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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

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CONTENT:

1 - SWAZILAND: Order needed in chaotic ARV programme

1 - SWAZILAND: Order needed in chaotic ARV programme

MBABANE, 1 July (PLUSNEWS) - Citing deaths they claim are due to the

improper introduction of antiretrovirals (ARVs) in Swaziland, AIDS

activists have called for an urgent public education campaign and proper

testing facilities to monitor patients' reaction to the drugs.

" The WHO [World Health Organisation] guidelines specify that people taking

ARVs must be tested 14 days after they first use them. This is important

for Nevirapine, which can be toxic in some people. But in Swaziland, it

takes up to a month before testing can be done, " Hannie Dlamini, president

of the Swaziland AIDS Support Organisation, told PlusNews.

Dlamini said members of his group, which counsels people living with HIV

and AIDS, and dispenses ARVs, have died of liver poisoning, allegedly due

to Nevirapine. Sempiwe Hlope, founder of another HIV support group, Swazis

for Positive Living, agreed. " There aren't the facilities yet, and the

public has to be aware of the dangers of some drugs, and what happens when

ARVs are not properly taken, " she told PlusNews.

No autopsies have been conducted to determine the cause of death, but AIDS

activists are adamant that Nevirapine was to blame.

" It's so painful to me. People are given ARVs, and two weeks later you see

in the papers they are late [dead]. If it were my country, I'd stop

distribution now. There must be a six-month public education campaign

before they are reintroduced, " Dlamini said.

There is only one machine in Swaziland to test the toxicity levels of

blood from patients taking ARVs. Located at the government hospital in the

capital, Mbabane, it has to do all the work in a country with the world's

highest HIV prevalence rate. An estimated 38.6 percent of adults are

infected with HIV, according to the most recent health ministry study.

Swaziland's only machine for counting CD4 levels - a gauge of the strength

of a patient's immune system - is located at the same hospital, where

blood samples from every hospital and clinic in the country are sent for

analysis.

A report published in the New England Journal of Medicine noted the

toxicity problems associated with some ARVs, called protease inhibitors.

The study, by the Weill Cornell Medical College in New York City, found

that the ARV mix that worked best was a three-drug combination of AZT,

Lamivudine and Efazirenz. " After 32 weeks on this 'cocktail', 89 percent

of the patients had almost undetectable levels of [HI] virus in their

blood, " the study reported.

WHO recommends 20 drugs that may be administered to people with HIV,

allowing for switching ARVs should a patient develop side effects to any

one drug.

The rollout of ARVs in Swaziland has been slow. Only 3,000 people are

eligible for the government's free drugs programme this year, rising to

13,000 in 2005. But activists complain that the delivery system is already

inadequate for the task.

" Yesterday, the doctor at the government hospital, who must approve

patients for ARVs, stopped after he saw 120 people. He was exhausted. But

there were 200 people still waiting to see him when he left, " Dlamini

said.

ARVs are currently distributed at only four places in the country: Mbabane

government hospital, Mbabane clinic, Pigg's Peak government hospital in

the northern Hhohho Region, Good Shepherd government hospital in the

eastern Lubombo District, and clinics at Big Bend and Simunye in the sugar

plantation belt, where HIV prevalence is particularly high due to an

itinerant population of migrant workers.

ARVs are not available in the southern Shiselweni region, or the central

Manzini region, where the commercial hub of Manzini is the country's most

populous urban centre, incorporating the University of Swaziland and

Matsapha Industrial Estate.

" Much of our time is devoted to scheduling transportation for indigent

people, who must be taken 80 km or more to pick up their weekly supply of

ARVs, " said Hlope.

At the country's most congested health facility, Mbabane government

hospital, patients sleep overnight in midwinter on the unheated concrete

floor at the dispensary for a chance to get prescriptions filled. " There

is only one nurse dispensing the drugs, and she has her other regular

duties at the hospital. If you come and she's not around, you're out of

luck, " explained Hlope.

AIDS activists agree that the country was not ready for the rollout of

ARVs, but unlike Dlamini, most would not halt their distribution. " If you

stop taking ARVs even for a day, their effectiveness is ended, " said

Hlope.

Dlamini said he fears 19 July, when the next group of HIV-positive people

will be eligible to receive ARVs. " The facilities cannot cope with the

patients now, and a more are on the way, " he said.

But it is unlikely that everybody eligible for the free programme will

take advantage of it. AIDS activists said stigma against HIV-positive

people remains so strong in Swaziland that many prefer to be tested by

private doctors, and purchase ARVs at pharmacies.

" They are worried about confidentiality. It is true that clinics do not

reveal the names of people who test positive, but there are a limited

number of places you can get ARVs, and everyone who goes to those places

is telling everyone else that he or she is HIV-positive. This has

discouraged people from getting tested, or learning the results of their

tests, " said Hlope.

[ENDS]

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