In-depth: The Treatment Era: ART in Africa

SENEGAL: Free ARVs not enough to ensure access

DAKAR, 6 December 2004 (IRIN In-Depth) - Although Senegal provides antiretroviral (ARV) drugs free of charge to people living with AIDS, health workers say this simply is not enough to ensure proper access.

Bernard Taverne, who heads the ARV programme at the French Development Research Institute (IRD) in the capital, Dakar, told PlusNews that free ARVs without free screening was a catch-22 situation, as the cost of the laboratory tests - from blood to x-rays - that determine whether a person will receive the drugs, was too expensive for most people.

"This is a major obstacle to ARV access," said Taverne. "Some patients, who could have access to free ARVs, can't afford the preliminary tests or the drugs to treat opportunistic infections, and die as a consequence."

Taverne is one of the authors of the "Free by 5" declaration (free access to a minimum medical package, including ARVs, by 2005), issued on 10 December 2004 to mark the end of World AIDS Week. Its backers say a new global strategy is needed to support HIV positive people. [www.ukzn.ac.za]

"We believe that a prerequisite for ensuring that treatment programmes are scaled up, equitable and efficient, and provide quality care, is to implement universally free access to a minimum medical package, including ARVs, through the public healthcare system," the declaration reads.

Senegal was the first country in Africa to introduce ARV treatment, and 2,700 people are receiving drugs free of charge under the programme known as ISAARV, which has won international praise. But the World Health Organisation estimates that 12,000 people - more than three time as many - need ARVs.

A study, quoted by the Free by 5 campaign, found that when the cost of drugs for opportunistic infections, laboratory exams, consultations and hospitalisation fees are calculated, patients on ARVs in Senegal pay an additional $130 a year - a significant amount for the majority of people who live on less than a dollar a day.

"Research in Senegal shows the main reason patients were not adherent was that financial problems led to treatment interruptions," the Free by 5 declaration noted.

"The biggest and most recurrent problem is the failure to provide free biological tests," said Seynabou Mbodj, spokesman for a non-governmental organisation, the National Alliance Against AIDS (ANCS).

"It's all very well handing out free drugs - now we need to provide free tests and free treatment for opportunistic illnesses," he said.

Senegal's last available national survey, carried out in 2003 among high-risk populations in 12 sentinel surveillance sites, showed 93,000 people infected with HIV, with more than 150,000 expected to be HIV-positive in 2010. The Muslim country has a prevalence rate of 1.5 percent - one of the lowest in Africa.

The Treatment Era ART in Africa December 2004 C O N T E N T S Lead Features The Treatment Era Overview - Focus on Mozambique PDF file  Download this in-depth report 2.3 MB Delivery AFRICA: Show us the money! AFRICA: Healthcare workers feel impact of HIV BOTSWANA: Model treatment programme has its problems DJIBOUTI: Grappling with the demand for ARVs LESOTHO: Not enough staff, poor infrastructure, but ART launched NIGERIA: Restocked rollout expanded SOUTH AFRICA: Lusikisiki - a new model for ARV delivery SOUTH AFRICA: Rollout bogs down UGANDA: PLWAs at the centre of AIDS response Access AFRICA: Treatment criteria - deciding who gets to live MOZAMBIQUE: People living with AIDS overlooked in response SENEGAL: Free ARVs not enough to ensure access SOUTH AFRICA: Poverty, stigma and ignorance blights ART SOUTH AFRICA: The two sides of workplace HIV/AIDS treatment programmes SOUTH AFRICA: Monitoring access to free ARVs ZAMBIA: Second-class women left behind in access queue Treatment AFRICA: A short history of antiretrovirals AFRICA: Local manufacture - competition key to cheaper ARVs AFRICA: "Positive living" eclipsed by ARV drive AFRICA: MSF calls for child-friendly ARVs SOUTH AFRICA: HIV-positive and pregnant - weighing the risk Interviews AFRICA: Interview with Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa AFRICA: Interview with Dr Jim Kim, director of WHO's HIV/AIDS department SOUTH AFRICA: Interview with treatment campaigner, Zackie Achmat ZAMBIA: Interview with Minister of Health Dr Brian Chituwo 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 In-Depth Feedback PlusNews welcomes feedback. Send your messages to feedback.

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