EPISODE 6 - ARV Shortages

Shortage of antiretrovirals (ARVs) is threatening the roll out of treatment. Since late last year in the Free State and in other provinces there have been months when patients found they could not access ARVs. Hospitals have had to stop putting any new patients on treatment because of the shortage. People die because of not starting treatment. When people start ARVs and then skip them for any reason it can also lead to HIV becoming resistant to the ARVs, then these life saving medicines no longer work for that patient.

Sello Mokhalipi lives with HIV. He works as an adherence counsellor at Pelonomi hospital, one of the sites in Free State hard hit by ARV shortages. He says he first noticed the shortage in November 2008 when Pelonomi stopped supplying ARVs to patients - because it is worse to take two of the required three drugs than to stop altogether. When the ARV supply stopped many people tried to buy them for themselves - a heavy burden on poor people who struggle to put food on the table. "If you start treatment and then you stop, the virus in your body multiplies too much and there is nothing to fight it," Sello explains. To government he says, "If you are dealing with people's lives you have to make sure they access treatment, a person's health should come first, to be successful in life a person needs good health."

Lawrence Vilakazi from Harrismith fell sick in 2005 and was started on ARVs. Between November 2008 and March 2009 he couldn't get his ARVs from the hospital where he lives. Those four months were a stressful time for Lawrence. His CD4 count dropped from 382 to 218. He started to feel the terrible tiredness he used to feel before he started ARVs. HIV robs one's body of energy - which is why people who start on ARV treatment have so much more energy. Lawrence started to feel depressed, worrying about what would happen to his wife and children if he were to die. The thought of dying "not because of something I did but because someone at the Department of Health" made him angry. He says that all the worry and anxiety has been stressing him out and stress is one of the factors that makes HIV worse.

Trudie Harrison, who coordinates the Anglican Churches' AIDS programme in Free State, describes the impact of the ARV shortages as "devastating" and sees the shortages as part of the legacy of the AIDS denialism of the Mbeki era. In that era far too few people were put on treatment. Now we have a new President and Health Minister determined to tackle the epidemic, many people are coming forward to seek treatment and the Health Department has not budgeted for them, she explains. Whereas Free State has about 37 000 people on treatment, Trudie thinks there should be at least 60 000 on treatment. As many of these untreated people come forward, the Health Department is overwhelmed. They had no idea of the real numbers needing treatment and no way of budgeting properly for them.

Richard Kheswa and Zimele Phungula are two self employed men who repair cell phones from home for a living. They are also both on ARVs at Edendale Hospital in KZN which has the largest public sector ARV programme in the country with over 11 000 patients on treatment. Richard and Zimele speak passionately about the stress and anxiety they feel when there are stock outages at Edendale. They understand all too well that ARVS are for life and that the worst thing they can do is to skip doses. Sometimes when they went on the correct day according to their appointment cards to receive ARVs they were told to come back the next day. But transport is expensive and often they can't afford to come back and end up not getting their medication. This can lead to HIV becoming resistant to the ARVs - and this resistant virus can be passed on to others.

This is why it is such a disaster if mismanagement of the Health Budget occurs. Under budgeting for the real demand for ARVs and mismanagement of the supply chain combine to undermine government's commitment to access to ARVs for all who need them.