The demand for anti-Aids drugs far outstrips supply in many African countries. But, Zambia appears to be an exception to this rule — at first glance.
The director of technical services at the country’s Central Board of Health, Victor Mukonka, said recently that people were not coming to clinics to get access to the life-prolonging drugs, also referred to as anti-retrovirals (ARVs).
“People were demanding ARVs before we had them. Now, very few are turning up. The turnout cannot be compared to the pressure that we received to have them in the country,” he observed.
According to the 2003 United Nations Human Development Report, almost 22% of Zambian adults are infected with HIV, the virus that causes Aids. The report puts the country’s population at about 10 million people.
Mukonka said the only condition attached to getting the drugs was that people should be tested for HIV — and counseled about ARV therapy. He believes most people avoid being tested because of the stigma attached to Aids, thereby disqualifying themselves from accessing the drugs.
In the initial phase of the ARV programme, the government ordered drugs to cater for about 10 000 people. But Mukonka said most people in this group had yet to be reached, and he appealed to the public to go for testing and counselling.
Mukonka said clinics had recorded a very low response to the programme in outlying towns like Kasama in northern Zambia, where three people had applied for ARVs. In the western town of Mongu, 10 cases were recorded — while Livingstone, in southern Zambia, had 22. The University Teaching hospital, the largest in Zambia, had recorded about 400 people on the drugs.
However, a spokesperson for the Network of Zambian People Living with HIV/Aids (NZP), Clement Mfuzi, says the government is not being honest about the reasons why people are not applying for the drugs.
He denies the claim that people are reluctant to be tested, pointing to the fact that many who live with Aids have already gone public with their HIV status. It is not possible, he adds, that they would suddenly become too “shy” to seek treatment.
Mfuzi says the NZP has a membership in excess of one million people — but that none of these members has been able to take advantage of the drug programme.
“We do not know who is accessing the drugs, certainly none of our members. As a person living with HIV I have tried unsuccessfully to access ARVs. We are told we are on a waiting list and that is the end of the story,” he said.
Mfuzu has also alleged that the current system of drug allocation is open to abuse and favouritism.
Gertrude Mwashibantu, who is on the government-sponsored ARVs, agrees. She is only able to get drugs because she paid a nurse about $30 to jump the queue.
“I collected the drugs at lunchtime when there was no doctor around. I saw several people also collect their medicines and pass her [the nurse] an envelope. It appears to be common practice,” she says.
Mwashibantu adds that she heard about this arrangement from a neighbour, a medical worker who organises meetings with the nurse for a fee. She is not sure that her name would appear on a list of ARV beneficiaries should there be an audit of the clinic where she obtained them.
“I was surprised when I heard that people were shunning ARVs because when I go to the hospital, there are long queues for the drugs. I think there is just something not right about the way the ARVs are being allocated,” she said.
Zambia’s Minister of Health, Brian Chituwo, says he is aware of this alleged corruption, and that the matter was being investigated as part of a monthly evaluation of all aspects of the ARV programme.
Mfuzi also says it was wrong for the government to place ARV distribution and testing centres at hospitals and clinics, as these places are generally not visited by HIV-positive Zambians. By the time a person goes to a hospital, they are already too sick to benefit from the drugs.
“This programme should start with organisations such as ours that have a membership, and also provide testing and counselling,” Mfuzi says.
He also accuses the government of sidelining NZP members because they “made a lot of noise” over the lack of transparency in the distribution of ARVs.
“We … speak for the marginalised and discriminated, and that is why we are not popular,” Mfuzi says.
Chituwo maintains that the requirements for getting ARVs are reasonable.
“They [the NZP] claim to be already living positively with HIV and are of the view that they should be given first priority. But what about teachers, medical staff and others who are also justified in asking to have the first call on ARVs?” he asked.
The minister was surprised at Mukonka’s assertion that drugs are going begging. To his knowledge, there is a shortage of ARVs — not an over-supply — although he refused to be drawn on this matter.
At present, it costs as much as $300 to buy a month’s supply of ARVs on the open market. The government-sponsored drugs cost $9 per month after an initial payment of $15 for testing and counselling.
According to the 2003 UN Human Development Report, almost 64% of Zambians live below the poverty line of $1 a day.
The Global Fund to Fight Aids, Tuberculosis and Malaria has allocated Zambia $42,5-million to counter HIV/Aids. — IPS