High costs hamper access to ARVs

Almost two years after Zimbabwe's government declared a state of emergency over HIV/AIDS to allow the importation and manufacture of generic anti-AIDS drugs, accessing antiretrovirals (ARVs) remains a pipe dream for almost a million people living with HIV/AIDS in the country. With an estimated HIV prevalence rate of 27 percent, Zimbabwe is one of the countries worst hit by the epidemic. A recent survey conducted by the Southern Africa HIV/AIDS Information Dissemination Service (SAfAIDS) revealed that most single-drug therapies cost more than US $122 a month (Zim $100,000 at the official exchange rate of Zim $824 to US $1) in a country where a substantial number of those in formal employment take home less than that every month. ARVs have not yet been made available in the public sector. The costs of cocktail therapies were higher, with prices ranging from US $443 to US $530 a month, the survey of ARV prices in Harare pharmacies found. Most clients who bought the drugs from pharmacies in Harare were "senior management from huge companies, (who) get financial support from their companies," the SAfAIDS research said. Fear of stigma and discrimination, however, prevented many people who could afford it from taking advantage of this opportunity to access medication. The health ministry estimates that the capital city has about 3,000 HIV-positive people. "The ARVs available in pharmacies are very expensive and the income of ordinary Zimbabweans means they are not affordable. The number of people buying ARVs directly from pharmacies was small," SAfAIDS noted. The prohibitive prices of anti-AIDS medicines led to poor adherence, as patients discontinued treatment as soon as their health improved. Purchases were irregular and a significant number opted for cheaper sources of the drugs, in many cases visiting traditional healers. The survey revealed that most pharmacies charged up to 50 percent mark-up on drugs and added 10 percent on the ARVs because of the huge costs associated with the manufacture and distribution of the drugs. In all the pharmacies SAfAIDS visited, ARVs were sold on a cash basis because they were not covered under any medical aid scheme, and pharmacists feared clients might die before settling their bills. The high cost of ARVs has also been blamed on the shortage of foreign currency. "The critical foreign exchange shortage caused by withdrawal of donor funding and collapse of commercial sector exports makes it difficult for local resources to be used to purchase ARVs. Most retailers use 'black market' rates for drug prices because it is impossible to source foreign exchange through the banks," the Regional Network for Equity in Health an Southern Africa (EQUINET) said in a discussion paper in August last year. Most of the Zim $2.5 billion fund set aside to buy ARVs in the 2003 fiscal year has been lying idle, as it cannot be used to buy foreign exchange at parallel market rates, and much of it has since been eroded by steadily rising inflation and rapidly fluctuating exchange rates. PWAs living in rural areas fare even worse. "The majority of the people in those areas do not have a steady source of income and are generally poor. Normally, they depend on annual harvests - that means that if they [or relatives] fall ill, it will be difficult for them to access ARVs because they do not have the money," an official with the Rockefeller Foundation in Zimbabwe, who asked not be named, told PlusNews. "Lack of sufficient nutritional standards, particularly when there is a food crisis, like now, compounds the situation of patients as they become susceptible to opportunistic infections," the official added. Farm workers displaced by the fast-track land reform were particularly vulnerable, as they had lost income and were ignorant of how they could access free treatment offered by NGOs. The Rockefeller Foundation in Zimbabwe has embarked on a 15-year programme, the Development of Antiretroviral Therapy (DART), which seeks to make ARVs more accessible to the poor. Up to 1,000 HIV-positive people have been identified as beneficiaries of the programme.