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Government proposed HIV/AIDS treatment programme
Women and AIDS Support Network (WASN)
November 20, 2002

While we welcome Government’s attempt to avail treatment to people living with HIV/AIDS, in the form of antiretroviral (ARV) drug therapy, we however, foresee some serious problems in the recently announced Government programme and feel that there is need to speedily address our concerns.

According to The Herald of Wednesday, November 20, 2002, an allocation of Z$2.5 billion has been set aside for the treatment of people living with HIV/AIDS, as well as post exposure prophylaxis for medical personnel and survivors of rape or sexual assault.

Indeed while the allocation is a progressive move that will contribute towards improving the quality of life for people living with HIV/AIDS while reducing deaths, we however, feel that Z$2.5 billion for a whole year is a drop in the ocean and will not adequately address the problem of HIV/AIDS.

Given the high price of antiretroviral drug therapy, coupled with the escalating costs of the drugs due mainly to inflation, this allocation will be exhausted before the end of the year, unless it is intended for an insignificant number of people. This will be the case even if Government opts for cheaper, generic drugs.

We therefore urge Government to revise its allocation upwards, if its programme is to avail treatment to people living with HIV/AIDS and save their lives in earnest.

Rather than focus solely on ARV therapy, the Ministry of Health and Child Welfare (MoH&CW) should also concentrate on prevention and treatment of HIV-related Opportunistic Infections (OI’s), which are the major killers of people living with HIV/AIDS. Some common OI’s include Pneumocystis carinii pneumonia (PCP), oral thrush and tuberculosis (TB), among others.

It is a well-known fact that many Zimbabweans and Africans at large, die prematurely of avoidable and treatable OI’s because they lack access to information, treatment and care. Some of these people die of OI’s before they even reach full-blown AIDS, when they would require ARV therapy.

To this end, we feel that Government should also invest in prophylaxis, by providing drugs such as Cotrymoxizole, which are cheap, locally made and are effective in the prevention of fatal OI’s such as Pneumocystis carinii pneumonia and Toxoplasmosis.

The combination of these two strategies should assist in delaying progression to full-blown AIDS, resulting in less people requiring ARV therapy.

Criterion for selection of ARV therapy users
Although we welcome the idea of using the Prevention of Parent-To-Child-Transmission (PPTCT) programme as a logical entry point to the proposed Government programme, with HIV positive women who have enlisted for the Nevirapine programme being given priority, there are some serious issues that need to be addressed first.

For instance, it has taken Government over two years to put in place mechanisms for the distribution of free Nevirapine, which was donated for PPTCT by Boeringher-Ingelheim. To date, only 59 health centres have received approval, while only 35 are actually administering the drug.

Given the Ministry’s shortcomings in the delivery of a simple, free drug to an estimated population of 200 000 women, we are concerned about its ability to handle the distribution of more complicated, expensive ARV drugs to a larger population.

Further to this, uptake of the Nevirapine programme has been minimal because of inadequate information to the intended beneficiaries. Given the problems faced by the Nevirapine programme, we are wary about the use of PPTCT patients as an entry point to the proposed programme because we wonder where the women are going to come from.

Also, given the uneven distribution of Nevirapine centres, this strategy inevitably means that the ARV drugs will be unevenly distributed in the country. We feel that there is need for a fairer distribution system that prioritises women without prejudicing those in areas where Nevirapine is not being distributed.

There is a definite need for a selection system that will ensure equitable distribution of drugs to all deserving Zimbabweans, and we urge the MoH&CW to consult the relevant stakeholders in crafting an effective and impartial selection system for the beneficiaries of this programme.

It is also a well-known fact that an effective HIV-treatment strategy has to be built on a sound health delivery system, which is lacking in Zimbabwe at the moment. To this end, we hope that the MoH&CW, will address this issue in the process of availing treatment to people living with HIV/AIDS.

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