Although the cost of HIV treatment has significantly declined over the last decade, access to comprehensive HIV services remains low especially in Africa. Civil society must step up its game to change this.
Although the cost of HIV treatment has significantly declined over the last decade, access to comprehensive HIV services remains low especially in Africa, as compared to the rest of the world. Civil society must step up its game to change this.
Barriers to access to HIV treatment include a lack of decentralised health facilities, financial and human resource shortages, poor health policies, weak or inadequate community health systems, poor supply chain management that cause antiretroviral (ARV) stock-outs, excessive red tape, inability or failure to hold political and other leaders accountable for failing health delivery systems and in some extreme cases non-existent health systems.
In January, I was involved in a community treatment consultation, funded by HIV I-Base, that took place in Nairobi, Kenya to help tackle some of these issues. Regional non-governmental organisation AFROCAB, whose role is to link people living with HIV, activists, communities, and health care providers, and to amplify community voices on HIV treatment and support, was also involved.
The Nairobi Consultation
I was selected to attend along with other activists from 13 African countries after a call for papers was made by the International Treatment Preparedness Coalition. The consultation was also part of a technical capacity building process designed to build the competencies of African activists to advocate for better treatment and enable people living with HIV to take an active role in their own HIV care.
We hope this consultation will lead to the demand for better quality commodities and services provided to people living with HIV, but a number of obstacles must be overcome first to rapidly provide newer, less toxic antiretroviral medicines in African countries. These obstacles include: lack of treatment formulations for children with HIV; patents that prevent wider access to new and improved quality versions of HIV medicines, including combination pills; challenges in healthcare financing; and human resource shortfalls.
Participants shared and discussed strategies for overcoming these challenges, including looking at ways to monitor and ensure quality treatment care and services. This will contribute towards the establishment of a better informed community on matters pertaining to treatment access and research trials.
We also discussed how community activists can engage with local and regional policy frameworks, which is critical to ensure rapid uptake of various products, and must include engaging health authorities to quickly adapt global ARV guidelines in their countries.
The 90-90-90 targets
The 90-90-90 global targets set by UNAIDS – to achieve by 2020: 90% of all people with HIV know their status; 90% of all diagnosed people on ARV therapy; 90% of all people on ARV therapy will have viral suppression – was also a hot topic during the consultation.
Discussions focussed on community mobilisation strategies towards attaining these targets. For example, AFROCAB is engaging with drug manufacturers (Gilead, Jannsen, Mylan, Cipla etc) to get the price reduced for formulations like Tenofovir, as well as convince patent holders to reduce the years in which a patent is held.
Harrison Mwima, who is from Zambia and living with HIV, gets his medication from Kanyama clinic in Lusaka. He told me: “I do not think we can reach that target in Zambia because of long [waiting times for] appointments which lead to death before one can be seen, lack of healthcare staff, and the rationing and shortages of drugs especially ARV regimens for children.”
He went on to say that test results for his one-year-old son are not yet out and he had not yet been put on antiretroviral medication but has been on Septrin (an antibiotic) for the past year. Also, in Zambia, those who are newly diagnosed with HIV, irrespective of their level of infection, are asked to go back after three months in order to commence treatment.
On 3 February, the Post Newspaper (Zambia) reported that the newly elected President Edgar Lung urged the minister of health, Dr Joseph Kasonde, to ensure there were no drug shortages in health centres. But Fred Mwansa, Treatment Advocacy and Literacy Campaign (TALC) Lusaka hub co-ordinator, told me that at the moment health centres were experiencing drug shortages due to poor planning by Medical Stores.
Communities’ role in attaining targets
AFROCAB needs to strategically position itself and examine how communities can support the attainment of the 90-90-90 targets and help ensure that no Africans living with HIV are left behind, especially those who come from marginalised population groups, such as LGBT people, sex workers and people who use drugs.
The consultation concluded with in-country action plans for civil society organisations, with goals for raising awareness and advocating for better or improved access to HIV commodities and services for all who need them.
For us to attain these goals there is an urgent need to ensure more people are tested for HIV and to strengthen health systems to cope with this, including recruiting nurses and doctors, developing health infrastructure, and decentralising medical stores to end drug shortages.
Zambia also needs to come up with its own targets or model to suit its own context. Although targets may be achievable, they are ambitious and require increased investment. My worry is that until the problems discussed are addressed they will remain a pipe dream.