In-depth: The Treatment Era: ART in Africa

ZAMBIA: Interview with Minister of Health Dr Brian Chituwo

Photo: IRIN

Minister of Health Dr Brian Chituwo

NAIROBI, 6 December 2004 (IRIN In-Depth) - Zambia has one of Africa's largest HIV/AIDS treatment programmes, reaching almost 14,000 people, and is projected to expand to 100,000 by the end of 2005. PlusNews spoke to Minister of Health Dr Brian Chituwo about the treatment challenge.

QUESTION: After the problems seen in Arusha with the Fund's next round and donors' apparent reluctance to increase their funding, what guarantees of sustainability can mass antiretroviral (ARV) treatment have?

ANSWER: The question of ART [antiretroviral therapy] sustainability is on the government's agenda. We were of the view that we did not have the reassurance of the sustainability of this programme and, therefore, what Zambia did last year was introduce a medical levy into our tax revenue system in order to support the ART programme with readily available funds, should donors decide to withdraw for one reason or another.

It is an amount of money which is nowhere equal to, in the short term, the funding that we have been promised by the Global Fund. We have been urged to target 100,000 people with ARVs by the end of 2005, as part of the [World Health Organisation] WHO's "3 by 5" [three million people in the developing world on treatment by 2005] initiative. Prior to this initiative, in 2002, we allocated [US] $3 million of our own resources to purchase ARVs, targeting 10,000 people.

This was following a decision we made that Zambia's socioeconomic development would almost come to a halt if we did not make ART available in our public health institutions. By September of this year [2004], after an initial very sluggish start, we had nearly 14,000 patients on ARVs - certainly, we have embraced the 3 by 5 initiative. We have an estimated 1.1 million people living with HIV/AIDS in Zambia, out of whom 140,000 require ARVs.

We have additional funding from PEPFAR [US President's Emergency Plan for AIDS Relief] and an additional grant from the World Bank, and with this funding we should be able to cover the 100,000. Our serious handicap, however, is the human resource shortage in the health system - that, believe you me, is a headache.

So, we are scratching our heads to find out how best can we scale up, and we've embarked on a training programme [for health workers]. Of course, we're also mobilising communities to participate in this programme. Given any opportunity, I have reminded the Zambian people that the fact that the government and its partners are providing therapy should not negate the important issue of prevention - so this message is being repeated again and again, especially for the youth.

Q: Are we urging poor countries to take on life-or-death commitments that are dependent on erratic outside funding?

A: Nobody is urging Zambia to take on the commitment, because we foresaw the catastrophe and the need to make as widely accessible as possible life-saving ARVs. The next thing was to urge our cooperating partners to see what we've done, and come on board and assist us. We can only urge PEPFAR and the Global Fund that they have to assist us in this life-long commitment.

Q: To what extent has the recent controversy around some generic companies withdrawing from the World Health Organisation's prequalification list threatened the survival of ARV programmes?

A: If that threat is real, it is definitely a source of worry for developing countries like Zambia, who cannot afford the brand-name drugs. We sincerely hope that, whatever difficulties or differences there were, these should be resolved in the shortest possible time.

Q: Isn't there a danger that the positive living aspect of HIV/AIDS treatment is being lost with all the focus on ART?

A: In a way, I must say 'yes', because one can see such a dramatic improvement in patients who are on their deathbeds, and within a short space of time after being on ART, they're able to walk; they're able to look after their children. That in itself, indeed, has endangered the positive living philosophy. It has helped us too, in that people now wish to know their status. Because of this dramatic improvement in quality of life, more and more people are being encouraged to undergo voluntary counselling and testing. Living positively, therefore, is in my view complimenting ARVs. We believe there's a role to play in advocating for positive living prior to people becoming very ill, because then one can put off for quite some time the need to start ARVs.

Q: What do you think are the key components of a successful government rollout of ART?

A: For us, we feel we have been fairly successful so far in that, as a government, we took the lead. We said, 'No one can do this for us, we must do it ourselves'. We also recognised that government alone cannot succeed. So we brought on board faith-based organisations, who provide nearly 30 percent of the health care in our rural areas. Of course, we support them very seriously - we give them monthly grants, pay for their staff and provide the drugs. In addition, we involved churches in advocacy campaigns promoting messages of prevention and encouraging home-based care.

We also brought on board civil society - and Zambia depends on our mines, so we brought them on board as well - and then there is an army of NGOs. So what I'm saying, in a nutshell, is that in our planning on issues of implementation, all those things are discussed and reviewed together with these partner organisations.

I must state that one of the keys is that we have a National AIDS Council, which is a corporate body mandated to coordinate and monitor all activities to do with HIV and AIDS. It is overseen by the Cabinet Committee of Ministers. The Council works on strategic plans for the whole country: through their technical committee they undertake research, they promote advocacy, they mobilise the communities and monitor this army of NGOs. We just provide the political leadership and really push them, and I think so far we've been able to do what we have because of the Council, but there's a lot of work to be done.

Q: Beyond the rhetoric, are people living with AIDS really considered an asset in the response to HIV and AIDS, rather than the source of the problem?

A: I think in many countries, as in Zambia, there are networks of people living with AIDS. Initially there was a misunderstanding that government should only look after the people who registered with those institutions. Our view is broader than that - as far as we're concerned, any Zambian citizen who has undergone voluntary counselling and testing is a person living with HIV and, ultimately, AIDS.

So our constituency is broader than organizations that call themselves people living with AIDS. These people are represented on the National AIDS Council, so they have a voice. Secondly, we are utilising them, in that they are living testimony to the fact that AIDS has got a human face, it's not just numbers; they're being utilised in our hospitals and communities as counsellors. So, as far as we're concerned, people living with AIDS are not a problem, they are, indeed, part of the solution.

The Treatment Era
ART in Africa

December 2004
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Links & References

The WHO 3 by 5 Initiative
www.who.int
The Global Fund to Fight HIV/AIDS Tuberculosis and Malaria
www.theglobalfund.org
The President's Emergency Plan for AIDS Relief
www.usaid.gov
World Bank AIDS site
www1.worldbank.org
Pan-African Treatment Access Movement
www.patam.org
WHO Prequalification Project
http://mednet3.who.int/
Eldis Resource on ARVs
www.eldis.org

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