A mixture of hope and gloom hangs as thousands of HIV/AIDS patients receive and others await free antiretroviral drugs in different parts of Uganda. Gertrude Akol, 43, who started ARV treatment in 2007, says she owes all her life to ARVs, because she found out her HIV status late.
“When my husband died in 2005, we did not suspect he could have died of AIDS. But when I started getting sick often, I decided to go for an HIV test. I was counseled, but learning that I was HIV positive was devastating. My heart only returned (sic) when they told I will get free treatment and can live on for many years,” says Akol who in 2008 regained good health and was able to resume her work as a teacher in a local primary school.
She says she would have died by now if she did not get free ARVs provided at the government hospital in Soroti, eastern Uganda. The ministry of health in 2004 announced plans to avail free ARVs for all, and in effect resurrecting hopes of many HIV positive people who could not access the life-prolonging drugs through private means.
Although ART has been available in Uganda since 1998, it was not yet possible for all people who need ART to access it, leave alone finding ARVs in the public health centers.
Antiretroviral (ARV) access in Uganda
Since 2005, the ministry of health using part of the Global Fund to mitigate the impact of AIDS, TB and Malaria has worked in direction of the above declaration. Before the ministry received money from the global fund, a minute percentage of 8.3 or 10.000 out of 120.000 people who desperately needed ARVs could afford it through private means, leaving the rest to face the inevitable danger of death.
The government of Uganda has expressed its commitment to action for expanded access to ARV drugs, including mobilization of national and international resources for the provision of ART services. “With the recent availability of lower cost, high quality generic drugs, often in fixed dose combinations, the Government is now able to make ART progressively accessible to the public,” reads a 27 page document guideline of the government’s Anti retroviral therapy strategy.
Using the Global Fund project money, Prof. Francis Omaswa, the Director General of Health Services in the ministry of health says it has since made it possible for more people to access the much needed ARVs, although still far from reaching all the people who desperately need the drugs. He says the 2009 launch of an ARV producing factory in Uganda by Quality chemicals is also expected to boost ARV access in Uganda through making it cheaper for the government to acquire the required drugs.
Many who need ARVs unable to access them
But according to the 2010 UNAIDS report on the global AIDS situation released recently, 200, 000 of the 1.2 million Ugandans living with HIV are receiving antiretroviral therapy. Yet more than 350,000 people are currently need the life prolonging drugs.
Akol says she knows three people in her sub-county who have spent two years waiting on the promise to be put on ARVs. “The hospital people say they can accommodate only a few people on the ARV treatment due to limited funding,” Akol says in an interview.
After more than 6 years of promises for offering free access to ARVs, Antiretroviral therapy is still available mostly through NGOs, research and pilot projects, leaving many yearning for the “miracle drug”.
Some advocacy organizations are saying the ministry of health targets for ARV access are not covering even half of those who need the drugs.
“Government is the key duty bearer tasked with keeping Ugandans alive, which means ensuring that people on ARVs are able to continue on their medication, and people who are newly diagnosed are able to access treatment,” says Beatrice Were, one of the founders of TASO.
“What does the government think happens to the remaining people who don’t access the ARVs? Should they just be left to die with out help,” asks Michael Ruhindayo, the General Manager of Health Rights Action Group (HAG). He says that some of the accredited health centers to distribute ARVs do not have necessary manpower to administer antiretroviral therapy.
Government counting on NGOs and donors for ARCs and general HIV/AIDS response
Prof. Omaswa says the ministry of health hopes that other private players like non-government organizations will continue boosting government efforts to provide free ARVs. In fact, some non-government organizations like The Aids Support Organization (TASO) were already giving free Aids care and antiretroviral therapy long before government and ministry of health started.
According to the public relations officer for TASO central region, Ann Kaddu, under president George W. Bush emergency plan for Aids in Africa initiative, TASO in 2005 started to to cater for over 3000 people in five of their ten centers across the country.
“The target is to reach 10,000 people on free antiretroviral therapy in the next four years. This is in addition of already 120,000 families on TASO’s AIDS care and support program,” says Kaddu.
Other civil society organizations see more on page 2 like Aids Healthcare Foundation have even taken this a notch higher. The organisation in December 2010 launched a HIV Test and Treat campaign to ensure that all people who are tested and found to HIV positive are put on some form of treatment.
“We want to introduce those who are found HIV positive to some form of immediate care including for TB and HIV/AIDS related opportunistic infections. We shall follow up all the people we are treating to ensure they continue to receive necessary HIV/AIDS treatment,” says Dr. Mina Nakawuka, the Director of Advocacy & Public Relations for AHF’s East West Africa Region based at Uganda Cares. She says starting 2011, AHF Uganda Cares will ensure all the people they test benefit from treatment.
Concerns in rising population of HIV positive people
But despite all this, there is a growing concern that with infection rates in the country having stagnated between 6 and 7 percent over the past seven years, the country is not anywhere ready to meet the treatment and care needs of the growing population of HIV positive people.
Although Ann Kaddu believes that it is people’s right to access free ARVs just like any other treatment, she says that people should also know their duty of demanding them from government and go out to access them. She says that government should do more sensitization on how and where to get ARVs; a fact she noted is already on ground but needs boosting. She bases her argument on reports that not all ARVs purchased by the government are accessed by the people who need them.
But for many people, it is not knowing about availability of the ARVs that is a problem. There are concerns that many of the people who are receiving the ARVs are not adhering to treatment.
ARCs adherence another rising concern in HIV/AIDS fight
Beatrice Rwakimari, the Chairperson of the HIV/AIDS committee in Uganda’s Parliament says while they continue to implore the government to increase funding for ARVs and care for HIV/AIDS, there are emerging concerns of adherence. She says many HIV/AIDS patients (some really) have to travel long distances to centers where free ARVs are offered. For some affording the transport is difficult.
“If I don’t get someone to help and ride me to Soroti hospital, I sometimes forego going to meet the doctor and next dose,” Akol says.
“We are learning that if some patients are not supported with food supplements or given transport to come back to the health center for follow up, it will be difficult for them to continue treatment,” Rwakimari says.
More funding needed to keep hope alive for HIV positive people
That is why, while adequate access to ARVs is a big demand, there is an enormous need for more funding not just for buying ARVs but to ensure adherence. Yet most of the funds (more than 80%)used by both the ministry of health and NGOs that give free ARVs is foreign donations, creating room for uncertainty in case the foreign funders tighten up their pockets. It is a tricky question many beneficiaries of free ARVs will probably not wish to hear about, given the fact that once one starts taking ARVs, there is no stopping.
Some non-government organizations like TASO have started encouraging people on ARVs to save as much money they can in case the funding for free ARVs ends. In fact, according to Kaddu, TASO has included the component of saving in their counseling system.
Ruhindayo says that they have proposed to government to create a pool of consolidated funds to cater for such eventualities. But the Minister of Health, Dr. Stephen Malinga says the government is faced with many needs and challenges like education, infrastructure and energy and cannot allocate more funding to Health, leave alone to HIV/AIDS care and treatment when many other diseases plague the country.
While Akol is happy about the opportunity to prolong his life and continues to hope the free ARVs can continue, he is concerned about how possible it will be for him and other HIV positive people to get ARVs and keep their hope for life alive.
Related links
From Access to Adherence: The Challenges of Antiretroviral Treatment – Studies from Botswana, Tanzania and Uganda, 2006 – World Health Organisation publication
Treatment of HIV/AIDS– a detailed update and analysis on current prevention and treat of HIV/AIDS related infections
Scaling up Antiretroviral therapy experiences in Uganda– A World Health organisation publication from a study done by F. Amolo Okero, Esther Aceng, Elizabeth Madraa, Elizabeth Namagala and Joseph Serutok
Treating aids: Dilemmas of unequal access– a research on the difficulties many Ugandans go through to access ARV treatment- done by S R Whyte, M A Whyte, L Meinert, B Kyaddond
By Gerald Businge & Enoch Mutabaazi, Ultimate Media