DREAM in the “Warm Heart of Africa”

Renán Orellana, Co-Editor-in-Chief

AIDS is not a death sentence. For this reason, people living with HIV should be given an opportunity to live a full life, irrespective of their socioeconomic situation. The impact of AIDS in Malawi is a critical concern for communities already devastated by deeply-rooted poverty and malnutrition. The epidemic has left millions of orphans and provoked a disastrous human resources crisis for Malawi’s workforce, particularly in the country’s agrarian regions where rural families are dying of both AIDS and hunger. This summer, I had the opportunity to see public health in action through my work with DREAM (Drug Resource Enhancement against AIDS and Malnutrition), an AIDS therapy program that provides gratuitous HAART (Highly Active Antiretroviral Therapy) and nutritional support to the poorest of the poor in Africa.

DREAM has become an exemplary healthcare model that addresses both treatment and prevention, while demanding that patients in the poorest countries receive the same standard of care offered to patients in rich countries. DREAM envisions a new Africa in which seropositive mothers have access to tri-therapy so that their children can be born healthy and without HIV; in which entire villages affected by AIDS are no longer communities of orphans; in which advanced diagnostic-therapeutic practices like virological monitoring are commonplace in clinics and hospitals alongside conventional clinical monitoring; and in which stigma, discriminatory behavior, and humiliation for one’s health condition are nonexistent.


DREAM is not an emergency-type response to the AIDS crisis. The sustainability of the program is the fruit of a collaborative effort between local doctors, politicians, technicians, and communities in Africa and people in the West – a partnership founded on the idea that the key to the revitalization of Africa lies in the potency and resilience of Africans themselves. In public health, we often speak of the challenges of accessibility. DREAM proposes a sustainable model that modifies the familiar immobile health system of clinics and hospitals so that care can reach patients wherever they are – be it their homes, the streets, orphanages or hospitals. One of the most important components of the treatment process of DREAM involves the active participation of hundreds of local HIV positive men and women who become cultural intermediaries for the programme while they themselves adhere to the ARV regimens. These paid activists provide patients with the support and counselling that medical personnel cannot offer.

The triumph of this movement of activists in securing adherence and optimal care for DREAM patients is solidified in the “homecare” component of the model. The activists develop strong bonds with patients and their communities. They become catalysts for the eradication of stigma by providing health education in remote villages and helping in the reintegration of patients into community life. At the core of the DREAM model is an assurance that the holistic well-being of every individual will be cared for regardless of whether they are in the clinic or in their homes. This centrality of the patient in their own care is a concept often overlooked by international and humanitarian aid agencies that often place a larger focus on the timely fulfillment of empirical benchmarks and fixed strategic goals.

As the weeks pass, I hope to write about my experiences, but most importantly, stimulate a conversation about the dynamics of poverty, nutrition, health and well-being in both developing countries and the United States.

Renán Orellana is a senior at NYU Steinhardt studying Public Health and Poverty Studies. Contact him at: renan.orellana@nyu.edu.


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