Projects under President Bush's global five-year, $15 billion Emergency Plan for AIDS Relief program are getting under way. In Kenya, a consortium funded by the program has opened several sites to offer anti-retroviral drug treatment to people living with HIV/AIDS.

Clinical officer Walter Kizito smiles, as he recalled how anti-retroviral drugs (ARV) recently transformed the life of an elderly patient suffering from AIDS.

?He had lesions all over and he had been to all the hospitals,? he said. ?He had been given several drugs, and with time, the lesions were really worsening. We started him on ARVs. We reviewed him after two weeks starting treatment. The lesions had really, really subsided and they were drying up. I think his quality of life has really, really improved. Within two weeks, he had seen marked changes.?

Mr. Kizito is based at the bustling Saint Vincent's Integrated TB/HIV Clinic in Kenya's capital, Nairobi. Located across the street from a sprawling slum in which most people lack running water and toilet facilities, and live on less than one dollar a day, the clinic gives out medicines to tuberculosis and HIV-positive patients from the surrounding community.

Starting next month, Mr. Kizito and his colleagues at the clinic, owned by the Catholic Archdiocese of Nairobi, will implement a five-year program in which several hundred adults, pregnant women, new mothers and children living with HIV/AIDS in the surrounding community will be put on free ARV treatment.

The managing director of the Archdiocese of Nairobi's Eastern Deanery AIDS Relief Program, Father Edward Phillips, says low-income people living with HIV/AIDS are in desperate need of ARVs, because they have to be strong to earn income for their families.

He says premature deaths of parents means the family unit is broken and orphans too often end up on the streets.

Yet, said Father Phillips, there are precious few opportunities for low-income HIV/AIDS sufferers to get the medicines they need.

?These are all poor people in the slums,? he noted. ?These are the folks that are never going to get anti-retrovirals through any other system. We're really reaching out to the people at the bottom. Without this type of money, these folks would have just been left to continue to live and to die with AIDS.?

Governments and international institutions, such as the World Health Organization (WHO), are increasingly under pressure to provide free ARV treatment to the world's poorest people living with HIV/AIDS.

In Kenya, the medical aid agency, Doctors Without Borders, estimates that about 500,000 people of the country's 2.5 million HIV-positive are in need of ARVs. Yet, it says, only about 12,000 people receive the treatment.

Lack of money is a big concern for a consortium headed by Catholic Relief Services, which is funding Saint Vincent's clinic's ARV program. The group includes the University of Maryland Institute of Human Virology and the Catholic Medical Mission Board.

Under President Bush's five-year, $15 billion Emergency Plan for AIDS Relief program, the consortium has been awarded a $25 million grant in the first year alone to offer ARV treatment to about 137,000 HIV-positive patients in nine African and Caribbean countries.

The clinic is one of several sites in Kenya where the consortium will operate. Its senior program director, Dr. Carl Stecker, said he wants to work in partnership with churches and other faith-based organizations.

?So, these are not new kids on the block,? he said. ?They know what they're doing, they have structures in place, they have good accountability, and in many other areas of public funding, church groups and missions and faith-based organizations have received funding because they've been known as being accountable.?

A researcher at the University of Maryland, Dr. Anthony Amoroso, said that a major challenge for the consortium is regular delivery of the ARV treatment.

He says people taking part in the treatment must adhere to a strict schedule of when and how to take the drugs or else the HIV virus could mutate and become resistant to the drugs.

?Most health care systems within Africa really are acute health care systems,? he explained. ?They handle the acute problems, they don't handle chronic diseases and they don't handle diseases where, if you're not adherent 100 percent of the time for life, the medications can quickly fail.?

Dr. Amoroso added that treating people for a second time becomes a lot more expensive and complicated and requires specialized knowledge and training.

The Archdiocese of Nairobi's Father Phillips agrees that adherence to a strict drug regime is a big problem, especially in areas where people may be illiterate, have unpredictable schedules because of casual labor or are isolated.

For instance, he says that mothers often share their AIDS medication with their children, because the mothers do not have access to these medicines for their children.

Father Phillips says nurses visit patients at home one week after they begin receiving ARVs from Saint Vincent's Integrated TB/HIV Clinic and evaluate whether patients have any difficulties adhering to the strict ARV schedule.

The nurses continue with their home visits. As well, patients are required to join a twice-monthly support group that will help them to adhere to the drug schedule.

?We also see that people [who] are going to be on the medication for a longer period of time will be able to help new patients getting on the medication, to either share some of the difficulties they might have had with the side affects that can come from anti-retroviral drugs,? Mr. Phillips noted. ?Then, on the other side, they can start to tell their success stories, too.?

Father Phillips added that those who do not adhere to these conditions may be asked to leave the program.

There are obstacles to overcome, but the staff of Saint Vincent's clinic is thankful President Bush's AIDS initiative is bringing long-awaited relief to those infected with the HIV virus.