4 July 2012

Zimbabwe: ARV's Shortage a Time Bomb

MARIA Murudzi is a mother of four, an alcoholic going through rehabilitation and former commercial sex worker who has not allowed her HIV status diagnosed in 2006 from stopping her from living positively.

She has used her status HIV as a means to quit alcohol and sex work to become a community-based care giver in Hurungwe, Mashonaland West.

It has not been easy since she lost her fourth child to Aids. Thanks to the availability of antiretroviral drugs (ARVs), she got a new lease of life.

But when she visited her local clinic to collect her two-month supply of the lifesaving drugs recently, she was given just enough to last another two weeks because the clinic had run out of the medication.

Determined to continue living positively, Murudzi sold two bags of grain and groundnuts to buy the drugs for the next two months but she now fears she cannot continue selling the staple grain considering her children need to go to school and are already threatened by hunger due to a failed agricultural season.

Murudzi is not alone in this dilemma. There are at least 350 000 people living with HIV who face the prospect of losing their current access to the drugs because of poor funding for treatment programmes.

Early this year, principal director for Curative Services in the Ministry of Health and Child Welfare, Christopher Tapfumaneyi, told the Senate Thematic Committee on HIV and Aids that donors had indicated that they will no longer continue funding the HIV and Aids programme in the country.

Tapfumaneyi observed with regret that the country used to provide a three-year supply for everyone on ARVs but the number had declined, indicating that 350 000 people would be unable to access their drugs by the end of this year. Justice Aids Trust director, Albert Chambati, said the current shortage of ARVs is as a result of dwindling international funding for HIV and Aids programmes.

Most of the HIV and Aids programmes, including ARV rollout in Zimbabwe, are donor funded with little support from government. The financial crisis in most of the donor countries has resulted in the scaling down of funding to developing countries.

By 2011, a pool of funds financed by the United Kingdom, Sweden, Norway, Ireland, Canada and the Global Fund to fight Aids, Tuberculosis and Malaria paid for ARVs.

"The government has struggled and failed to continue from where these funders who are slowly pulling out left and therefore supply gaps of the drugs are now emerging.

"The shortage of the drugs is going to have a devastating effect on HIV and Aids programmes as many people living with HIV are going to fail to get supplies of their drugs resulting in lack of treatment adherence, which causes drug resistance and consequently more Aids deaths than we are currently experiencing," Chambati said.

Chambati noted that the shortages in ARVs will reverse many of the gains made in the fight against HIV and Aids.

"I believe government should resolve this issue through finding ways of increasing mobilisation of resources for HIV and Aids programmes including increasing more resources to the health sector in the national budget rather than depending on donor funds for these programmes.

"The government must take full responsibility for funding these programmes rather than sit and wait for donor funds. To do so will have catastrophic effects as we are already witnessing through the current drug shortages," Chambati added.

Despite limited funds, the government had established a national antiretroviral rollout programme consisting of a single-dose formulation of stavudine, lamivudine, and nevirapine as first-line therapy but the weakened health sector, which relies heavily on donor funding is unable to take over from the donors.

For the past decade, ARVs have changed the way in which HIV was viewed, from a death sentence to a chronic illness.

The achievement was propelled by a surge in donor funding and by the drastic reduction of the cost of first-line antiretroviral treatment from around US$10 000 to under US$100 per person per year over the past decade.

Some light is, however, appearing at the end of the tunnel after the Global Fund suddenly decided to release over US$29 million for HIV programmes in the country. The bulk of the money is going to be used to procure ARVs.

"The Global Fund round eight Phase 11 grant for Zimbabwe worth US$194 million was approved for HIV and Aids and the grant implementation will start in July 2012 to run until December 2014. The bulk of the money under the grant is targeted towards procurement of ARVs.

"The current Global Fund support is anticipated to sustain the following patients on ARVs: 193 500 end of 2012, 223 500 end of 2013 and 238 500 by end of 2014. The Global Fund has also indicated that they will make a call for new applications by end of September 2012 and the CCM will submit an application," Zimbabwe Country Co-ordination Mechanisms (CCM) secretariat for Global Fund, co-ordinator, Rangarirai Chiteure said.

An estimated 1,2 million adults and children are living with HIV in Zimbabwe. Only 55 percent of the almost 600 000 people in urgent need of life-prolonging ART are receiving the therapy.

Africaid director, Nicola Willis whose organisation supports more than 600 HIV-infected children with educational, material and psychosocial support services, said children on anti-retroviral treatment were very worried about the reported shortages of drugs.

"Children have heard there is a lack of drugs and they are concerned for their future. It is also affecting some children at school -- while children used to be given a three month supply of drugs, a few are now receiving enough drugs for two to three weeks.

"This means they have to miss school more often in order to go to the clinic. These children tell us that they will not go for their drugs because to continually miss school leaves them open to questions about their HIV status and stigma," Willis said.

The biggest ARV support is received from the Global Fund supporting 193 500 people taking ARVs through the government programme.

Government, through the Aids levy caters for 100 000 people, while the United States supports 80 000 people, with the British DFID supporting 43 324 and the Expanded Support Programme (financing from Britain, Norway, Sweden, Canada and Ireland) providing for 23 989.

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