Provinces left behind in ARV rollout

In the remote district of Zambezi, near the Zambian border with Angola, getting hold of anti-AIDS drugs is a major struggle for those living with the virus.

HIV-positive Zambians in need of treatment have to travel more than 500 km on potholed roads once a month to receive the life-prolonging medication at a health facility in Solwezi. The provincial capital is the only centre providing antiretrovirals (ARVs) in this impoverished region.

Melody Sachikoka discovered she was HIV-positive about three years ago, but does not have the 300,000 Kwacha (US $65) it costs for a round-trip to Solwezi for a CD4 count test (which measures the strength of the immune system) - a requirement before treatment can begin.

Getting to the provincial capital is not only expensive, but also extremely uncomfortable; public transport is erratic, and the greater part of the journey is made on rutted dirt roads in vehicles that have seen better days.

"Most of our members can't even raise K50,000 (US $11) per month ... they have been dying before receiving treatment," said Alex Kalukangu, secretary of the Zambezi branch of the Network of Zambian People Living with HIV/AIDS (NZP+).

Sachikoka, who makes ends meet by doing menial jobs, is not looking forward to the time when she becomes ill and needs to start taking ARVs.

"For now I am stranded and don't know what to do next. I am just looking forward to support groups and other well-wishers to help in any way," the 34-year-old NZP+ member told PlusNews.

With a poor harvest driving up food prices, even those receiving treatment are struggling to complement it with a balanced diet.

NZP+ used to distribute food parcels with maize-meal, sugar, groundnuts and beans, until their funding for the nutrition programme ran out last year. "The only support [for positive people] at the moment is counselling," said Sachikoka.

According to Kalukangu, statements by government officials in the media congratulating themselves on the widespread availability of treatment in Zambia were giving people in inaccessible areas "false hope".

"It is saddening to hear ministers or anti-AIDS activists saying we have so many ARVs, but people here are dying ... they should not just be speaking in Lusaka to please donors - we need ARVs here," he stressed.

Although an estimated 25,000 Zambians are currently receiving anti-AIDS medication, the government has to scale up treatment in rural areas, warned local NZP+ chairman Jackson Likoso. He said that three NZP+ members he knew had died while waiting for ARVs.

For those already on therapy, but who cannot afford to keep making the arduous trip to Solwezi for their monthly supply, health workers and caregivers in the area try and help.

Zambezi Home-Based Care coordinator Machune Chivunda, for example, travels to Solwezi regularly and is often asked by her clients to replenish their medication.

Although a nurse at the local Zambezi District Hospital, Chivunda spends a long day waiting in line like everyone else at the health centre in Solwezi.

NZP+ national coordinator, Clement Mfuzi, said government could not afford to ignore the provinces. Not only were there local inhabitants that needed treatment, but sick people from urban areas were relocating to the villages.

The government hopes to have about 100,000 people on treatment by the end of 2005. An estimated two million Zambians are living with HIV/AIDS.

"We have opened 65 centres countrywide, and we are hoping that by the end of the year all the districts will be providing ARVs ... then we will move to sub-district level," said Victor Mukonka, a spokesman for the Central Board of Health.

"The important thing to note is that a year ago only nine provincial centres were providing ARVs, but we have scaled up."

HIV-positive activist Winston Zulu acknowledged that Zambia's treatment programme has made progress.

"We have moved on, and we should now build capacity at every health centre to provide ARVs," he told IRIN. But, as in most countries in the region, the exodus of healthcare professionals remained a major obstacle, he warned.