Dakar/Bissau — One year after the Global Fund to Fight AIDS, Tuberculosis and Malaria, reduced funding to the Guinea-Bissau government body in charge of coordinating HIV prevention and treatment activities, health centres outside the capital are facing medicine shortages, patients are not receiving the treatment they need, and the transport of patients to treatment centres has been cut.
Patients, support groups and health workers fear the fight against HIV is being hampered.
The Global Fund stopped most of its funding to the Secretriado National de Luta Contra le Sida (SNLS), the government structure in charge of coordinating the HIV response, at the end of 2011, because of poor performance management and a lack of transparent fiduciary controls.
The Fund's decision to withdraw was strengthened in April 2012 following a coup d'état which meant the body charged with programme verification could not carry out its work because of security concerns.
The UN Security Council ceased to recognize the post-coup transitional authorities following the putsch.
The Global Fund continued to supply basic medicines and testing through their Voluntary Pooled Procurement facility, the official procurement body of the Global Fund, which buys and delivers medicines for countries unable to do so themselves, said David Té, director of care at SNLS.
But SNLS, which is in charge of transporting medicines to clinics and hospitals across the country and overseeing medicine storage and stock-taking, has had no money to pay staff salaries for one year, and lacks finances for transport or even electricity.
Only 16 percent of HIV-positive children and 39 percent of HIV-positive men who were eligible for antiretroviral treatment were receiving it at the end of March 2012, according to Alison Jenkins, HIV/AIDS specialist at the UN Children's Fund, (UNICEF) in Guinea-Bissau.
"The essential medicines for HIV/AIDS that have been arriving are the procurement for 2012. Receiving them late is putting the system at risk," she told IRIN.
Pedro Mandica, president of Rede Nacional das Associações de Pessoas Viventes com Sida - a local association funded by SNLS to transport medicines and patients to treatment centres, told IRIN: "We're starting to face medicine shortages. Everyone is affected as we can't even redistribute medicines from regional centres that do have enough, because of lack of transportation."
In Cumura hospital, 13km from Bissau in Biombo Region, an important HIV treatment centre, the number of new cases has increased since the beginning of 2012, according to Valeria Amato, in charge of hospital administration.
However, 73 percent of HIV positive women in need have still received treatment, largely due to the expansion of the National Prevention of Mother-to-Child Transmission (PMTCT) programme whereby every woman receiving pre-natal care is HIV tested and if infected, put through an antiretroviral treatment programme, according to Jenkins.
Elisabeth Cabral, 30, was hospitalized in Cumura from May 2011 to 2012 and told IRIN she continues to receive free treatment, though she cannot afford the medicines for opportunistic infections.
Lack of money has also hampered patients' ability to access services and the food assistance they used to receive during treatment. "More patients are dropping-out," said Mandica.
"Before, especially in rural areas, we used to go to fetch them. But we do not have money to transport them any more," he told IRIN.
Some 40 percent of patients used to receive food as they were too poor or too weak to feed themselves, but this has also come to a halt, said Té.
Under SNLS management, medicine stocks were not being monitored and medicines were not being correctly distributed based on the number of patients in need in each region, according to health professionals, meaning distribution systems had basically broken down, leading to gaps in provincial health centres.
"To have drugs available when and where they are needed, you need to strengthen national procurement and supply management systems and ideally have a buffer stock of six months," Jenkins told IRIN.
Some 5.3 percent of adults aged 15-49 are estimated to have HIV/AIDS in Guinea-Bissau, with women three times more likely to be infected than men, according to a 2010 national seroprevalence study, giving it one of the highest rates in Western and Central Africa, according to Jenkins.
Currently 5,000 patients are registered across 37 health clinics and hospitals in Guinea-Bissau to receive antiretroviral therapy, according to Aneximandro Zilene, director of prevention at the Guinea-Bissau Secretariat to Fight HIV/AIDS.
The Fund told IRIN in a written statement that it is "working with partners in the country to find alternative arrangements for program implementation". It hopes to resume grant activities, financing essential prevention, treatment and care, once a sound fiduciary agent has been named.
Negotiations between SNLS and the Global Fund are ongoing, but do not appear to be bearing fruit. "The Global Fund has betrayed the SNLS," João José Silva Monteiro, the SNLS coordinator, told reporters on 4 December.
"The Global Fund should not penalize HIV infected persons," said Mandica. "While the people responsible for the problem of mismanagement are living well with no worries in their life, the patients pick up the pieces."
The Global Fund recognizes its moral obligation. "The Global Fund is confident that it is possible to provide help in Guinea Bissau and considers that it is a moral obligation to make every effort to continue providing health services for the people," the statement said.
This report does not necessarily reflect the views of the United Nations.