chibhebhi: ARVs For All...But Zimbabwean Women

Gender

ARVs FOR ALL BUT… ZIMBABWEAN WOMEN
Phyllis Kachere
Harare, Zimbabwe (2010 Features): When her doctor placed Delia Mabasa (name changed to protect identity), HIV positive and pregnant mother of two, on the government's prevention of mother-to-child transmission (PMTCT) programme, she was profoundly relieved. Chances were her unborn child would be able to live without the threat of the human immunodeficiency virus (HIV). Her relief, however, was short-lived. Less than a month later, Delia's dream was snatched from her, when her husband of nine years told her he had taken the sole life-saving nevirapine tablet given to her as he "too wanted to be cured of the deadly disease".
The World Health Organisation (WHO) endorses the use of a single-dose of nevirapine in many developing nations as a cost-effective antiretroviral (ARV) prophylaxis against HIV1 in mother-to-child transmission. Delia, who lives in Mabvuku, a high-density suburb in the Zimbabwean capital of Harare, would have taken her nevirapine the day she was to deliver her baby.
Delia's dilemma is not unusual. Mary Sandasi, director of the Women and AIDS Support Network (WASN) in Harare says the nongovernmental organisation receives reports such as these every day from the women who visit her office.
"Trouble started when the prevention of child transmission (PCT) was named prevention of mother-to-child transmission (PMTCT)," says Sandasi. "[As a result], men became excluded from the programme, and because of misinformation on how nevirapine prevents transmission of HIV to the baby, some husbands have become vindictive in the mistaken belief that their wives were already receiving the life-saving antiretroviral drugs while they not."
"We have received numerous reports of husbands confiscating the single nevirapine dose and, for those women lucky enough to be on the government's antiretroviral therapy, there have been reports of husbands insisting on sharing them, or they [the women] are sent back to the hospital or clinic on the pretext that the supply was stolen or got lost," adds Sandasi. "Any other flimsy excuse will do, just for the woman to get an extra allocation for her husband at home."
Where men work and leave the women to occupy the traditional role of unpaid caregivers, the latter cannot afford to buy ARVs.
"While it is a disadvantage for the woman to remain at home and be the unpaid caregiver worker, she is better placed and networked to AIDS organisations that might provide her with the drugs," Sandasi says. "Unlike the husband, who earns a salary that might not be enough to buy a week's supply of drugs, the woman ends up faring better in receiving them than her husband."
BEHIND THE NUMBERS
Zimbabwe's UNGASS Report 2008 states that a total of 1,085,671 adults aged 15 – 49 years old live with HIV and AIDS in the country. The report further notes that of this number, more than a half - 651,402 are women, and 17.1 per cent of them were pregnant. Of the total number of persons who need antiretrovirals to fight AIDS, only 38 per cent were receiving the lifesaving commodity. Sixty seven per cent of pregnant women receive ARVs under the government's PMTCT programme. Dr Owen Mugurungi, Director, AIDS and Tuberculosis in
the Ministry of Health and Child Welfare in Zimbabwe, reports that as of March 2008, 55,737 women, 31,417 men and 9,287 children were receiving free government antiretroviral drugs.
He added that while government figures indicated a high uptake of ARV drugs by women, the opposite was true for private sector ARV drug initiatives.
"Figures of people on government sponsored ARVs are usually [those of] the vulnerable, who are too poor to afford the drugs in the private market," Dr Mugurungi says. "These are women and children, and a few men. The figures are higher for men taking drugs through the private initiative scheme. It's simple — the men who can afford them don't want the hustle of scrambling for them in the government programme. So, the government figures do not necessarily represent the national picture."
Zimbabwe battles runaway inflation as high as two million per cent, and a critical shortage of foreign currency. Antiretroviral Therapy (ART) is accessible only to the rich or the very lucky, both few in number.
The average salary in Zimbabwe is Z$30 billion (US$6) per month. Up to mid-June (16 June 2008) a monthly course of first-line drugs cost (Zimbabwe dollars) Z$56 billion (about US$10) while a third-line course cost Z$220 billion (about US$40) monthly.
Despite the dire economic, social and political situation in the country, Zimbabwe continues to experience a decline in the number of new HIV cases. HIV prevalence rate now stands at 15.6 per cent down from 19.4 per cent in 2005.
The 2008 UNGASS report attributes the substantial decline in the number of adults living with HIV partly to changes in behaviour. Other experts have attributed the decline to the high mortality rates associated with AIDS.
Dr Mugurungi confirmed receiving reports of men taking ART drugs issued to women, and warns that single doses of nevirapine would not do anything to change the HIV status of the male perpetrators.
"Instead, the single dose would increase their chances of developing resistance," says Dr Mugurungi. "Men should be encouraged to test for HIV and get themselves on the government programme. We have scaled-up our awareness campaigns for the dangers of taking ARV drugs without having undergone the due processes. It is actually dangerous to self prescribe ARV drugs. ARVs are a life-time commitment and adherence is important for their success."
BARRIERS TO UNIVERSAL ACCESS
Counterfeit drugs and economic turmoil are among the top barriers to universal access to ART. Unlike neighbouring countries like Zambia or Botswana, where anyone needing ARVs has access to them, Dr Mugurungi says the Zimbabwean government's programme has limitations as there is not enough funding for the procurement of the drugs.
Dr. Mugurungi also feels that the government in Zimbabwe has done extremely well on some counts. "In countries like Zambia or Botswana, ARVs actually expire because of a low uptake, and because of fear of stigmatisation," he notes.
"Zimbabwe's case is different. More and more people are getting tested for HIV and those needing them are still queuing up. Those are the ironies of life. Where there are people willing to take the drugs, you don't find them. But they are to be found where people still fear to use them."
However, Mary Sandasi of WASN, laments that the country's efforts to reach its 2010 targets are becoming increasingly difficult to meet as there are inherent weaknesses within the 2010 targets.
"I feel governments, consumers, service providers and funding agencies should all shoulder the blame of the imminent failure of the 2010 targets on universal access to treatment," she observes candidly. "Instead of addressing and closing the gaps that caused the failure of the 3 by 5 campaign, we jumped on the 2010 target bandwagon. Soon, we will be content in the failure of the 2010 targets and move to the next programme. It is deplorable." /2010 Features
About the author Phyllis Kachere is a senior journalist and editor based in Zimbabwe. She has won several awards for reporting on HIV and AIDS.