26 March 2011

Zimbabwe: Abuse of ARV Drugs Rampant

THERE are genuine fears that antiretroviral drugs (ARVs) dispensed by different institutions in Zimbabwe are being abused by drug addicts, who think they enhance ecstasy.

This has derailed efforts made so far in the fight against HIV and Aids, with health experts warning that the abuse might be worse than previously thought.

Addicts, who are known to abuse other substances such as cocaine, mbanje and mandrax, are said to be mixing some of these drugs with Efeveranz, a first line antiretroviral treatment drug.

The abuse is said to be most common among male youths looking for a quick fix as Efeveranz is said to enhance the effects of the drugs.

The reports have sparked serious debate among health professionals as well as people living with HIV, with some calling for investigations into the matter.

Others say there is a need for measures to tighten accessibility of all types of HIV drugs, so that only those who need them benefit.

National Health Care Trust chairperson Professor Norman Nyazema recently said there was rampant abuse of the ARV drug Efeveranz, as it can stimulate the nervous system, making one restless.

"We do not know how people discovered that they could mix the ARV drug with other substances," he said.

"They started by mixing the drug with tobacco and smoked it. They later mixed it with marijuana and now they are mixing the drug with a chemical found in rat poison and they smoke the concoction."

Prof Nyazema said the main causes of the abuse of the drug were ignorance and poverty.

Prof Nyazema holds a PhD in Pharmacology, the study of drugs.

It is estimated that 343 460 were on antiretroviral treatment (ART) in Zimbabwe in 2009 and approximately 150 000 had received ART in 2008 through the public sector programme which started in 2004.

In 2008, it was estimated that 1,1 million people, including adults and children, were living with HIV and Aids.

The proportion of women living with HIV and Aids remained at 60 percent in 2008 and 2009.

The chief co-ordinator for the Aids and TB programme in the Ministry of Health and Child Welfare, Dr Owen Mugurungi, said investigations should be carried out to determine the allegations of the abuse of HIV drugs.

He said very few people were on Efeveranz in Zimbabwe and, as a result, it was not readily available.

Dr Mugurungi said the abuse of HIV drugs was rampant in neighbouring South Africa.

"In Zimbabwe, we do not use it (Efeveranz) as a first-line drug, so very few people are using it at any given time," he said.

"It is normally prescribed to people with TB, but only for the duration of their treatment and they go back to other drugs once they are well. So, I doubt if it's being abused locally because it is not readily available."

But Harare-based Ms Martha Tholanah, who is living with HIV, said there are strong indications that some ARV drugs are prone to abuse due to the porous nature in which they are accessed.

Ms Tholanah said in Zimbabwe, it was easy for someone to use pseudonyms at different opportunistic infections clinics (OIC's) to acquire the drugs without being detected.

But she said the practice of mixing ARVs with other drugs was mainly rampant in South Africa where some people were actually waylaid on their way home from collecting the drugs.

"I am not really sure about the situation on the ground in Zimbabwe, but I know that it is happening," said Ms Tholanah.

"Not many people are on Efeveranz, but our system is so porous that one can claim drugs at different clinics without anybody noticing and what they do with the drugs thereafter is anybody's guess."

When taken orally, Efeveranz does have initial side-effects including dizziness, double vision and vivid dreams, effects that have fuelled abuse of the drug in pill form.

While some people are quick to point at health professionals as the main perpetrators in the channelling of antiretroviral drugs to the black market, Ms Tholanah said some people who are living positively were also to blame.

"It's not just nurses or doctors and pharmacists who are guilty," she said.

"If one is able to make five collections, they will obviously only keep what they need for the month and sell the rest." Ms Tholanah said that no organisation (private or public) would openly admit that AVRs are being abused because this would have a negative impact, considering that most of the drugs are sourced through donor funding.

She said while investigations into the abuse of drugs have been carried out before, there was need for relevant authorities to come up with a concrete plan to curb this abuse so that those who need the drugs benefit.

National Aids Council (NAC) spokesperson Mr Orirando Manwere said they were not aware that some drugs were being abused because they were mainly involved in the distribution of the drugs.

Mr Manwere said if drugs were being abused, it was being done in private as the drugs could easily be accessed.

He said people could get the drugs from pharmacies, through friends and on the black market.

"All I can say is that those who are doing so are putting their lives at risk for obvious reasons," said Mr Manwere.

"There are people who genuinely need these drugs and it is so sad to learn that there are some people using them for amusement."

The South African government, where this phenomenon is reported to have originated, is fighting to dismiss reports that the abuse of HIV drugs is rampant.

Many South Africans believe that low- grade heroin, common in Durban and popularly known as "whoonga", is made up of a mixture of HIV drugs.

But "whoonga" is made up of substances like rat poison and detergent which are added to increase its volume prior to sale.

Delivering a keynote address during the first day of the second Biennial Summit on Substance Abuse at Durban's Inkosi Albert Luthuli International Conference Centre last week, South African President Jacob Zuma denied that "whoonga" contains HIV drugs.

President Zuma said many people believed that "whoonga" was made up of crushed HIV drugs mixed with other substances.

"Perpetuating such inaccuracies is dangerous as it may make drug addicts steal ARVs, which would put the lives of people on treatment for HIV at risk," he said.

Local experts doubt the notion that one could get high by smoking ARVs.

"There is no ingredient in ARVs that acts as a stimulant, therefore it is impossible for someone to get high from using them," said Mr Joseph Murombo, a local pharmacist.

"Most probably the only reason dealers of this new drug mix antiretrovirals with marijuana is maybe to add mass when it is sold so that they get more money."

A local anti-drug abuse lobby group, Anti-Drug Abuse Association of Zimbabwe (ADAAZ), says drug abuse in the country, just like anywhere in the world, has increased in the past two decades.

With formal employment problems in Zimbabwe, drug abuse is set to increase as some sell the narcotics to earn a living.

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