ARVs extending life, but not improving it

HIV-positive people are living longer on antiretroviral (ARV) medication, but many of them remain poor and hungry, highlighting the need to create incomes for them, says a new report.

"The long-term sustainability of people on ART [antiretroviral therapy] and the [treatment] programmes are threatened by the continuing lack of food and economic independence," said a press release on the report, produced for CAFOD, a development NGO based in the United Kingdom.

The report noted that ART had had a significant impact on patients, whose expectations had changed from "preparing for death" to looking to the future for ways to sustain themselves and their families.

However, many people had started taking ARVs after periods of illness during which they had lost their jobs and sold their assets to survive, so returning to a more normal life has proved difficult.

"ART programmes need to take into account the fact that people on treatment still need to eat and still need an income," Jo Maher, author of the CAFOD report, told IRIN/PlusNews.

According to James Kamau, coordinator of the Kenya Treatment Access Movement, ART programmes need to include food as part of their support to people living with HIV.

"Most ARV programmes started with the basic aim of keeping people alive, but drugs alone cannot keep you alive - are people going to eat stones?" he said. "If you don't feed people they can't regain enough strength to work and earn a living," he pointed out.

"In Kenya, where more than half the population lives on less than a dollar a day, poverty is a huge problem," he added. "Women in particular suffer because they are responsible for caring for and feeding people in the home, and when they have no means to do this the whole household suffers."

The best person for the job

Maher said programmes needed to decide - based on their individual capacities - what form the income support should take. "HIV-specific organisations, for instance, should decide whether to retain their HIV focus and partner with organisations with better skills in income generation, or expand their activities to include income generation. Sometimes they may not have the skills or manpower to take on the task themselves."

The report said several organisations interviewed during research for the report found challenges in two particular aspects of sustainability: the need and desire of clients to become independent of the programmes, while the organisations need the clients to become self-reliant for the programme's own sustainability.

"If an agency takes on 10 new patients every month then the organisation grows and grows but is not really sustainable, so organisations must find a way to empower people economically so that the organisations themselves can remain sustainable," Maher said.

Kamau said although ARV programmes need to provide food as part of a complete treatment package, they should stop short of going into providing income-generating projects for their clients. "Those who get better should be able to find work for themselves and, if they fail, it is the responsibility of the government to look after their needs," he commented.

"The ARV programmes should concentrate on ensuring access and adherence to the drugs - treatment programmes still have many gaps," he added. "In Kenya, 200,000 people are on ARVs, but another 260,000 need them urgently; and then we still have many people unable to access drugs for opportunistic infections."

He said the problems of distance and transport to health facilities, particularly with the current hike in fuel prices, had made it increasingly difficult for people living in remote rural areas to access their medication.

"If the government spent a decent amount of the national budget on health, people would get their drugs and would be well enough to work, thereby improving the economy and creating enough work for everyone," Kamau said.

kr/he/kn