HIV-positive people floundering as economy sinks

Newspapers headlines in Zimbabwe's capital, Harare, announced last week that anti-AIDS drugs were in perilously short supply, endangering the lives of HIV-positive people. The government has attributed the crumbling of its healthcare system - which threatens its free antiretroviral (ARV) programme - to sanctions imposed by western nations. Whether part of a western conspiracy or not, the reality is that last month, Evellyn Chamisa, 36, had to share her month's supply of ARVs, which help prolong her life, with two of her friends. "One of them [friend] gets hers from Parirenyatwa hospital but she didn't get them last month, and one buys them privately but she had no funds because they had increased the prices. So they came to me and I gave them each tablets so they could at least have something," she said. The HIV-positive widow has been taking ARVs since February 2005. Zimbabwe, which has one of the world's highest rates of HIV infection, is going through a severe economic crisis. There are shortages of food and fuel and inflation reached 913.6 percent in March. The government's response to the AIDS crisis was to declare a state of emergency in 2002, allowing cheaper generic drugs to be imported as well as locally made under World Trade Organisation rules. But local generic drug manufacturers are hamstrung by the scarcity of foreign currency, which they need to import raw materials to make the ARVs. Last year's Operation Murambatsvina ('Clean Out Garbage'), officially aimed at rooting out the blackmarket and criminals, encompassed unapproved housing owned or rented by the poor, and made life even more difficult. A year after the campaign, AIDS NGOs are still trying to locate displaced HIV-positive people, and fear that many have had to discontinue their drug treatment. "We still haven't traced some clients ... they've vanished as far as we're concerned. Others disappeared for weeks and were homeless and incomeless, which means they were not eating, and that's a problem when taking [ARVs]," Lynde Francis, who runs The Centre, an HIV/AIDS NGO with 4,500 registered clients, told IRIN. Any interruption in treatment can lead to the HI-virus becoming resistant to the medication, hastening progress towards AIDS. Chamisa was one of the victims of Murambatsvina. She was living with her two sons in a back room in Harare's high-density suburb of Kambuzuma when the crackdown on informal settlements was launched. She was forced out of her home but fortunately her landlady allowed her to move into the two-bedroomed main house. Francis pointed out that a growing number of people were finding it harder to obtain ARVs in the present economic climate, making resistance to first-line medication inevitable, as "it only takes a few [missed] doses to develop resistance". People living with HIV/AIDS begin treatment on first-line drugs, and only need second-line ARVs if they become resistant. In Zimbabwe, second-line treatment is not free. The Harare district coordinator of the beleaguered Zimbabwean Network of People Living with HIV/AIDS (ZNNP+), Sebastian Chinhaira, said accessing ARVs "in the first place" was a big enough challenge. "People wait for a long time, there are long waiting lists, we are told there are no doctors, and now, because the prices in the private sector are too high, they are coming to government hospitals and causing even more bottlenecks," the HIV-positive grandfather of three commented. An estimated 26,000 people are receiving ARVs, but just over 340,000 need them. Accessing medication is also vital to people who are not yet eligible for anti-AIDS treatment, but are suffering opportunistic infections; they often find there are no medicines in clinics. "If you get a prescription and have to pay for medicines, you have no choice but to throw it [prescription] away," Chinhaira said. WHEN ELEPHANTS FIGHT Zimbabweans have had to make do with very little HIV/AIDS donor funding, which Lynde Francis described as trying to manage an "ever-expanding problem with an ever-diminishing pot of money". She said it was "understandable" that donors wouldn't want to "prop up" the existing government, but pointed out that by "withdrawing [funding] it's not the regime suffering, it's the man on the street". Chinhaira agreed, saying, "It really is true that when elephants fight, it is the grass that suffers." According to a 2004 analysis by the World Bank, neighbouring Zambia received US$187 in aid for every HIV-positive citizen, whereas Zimbabwe's strained relations with some donors meant it received just $4 per person. After a three-year delay, a US $10.3 million grant by the Global Fund to Fight AIDS, Tuberculosis and Malaria is finally making its way to Zimbabwe. But activists have stressed that this paled in comparison to what countries "just across the [Zambezi] river" were receiving from international donors. Nevertheless, AIDS NGOs are managing to make a difference. The way Francis sees it, "it's like we're on a speeding train with no brakes, and we're trying to save as many people as we can on a day-to-day basis".