Center for AIDS Care and Treatment Programs (ICAP), based at Mailman, had provided care and treatment to more than one million people.

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