Govt treatment programme brings hope to thousands

In January 2005 the Ethiopian government launched a programme to give universal access to free antiretroviral therapy (ART) to people living with HIV/AIDS. Just over a year later, the initiative has changed the lives of approximately 23,000 people. Last October, for the first time in months, Almaz Eshaw, 35, an HIV-positive mother of three who is around 1.6 m tall and weighs just 40 kg, was able to leave the bed of her tiny mud house on the outskirts of the capital, Addis Ababa. She is one of the beneficiaries of the programme. "This medicine saved my life," she said. "I've spent so many months unable to leave my bed and to do anything. Now I can take care of my children again, dress them up to go to school, prepare some food and take care of the house." From a plastic bag placed under her pillow she removed two boxes of pills from India that she takes twice a day. A voluntary nurse, Dekenera Getachew, from the Hiwot HIV/AIDS Prevention Care and Support Organisation (HAPCSO), a local NGO, visits Almaz three times a week to make sure she is adhering to her regimen and to help her with household chores. "The difference between now and before [she started ART] is really impressive," said Dekenera. "A few months ago I had to spend all my days with her to wash her and feed her." According to the Ethiopian Ministry of Health, at least 1.5 million people are living with the HI virus and some 285,000 people need ART. When the programme started in 2005, just 900 people were accessing the free treatment. In March 2006 the health ministry announced that it planned to provide ART and treatment for opportunistic infections to 58,000 people by beginning of July, to reach 100,000 patients by December, and increase that number to 200,000 by August 2008. Since the beginning of the year, 126 hospitals have been able to offer voluntary HIV/AIDS counselling and testing (VCT), and services for the prevention of mother-to-child transmission of the virus. "For us, this really means hope," said Selamawit Gesamasanm, a trained nurse working for HAPCSO, which tries to ensure free access to ART and home-based care for the poorest in Addis Ababa. "Before, we had approximately 10 people dying every week. Now it is one or two in a month." At the centre where Selamawit works in southern Addis Ababa, some 463 people have tested positive for HIV, 267 of whom are receiving the free ART; last July only 10 people were accessing the free drug. "There are still probably a lot of people who don't know, or don't want to know, their status and probably need ART. We still have to fight against a lot of stigma and wrong ideas," she commented. "Many people still don't realise that they are not condemned once they have HIV and that they can live with it." Almaz's husband, for example, refuses to know what his HIV status is and has stopped having sexual relations with her as a way of protecting himself. Thankfully, her daughter has tested HIV-negative. The free ART programme is mainly financed by the Global Fund to fight AIDS, Tuberculosis and Malaria. Another source of funds is US President George Bush's US $15 billion emergency plan for HIV/AIDS relief. Around half of Ethiopia's 77 million people have limited access to health facilities, according to government and UN figures. The HIV prevalence rate is 4.4 percent, and at least 900,000 people have died from the pandemic since 1986. In 2004 the US spent $43 million on anti-AIDS activities in Ethiopia, and a further $61 million was earmarked for 2005, half of it for purchasing antiretroviral drugs. ART PROVISION UNDER THREAT "Without this programme, probably less than five percent of the people who need ART would have access to it," one aid worker estimated. The medication costs around $30 a month, but nearly 50 percent of Ethiopians live on less than a dollar a day. "There is a problem of viability in the long term, because you would need to take ART for life, but for now, the programme is only financed until 2009," the relief worker noted. Other service providers are more optimistic. "Morally, it is impossible for the donors to say we [should] stop financing ART when people's lives are depending on it," said a UN official, who preferred anonymity. "In the long run, the prices are also expected to go down, so that people can have easier access to the drugs." The extreme poverty of most Ethiopians, coupled with the ongoing severe drought in the south and southeast and the resultant food insecurity, are also hindrances to the success of the ART rollout in this vast country. "An important challenge is the nutritional aspect: if you give drugs to people without adequate nutrition it can be really difficult to keep them on track - we need to be able to couple treatment and food," the UN official added. "One of the main challenges we are having is to put a good follow-up system of the patients in place," said Negatu Mereke, head of the government's HIV/AIDS Prevention and Control Office. "Now we have 658 VCT sites, but we still need more to reach the rural areas and the patients there."