ARVs nightmare

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 Erina 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.


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