TANZANIA: Policy indecision, staff shortages jeopardise PMTCT programmes

Dar Es Salaam, 5 July 2006 (PlusNews) - Indecision over the policy for prescribing and dispensing antiretroviral (ARV) drugs in Tanzania is restricting access by HIV-positive pregnant women, who bear the brunt of the pandemic, according to national statistics.

Whether the ARV programme should be implemented by government-owned health facilities, or by co-opted community-based organisations on account of their grassroots reach, or an integrated programme that cuts across profession, geographical setting, gender, age, culture, religion and education should be adopted, has been the sticking point since the government started providing subsidised ARVs to pregnant women more than three years ago.

Nelson Kegode, Tanzania country representative of Pathfinder, an international nongovernmental organisation, said policy issues were being compounded by an acute shortage of qualified health personnel to diagnose patients and prescribe anti-AIDS medicines, as well as budgetary constraints.

United Nations statistics show that just seven percent of HIV-infected pregnant women receive ARVs for prevention of mother-to-child transmission (PMTCT) of the virus. Prime Minister Edward Lowassa recently told UNAIDS Executive Director Peter Piot that 10,000 more paramedics, including traditional birth attendants, would have to be trained to implement PMTCT programmes if the rapid spread of the pandemic was to be curbed.

ARVs are available at sparse health facilities, mostly concentrated in urban areas, where less than 20 percent of the country's 35 million people live. In a few cases, private hospitals and clinics, especially in urban areas, are allowed to distribute ARVs.

Dr John Semkuya, head of the natal unit at the state-run Mwananyamala Hospital in the commercial capital, Dar es Salaam, said stigma made the number of women enrolled in PMTCT programmes one of the lowest in the region.

STIGMA, POVERTY ALSO AFFECTING PMTCT

"We're unable to prescribe ARVs to expectant women because many of them fear to be tested for HIV. In situations like this it is difficult to determine if antenatal services seekers are infected with HIV or not," Semkuya said.

A significant proportion of the roughly 25,000 HIV/AIDS patients receiving ARV treatment at Mwananyamala Hospital were women, but "the availability of the drugs is contingent upon the compliance of patients to undergo HIV tests voluntarily".

"We have enough stocks of ARVs to give out for free, or at subsidised rates, to prevent infection of infants during birth and breastfeeding," Semkuya said. "However, most women are still reluctant to acknowledge that HIV/AIDS is real, and believe that it is an act of witchcraft."

A subsidised monthly dose of Nevirapine, the first-line drug used in PMTCT programmes, cost about US$20, but this was beyond the reach of most patients.

Herman Lupogo, chairman of the Tanzania Commission for AIDS (TACAIDS), told a recent HIV/AIDS seminar in the northern city of Arusha: "We cannot talk of effectively combating the spread of HIV/AIDS in an environment characterised by an acute shortage of food and water, which are indicators of extreme poverty."

Women were in the extreme poverty bracket, making access to ARVs difficult even when they were free.

"HIV/AIDS tends to be given undue priority over other health issues," Lupogo said. "It must be part of the general campaign to rid the country of major killer diseases and poverty, and not an isolated problem that only stigmatises a section of the society that requires help."

Theme (s): Care/Treatment - PlusNews,

[This report does not necessarily reflect the views of the United Nations]