Too poor to access free AIDS drugs

Twenty-one-year-old Nonhlanhla Zuma (not her real name) lies on a mattress on the stone kitchen floor. Her bony, almost childlike body, weakened by HIV, makes standing up a major effort. The mattress is next to the door of the tiny family kitchen. Relatives bustling in and out to tend a pot of maize cobs boiling on the stove prevent her from getting the rest she urgently needs; her child, not yet a year old, is sleeping naked next to her. Over the past few months she has developed full-blown AIDS and is unable to work. Her mother takes care of her and her child, as well as other family members, some of whom are also sick. Only a few days ago Nonhlanhla lost one of her sisters to AIDS. She and her family live in Mnini, a rural area in KwaZulu-Natal on South Africa's east coast, largely cut off from healthcare services. Nonhlanhla is too weak to walk to the local clinic to get basic medication like painkillers, and her house - like many homes in the area - is not accessible by car. If her mother wants to move Nonhlanhla, she has to haul her in a wheelbarrow. The closest AIDS treatment site is Prince Mshiyeni Hospital in Durban, a good 35 km from Mnini. As most patients are too weak to use public transport, they have to hire a taxi to get there, at a cost of R400 (US $66): an amount very few in this poverty-stricken community can afford. Mnini used to be a lively community, farming sugarcane next to the once flourishing Umgababa seaside resort. But the community sank into destitution after years of faction fighting in the 1980s and 1990s and today the majority of its inhabitants are unemployed. Because Mnini's sick and poor are cut off from public health services, their only help is a group of volunteer women trained as home-based care counsellors. The group is run by Zanele Sithole, a traditional healer and former teacher. The organisation, called Hlangabeza Home-Based Care and Women's Co-op, is a consortium of 25 voluntary helpers who each visit an average of 200 houses in the Mnini area. In these 5,000 homes they generally find at least one family member infected with the HI virus. Sithole reckons that in Mnini, with a population of about 40,000 people, close to 70 percent are HIV positive - more than double the 33 percent prevalence rate in the rest of the province. The Hlangabeza volunteers received training in home-based care from the South African Department of Health, but get no stipends to pay for materials or their expenses. The group has been waiting since the middle of last year for the department to train them in administering antiretroviral (ARV) drugs, Sithole said. The only support they receive is a few bags of rice and beans every month from a partner organisation, an AIDS hospice in the Valley of a Thousand Hills, which struggles to get funding but nevertheless shares some of its clothing and toy donations with the sick in Mnini. Despite being poor themselves, the Hlangabeza voluntary carers pay for soap, Vaseline and food for patients out of their own pockets. Transport is an almost insurmountable problem, and it has been impossible for those in Mnini with full-blown AIDS to enrol on the government's free ARV treatment programme. Being part of the programme means the patient has to visit the treatment site to receive the drugs and undergo monitoring and health check-ups on a regular basis. "Not a single one of our patients [in Mnini] is on ARVs," Sithole told PlusNews, adding that, due to poverty, is was hardly likely that they would be able to enrol for ARV treatment in the near future. From Sithole's perspective, people in rural areas could only be properly helped if health professionals started visiting communities, rather than expecting people from rural areas to go to them. "We need doctors, nurses and social workers to accompany us volunteers on home visits," she stressed. Home-based carers also needed to be better trained. "Carers need to be authorised to administer painkillers and other basic medicines. They need to learn how to take down a patient's medical history so that they are permitted to receive medication at the clinics for those patients who are unable to go there themselves," she explained. The number of problems the Hhlangabeza volunteers have to face continually grows. One of the core issues is the rising number of AIDS orphans in the Mnini community. Thus far, the carers have found more than 450 orphans in the homes they visit, many living in child-headed households. "As it is, we can hardly handle the number of AIDS patients. We have no time and resources to help the orphans," said Sithole. "Many orphans have stopped going to school, and we fear that many will become criminals."