Government needs help to increase numbers on ARV, aid workers say

Health authorities in Burkina Faso have already admitted they will not be able to meet global goals for providing antiretroviral (ARV) drugs to people living with AIDS, but aid workers say even the government's scaled-down target will be under threat if grassroots groups are not drafted into the fight. Burkina Faso, one of the world's poorest countries, has pledged that 15,000 people will receive the life-prolonging ARV drugs by 2007. That would be a five-fold increase on the 2,700 patients that currently access treatment, but would fall short of the 27,000 people which the World Health Organisation said should receive medication by the end of 2005. Aid workers in this impoverished country say if the new target is to be realised, the contribution of grassroots AIDS organisations needs to be cranked up because the public health system is ill-equipped to shoulder the burden alone. For example, statistics from UNAIDS show that there are just 400 doctors in this country of 13 million - or one doctor for every 32,500 people. And there are only 23 regional and local health centres that are set up to hand out treatments for HIV/AIDS or to cure the secondary illnesses that often spring up in tandem with the virus. "A lack of healthcare infrastructure and qualified medical personnel means that the government can't take charge of everyone," explained Luc Derlet, who works for Medecins Sans Frontieres (MSF) Luxembourg. The HIV/AIDS prevalence rate in this landlocked country is estimated at 1.8 percent by government health officials and around 2.7 percent according to UNAIDS. MSF has been handing out free ARV drugs in Burkina for the past two years in four centres across the capital, treating more than 1,000 people a year. ARV drugs and the laboratory tests needed to prove treatment is necessary cost as much as 33,000 CFA (US $69) a month for patients that go to state clinics. But Derlet says that in another two years, the free MSF projects will be not be able to keep up with demand. "We have to find solutions to decentralise the healthcare so we can refer people who need treatment to health centres or groups in their local areas," he said. It is a message echoed by Mamadou Sakho, the head of UNAIDS in Burkina Faso. "Even if there is real political will to improve the care, there is the problem of access to treatment and care because of structural and financial reasons," he told IRIN. CLANDESTINE OPERATIONS Local organisations complain that they are being sidelined in the fight against AIDS, limited to information campaigns and efforts to destigmatise the disease, or else forced to administer drugs clandestinely. The REVS+ organisation (Responsibility, Hope, Life and Solidarity) is a case in point. Director Martine Somda explained that thanks to foreign donors, her group is able to provide free ARV treatment to 79 people in Burkina's second city, Bobo Dioulasso. But it is doing so without the necessary government permit. In September the government authorised four grassroots groups to provide general treatment, out of the 20 or so that offer help to people living with AIDS, but none were authorised to prescribe ARVs. "The government is thinking about giving us provisional approval for six months, but we're still at the discussion stage and nothing has been signed," Somda said. Nevertheless the group gives out the drugs, without the desired facilities, and has a waiting list of some 700 people. "We work in great uncertainty because we're not equipped to hand out medication," Somda said. "But we're obliged to do it. The hospital in Bobo and its four doctors are swamped. They have not had ARVs for the past six months and they send people here. We are the last chance for these people." Support for local groups may come next year when the World Bank is due to dispense around $4.6 million to help speed up access to treatment. The funds are destined for a dozen local non-governmental organisations involved in the fight against AIDS. For UNAIDS' Sakho, it is imperative that the government realises grassroots groups can be powerful allies. "They are very mobilised and call us on a daily basis, letting us know the problems they face on the ground. For that reason they should be included in the government's action plan," he said.