Amid a stock out of HIV medication in Uganda, the National Forum of People Living with HIV/AIDS Network has launched a campaign to meet UNAIDS’ treatment targets.
According to Uganda health indicator survey 2011, Uganda has 1.6 million people living with HIV, and only half of these are on treatment. But even for those already started on antiretroviral medication accessing treatment is challenging as a number of districts have been short on medication since August.
Moses Nsubuga, has lived with HIV for 21 years. In Kampala on 11 November during the launch of the network’s campaign to help achieve UNAIDS’ 90-90-90 treatment targets, he said: “Every time you fail to take your antiretroviral treatment you are exposed to drug resistance. We’re going to have an increase of new infections, and more people will fall sick and die.”
UNAIDS’ treatment targets
The 90-90-90 global targets set by UNAIDS aim to have 90 per cent of people living with HIV knowing their status, 90 per cent of all those diagnosed HIV positive receiving sustained antiretroviral therapy and 90 per cent of those on antiretroviral drugs having undetectable viral loads by 2030.
Nsubuga, who is the director of People in Need of Urgency (PINU), said in order to meet the target and ensure that people living with HIV have quality and productive lives, antiretrovirals must be readily available.
Nsubuga cited drugs such as TDF, 3CT, RS-TBA1, Izonas (a TB drug), Alvia, ABS Travili 3T3 for adults and Virapine 4 for children which are currently unavailable.
“Without drugs, those of us who are on antiretroviral treatment will have our viral loads going up,” he said. While on treatment the viral load of a person living with HIV is reduced, as is the risk of transmitting the disease to someone else, but this risk will increase again without the correct drug regimen.
Babies affected by stock out
Stella Ketutsi, the executive director of the National Forum of People Living with HIV/AIDS Network Uganda (NAFOPHANU), said the districts of Amuru, Apac, Arua, Budaka, Bulambuli, Bukedea and Bugiri are the most affected. Others are Bukomansimbi, Butalejja, Mbale, Buyende, Kiruhura, Kyegegwa, Moroto, Tororo, Serere, Otuke, and Agago.
Sylvia Nalukwago, 23, who was born with HIV said that the drug stock out will also hinder the elimination of mother to child transmission of HIV. “My baby is five months old and she is still HIV negative, we need more children who are free from HIV,’ she said. But it is vital that mothers who are breastfeeding receive the proper medication to prevent passing the disease to their babies.
Fred Balongo, chairman of NAFOPHANO, said: “If the drugs issue is not addressed, Uganda is likely to go back to the situation in the 1980s. People living with HIV would become thin and die with shame. This is not the situation we need. Drug stock outs kill! They must be stopped.”
Changing people’s drug regimens
According to NAFOPHANU, people have been forced to take children’s drugs while others have been switched to different drug regimens, without proper counseling.
Elivaida Nalubega a resident of Kitintale in Kampala said she had been taking two tablets every day but now she has been shifted to eight every day.
“When I asked the nurse at Kiswa health center where I have been getting my treatment from, I was told that there are no drugs for adults and they are now giving children’s dose to make up an adult dose,” she said.
“Coping with eight tablets is a challenge and at times I feel like stopping taking the drugs.”
High numbers of people enrolled for treatment
Kenneth Mwebonge, programme officer for advocacy and networking at Health Promotion and Social Development (HEPS), said: “The drug stock-out is a big setback to our campaigns where we have seen people living with HIV living better, longer and healthier lives. When people miss their doses it creates drug resistance since the virus takes advantage of the low levels of the drug in the blood.”
Mwebonge suspects that one of the reasons for the stock out is the fact that more people have been enrolled on treatment since the adoption of the WHO guidelines in 2013, which advise putting people on treatment at an earlier stage before their immune system becomes too compromised.
“With the adoption of these guidelines we have had more people enrolled on treatment but the budget for the medicine has not matched with the new guidelines,” says Mwebonge.
According to the ministry of health pharmacy division’s stock out report as at 1 August, it projected that the stock out is supposed to last for three months from August to the beginning of December.
A spokesperson from the ministry of health, Rukia Nakamatte, confirmed that there is currently limited stock of antiretrovirals, but plans are underway to ensure supply is enough by early December.
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