South Africa: HIV drugs and food not keeping up with demand

by, Caroline Hooper, Health Systems Trust, South Africa

An estimated 200 000 South Africans living with HIV and AIDS are in urgent need of anti-AIDS drugs, but supply is not keeping up with demand. And, despite good nutrition being an essential pre-requisite for starting anti-retroviral (ARV) treatment, only a fraction of HIV and AIDS patients are receiving the supplements and food parcels.

This is the finding of a monitoring report compiled by the Treatment Action Campaign (TAC) and Aids Law Project, 18 months after the government approved the national HIV and AIDS treatment plan. But not all the news about the roll-out is bad. Several studies have confirmed good outcomes in the use of ARVs in the public health sector, said the report, saving the lives of thousands of people living with HIV and AIDS. About 42 000 patients are receiving ARV treatment in the public health sector.

'The unexplained and unjustified delay in formal accreditation is one of the main reasons' North West province has in the past few months increased its ARV patient numbers dramatically, a development the report attributes to exemplary leadership and commitment shown by healthcare workers.

Limpopo, on the other hand, has still not accredited essential treatment sites, and refuses to release information about its roll-out programme. And the Eastern Cape is still underspending on its health budget. A combination of a shortage of medical staff and inefficient systems has resulted in waiting lists of up to six months in some areas. The problem is compounded by the fact that several sites ready to start treatment are still awaiting formal accreditation.

The unexplained and unjustified delay in formal accreditation is one of the main reasons why several sites across the country cannot commence ARV treatment and help share the burden, the report said. In some areas waiting lists for treatment go back four months. Given the need, patient numbers in the public sector are significantly lower than what the demand actually requires, the report said.

In comparison, the number of patients on ARV treatment in the private sector is between 50 000 and 60 000. This figure includes medical scheme beneficiaries, patients on employer-funded workplace treatment programmes, out-of-pocket payments, and patients receiving treatment through the support of non-profit programmes, run mainly by faith-based and community organizations. According to the government's operational plan, the department of health's nutrition strategy must dispense a meal and micronutrient supplements to selected groups of people living with HIV/AIDS and tuberculosis.

Good nutrition is medically necessary for people with HIV and AIDS before they can start ARV treatment - yet there are serious gaps in the government's nutrition programme, the report found. About 14 million South Africans do not have a secure food supply, and 1,5 million children suffer from malnutrition.

Manto Tshabalala-Msimang, the health minister, angered AIDS activists at the South African AIDS Conference in Durban last month when she claimed that 90 percent of people who access ARV treatment through the public service are given food supplements. Strong anecdotal evidence points to the fact that few patients receive nutritional support, the report said.

At the Harriet Shezi clinic at Chris Hani Baragwanath hospital in Soweto - the largest paediatric treatment site in the country - only 6 percent of children on ARV treatment have access to nutritional support through the resident dietician. Often there are not enough social workers available to advise patients on where and how to access food parcels and supplements, the report said, and the administrative burden of processing hundreds of applications for food parcels also results in limited access. As of April, no patient at the clinic had received food parcels.

Francois Venter, the head of the Wits AIDS Research Unit, said it was noteworthy that in areas with proper leadership, results had been excellent, as in the case of North West where people on ARVs had risen from zero to 1 000. In Mpumalanga and Limpopo, however, the situation did not look good, Venter said.

(Source: Pambazuka News, July 30, 2005)

LESOTHO: Numbers of people in need increasing, WFP/FAO

JOHANNESBURG, 22 Jun 2005 (IRIN) - Declining agricultural production and incomes have combined with HIV/AIDS to undermine the ability of Lesotho's poor to cope with external shocks such as drought, said a joint World Food Programme and Food and Agriculture Organisation report.

The recent WFP/FAO crop and food supply assessment mission conducted in Lesotho found that the country was facing a "triple threat of increasing chronic poverty, rising rates of HIV/AIDS and weakened government capacity".

According to the Vulnerability Assessment Committee, 548,000 people will have "a significant food deficit between June 2005 and March 2006", and will require about 20,200 mt of food aid.

"Domestic cereal production in 2004/05 is estimated at 119,000 mt, consisting of 92,129 m of maize, 16,442 mt of sorghum and 10,339 mt wheat," the assessors said.

While production showed an improvement of about 15 percent over last year's, it was about 84 percent of the five-year average.

"Lesotho's cereal production appears to be on a downward trend, especially in the main producing districts of Berea, Butha-Buthe, Leribe and Maseru. This is cause for concern and should be fully investigated. Endemic soil erosion, weather-related disasters and the impact of the HIV/AIDS pandemic are likely to be major underlying causes," the report observed.

The 'triple threat' has taken a heavy toll, particularly on the households of the rural poor in Lesotho, "who are faced with a limited number of coping strategies to respond to the intensifying hazard".

A UN Country Assessment found that 59 percent of the population are living below the poverty line, and about 40 percent of the population of Lesotho fall into the 'ultra-poor' category.

"Studies indicate that HIV/AIDS is a leading factor in the drastic reduction of household income for much of the population. Against this background, falling agricultural production, trade constraints, and collapsing employment opportunities combine to increase the vulnerability of poor households to food insecurity," the UN agencies noted.

HIV/AIDS had become not just a health issue for the government, "but rather a development issue with social, economic and cultural implications".

World Bank estimates predict that Lesotho's GDP will be halved by 2015, with HIV/AIDS having a clear effect on household food security.

Despite evidence of increasing need in Lesotho, aid agencies have struggled to run existing programmes aimed at assisting people affected by the previous year's crop failures.

"With food aid stocks and pipeline as of 1 April at 61,000 mt, there remains an uncovered deficit of 19,000 mt (6,000 mt of maize, 13,000 mt of sorghum) which need to be covered by additional donor assistance," the report pointed out.

WFP's deputy country representative, Mads Lofvall, had earlier told IRIN that the agency had to suspend its operations throughout Lesotho towards the end of May due to a shortfall in funding.

By early June the agency had managed to secure some funding and was planning to reach 80,000 people, out of the 240,000 it had initially planned to assist.

"We are having to make very difficult choices [about who gets aid]," Lofvall commented, "... as the number of orphans keeps going up and the number of HIV/AIDS patients keeps growing."

Source: Pronut-HIV eForum, to join email pronut-hiv-join@healthnet.org

Namibia: Ministry Gives ARVs, Not Food

New Era (Windhoek), July 25, 2005

Though the focus has been directed towards making nutrition and the intake of antiretroviral drugs (ARVs) a top priority by most countries, the Ministry of Health and Social Services in Namibia only distributes drugs and not food to people living with HIV.

ARVs are a cocktail of drugs given to HIV infected persons to reduce the rate of replication of the virus in the body and thus prolong their lives.

These drugs are usually prescribed when the virus has reached an advanced stage in which the body's defence mechanism is compromised.

The Permanent Secretary in the Ministry of Health and Social Services, Dr Kalumbi Shangula told New Era that Namibian hospitals do not distribute food rations to people receiving these drugs.

"It's not in our mandate to do that. It falls under the drought relief programme," explained the top Health and Social Services official.

However, the chief clerk responsible for coordinating the Khomas Region Emergency Services, Sebastian Uahengo indicated that when his desk normally registers people for food rations, it does not make provisions to provide food to those receiving ARV treatment. "We only give food to pensioners, the differently abled, lactating mothers and pregnant women who are unemployed," he said.

Currently, there are 11 000 HIV/AIDS patients on ARV treatment in the whole country, confirmed the Director of Special Programmes in the Ministry of Health and Social Services, Ela Shihepo. Just like any other drug would have side effects on patients, different people are affected differently when they take the drugs; hence the recommendation that patients have something to eat before they take their medication.

In 2003, cases of HIV/AIDS people totalling 136 068 were reported to the Ministry of Health and Social Services.

Recently, a media report highlighting the plight of those affected and infected with HIV/AIDS found that many people in the country stop taking their medication due to hunger. "You must eat first, but what can you eat if there is no food? Sometimes, they are forced to stop going to the hospital for medicine, but on an empty stomach what is the use?" asked a community-based counsellor who declined to be identified.

Emphasis is being placed on the fact that although the virus can weaken the immune system, it is possible to strengthen the immune system by practicing healthy eating habits. This includes eating food that is rich in all nutrients.

In cases where an HIV and AIDS patient has no access to ARVs, nutritious foods are the best way to boost the body's immune system. Even where ARVs are available, a healthy diet is essential.

Health experts believe a combination of the right medication and good nutrition strengthens the immune system, thwarts opportunistic infections and slows the progression of HIV and eventually AIDS.

They further believe that insufficient dietary intake leads to muscle wasting which in turn increases viral replication and quickens the progression of an HIV infection to AIDS.

However, the situation calls for a concerted effort in promoting healthy eating habits.

Source: AllAfrica.com

Govt to Help 5,000 Aids Patients With Nutrition, Reveals Chituwo

Doreen Kambangaji, The Post. Lusaka, July 25, 2005

The government is to assist 5,000 people on anti-retroviral (ARVs) who cannot afford good nutrition, Minister of Health Dr Brian Chituwo has said.

Speaking on ZNBC's Radio Four's Telehelp 399 programme yesterday, Dr Chituwo said plans were underway with the Ministry of Community Development to assist people on ARVs with good nutrition.

"Part of the $65 million that was received from the World Food Programme will be used for this purpose and government has targeted 5,000 people who clearly cannot afford good nutrition," he said.

However, Chituwo said the provision of food to the affected people needed cooperation from all sectors of life if the programme was to be implemented successfully.

He said good nutrition played an important role before and during treatment.

"It is very evident that the progression of HIV to AIDS takes longer if there is good nutrition," he said.

He also said the ministry had engaged in running a programme with WFP who were currently providing high-energy proteins (HEPs) to TB patients.

And Chituwo said his government would not compromise the quality of treatment just to reach the target of putting 100,000 people on ARVs by the end of this year.

"Patients have to be carefully monitored once they commence treatment to avoid future problems such as resistance to the drug by the patient," he said.

He urged other members of the community to assist the medical personnel especially in the area of counselling as reaching the 100,000 target was not the domain of medical personnel only.

And commenting on the high cost of ARVs and other laboratory costs, Chituwo said government had now started providing free laboratory services and ARVs.

He said the programme was being supported by the Global Fund on HIV/AIDS, TB and Malaria but could not predict the sustainability of the programme.

"What we need is life-long support and we cannot always depend on donors. Zambians must contribute by creating harmony in the country so that the economic sector is more productive. This will enable government to cushion the provision if the donors decide to pull out," he said.

Chituwo said what was now remaining was for the health permanent secretary to implement the Cabinet decision by issuing circulars to all the hospitals and clinics.

"The medical personnel were saying that they could not start giving out free ARVs because they only heard about this in the media and had not received circulars. However, they must have received the circulars by now from the permanent secretary," said Chituwo.

Source: AllAfrica.com

Mukula Pleads for HIV Patients

By Peter Nyanzi, ,The Monitor (Kampala), July 1, 2005

Good nutrition is key to the treatment of people living with HIV/Aids, the State Minister for Health, Mr Mike Mukula, has said.

"The role of nutrition in the care and treatment of people living with Aids cannot be underestimated. There is therefore need for integration of nutrition into the national HIV/Aids responses," Mukula said.

He was opening an international workshop on the integration of nutrition into HIV/Aids care and Antiretroviral treatment (ARVs) at Kabira Country Club on Monday.

The Programme Manager of the Aids Control Programme, Dr Elizabeth Madraa, said the government had submitted proposals to the Global Fund for funds to support the integration of nutrition in the Aids control programmes in the country.

Findings
She said research had shown that good nutrition could delay the onset of full blown Aids and adherence to ART.

The participants from 13 countries of East, Central and Southern Africa were devising modalities for integrating nutrition into national ART policies. Officials from NGOs, international organisations and the private sector attended the workshop.

World Health Organisation (WHO) Country Representative, Dr Rosamund Lewis, said, "I urge you to integrate nutrition in your response to the challenges of the HIV/Aids pandemic."

Source: The Monitor