Calls for decentralisation of ARV programmes

A government decision to distribute anti-AIDS drugs at two of Zimbabwe's largest urban hospitals has been criticised because the majority of people in need of antiretroviral (ARV) drugs live in rural areas. As Zimbabwe moves towards its third decade of the AIDS pandemic, more people are falling sick and there is a greater need for care and treatment in rural areas, where it is estimated that over 70 percent of people living with HIV/AIDS are located. The lack of voluntary counselling and testing (VCT) centres, said Shadreck Ndhlovu, coordinator of the Binga rural District AIDS Action Committee in Matabeleland North province, makes precise data on the HIV/AIDS prevalence in most rural areas extremely difficult to obtain. There is only one district hospital in Binga, and it provides VCT services for antenatal clients only. But evidence in two of the most remote and poorest provinces in Zimbabwe point to a rising AIDS epidemic in the rural areas. Veronica Nkomo (67), a home-based care volunteer in the Mangwe district in Matabeleland South province, told PlusNews that "in almost every village an average of 12 people are bedridden and need some urgent attention, but there is nothing we can do for them, except pray for them. Most times our home-based care kits do not even have painkillers to relieve their pain". Against this backdrop, there are rising demands that palliative drugs, VCT services and ARVs be rolled out urgently in rural areas. Although not a cure, ARVs inhibit replication of the HI virus that leads to AIDS, and boost the immune system's ability to fight infections. In countries where the anti-AIDS drugs have been widely available to people living with HIV/AIDS since 1996, the medication has led to a dramatic reduction in HIV/AIDS-related illnesses and deaths. Edwin Ndlela, a secondary school teacher in the Nkayi rural district, said the government should have given first priority to the rural areas. "Logic follows that a service should be given to the area that has the greatest need, and in Zimbabwe it is a well-known fact that the largest number people living with HIV/AIDS is found in the rural areas ... ARVs are therefore needed most in the rural areas," he said. The Zimbabwean government has said it would be difficult to provide ARV therapy (ART) in rural areas because of limited infrastructure. However, AIDS activist Lynde Francis was quoted in the official Sunday Mail newspaper as saying that "it seems they [government] are trying to roll out free antiretroviral drugs in places where they are gunning for political support". While the questions of priority are important, the vast majority of people living with HIV/AIDS lack even the most basic health care and support services. Drugs that treat opportunistic infections are unavailable in hospitals countrywide, due to the country's economic problems.