Harare — HIV-infected women living in rural areas are finding it increasingly difficult to access life-prolonging antiretroviral drugs (ARVs) and tend to be more marginalised than those living in urban areas, non-governmental organisations say.
"Rural women who need ARVs find themselves in a quandary because levels of income for a rural household tend to be low," said Tariro Kutadza, provincial coordinator of the Zimbabwe AIDS Network (ZAN) in the northern province of Mashonaland West.
According to research conducted by the Zimbabwe Women's Resource Centre Network, three-quarters of all women on ARV treatment are from urban areas, yet most of those who need it live in rural areas and are often forced to rely on herbal remedies.
With Zimbabwe in its eighth year of an economic recession, marked by an inflation rate officially cited at 8,000 percent but estimated by independent economists to be running at about 25,000 percent, ARVs have become unaffordable for rural women, who are often dependant on husbands working in urban areas.
This week, the Herald, an official daily Zimbabwean newspaper, reported that a one-month prescription of Stalenev 30, a common first-line ARV drug, now cost Z$85 million (about US$42.50 at the parallel exchange rate).
Kutadza, who works mainly in rural areas, said the financial burden on rural women went beyond the high cost of the drugs; they also had to travel long distances to health centres to obtain them, so women who could not afford the transport and drug costs tended to take ARVs infrequently or not at all.
Zimbabwe is already experiencing a huge gap between the number of people who need ARVs and those accessing them. According to the World Health Organisation (WHO), only about 91,000 out of the estimated 321,000 in need of treatment are getting it.
An acute shortage of foreign currency has made it difficult for the government and even private pharmacies to import enough ARV drugs to meet demand. The Herald reported that most essential drugs, including ARVs, were now only found in one out of four pharmacies.
A recent report by the International Treatment Preparedness Coalition (ITPC) estimated that the number of people accessing treatment privately has declined from 10,000 to 6,000 due to inflation and the unavailability of drugs.
More problems for women
Those rural women lucky enough to get hold of ARVs sometimes have difficulty taking them. "I have noticed that some men, particularly those that think that they are not infected themselves, discourage their wives from taking the ARVs," Kutadza told IRIN/PlusNews.
Betty Makoni, director of the Girl Child Network (GCN) and chairperson of Ray of Hope, an organisation promoting the rehabilitation of mostly rural women who have experienced domestic violence, said some women hid their ARVs from abusive husbands.
"As a result, women resort to taking the ARVs when the men are not watching, for instance, when they go to search for firewood or water, and in some cases they leave the pills in the custody of other women," Makoni said.
Many people in rural communities still view AIDS as a dreaded disease with no cure. Men and their relatives often viewed HIV-infected wives as a shameful burden and chased them away from their homes.
Kutadza pointed out that this created further problems for women registered to receive ARVs at their local health centre, because they might not be able to find the drugs they needed if they were forced to live somewhere else.
Fear of stigma and discrimination also discouraged HIV-infected people from coming forward for counselling or treatment, said Kutadza, with some claiming that they had been bewitched.
Makoni said although men often contracted the virus while working in town and then passed it on to their wives during occasional visits to their rural homes, relatives and other villagers often accused the women of infecting their partners.
Many people in rural communities still view AIDS as a dreaded disease with no cure. Men and their relatives often viewed HIV-infected wives as a shameful burden and chased them away from their homes
She added that girls were especially vulnerable to infection because they became sexually active at a relatively early age and were not empowered to make their own decisions "due to a rigidly patriarchal society".
"There is much need for social structures to impart information to poor rural women and girls, so that they know their rights as far as getting tested and counselled, how to get treatment and the best way to deal with husbands and partners who insist on unprotected sex," she said.
Rocketing prices and shortages of even the most basic foods have also reduced the ability of rural women to benefit from ARV treatment.
Sekai Chirevo, 36, of Musana village in Shamva District of Mashonaland Central Province, was diagnosed HIV-positive immediately after the death of her husband from an AIDS-related illness three years ago. She was placed on ARVs but constant bouts of tuberculosis have left her bedridden and unable to generate an income.
"I cannot till the fields to ensure food for my five children," she told IRIN/PlusNews. "That makes my position even more tragic because, as a sick person, I need good food to boost my immune system."
On the irregular occasions when she gets food handouts from donor organisations, she gives most of it to her hungry children.
[ This report does not necessarily reflect the views of the United Nations ]