Free ARVs not enough to ensure access

Although Senegal provides antiretroviral (ARV) drugs free of charge to people living with AIDS, health workers say this simply is not enough to ensure proper access. Bernard Taverne, who heads the ARV programme at the French Development Research Institute (IRD) in the capital, Dakar, told PlusNews that free ARVs without free screening was a catch-22 situation, as the cost of the laboratory tests - from blood to x-rays - that determine whether a person will receive the drugs, was too expensive for most people. "This is a major obstacle to ARV access," said Taverne. "Some patients, who could have access to free ARVs, can't afford the preliminary tests or the drugs to treat opportunistic infections, and die as a consequence." Taverne is one of the authors of the "Free by 5" declaration (free access to a minimum medical package, including ARVs, by 2005), issued on 10 December 2004 to mark the end of World AIDS Week. Its backers say a new global strategy is needed to support HIV positive people. [www.ukzn.ac.za] "We believe that a prerequisite for ensuring that treatment programmes are scaled up, equitable and efficient, and provide quality care, is to implement universally free access to a minimum medical package, including ARVs, through the public healthcare system," the declaration reads. Senegal was the first country in Africa to introduce ARV treatment, and 2,700 people are receiving drugs free of charge under the programme known as ISAARV, which has won international praise. But the World Health Organisation estimates that 12,000 people - more than three time as many - need ARVs. A study, quoted by the Free by 5 campaign, found that when the cost of drugs for opportunistic infections, laboratory exams, consultations and hospitalisation fees are calculated, patients on ARVs in Senegal pay an additional $130 a year - a significant amount for the majority of people who live on less than a dollar a day. "Research in Senegal shows the main reason patients were not adherent was that financial problems led to treatment interruptions," the Free by 5 declaration noted. "The biggest and most recurrent problem is the failure to provide free biological tests," said Seynabou Mbodj, spokesman for a non-governmental organisation, the National Alliance Against AIDS (ANCS). "It's all very well handing out free drugs - now we need to provide free tests and free treatment for opportunistic illnesses," he said. Senegal's last available national survey, carried out in 2003 among high-risk populations in 12 sentinel surveillance sites, showed 93,000 people infected with HIV, with more than 150,000 expected to be HIV-positive in 2010. The Muslim country has a prevalence rate of 1.5 percent - one of the lowest in Africa. For more articles on the subject, plus interviews and a comprehensive database on numbers on treatment in sub-Saharan Africa, visit the PlusNews Web Special