HIV-positive Zimbabweans are reeling from a dramatic increase in the price of anti-AIDS drugs, which has quadrupled the cost of the life-prolonging medication in the past three months.
In July, a month's supply of a fixed-dose combination of antiretrovirals (ARVs) went up from Zim $200,000 (US $7.70) to Zim $450,000 (US $17) and now costs up to Zim $1.2 million (US $46) in most pharmacies.
Activists have warned that in the current economic climate, these price hikes could have critical repercussions for patients on treatment.
Zimbabwe, which has the world's fourth highest rate of HIV infection, is going through a severe economic crisis with serious fuel and food shortages due to recurring droughts and the government's fast-track land redistribution programme, which have disrupted agricultural production and slashed export earnings.
"People are giving up [their] drugs - they have to choose between feeding and educating their kids or taking ARVs. It's becoming more of a struggle to get the basic necessities ... ARVs are way down on their list of priorities," said Lynde Francis, who runs The Centre, an HIV/AIDS NGO with 4,500 registered clients.
Francis warned that people who were forced to interrupt their treatment regimen because they could no longer afford to buy the drugs were putting their health at risk. "These drugs need to be taken continuously ... any kind of hiccup can cause resistance [to the ARVs]," she noted.
Nevertheless, David Parirenyatwa, Zimbabwe's Minister of Health and Child Welfare, told IRIN that the government's treatment programme continued selling the drugs at the same price - Zim $50,000 (US $2) - and would continue to be heavily subsidised by the state, protecting patients from price fluctuations.
Although the price of ARVs remained constant in the state-run treatment programme, Francis pointed out that the same could not be said of transport fees, the cost of drugs for opportunistic infections and laboratory exams. "There's a huge amount of hidden costs [in the national treatment programme], and these things have become cripplingly expensive," she said.
Parirenyatwa noted that the public rollout of ARVs would also feel the pinch. "I anticipate that patients in the private sector will be jumping over to the public sector, so we need to expand our capacities to be able to absorb them," he added.
While it was difficult to quantify the number of people accessing ARVs in the private sector, "it should be a significant amount - you cannot ignore the companies [providing drugs to employees] and the people who prefer to use pharmacies," Parirenyatwa said.
A source in the pharmaceutical industry, who asked not be named, admitted that "it is the private sector which is currently facing a crisis" because it was experiencing shortages and had to use stock loaned from the public programme.
In 2002 the government declared a state of emergency over HIV/AIDS, allowing the importation and local manufacture of cheaper generic drugs.
According to Douglas Shoniwa, president of the Retail Pharmacists Association, even local generic drug manufacturers were being hamstrung by the scarcity of foreign currency. "They need to import raw materials to make the ARVs, but they lack foreign currency," he said.
The country also had to face this added economic burden with very little external financing. Western donors froze aid to Zimbabwe in response to its controversial land reform programme and reports of violence and intimidation during the 2000 and 2002 elections.
"The criminal politicisation of AIDS by the Global Fund, PEPFAR [US President's Emergency Plan for AIDS Relief] and other donors [has resulted in an] obscenely low amount of aid coming in," Francis commented.
Last year the Global Fund rejected Zimbabwe's request for US $218 million over five years for "technical reasons". Parirenyatwa accused the Geneva-based agency of political bias, which the Global Fund strongly denied.
Despite these setbacks, Parirenyatwa was optimistic that the country's application to the Global Fund would be successful. "If we can't get money from the Global Fund or PEPFAR, we will have to do as much as we can on our own," he commented.
According to the World Health Organisation's (WHO) progress report on its '3 by 5' initiative, an estimated 15,000 of the 295,000 Zimbabweans who need treatment are receiving it. The government has declared a national treatment target of 55,000 people by the end of 2005.