Inter Press Service - August 5, 1999
Zarina Geloo

Study shows that those who use the drugs inconsistently, or stop using them, when they cannot afford them, develop resistance to the medicine.

During the therapy, the virus mutates to defend itself from the multiple attacks from the ARVs. In most cases HIV testing will give a negative result giving the patient a false impression of 'cure'. The patient will also feel rejuvenated, resume an unprotected sex life and pass on the mutated virus.

There is debate going on in Zambia on the ethics of prescribing ARVs, which stops the virus from reproducing itself, to a population that cannot afford it and a medical infrastructure that is so weak it cannot deliver even the most basic health needs.

At 15,000 US Dollars a year, the drugs, a combination of three or more retroviral drugs -- like AZT, 3 TC and Crixivon and Combivor, collectively called Protease Inhibitors -- are out of reach of many HIV infected Zambians who earn less than 200 US Dollars a month.

Zambia's cash-strapped hospitals can neither afford routine HIV tests nor monitor the safe use of any drug let alone ARVs.

"Patients go on the drugs knowing that it's an expensive life commitment, but they are desperate. They will probably not be able to afford the drugs after a while. But the quality of their lives will be improved for the time they are on the drugs," says Dr. Boniface Kawimbe, former Minister of Health.

Kawimbe, now a private practitioner, owns the only clinic in the southern African country that has the facilities to monitor the safe and controlled use of ARVs. Describing the drugs as a 'miracle', Kawimbe says the mortality rate of his patients has reduced by 80 percent since he started prescribing anti-retroviral drugs.

Dr. Dorothy Kasonde, a private medical practitioner who also prescribes ARVs, believes that the only way to suppress the mutant virus is to have early diagnoses of HIV and tonnes of ARVs made available to infected people. But this could be a utopian dream. Medical doctors say it takes about two to three weeks for the virus to clear from the blood stream, but it is not known how long it takes to clear from other sites like lymphnodes, veins, and liver. The treatment goes on for years - most doctors think indefinitely. It would be both expensive and impractical for any African government to provide this kind of medical benefit.

"The problem of mutant resistant strains of diseases will always dog us in the medical profession. It's like antibiotics and malaria tablets, you can't stop prescribing them even though there is some resistance to the medicines," says Dr. Kawimbe.

Ceasar Mandona, chairman of Zambia's Poisons and Pharmacy Board, who was the first to import AZT, the first anti- retroviral drug that was developed, is concerned about the way the ARVs is being used.

"This uncontrolled selling of ARVs on the black-market, street corners and clinics, has made it very difficult to monitor people using the drugs. On a worldwide scale it is knocking back AIDS research because of these new strains we are seeing," he says.

In a country where 20 percent of the adult population is HIV infected, Mandona says he fears that the HIV pandemic in Zambia is not being solved but being exacerbated by the indiscriminate availability of drugs.

Fikansa Chanda of the Catholic Relief Agency, Cafod, objects to the use of ARVs as a drug for administering HIV/AIDS patients. "Contrary to popular belief it is not ARVs that will solve this problem. Give people food and you will see how much stronger they will be," he says.

Chanda, who often visits HIV patients in rural areas, says most die of malnutrition. "Give them ARVs and they will die from hunger tomorrow. What is the point of making them healthy when they will be ravaged by hunger ?" he asks.

Winston Zulu, chairperson of the Zambia HIV/AIDS Network, who was the first to publicly disclose his HIV status in 1985, has been taking ARVs for one and half years.

"I know that if I run out of drugs I might get a viral rebound which will kill me. I might develop resistance to one or more of the combinations, but those are the risks one takes. I am lucky I have people who supply me the drugs and ensure that I don't run out, but others may not be that fortunate," he says.

Dr. Moris Sibongo of the University Teaching Hospital in the capital Lusaka, confirms that his eight patients do not respond to any combination after developing resistant to ARVs.

Juliet Mandona is one such patient. She ran out of money after three months on an ARV. She recently got a loan from her company to buy a year's supply. "I am now trying out all sorts of combination because I developed resistance to the ones I was on," she says. "I have to find the right combination before starting getting sick again."

The government is aware of the impending crisis. Deputy Health Minister Ernest Mwansa urged the donors to help countries like Zambia to deal with HIV/AIDS. "It's a problem that is not confined to Zambia. It affects the entire world and the western world should start taking steps to help Third World countries contain the spread of AIDS," he says.(END/IPS/zg/mn/99)
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