Economic security is a challenge for ARV patients

Although anti-AIDS drugs have helped thousands of people in Mozambique, hundreds of thousands more still desperately need the life-saving medication but lack the money to continue treatment. When his wife died of an AIDS-related illness four years ago, Isufu Portina, 29, was wrongly arrested for allegedly poisoning and killing her. A priest from the Community of Sant' Egidio, a Christian civil society organisation, managed to get him released from prison after obtaining the autopsy report. However, Portina emerged from 14 months in detention suffering from tuberculosis and other AIDS-related complications and was too sick to look after his three children. "Although I didn't tell people I had just tested HIV positive, I was so thin that they knew," he told IRIN. "They would run away from me like I was a fierce, wild animal." Today, two years after he started taking antiretroviral (ARV) drugs distributed by DREAM (Drug Resources Enhancement against AIDS and Malnutrition), a project run by the Community of Sant' Egidio, Portina looks like any other healthy man. The DREAM project, which is integrated into Mozambique's national health system, was created to fight HIV/AIDS in sub-Saharan Africa and provides 4,200 people with ARVs. In total 12,600 people receive their anti-AIDS medication from the country's health system. Matteo Zuppi of the Community of Sant' Egidio recently noted that Mozambique's fight against HIV/AIDS was in many ways an "exemplary case" for Southern Africa. He commented that "behind each number, there is a story", which often included challenges that people living with AIDS continue to face even after they have begun treatment. While medication was "giving back their health", the main obstacle was for them to be accepted back into society, said Dr Ines Zimba. "As a doctor I can't do all that my patients need ... patients come to me and they can't get jobs because they are discriminated against; they don't have money and they have no food at home; then they tell me they can't take their tablets with no food," Zimba said. "We need more support from other sectors of the community, including the families, employers, activists and psychologists. Everybody needs to help and play his or her part - it is a race against time," the doctor stressed. It is illegal to discriminate against HIV-positive workers or dismiss them because of their status, but Zimba noted that legislation alone could not stop discrimination in a society where HIV/AIDS was still highly stigmatised - a major education campaign and change of attitude was needed. In Maputo, Dr Marc Biot, the medical coordinator of Medecins San Frontiers (MSF)-Luxembourg, agreed that although the ARV programme has had much success, the economic and social hurdles facing HIV positive people had to be addressed. MSF supports 5,000 people on ARVs within the national health system. Biot said many patients on ARVs were concerned about earning a living. One problem was that many of the men in the southern parts of the country wanted to return to neighbouring South Africa to work in the mines, where they had been employed before falling ill. "We are meant to give them a supply of drugs for one month, but they are requesting for three months so that they can return to South Africa - it is a problem we have to address somehow. It is an economic reality for the people; the economy here can't absorb them," Biot explained. Although the dropout rate was less than five percent, he pointed out that there were a number of constraints to people staying in the ARV programme. When traced, most of those who had dropped out complained of a lack of money for transport to health posts, while others said they had no food. The World Food Programme provides a food package to people suffering from anaemia and malnutrition while taking ARVs, but Biot said they gradually had to be weaned off their dependence on food aid. Despite the challenges, the reality is that Mozambicans on ARVs are still privileged: the 12,600 people receiving anti-AIDS drugs were a small percentage of the estimated 200,000 in need of treatment, and the country was lagging behind its goal of having 29,000 people on ARVs by the end of 2005. According to the National Statistics Institute (INE), the HIV prevalence rate in the age group 15 to 49 had reached 15.6 percent and AIDS accounted for 25 percent of all deaths. In 2004 some 97,000 people died from AIDS-related illnesses, 17,500 of them children under five. Portina said his life had been transformed by the ARV programme. Apart from enjoying good health, he has a job with a DREAM-supported project, where he earns US $100 a month - more than the minimum wage - at a community association that helps patients on ARVs adhere to treatment protocols. He is optimistic about the future: "I hope to continue to work to assist people who are living with HIV/AIDS. And I hope one day I can afford to buy my own home, so I can live with my three children again."