Integrated Regional Information Networks - October 12, 2000

MBABANE, 17 October (IRIN) - Anti-retroviral drugs can prolong the lives of people living with AIDS, but poverty, bureaucratic lapses and misinformation are limiting the life-saving potential of drug therapy in Africa's worst-hit countries, analysts warned this week.

Anti-AIDS crusaders said poorly designed health programmes and misguided public opinion could frustrate efforts to reduce AIDS-related deaths even more than the impossible prices anti-retroviral drugs command.

In Swaziland, a country of an estimated one million people, anti-retroviral drugs are readily available on prescription in the urban centres, but their use remains limited. While high prices keep the drugs out of the reach of many, a campaign by a leading anti-AIDS group discourages even those that can afford the drugs from using them.

The Swaziland AIDS Support Organisation (SASO), a group of people living with HIV/AIDS, believes that the use of anti-retroviral drugs is unsustainable -- in Africa, at least - and even harmful in the long run.

"We discourage our members from taking the drugs because one must eat if one is taking the drugs. However, the drugs are so expensive that one can not buy them and buy food as well," SASO president Hannie Dlamini told IRIN. "One is better off having food and no drugs than having drugs and no food."

In a country where an estimated 25 percent of adults are HIV-positive, a cocktail of anti-retrovirals that includes AZT and 3TC costs the equivalent of around US $618 for a month's supply - an impossible sum in a country where most workers earn under US $275.

Health sector problems

Meanwhile, an inefficient health sector appears unable to apply even basic preventive measures to curb the spread of HIV/AIDS. Two months ago, for example, widespread condom shortages were reported in Mbabane, the capital, and Manzini, the country's industrial hub.

Anti-AIDS groups also fear that "ignorant" politicians and traditional leaders may be frustrating efforts at a communal approach to HIV/AIDS. Traditional leaders recently proposed that people with HIV/AIDS be isolated and banned from marrying. Earlier, some parliamentarians proposed the branding and sterilisation of people that test HIV-positive.

"Such attitudes lead not only to the ostracism of people living with HIV/AIDS, but frustrate efforts at finding communal solutions to the problems the epidemic creates," Beatrice Dlamini, the head of the government-run Swaziland National AIDS Programme (SNAP) said.

Malawi's experience

In Malawi, a government scheme to provide subsidised anti-retroviral drugs for the poor is said to be serving only the relatively affluent. Under the scheme, the price of a month's supply of anti-retroviral drugs is reduced from the equivalent of US $553 to US $221. The health ministry plans to start trials with nevirapine, a drug believed to reduce HIV-transmission from mother to child during pregnancy. If the trials prove successful, the drug will be made available under a revolving fund.

However, anti-AIDS groups say most Malawians cannot afford the drugs even after the subsidy. "There is a great need to make the drugs accessible to everyone. At present, only people with money can afford them," an official of the National AIDS Control Programme (NACP) said.

An estimated one million of Malawi's 10 million people are believed to have HIV, the virus that causes AIDS. Agriculture-dependant Malawi is one of the poorest countries in the world. Its social services remain rudimentary, with 50,000 people sharing one physician and life expectancy standing only at 41 years in 1994, up from 38 years at independence in 1960.

No drug policy in Mozambique

In neighbouring Mozambique, where an estimated 15.4 percent of the population is believed to be HIV-positive, the government is yet to come up with a policy on the use of anti-retroviral drugs. The national health system does not provide the drugs, but it allows the private sector to provide them -- again at prices few people in the country can afford.

According to the UNAIDS office in Maputo, a three-drug cocktail of anti-retroviral drugs costs around US $1,000 for a month's supply. "There are no schemes in Mozambique that make the drugs available to people at reasonable prices. However, a few private pharmacies are importing the medication, but the cost is extremely high," UNAIDS spokesperson Maria Tallarico told IRIN.

"There isn't yet an official position by the government on the use of anti-retroviral drugs. At present there is a group that is working on the issue so that they may advise the ministry of health and this will then be taken into consideration before the government takes an official position on the issue," Tallarico added.

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