HIV/AIDS treatment in Zambia
Zambia, in sub-Saharan Africa, is rated among the world’s highly indebted poor countries. According to the 2000 national census of population, the country has 10.3 million inhabitants. It is estimated that nearly eighty percent of the population live on less than a dollar per day.
According to official estimates of the Ministry of Health, 19.3 percent of Zambia’s total population are infected with HIV/AIDS. There are large regional variations with Lusaka Province recording the highest infection rate at 33% and North Western Zambia the lowest at 11%. Women and children are the most vulnerable to both an infection with the virus and the effects of the pandemic: one out of four women attending antenatal clinics is HIV positive and 40 percent of the women aged 24 to 39 are infected. And yet, due to socio-economic and cultural factors, access to antiretroviral therapy/treatment (ART) is beyond reach for most of them. For children there are hardly any paediatric drugs.
Sub-Saharan Africa is undoubtedly the region worst affected by HIV/AIDS. With its Three by Five Initiative, the World Health Organization (WHO) intends to give treatment to at least three million people in the developing world by the end of 2005. At the Zambian level, this translates into treating at least one hundred thousand people.
A joint statement issued on June 29, 2005 by the WHO and the Joint United Nations Programme on HIV/AIDS(UNAIDS) indicated that despite progress in providing ART the target was too ambitious. "The number of people receiving combination antiretroviral therapy (ART) for HIV/AIDS in developing countries is increasing significantly - more than doubling from 400,000 in December 2003 to approximately one million in June 2005. However, access to HIV treatment continues to fall short of the growing need, and overall progress is unlikely to be fast enough to reach the target set by the WHO and UNAIDS of treating three million people by the end of 2005".
The then Zambian Minister of Health, Dr Brian Chituwo, announced that Zambia, too, would fall short of its target as only 27,000 people out of the intended 100,000 were on treatment as of 30 June, 2005. Although this was far below the target, it also indicated clear progress, considering that less than 10,000 people had been on treatment a year before.
A multi-sectoral approach
Realizing that HIV/AIDS was a crosscutting issue, the Zambia government started to streamline the disbursement of the available funds for fighting HIV/AIDS. Within this process, the National AIDS Council plays the role of a coordinator. Part of these funds is invested in treatment while others go to awareness/prevention and care programmes. In 2001, the University Teaching Hospital started to offer ART. Clients pay about 15 dollars for a CD4 estimation and a monthly contribution of 8 dollars towards their drugs. Since then, there has been a phased introduction of ART in all nine provincial health centres.
Although the UN system, including the World Health Organisation, is providing technical, financial and material support, the contribution from part of the donor and NGO sectors is still indispensable. With the support from donors like the Japanese International Co-operation Agency (JICA) and the Norwegian Agency for Development Cooperation (NORAD), voluntary counselling and testing services have been reinforced in the country. Apart from numerous international ones, there are many community-based local NGOs and organisations playing their part in mitigating the impact of HIV/AIDS. Some of them run clinics offering free ART. SOS Children’s Villages Zambia is a player in this multi-sectoral approach and recently received grant from Zambia National AIDS Network, to carry out more and more intense awareness, prevention and care programmes within the frame of the social outreach programme. The SOS Medical Centre in Lusaka plays the role of a facilitator, providing counselling, testing and care services at the clinic and referring those in need of treatment to the various health centres where they can access free ART.
What are the future perspectives for ART in Zambia?
Although the country has made strides in providing ART, many people still have no access to treatment, especially outside of Lusaka. There, centres for ART are fewer and facilities and personnel are inadequate. People have to cover long distances to be treated and access to free treatment is limited.
Furthermore, there is a lack of information. Even though people may be aware of the availability of treatment services, few have first hand information on what these drugs actually do and what they do not do. Those who do not understand or ignore the fact that drugs are only part of a whole regime of positive living that encompasses diet and the prevention and treatment of accompanying diseases, gain a false sense of security. Others, on the other hand, feel that these drugs are too toxic and that it is not advisable to take them for the rest of their lives.
The stigma associated with HIV/AIDS makes even those people for whom counselling is available unwilling to undergo testing. This is one of the challenges the SOS Medical and Social Centres face within their social outreach programme.
Another issue nobody is ready to tackle adequately right now is sustainability. It is still unclear who will win the trade wars on drugs. Price drops are probably inevitable but how practical is it that someone living on less than a dollar a day will contribute eight dollars monthly? How can governments that have failed to tackle the shortages of drugs to treat common problems like malaria safeguard the provision of medication? How long shall the international good will that has precipitated the establishment of the Global Fund to fight AIDS, tuberculosis and malaria last? Will this massive aid, in the long run, have any negative effects on the debt burden of poor countries like Zambia?
Many patients are uncertain about whether and how the WHO and United Nations AIDS programme (UNAIDS) will continue. They ask themselves what will happen when these people (donors) go. With the hope of stocking up drugs for such a case, some register at more than one health centre, without being aware of the repercussions of such actions. At some stage the drugs will have expired, the viruses may have become resistant to the medication. Or the combination of drugs in the patient’s antiretroviral treatment (ART) may have to be adjusted. The accumulated drugs will then lose their value for this particular patient. What will stop him or someone else from selling his worthless stock of drugs out of financial need and thereby possibly causing damage?
Alternatives to ART
There are also other interventions that are being sought nationwide. Some are based on scientific research, others on traditional herbal treatment. Dr Waza Kaunda, a Lusaka based medical practitioner and researcher, is one of those health professionals that are trying hard to see beyond ART. At a clinic he runs with support from the United Nations Development Programme, Dr Kaunda investigates the significance of nutrition for AIDS patients and explores the value of traditional, locally and readily available food in maintaining or improving the health status of AIDS patients. "The findings are very encouraging", says Dr Kaunda. "Most of our patients are doing very well with good nutrition".
Due to the given constraints in the health care system, a large number of people are increasingly turning to these options. Also, there are traditional beliefs and stigma that cause some people to live in constant denial of the reality of HIV/AIDS. Such people would seek these interventions rather than ART.
Dr. Clementina Lwatula
Co-ordinator of the SOS Medical Centre in Lusaka