Despite having undergone timely HIV testing and counselling, it took eight years for Gertrude Kateta, from Mangochi District in Malawi, to access antiretroviral therapy.
Despite having undergone timely HIV testing and counselling, it took eight years for Gertrude Kateta, from Mangochi District in Malawi, to access antiretroviral therapy.
Getrude, who lives in a rural area, tested HIV positive way back in 2006 but was not enrolled for antiretroviral treatment until 2014, when her health visibly declined. Her situation prompted a senior medical officer to immediately refer her to an antiretroviral clinic, although her CD4 count (level of infection-fighting white blood cells, which indicates how effectively a person’s immune system is working) was still above 350.
But upon arrival at the clinic, a health worker responsible for data entry gave Kateta a cold reception. The health worker briefly looked at Kateta’s health passport, right at the entrance, and spoke loudly in the presence of several people in the corridor saying: “You are not yet eligible for antiretrovirals because your immunity is still okay.”
Kateta says: “I felt humiliated by the health worker’s remarks whom I thought was the ideal person to give me psychosocial and medical support.”
New SMS service
Kateta urgently reported the incident to the person in charge of the health facility, who summoned the health worker and immediately included Kateta on the antiretroviral therapy enrolment list. However, she believes there are many others, especially in rural areas, who do not know where to lodge their complaints.
With this in mind, Kateta welcomes the introduction of an SMS project which enables people living with HIV to send free text messages reporting issues such as drug stockouts or difficulties in accessing services.
The project, which is being run by National Association of People Living with HIV and AIDS in Malawi (NAPHAM), was launched in Lilongwe in May. It has been given financial and technical support from UNAIDS and Airtel Malawi.
However Kateta recommends that in order for the project to be successful, it needs more publicity. She recalls that the only time she heard about it was during its launch and believes that she is among many Malawians who do not know how to successfully send messages through the facility.
90:90:90 targets
Guidance set out by UNAIDS in the HIV and AIDS 2015-2020 National Strategic Plan (NSP) states that by 2020: 90 per cent of people living with HIV in Malawi must know their status; 90 per cent of those known to be HIV positive must be initiated on treatment; and 90 per cent of antiretroviral clients must be retained in care, so that their viral load is suppressed.
NAPHAM programmes manager Paul Manyamba says that despite various attempts to solicit funds to publicise the SMS project, no donor has so far come forward since its launch. He added: “We are certain that if given enough publicity, no Malawian would be left outside the [UNAIDS] 90:90:90 targets.”
In order to achieve the targets the NSP states that from 2016, all Malawians living with HIV will be universally eligible for antiretroviral treatment. The plan also states that by 2014, 10 years after the start of antiretroviral roll-out in Malawi, only half of the one million Malawians living with HIV were on life-prolonging medication.
Davie Kalomba, acting executive director of the National AIDS Commission in Malawi, says: “We cannot talk about these targets [90:90:90] when our antiretroviral clients are facing stigma and discrimination in health facilities.”
Benefits of early treatment
Dr Frank Chimbwandira, director for HIV and AIDS in the Ministry of Health, who was the guest of honor at the launch of the SMS project, says that the Malawi government wants to ensure that 90 per cent of people living with HIV are on treatment.
He says: “While the government of Malawi has made strides in ensuring that over 500,000 people living with HIV are currently on treatment and alive, there are some who are in need of treatment [but] for one reason or the other they are not on treatment.”
The UNAIDS executive director, Michel Sidibé, says: “Every person living with HIV should have immediate access to life-saving antiretroviral therapy. Delaying access to HIV treatment under any pretext is denying the right to health.”*
An international randomised clinical trial funded by the United States National Institutes of Health has found compelling evidence that the benefits of starting antiretroviral therapy as soon as someone is diagnosed outweigh the risks of delaying until their CD4 count has fallen to 350.
*Quoted in the 2015 UNAIDS Implications of the START study data
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