A STRUGGLE TO ACCESS ARVs

[Guest guest]

The Sunday Mail

Sunday, March 12, 2006

By Phyllis Kachere

FOR the past two weeks, relatives of 36-year-old Mrs Sekesai Mukahiwa

(not her real name) have been taking her to a polyclinic in the

high-density suburb of Glen View where she lives.

Having been bed-ridden for the past three months, relatives of the

widowed mother of three children finally decided to have her tested for

HIV and with the hope of enrolling her for the Government's free

anti-retroviral therapy.

"All has been well for us as we have managed to convince Mrs Mukahiwa

to be tested for HIV with the hope that if she is positive, she will

automatically qualify for the Government's free anti-retroviral

programme. She has been ill and bed-ridden for a long time and we have

tried everything we can without her getting well," said Mrs Mukahiwa's

sister, Ms a Muzondo.

But she said after paying the $100 000 consultation fees at the

polyclinic and explaining to the sister in attendance that Mrs Mukahiwa

wanted to be tested for HIV and eventually enrol in the anti-retroviral

treatment programme, she was referred to Harare Central Hospital.

And that's when all hell broke loose for the family.

"At Harare Hospital, we were referred to the opportunistic infections

clinic where we made known our intentions. But, it was not to be.

"After undergoing another HIV test, my sister was sent for post-test

counselling. Not only that, she was informed that before she could be

taken in on the programme she had to undergo tests to determine her CD4

cell count, liver function and full blood count. As these tests could

not be done at the hospital but at private laboratories, and she was

expected to pay the costs," said a dejected Ms Muzondo.

Private laboratories in Harare charge anything between $10 million and $20 million for the tests.

At one of the laboratories visited in the Avenues area, relatives of

the sick sat patiently as they waited their turn to have their blood

drawn for the tests.

Another relative, Mr Ngoni Kuvagonera, said they had to pool their

resources in order to raise the required $17 million for tests to

establish the CD4 cells and the full blood count.

He said they were still to raise $8 million needed for the liver

function test which their bed-ridden sick relative whom he declined to

identify had to go through before being accepted on the Government's

subsidised anti-retroviral programme.

For the duration of the interview, the frail and sick woman lay motionless on the back seat of Mr Kuvagonera's car.

He said he was worried that valuable time to save her might be slipping

away as she went through numerous tests while they also struggled to

put together enough money for the tests.

"When we took my sick brother to Harare Hospital seeking to have him on

the anti-retroviral programme, little did we know we would be asked to

pay for these expensive tests.

"If Government is serious about treating people with Aids, these tests

should be conducted at all public hospitals. They are too expensive at

private laboratories," said Mrs Nyasha Gondongwe from Norton.

But the chief co-ordinator of the Aids and TB programme in the Ministry

of Health and Child Welfare, Dr Owen Mugurungi, said paying patients at

Government hospitals are not exempted unless they were covered under

the Social Dimensions Fund.

"The moment one pays for consultation, they are expected to pay for the

tests. If they cannot afford to pay, the onus rests with them to prove

that they can't pay so they have to get a letter from the Social

Welfare Department. Without that they will have to foot the bill," said

Dr Mugurungi.

Where patients have to pay at public health institutions, said Dr

Mugurungi, the amounts were as low as $50 000 for a month's supply,

which would cost about $7 million from private pharmacies.

He also explained that while it would appear valuable time was being

wasted as tests were being conducted, the tests were crucial before

ARVs were administered.

"We also have to screen for other opportunistic infections before we

commence treatment otherwise we would be worsening an already bad

situation. ARVs are not just administered before we have a CD4 cell

count, full blood test, liver function test and a host of other tests.

"Besides there is a certain level of the CD4 cell count which signals

we should commence treatment. A CD4 cell count of above 500 does not

warrant commencement. But anything between 500-300 will also be okay

unless the person has tuberculosis or any other opportunistic

infection," he said.

Dr Mugurungi said the hospital had to treat the tuberculosis or opportunistic infection first before ARVs were administered.

He said that while Government may not have enough funds for new

patients on the programme, it had enough drugs for those that are

already registered.

"For the success of the ARV treatment and lessening development of

resistance to the drug, we encourage an adherence percentage of at

least 98. We cannot afford to let patients miss a day's in- take of the

drugs," he said.

Both Unicef and WHO have pledged funds for the programmes and Dr Mugurungi said the drugs were available.

He said it was important that people living with Aids reduce stress in

their lives and underscored the need to join support groups for

psycho-social support.

"Anti-retroviral therapy will become more beneficial if patients

quickly go to the opportunistic infection clinic should they have other

illnesses. Before they are enrolled for the programme, administering of

cotrimoxazole is also helpful in managing other illnesses," said Dr

Mugurungi.

HIV/AIDS|ZMBABWE CHARITY, INC.

http://www.hivaidszimbabwe.com