Aids medicine stocks run low as donors start to close their taps

Funding for Aids is becoming increasingly uncertain as donors change their priorities and the global financial and economic crisis persist.

Now the gains made in the fight against HIV in Kenya faces a litmus test, even as the National Aids Control Council estimates that about 1.2 million people are infected with HIV while 85,000 people die of Aids-related complications annually, leaving behind more than 2.4 million orphans.

“The challenge is to ensure that the 520,415 people who are infected and are currently receiving anti-retroviral (ARV) treatment continue to do so for the rest of their lives,” NACC director Prof Alloys Orago says.

“However, we cannot experiment with their lives, and that is why we cannot allow them to either skip treatment or experience stock-out of the ARV drugs...”

Skip treatment

According to Prof Orago, if the patients skip treatment, they are at a risk of complications which would result in them developing resistance, forcing them to switch to the more costlier second line or third line ARV treatment regimens.

“The story is the same everywhere ... great fear looms

“It is a race against time, and I’m pessimistic the odds are stacked against us, and we shall lose the battle against the pandemic unless the trend is urgently reversed,” he said

During the 2000/2001 budgetary allocation, for example, the total expenditure on HIV and Aids rose from about Sh7.7 billion to Sh53 billion in 2008/2009.

This increase translates to the Aids spending rising seven-fold between 2000/2001 and 2008/2009, including 18 per cent in 2008/2009 alone.

The bulk of this funding — which is estimated at 87 per cent — comes from donors, with the Government contributing the remaining 13 per cent.

Prof Orago cites the Clinton HIV/Aids initiative which has already indicated its intention to discontinue support for paediatric ARVs and second line treatment last year, President’s Emergency Plan for Aids Relief (Pepfar) which has capped the number of patients it will support to 190,000 patients for the next couple of years and Medecins Sans Frontieres (MSF) which has transferred its facilities and patients to the Government in the phase out plan.

Due to the dwindling donor funding, Prof Orago says the country faces a serious sustainability problem as well as challenges in financing scale-up of HIV and Aids services to achieve universal access.

Currently, an average of 11,500 people who are infected are enrolled into the ARV programme on a monthly basis.

In order to address the sustainability problem, the director says the country needs to urgently come up with innovative domestic ways of raising additional funding to fight the pandemic.

“As the country works towards universal access to HIV prevention, treatment, care and support, the gap between available resources and actual needs is projected to increase in the coming years,” Prof Orago says.

To reverse the situation, there is need to establish a Trust Fund where all stakeholders will contribute through private public partnership to finance HIV and Aids; introduce a small levy on passenger air ticket and mobile telephone services; consider taxing two per cent of remittances from people living in the diaspora towards the proposed Aids Trust Fund; and enrol more households to be members of the National Health Insurance Fund (NHIF)

Prof Orago proposes that the Government sets aside 1 per cent of its annual budget — which currently stands at one trillion shillings — towards the establishment of the Aids Trust Fund.

“This will ensure that the Government owns the national response in the fight against HIV and Aids and provides a guarantee for other stakeholders to contribute towards the Trust Fund.

“This will also bridge the gap between the projected resources required for the national response for prevention, treatment care and support services.”

During a recent tour of Kinango, Ganze and Mombasa districts, the Nation encountered several projects which had been abandoned after donors pulled out.

In the humid and desolate Nguluka Village in Kinango District, a widow, Ms Nadzua Bedzame who is living with HIV stared into space as she talked of the predicament she is facing.

“I was enrolled in the ARV programme six years ago after I was diagnosed to be infected with HIV. However, I have stopped taking ARVs for the last six months or so after donors pulled out,” Ms Bedzame whispers.

The mother of six children, who is also caring for two orphans, says she stopped taking ARVs after Action Aid which was supporting her group pulled out.

“I’m unable to raise the Sh300 fare for the 52 kilometre journey to Kinango hospital to access the ARVs,” Ms Bedzame says.

Before pulling out, the NGO regularly provided ARVs and nutritional supplements such as unimix, maize and rice to those infected.

Ms Bedzame, together with other people living with HIV, have now become “orphans” after the “abandonment” by the NGO.

The help they were receiving for ARVs among others through their Zigatiya Chat community based organisation has dried up.

“Since the donors pulled out, those of us living with the virus are unable to access services at the nearby Ndavaya Dispensary which lacks staff and continues to experiences a shortage of HIV testing kits.

“We have no option but to travel to the far-flung Kinango or Msambweni district hospitals for essential services,” she whispers.

Kinango Constituency Aids Control Coordinator Bonaya Bissani says similar cases of those infected with HIV — including those who are bed-ridden — interrupting their daily ARVs medications abound in the district which currently has one of the highest poverty indexes in the country.

The story is no different in the neighbouring sprawling Ganze, in Kilifi District where the Ganze Constituency Aids Control Coordinator Amos Ndenge says the high poverty levels are contributing to increased cases of HIV in the area.

“Due to the semi-arid conditions, farming in this area results in either little or no harvest leaving residents to engage in charcoal burning — which is illegal — as the only means of livelihood,” Mr Ndenge, who is based at the Ganze Health Centre says.

He says that out of the 10,851 patients accessing services at the health centre, 5.2 per cent are infected by HIV.

And as donor funding continues to dwindle, the fate of the hundreds of people who are already enrolled in the ARV programme and are expected to take medication daily remains in jeopardy.