[pronut-hiv] Ethiopia: Govt Treatment Programme Brings Hope to Thousands

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Ethiopia: Govt Treatment Programme Brings Hope to Thousands
An important challenge is the nutritional aspect

UN Integrated Regional Information Networks 

April 13, 2006
Addis Ababa

In January 2005 the Ethiopian government launched a programmed to give
universal access to free antiretroviral therapy (ART) to people living
with HIV/AIDS. Just over a year later, the initiative has changed the
lives of approximately 23,000 people.

Last October, for the first time in months, Almaz Eshaw, 35, an
HIV-positive mother of three who is around 1.6 m tall and weighs just 40
kg, was able to leave the bed of her tiny mud house on the outskirts of
the capital, Addis Ababa. She is one of the beneficiaries of the
programme.

"This medicine saved my life," she said. "I've spent so many months
unable to leave my bed and to do anything. Now I can take care of my
children again, dress them up to go to school, prepare some food and
take care of the house."

>From a plastic bag placed under her pillow she removed two boxes of
pills from India that she takes twice a day. A voluntary nurse, Dekenera
Getachew, from the Hiwot HIV/AIDS Prevention Care and Support
Organisation (HAPCSO), a local NGO, visits Almaz three times a week to
make sure she is adhering to her regimen and to help her with household
chores.

"The difference between now and before [she started ART] is really
impressive," said Dekenera. "A few months ago I had to spend all my days
with her to wash her and feed her."

According to the Ethiopian Ministry of Health, at least 1.5 million
people are living with the HI virus and some 285,000 people need ART.
When the programme started in 2005, just 900 people were accessing the
free treatment.

In March 2006 the health ministry announced that it planned to provide
ART and treatment for opportunistic infections to 58,000 people by
beginning of July, to reach 100,000 patients by December, and increase
that number to 200,000 by August 2008.

Since the beginning of the year, 126 hospitals have been able to offer
voluntary HIV/AIDS counselling and testing (VCT), and services for the
prevention of mother-to-child transmission of the virus.

"For us, this really means hope," said Selamawit Gesamasanm, a trained
nurse working for HAPCSO, which tries to ensure free access to ART and
home-based care for the poorest in Addis Ababa. "Before, we had
approximately 10 people dying every week. Now it is one or two in a
month."

At the centre where Selamawit works in southern Addis Ababa, some 463
people have tested positive for HIV, 267 of whom are receiving the free
ART; last July only 10 people were accessing the free drug.

"There are still probably a lot of people who don't know, or don't want
to know, their status and probably need ART. We still have to fight
against a lot of stigma and wrong ideas," she commented. "Many people
still don't realise that they are not condemned once they have HIV and
that they can live with it."

Almaz's husband, for example, refuses to know what his HIV status is
and has stopped having sexual relations with her as a way of protecting
himself. Thankfully, her daughter has tested HIV-negative.

The free ART programme is mainly financed by the Global Fund to fight
AIDS, Tuberculosis and Malaria. Another source of funds is US President
George Bush's US $15 billion emergency plan for HIV/AIDS relief.

Around half of Ethiopia's 77 million people have limited access to
health facilities, according to government and UN figures. The HIV
prevalence rate is 4.4 percent, and at least 900,000 people have died
from the pandemic since 1986.

In 2004 the US spent $43 million on anti-AIDS activities in Ethiopia,
and a further $61 million was earmarked for 2005, half of it for
purchasing antiretroviral drugs.

"Without this programme, probably less than five percent of the people
who need ART would have access to it," one aid worker estimated. The
medication costs around $30 a month, but nearly 50 percent of Ethiopians
live on less than a dollar a day.

"There is a problem of viability in the long term, because you would
need to take ART for life, but for now, the programme is only financed
until 2009," the relief worker noted.

Other service providers are more optimistic. "Morally, it is impossible
for the donors to say we [should] stop financing ART when people's lives
are depending on it," said a UN official, who preferred anonymity. "In
the long run, the prices are also expected to go down, so that people
can have easier access to the drugs."

The extreme poverty of most Ethiopians, coupled with the ongoing severe
drought in the south and southeast and the resultant food insecurity,
are also hindrances to the success of the ART rollout in this vast
country.

"An important challenge is the nutritional aspect: if you give drugs to
people without adequate nutrition it can be really difficult to keep
them on track - we need to be able to couple treatment and food," the UN
official added.

"One of the main challenges we are having is to put a good follow-up
system of the patients in place," said Negatu Mereke, head of the
government's HIV/AIDS Prevention and Control Office. "Now we have 658
VCT sites, but we still need more to reach the rural areas and the
patients there."