Poor health services further hurdle for HIV-positive patients

Zambia's over-stretched health facilities are inadequate at the best of times, but the situation is especially grim for the more than 1.2 million people living with HIV/AIDS. Kanatapa Hantuba has an opportunistic TB infection. He told PlusNews that on the occasions the state hospital has drugs, he can sometimes beat the clamour of patients because he "knows" somebody in the hospital. At other times he has to scrabble around to raise the US $100 - a huge amount for the average Zambian - needed to buy his medication from private pharmacies as he cannot stop treatment mid-stream. "It's the same with X-rays and antibiotic drugs. Sometimes the hospitals have them, other times they refer you to private services. This is difficult for most PWAs [people living with HIV/AIDS] because we are not in regular employment due to bad health, so we have to keep harassing friends and relatives for money." Nurse Shupa Munkombwe said that some families, when they can no longer afford to support HIV-positive relatives, "dump" them on the hospitals. "We in turn pass them back to their families for HBC [home-based care] because there is a shortage of everything - nurses, drugs and even bed space." Zambia has adopted an HIV/AIDS health policy in an attempt to reduce infections and help with treatment. But the implementation of the framework has been stymied by a lack of finances in a country with a per capita income of US $300, and an economy dependent on donor aid flows. A report by the National AIDS Council noted that 48 percent of hospital beds are occupied by PWAs. The government has tried to decentralise services and resources to clinics and health centres to improve PWA access to health care and relieve the pressure on hospitals. But with over 21 percent of Zambian adults HIV positive, demand remains high. Apart from the acute shortage of drugs, many health centres, especially those in rural areas, do not have sufficiently well-trained personnel to manage AIDS-related conditions. Clinics and health centres often also do not have enough information on voluntary counselling and testing (VCT) and support services to help people cope with the effects of HIV/AIDS. "This means that the expensive treatment of opportunistic infections from AIDS, most of which would require admission, continues to place an unprecedented burden on the delivery of health services in Zambia," the report said. The development of HBC models has helped alleviate some of the pressure on hospital beds. However, most HBCs are run by NGOs whose facilities are limited. "These organisations are informal and manned by volunteers, there is just too much pressure on them. How long do you think people can sacrifice their time and effort to look after others at the expense of their own families? At some point something has to give and it will be the voluntary work that will suffer," explained Richard Chama, the manager of a VCT centre. Recently, the government imported a consignment of antiretroviral (ARV) drugs to distribute free of charge to about 10,000 PWAs. Hitherto, only the wealthy and well-connected were able to afford them. But the Network for Zambian People Living with AIDS (NZP+) has urged its members not to start ARV treatment until there are guarantees from the government that there will be a continuous supply of the drugs. "We know government has no money to buy basic drugs like panadol. We (PWAs) cannot afford to stop and start medication, it is fatal, and at the very least we can acquire resistant strains," said Eric Nachibanga of NZP+. His colleague, Rodgers Mumba, pointed out that poverty means that many PWAs cannot even afford enough food, the first line of defence against AIDS. For most Zambians, the issue has been access to proper nutrition rather than ARVs. "The reason that medicine becomes too toxic for us is because the stomach is not lined with food, they [the government] should not give us medicine without food. We cannot afford to buy food on our own, the little that is in our homes is for the entire family so the ARV course should include some kind of food supplement," he said. The Zambia Federation of Employers has encouraged its members to assist their workers in accessing ARVs. But most Zambians who do work are either in the informal sector, or non-skilled employment like gardeners, house workers and nannies. They are not unionised and depend on the largess of their employers for medical assistance. "We need to make it compulsory for those who employ non-skilled PWAs to assist them get medical treatment, just like they would a person without HIV/AIDS. It is only fair," said Nachibinga. Visit IRIN's PlusNews Zambian HIV/AIDS Country Brief