Who Should Have Access to Free ARVs? 24/2/11

Implementation of the new WHO guidelines in Zimbabwe will see the number of people in need of ART on the waiting list going up drastically.

The Government free programme on the provision of anti-retroviral drugs was started in 2004.

It aims to help those who cannot afford to buy ARVs on their own. The programme is a noble idea but has it been used as expected?

By the end of 2005 about 25 000 Zimbabweans were receiving ART roughly 7 percent of those in need, this figure included 6 000 in the private sector.

Currently, 260 000 are on the free national programme out of an estimated 593 000 in need.

This figure is based on the pretext that ART should be started when CD4 count reaches 200.

Now with the new WHO guidelines, one has to begin ART when the CD4 count is 350. This will see the number of people in need of ART on the waiting list going up drastically. An estimated 1,610,000 (2006 national estimates) Zimbabweans out of a population of 11,6 million were living with HIV and Aids.

Of these 115 000 are children under the age of 15. Fifty five to sixty percent are women.

The free national ART programme has seen the quality of life of those infected improving.

It is expected that with scaling up of the ART programme, the number of people living with HIV is likely to increase as a result of survival on ART.

Undeserving people gainfully employed and earning way above the poverty datum line are beneficiaries of the scheme. Some informally employed people who realise more than those formally employed also make the ranks of people on the free programme.

So, can this not be a strain on the programme if undeserving people keep filling the ranks? The programme is meant to help those who do not afford medication, access ART for free. This is a life serving measure.

The vulnerable orphans, people in the rural areas, the unemployed, the aged, people living in the mining communities which have long ceased operations and those who work on the farms earning less that US$100 a month must be the ones benefiting. Is this the case on the ground?

For example, at the Harare Hospital Opportunistic Infections clinic, which is one of the centres disbursing ART, the number of people collecting ARVs keeps swelling.

Although, no figures could be gotten from the institution, everyday the OI clinic is a hive of activity that sees over 200 patients. People driving top-of-the-range cars can be seen accessing medication.

The hordes of people visiting the hospital vary from those who have just tested HIV positive and are coming for post test counselling, to those on general review and are seeing nurses or doctors, depending on need.

The nurses are able to prescribe medication to those not having any problems but those experiencing side effects and ill have to see the doctor.

Those coming for the first time should know that it is a process and should not expect preferential treatment.

They are required to have a CD4 count done to assess the levels to which the virus has gone and also to have a liver function test done.

The CD4 count is a measure to determine the weakness/strength that one's blood has.

This accurate measure takes time at the above institution because large volumes of people use the facility. Those who can afford to see private doctors are urged to do so.

Such institutions are heavily congested, which cannot be blamed on them.

The test costs US$5 and one has to pay that for the subsidised laboratory fee. In private laboratories, the charges vary from US$60 to US$80 and that is prohibitive for most people.The staffers at the hospital and similar institutions disbursing ART cannot turn away anyone seeking assistance hence this results in undeserving people benefiting at the expense of genuine cases.

The non-awarding of Round 10 for HIV and Aids and TB programmes by the Global Fund means that new ways to fund the programme have to be found.

The CCM, a multi-sector consensus group which is responsible for developing and submitting Zimbabwe's proposal to the Global Fund said currently, the country has enough stocks because they are still using funding from Round 8.

"The non-approval of the R10, HIV proposal means the financial and programmatic gaps to HIV and Aids, and TB responses in Zimbabwe remain unfilled unless if new funding is found. Impact of non-approval will be felt from 2012, the year in which grants were expected to start flowing," CCM co-ordinator, Chiteure Rangarirai said in a report during a media briefing.

The report said the call for Round 11 application is expected to be open in August 2011.

"The proposals will be due for submission in December 2011. The outcome will be known after the Global Fund board meeting in April/May," said the report.

We cannot afford to be in the comfort zone, parliament must authorise other ways to access funding and even increasing the catchment zone for the Aids Levy.

There should be ways to get funds from the informal sector and channel it to the levy.

a workable solution will be to have one pay a fee towards the fund when being issued with a trader's licence.

All informal traders should be contributors to the fund in this way. Councils could also contribute to the fund when giving out even stands to new buyers.

Sounds too far fetched - but these could be ways devised to get more funds into the coffers.

As a country we should have a Plan B.

What will we do if funding is denied again in the next round, which is a possibility?

We must find alternative funding right now.

How can the institutions giving out free ART screen deserving people from those who do not deserve?

That is the problem - there is no formula to determine who must be on the programme but only one's word that one does not afford is all it takes.

For people gainfully employed they would rather be on the free programme than use their medical aid schemes.

There are people who can afford to buy but will rather be on the government programme. It is this warped thinking that we have to fight. That is being heartless and denying someone the chance to live yet you have an option at work or you can afford to buy.

It could still be due to stigma that HIV has, as compared to other conditions that sees people not openly disclosing and using facilities at their workplaces.

One man who admitted to not using his medical aid scheme said his organisation was small and did not like the idea that the medical officer would know that he was buying ARVs.

He therefore opted to get it from the government free programme where no one knows him.

"The problem is that I work for a small organisation, which has its own medical aid scheme. If I were to get ARVs, the guy who processes the forms will know and tell everyone, so that is a no from me," he said recently.

On being asked why he did not buy since he earned well above the poverty datum line he laughed it off as madness.

"Why should I buy if it's free? You know, even ministers could be getting it for free, so why should I bother my sister?" he boasted.

That is the problem that we have, when well-meaning schemes are abused, and deserving recipients are left out.

How many people out there do not even know that there is such a scheme and are dying?

How many vulnerable and orphaned children deserving to benefit are not accessing the scheme because a greedy person is occupying their place?

Just like all other schemes meant for the disadvantaged, they have been hijacked and misused. How does a nursing sister tell a deserving person from a non-deserving person?