BURUNDI: HIV-positive people struggling for treatment of opportunistic infections
Failure to access treatment for opportunistic infections can hasten progression to AIDS
BUJUMBURA, 11 August 2010 (IRIN) - Thousands of Burundians living with HIV are failing to obtain drugs to treat opportunistic infections since a system to provide them with free medical care has come to an end.
The National AIDS Control Council (CNLS) has, for the past two years, provided free medical care to an estimated 22,000 members of the Burundi Network for People living with HIV (RBP+). Under the system, members are issued with cards entitling them to free treatment, which is then billed to RBP+.
However, following the end of the agreement in April 2010, access to these essential drugs has been difficult.
According to one woman, who preferred anonymity, the cards are now virtually useless. "I was getting Bactrim [also know as co-trimoxazole, an antibiotic prophylactic to prevent infection] and other medicines free of charge; hospital bills were catered for... now I have to pay for everything. They [RBP+] tell us the funding has stopped," she said.
Too poor to pay
Déo Kameya, head of the RBP+ branch in the eastern province of Rutana, told IRIN/PlusNews that out of 500 registered HIV-positive people in the area, about 350 now had to provide for their own medical care.
"If a person living with HIV goes to the hospital for medical care and receives a prescription, if he can afford the price of medicines it is ok, if not, he simply dies," he said. "At present we have nowhere to [go] to get support for them."
Rose Nyandwi, health coordinator in the northern province of Ngozi, said people in her province could not afford the tests required to determine eligibility for antiretroviral drugs (ARVs).
"We direct them to do tests but sometimes we wait for them to bring back results in vain. With such low CD4 counts [a measure of immunity] as 50 or 100... they stay home and die," she said.
Sylvain Ndayikengurukiye, CNLS communication officer , noted that CNLS had recently directed health centres to continue offering medical support free to HIV-positive patients and forward the bills for payment, along with evidence that the stock had been used for people living with HIV.
Kameya said, however, that without official documentation, health centres had refused to implement the measure.
The problem is compounded by an ongoing shortage of Bactrim and other drugs to treat opportunistic infections. At the Prince Regent Charles Hospital in the capital, Bujumbura, the pharmacy's stock of Bactrim is running dangerously low.
"If there is no new supply, we will not cover this month [August]," said Dominique Surwavuba, head of the HIV unit at the hospital. He added that the unit normally received a monthly supply from the government but in July, there were no new supplies.
"Out of a list of 46 medicines the council [CNLS] is likely to refund the hospital, only five are available... there is little chance for a patient to get it," Nyandwi said.
According to Ndayikengurukiye, the shortage is because all patients, not just HIV-positive people, take medicines for opportunistic infections.
"Take coughing - every patient can cough even without HIV," he said. "Medicines supplied to health structures are used also for other patients; that is the reason the stock sometimes runs out.
"We must ensure that the stock intended for persons living with HIV is really serving them," he added.
CNLS estimates that just 19,000 of 59,000 Burundians needing ARVs could access them. Burundi has struggled to fund its ARV programme after the Global Fund to fight AIDS, Tuberculosis and Malaria rejected
its request for a grant in 2008.