When a patient is initiated on ARVs that becomes the first line treatment and these regimens, which have been recommended in low- and middle-income countries, have successfully treated over 15 million people globally
BY PHYLLIS MBANJE
LAST Sunday, Zimbabwe joined the rest of the world in commemorating World Aids Day, which is always marked with much pomp and fanfare as well as passionate declarations and pledges for enhanced access to treatment.
This year was no different and a government convoy made its way to Mucheke Stadium in Masvingo, where presenters made glowing remarks about how the country has done well in combating the spread of HIV and Aids.
It was, however, noted that the HIV prevalence rate currently stands at 12,7% and is one of the highest in sub-Saharan Africa.
However, away from the outstanding presentations, stakeholders, activists and those living with HIV are disgruntled and feel the day has lost its lustre in the face of many challenges bedevilling the health delivery system, which include perennial shortages of antiretroviral drugs.
The activists, who protested by laying prostate on the ground as Health minister Obadiah Moyo made his speech, shared the same sentiments. Their demands were simple: consistency in provision of medication and restoration of health facilities.
Besides the drug outages, there are growing concerns over the new HIV infections, especially among young people. And then there is the scarcity of data on key populations which are critical in the management of HIV and Aids.
Currently, over 1,3 million people are living with HIV in Zimbabwe, according to Avert Report for 2018, with 38 000 new infections.
The statistics indicate that the fight against the disease is far from over and authorities should not slacken in terms of programming and sourcing for additional funding.
Charles Kautare from the Zimbabwe National Network of People Living with HIV (ZNNP+) said they were still struggling to get ARVs, especially for second line treatment.
“Challenges still persist for those on second line. There is no abacavir and others are being switched back to zidovudine whose main side effect is bringing down red blood cells in our bodies,” he lamented.
Fungisayi Dube, of the Citizens Health Watch (CHW), proposed a more radical approach in view of the obtaining challenges.
“I think we should stop all these celebrations as there is nothing to celebrate. We have a collapsed (health) system that needs serious efforts to mend. Every cent should be channelled towards saving people who are dying due to lack of drugs,” she insisted.
Dube said anything that required money on travel and accommodation of ministers and staff should be stopped.
“Medical personnel have been on strike for more than three months. We have nothing to celebrate. We need to stop this pretence, this culture of living a lie. We need to start acting to save our people’s lives,” she said.
Senior doctors on Wednesday marched to Parliament where they delivered a petition demanding the axing of Moyo as Health minister, on allegations of running the healthcare system to the ground.
Foreign currency challenges
In September, NAC said it was facing foreign currency challenges to settle a US$6,9 million owed to suppliers, with NAC acting chief executive officer Albert Manenji said the debt was proving to be a challenge to the council.
Every year there is a shortage of ARVs, a situation which can potentially reverse the gains made so far.
This is despite the fact that treatment remains key in viral load suppression and according to WHO restores the immune response, halts disease progression, increases survival rates, and provides for a better quality of life.
New studies have confirmed that once the viral load becomes undetectable it is also untransmutable, making treatment a strong prevention strategy alongside other methods like condom use.
Early this year researchers from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases reviewed clinical trials and studies validating the concept that people living with HIV who have achieved viral suppression cannot sexually transmit HIV.
But the perennial shortages of ARVs in Zimbabwe will result in some defaulting and not realising the full potential of the ARVs.
In a ministerial statement presented in the National Assembly recently, Moyo acknowledged that the shortages of second line drugs were posing a huge headache for the country.
“Second line medicines are a challenge because there is a global shortage on some of them. Efforts have been initiated to order from the suppliers that have the stock,” Moyo said, adding that for the first line treatment there was enough supply and that they were issuing three months supplies to each patient.
Community Working Group on Health (CWGH) executive director Itai Rusike said while the country has battled the HIV and Aids pandemic and registered successes of reduction in both incidents and prevalence, that has not yet stopped Aids deaths.
Rusike said there was need to explore home-grown solutions as a country, which include expanding the Aids Levy to fully capacitate the National Aids Council (NAC) to carry its mandate effectively.
“We should find ways on taking everyone on board including those in the informal sector that are not currently contributing to the Aids Levy because without this inclusive approach NAC’s noble efforts would end up in vain,” he said.
The Aids Levy was introduced in 1999 and became effective in January 2000. Resources for the fund are collected through a Parliament special tax Act, which requires formal employers and their employees to contribute 3% of their monthly income.
Of concern also are the delays in appointing a substantive CEO for NAC which has a huge role of managing the Aids Levy as well as donor funds.
Rusike said NAC should not only become visible during the World Aids Day commemorations as its mandate was not only about organising public events, but to co-ordinate the national Aids response.