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Provision of Aids drugs fragmented
Wilson Johwa, IPS
June 03, 2004

Bulawayo - It wasn't an instance where absence made the heart grow fonder. A three-day regional conference on improving access to AIDS treatments held in Zimbabwe's capital - Harare - in March, failed to attract a single government representative from the host country. About 150 delegates from elsewhere in the region attended the summit, which took place under the theme 'Scaling up Access to Treatment in Southern Africa: A Way Forward' - and was convened by the South Africa-based Pan African HIV/AIDS Treatment Action Movement (PATAM), a non-governmental organisation (NGO). In the absence of the health ministry's permanent secretary, the conference was eventually opened by local cleric Trevor Manhanga, who drily remarked, "any government in Africa that does not make HIV/AIDS a priority must be voted out." A month after the meeting, Zimbabwean authorities began distributing ARVs in a pilot programme based in the country's two biggest cities: Harare, and Bulawayo in southern Zimbabwe.

However, officials still appear nonchalant in the face of the AIDS pandemic, and the need to provide treatment for it. This is despite the fact that official statistics put HIV prevalence in Zimbabwe at 24.6 percent, which means about two million of the country's 12 million people are infected with the virus. Although government declared HIV/AIDS a national emergency two years ago, enquiries from independent journalists or non-governmental organisations concerning the disease are usually ignored. When authorities do respond to written questions their answers are often too general to be of much use.

Believe Dhliwayo, Co-ordinator of Zimbabwe Activists for HIV and AIDS, an NGO, says the never-ending red tape proves the disease is not considered a priority among politicians, "and that's something that's very worrying." He adds that although there are a few "very selective" donor-driven or research-based ARV programmes across the country, no more than 2,000 Zimbabweans are taking the anti-retroviral drugs (ARVs) that prolong the lives of those with AIDS. Dhliwayo's concerns are echoed by model Tendai Westerhoff, a local celebrity who is living with AIDS. "They write in the newspaper the drugs are available. I went to Harare Hospital personally, and there were no drugs," she told IPS. According to a source who preferred not to be named, only 11 people at the Harare pilot site have received ARVs to date. Government has indicated that it plans to place half of the estimated 520,000 citizens in need of ARVs on medication by the end of 2005. The project is supposed to be partly funded by the proceeds of an AIDS levy: since 1999, 2.4 percent has been deducted monthly from the salary of every formally-employed Zimbabwean to fund this levy.

While treatment might be negligible in Harare, Bulawayo appears to be faring better, thanks largely to the Spanish chapter of Medecins San Frontieres (MSF, an international NGO also known as Doctors Without Borders), which is assisting with the pilot programme. MSF's head representative in Zimbabwe, Alexandre Boon, says by the end of last month, at least 127 of the city's residents had received free ARVs from the NGO and the Ministry of Health. A further 650 people had registered to receive the drugs, while 300 more had made appointments for registration at Mpilo Hospital, the site of the project. Bulawayo has a population of 800,000. MSF calculates that about 25 percent of the adult population, or 130,000 residents, are HIV-positive - and that 10 percent of these require ARVs.

The organisation has committed itself to treating 1,500 Bulawayo residents within five years. "We have drugs to start 180 patients (and) more drugs are coming," says Boon. Apart from the Health Ministry and MSF, three American donors - including the Centre for Disease Control - are also participating in the pilot programme. Other ARV initiatives include a government project to prevent mother-to-child transmission of HIV at four clinics in Bulawayo. Efforts to prevent this transmission are also about to be expanded with assistance from the United Kingdom-based John Snow International foundation. In addition, the Zimbabwe Red Cross Society is on the verge of starting up its own ARV programme. "We have to start small to make sure we can sustain the programme," Secretary-General Emma Kundishora told IPS. "Once someone is on anti-retrovirals, it's for life." However, this diverse array of projects prompts Boon to urge caution. "It would be much better for the various parties to come through a central structure than to start small programmes here and there," he says.

Government's reported intention to recover some of the treatment costs from patients has also frayed tempers. A circular sent to various state health centres says patients on ARVs should be prepared to pay 50,000 Zimbabwe dollars (about 10 U.S. dollars) per month. This comes at a time when a shrinking economy has impoverished most Zimbabweans. Four years since the start of a violent land reform programme and disputed elections in 2000 and 2002, investor confidence in the country has all but vanished. Inflation is presently sitting at 600 percent while unemployment stands at over 70 percent. A woman who wished only to be identified as Constance told IPS that she had just started taking ARVs - but that she might have reconsidered this move had she known that payment could be demanded. "You need to eat a lot when taking those drugs," she said. "I want to live. I will find the money for the pills. But what of food? I'm a widow and have no working child to look after me."

A member of PATAM's steering committee, Matilda Moyo, says they believe most of the ARVs which are currently being provided have been donated, and are earmarked for free distribution. As parliamentary elections are due in nine months, there is also the feeling in some quarters that government might see it as imprudent to start charging for treatment just yet. PATAM is seeking an audience with the Minister of Health and Child Welfare to discuss this matter - as well as its concerns about the representation in national bodies of people living with AIDS, and other AIDS groups. The organisation is also planning a protest during the National AIDS Conference, scheduled for June 15-18. Companies in Zimbabwe, many of which are many battling financially, have also been slow in responding to the pandemic. Diamond multinational De Beers is one exception to this rule, however. As part of the company's HIV/AIDS programme, DeBeers Zimbabwe provides free ARVs to employees and a single life partner. In other rare instances where the drugs are provided, the stigma attached to AIDS continues to take its toll. Winfrida Mahere, a nurse who runs a health centre for two large companies, Phoenix Consolidated and the Apex Corporation, says fear is preventing workers from taking advantage of the firms' in-house HIV/AIDS programmes. "They deny even when they have all the symptoms," she says. "Because of this we can't start them on ARVs. The starting point is disclosure."

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