International Seminar on Access to Treatment for HIV in Developing Countries 
5-6 June 1998 London, UK
 

Realities of access to treatment: perspective of a person living with HIV/AIDS

David Chipanta, President
Network African People Living with HIV/AIDS (NAP+)
Lusaka, Zambia

Access to treatment in resource constrained communities has inherent impediments such as inadequately trained medical staff and poor facilities and negative attitudes which discourage health seeking behaviour. Such attitudes may take the form of belief in fate or predestination - things occur because they were destined to happen.

The patient to doctor ratios in many developing countries are very high. As a result, physicians spend an average of two minutes for every patient per visit made. They may also prescribe drugs which may not be easily and consistently available. As people spend more time and effort than the little benefits they get from hospitals justify, confidence in health institutions' ability to effectively treat patients is lost. Consequently health institutions become the last resort to go to when one is ill. It is only when one is too ill and all other sources of health have been exhausted that the patients may be taken to the hospital, to die and not to be treated.

For people living with HIV/AIDS (PLHA), the process may be bleaker. On learning about one's sero-
status, mainly through an illness, death of a partner or through routine HIV tests for career or travel, a quick referral to a usually ill prepared household and community home-based care programme is effected. From here the patient will have difficulties in accessing treatment due to reasons which will include the following:
 

As most of the patients are being referred to the community, its members will have a very significant role to play in the care and support of PLHA. Communities will have to be mobilised and their experiences of living with HIV/AIDS should inform the response to mitigate the impact of HIV/AIDS. Such groups should be strong and vocal enough to demand and access both services and the means to deliver these services in their communities. These stronger links and co-operation between people living with HIV/AIDS and their communities can effect better lobbying of access to relevant treatment and the sharing of information and lessons on treatment.

Communities' capacity to effectively care and support those living with HIV/AIDS needs to be improved. People living with HIV/AIDS and members of the community will have to be equipped with skills to address psycho-social issues related to HIV and be able to recognise common opportunistic infections and refer them to appropriate institutions. They also need up-to-date information on the services that exist in their community and how to access them. AIDS education and conscientisation of the masses and people living with HIV/AIDS need to be stepped up. Such conscientisation should concentrate on reducing stigma both of the general public and people living with HIV/AIDS themselves to the HIV infection. People need to know that those who are HIV positive are normal and capable people as anyone else. Above all, the knowledge that opportunistic infections are treatable and curable should be internalised by both the medical people and people living with HIV/AIDS and their close ones.

Research on the efficacy of traditional medicines in treating opportunistic infections, as these are used considerably by people in Africa, need to be done. Conventional and traditional doctors should work more closely together for the benefit of people living with HIV/AIDS. Both these institutions need to be continuously oriented to handle not only opportunistic infections but also the psycho-social issues that go with HIV.

Government must provide to its people quality care which should include the provision of adequate and relevant essential drugs and HIV medicines including antiretrovirals. This should be accompanied with the setting up and upgrading of facilities and guidelines for the administration of such medications. Among the practical ways of providing effective treatment of opportunistic infection Governments should consider is establishing HIV specialised clinics.

Health care should be high on the agenda of donor aid to developing countries as it is directly linked to development. The donors should demand minimum standards of health care from recipient countries as prerequisites for donor aid just as they require good governance and certain minimum human rights adherence for donor support. In addition, the donors and the international community need to broker discussion with pharmaceutical companies for reduction in prices and wide provision of essential drugs and HIV related medicines and services to developing countries.

AIDS is now a manageable infection in many developed countries. The infection will remain unnecessarily deadly in developing countries if efforts to reduce stigma associated to HIV/AIDS and the necessary services and resources are not provided. All this should be grounded on very active and involved communities of people living with HIV/AIDS and more co-ordinated collaborative work among the different local and international actors.

Discussion:
The fact was mentioned that among the six million people living with HIV in Asia, only about 2,500 of them had access to advanced HIV treatment which was an unacceptable situation. It was requested that Glaxo to re-examine its patent monopoly on AZT and asked how far African groups would support this?

In response, Mr Chipanta said that there was a need to strengthen links between PLHA in the community and groups in the North to advocate for things together. However, more information was needed in Africa. The fact that there were not even basic drugs in many parts of Africa should not deter us from trying to do a little to save a few people with HIV.

It was also noted that because of high debt repayments, it was hard for poor countries to provide adequate health care. For example, Zambia spends four times more on debt repayments than on health.