Activists slam poor management of ARV supply

HIV/AIDS activists in Zimbabwe have criticized the government's poor management of the national HIV treatment programme after an audit revealed that life-prolonging antiretroviral (ARV) drugs expired on the shelves of public health facilities.

An audit report released in May by the Comptroller and Auditor-General's department found that some 15,088 bottles of various ARVs had expired between 2006 and 2010 while in stock at 15 pharmacies. The audit also showed that 33,241 bottles of HIV drugs belonging to the Ministry of Health and Child Welfare expired at the National Pharmaceutical Company (Natpharm), the national distribution point for all drugs in Zimbabwe.

"This is the most annoying issue, where a country like ours has gone through so much in the fight against HIV/AIDS, to have drugs expire while thousands of people are in need of ARVS," HIV activist Evelyn Mushamba told IRIN/PlusNews.

Zimbabwe has 1.2 million people living with HIV, which translates to a prevalence rate of 13.6 percent. Some 347,000 people are on treatment, but 600,000 are thought to need the drugs. The treatment gap has widened since Zimbabwe adopted new UN World Health Organization treatment guidelines, which recommend starting treatment for patients with a CD4 count (a measure of immune strength) of 350, compared to a CD4 count of 200 in earlier treatment guidelines.

The Comptroller and Auditor-General's report also found that the Ministry of Health and Child Welfare was failing to fully utilize funds allocated to it by the treasury and the National AIDS Council (NAC), which meant that some patients did not start treatment on time, there was poor monitoring of patients on treatment, and poor record maintenance.

It is like somebody is experimenting on our lives... A lot is taking place and nobody wants to take responsibility... it is frustrating

"There is so much mismanagement taking place on the ground, it is like somebody is experimenting on our lives. Drugs are being changed without adequate notification and proper patient education when switching drugs," said Mushamba, who has been living with HIV for more than 10 years. "A lot is taking place and nobody wants to take the responsibility - from the service providers to the so-called policy bearers. It is frustrating."

Tinashe Mundawarara, project manager for HIV, human rights and law at Zimbabwe Lawyers for Human Rights, also expressed concern about the poor management of the national HIV/AIDS programme.

"Any profile of problems faced by people living with HIV around the country will reveal a narrative of drug stock-outs… with people living with HIV being forced to share ARVs in provinces like Bulawayo. People living with HIV are usually forced to share ARVs when stocks allocated are inadequate, but when you hear that drugs expiring on the shelves, it is worrying," said Mundawarara.

"Diagnostic equipment is also not easily accessible for people living with HIV, with some provinces like Masvingo [in eastern Zimbabwe] having people living with HIV going for more than two years without having a CD4 count repeated because machines are either down or unavailable."

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