UN Integrated Regional Information Network - December 9, 2008

"The injection is giving me muscle cramps," he says, kicking his legs. "But I have to continue taking them to cure the gonorrhoea I picked up."

The person treating him has no medical training, but also gives him some pills that are supposed to reinforce the effectiveness of the injection.

Matope is one of many people who buy medication at informal markets, where traditional African love potions share space with antibiotics, anti-malarial drugs, and antiretrovirals (ARVs) for HIV and AIDS.

Some of these drugs, such as tetracycline, an antibiotic, have been banned for certain uses by the World Health Organisation, but are sold here without prescription.

The strolling vendors remove the pills from their original packaging so expiry dates cannot be checked, and keep them in small suitcases or carry them in their pockets.

They also administer injections, often using the same unsterilised needle on several patients, which facilitates the spread of diseases, including HIV.

Elaborate transaction

The sale of ARVs is usually a more elaborate transaction: contact between vendor and client is brief, the client provides his cell phone number and waits for the vendor to contact him from a public pay phone.

Sergio Silva*, one of the vendors, says a prescription is sometimes required to help the supplier, usually a pharmacy employee, fill the client's order.

The client then commits to purchasing at least a one-year supply of the drugs, which are dispensed on a monthly basis, along with an explanation of how to take them, provided by the supplier.

Money only changes hands when the ARVs are quickly and discreetly delivered to the buyer. On the informal market, a one-month supply of ARVs costs between US$90 and $120.

Why pay?

ARVs are distributed for free at public health facilities, but the low rate of coverage in Mozambique drives demand for them on the informal market.

The UNAIDS 2008 HIV and Nutrition Status Report on Mozambique released in June noted that 340,000 of the 1.5 million Mozambicans estimated to be living with HIV were in need of ARVs, but only 88,211 were getting them.

Persistent stigma associated with HIV and other sexually transmitted infections is another reason why many people prefer to buy their ARVs on the black market rather than go to a clinic or hospital.

"I chose to get treatment at the bazaar because sometimes the nurses insult you when you get a venereal disease," said Matope. "They ask why you didn't use a condom, but sometimes an infection is just an accident."

Supplying the illegal market

The drugs sold on the informal market in Chimoio are usually supplied by health professionals and pharmacy workers. Two health sector employees in Manica were accused of various infractions, including theft of medicines, and fired in 2008.

Eight other workers, who were supposedly part of a network stealing drugs from the health department's warehouse and selling them to vendors, were publicly reprimanded.

A case of robbery at a pharmacy was reported recently at a hospital in Sussundenga District, south of Chimoio, but did not involve employees. Thieves entered the hospital pharmacy wearing masks and overpowered the staff. According to health authorities, they stole analgesics, anti-malarial drugs, anti-fungal medication and ARVs.

Police spokesman Pedro Jemusse said a multisector project involving the health sector, police and customs was underway to put an end to the theft of medicines.

Marilia Pugas, head physician at Manica's Provincial Health Department, admitted that drugs were stolen from warehouses and health facilities, and that drugs were sold on the black market, but described reports that ARVs were being sold illegally as "pure speculation".

"I have serious doubts that antiretrovirals are sold [on the black market], because our control system is very efficient," she told IRIN/PlusNews.

Martinho Djedje, a spokesman for the health department, said there were awareness-raising campaigns to warn people about the dangers of buying drugs on the informal market, "But joint work must also be done to arrest the vendors and eliminate the main sales points."

*not his real name

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