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CAP TOWN, May 11 - Although antiretroviral therapy (ART) has been available in Zambia since 2002, few Zambians have joined the national treatment programme says research presented at a conference on the social aspects of HIV/AIDS care and treatment.
While antiretrovirals (ARVs) are relatively cheap, they are only accessible after both a CD4 test, which costs US $40, and a US $30 viral load test. "The doctors that are responsible for the rollout of ART insist on both tests, so the initial outlay is very expensive," Namposya Nampanya-Serpell, author of the research paper, "Access to Treatment and ARV Uptake in Zambia", told PlusNews.
Presenting her findings to the Second African Conference on Social Aspects of Access to Care and Treatment in Cape Town, South Africa, Nampanya-Serpell, the outgoing UNAIDS country coordinator for Zambia, said that just over 4,000 Zambians were on ART.
In the first phase of Zambia's rollout plan, ARVs have been available in all nine provincial hospitals since 2002, at a cost of $10 for a month's supply. The goal was to have 10,000 people living with HIV/AIDS on treatment by the end of 2003. The second phase, now underway, will introduce the programme in all 72 districts of Zambia.
Around 120,000 people per year are visiting voluntary counselling and testing (VCT) centres, about 20 percent of whom are infected.
"Zambia, realistically, can only put 15,000 people on treatment per year, unless the number of people going for VCT increases significantly," said Nampanya-Serpell.
In the catchment area for Livingstone General Hospital, in Zambia's Southern Province, the HIV prevalence rate is 22 percent - well above the national average of 16 percent. Livingstone is a tourist town on the Victoria Falls border with Zimbabwe.
By February 2004, after ARVs had been available at Livingstone General Hospital for seven months, only 100 clients were on ART - 58 females and 42 males - out of a possible 11,000 people thought to need treatment in the catchment area.
Nampanya-Serpell said there were numerous challenges to scaling up the numbers. "Just one example - we were so busy getting the VCTs in place that we forgot about the 'V', the volunteer; the individual; the person it was all intended for. What motivates them? Before we were crying because we didn't have the resources, the people, the medicines, the testing equipment. Now we have a dilemma because of the low uptake."
The World Bank and the Global AIDS Fund helped Zambia reduce the cost of ART to $10 per patient per month. The government is negotiating over drug prices again, in the hope of increasing the numbers of people on ART by dropping the cost to $4 (or Zambian Kwacha 20,000 - a loaf of bread costs around K3,000).
"The cabinet met in March to discuss how to make ART free. By August this year Zambia will have to throw away 18,000 doses of ART if we cannot find the people to purchase it, because it will expire," Nampanya-Serpell told PlusNews.
According to her research, the lack of privacy, sensitivity and culturally acceptable language associated with ART are among the factors inhibiting the uptake of treatment. For example: "A health worker comes out of the hospital and shouts 'all those waiting for ART, please follow me!'".
There was also a gross lack of understanding and appreciation by health workers that it was in the best interests of everyone to know their status. "A government minister went to a VCT clinic and a health worker asked him, 'are you sure you want to be tested?'," Nampanya-Serpell recalled.
Culturally acceptable language about HIV/AIDS, compatible with African social norms, was also required. "A more comfortable way for people to receive the news is, 'you have nasty little fellows in your blood that we should try to keep under control' instead of 'you have AIDS'," said Nampanya-Serpell. "People have been conditioned to think that contracting AIDS means that you have sinned and are issued a death sentence."
The study noted that further research on access to treatment was necessary, especially the social context of the demand for health care for serious illnesses like AIDS, and the language used to communicate about AIDS.
Fighting stigma through public debate, changing the attitudes of health workers to people living with HIV/AIDS and ensuring that staff in the health sector had access to HIV care and treatment were also essential.
An estimated 1.3 million people in Zambia are HIV-positive. Of those, 200,000 require treatment now.
According to the World Health Organisation's "three by five" initiative, which aims to have three million people on treatment by 2005, Zambia should try to have at least half that number, or 100,000, on treatment by then.
For more details on the conference visit: http://www.sahara.org.za/
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