[pronut-hiv] Kenya: Free ARVs a Step in the Right Direction, But Much More Needed

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

Kenya: Free ARVs a Step in the Right Direction, But Much More Needed
UN Integrated Regional Information Networks 
June 19, 2006
Nairobi

Kenyan President Mwai Kibaki's recent announcement that antiretroviral
(ARV) treatment will now be free of charge in public hospitals came as a
welcome relief, particularly to the East African nation's HIV-positive
people.

"Very few could afford the drugs when the ARV programme opened in
Kisumu [city in western Kenya] in 2004," said Dr Lennah Nyabiage, the
government's ARV officer for Nyanza Province. "Then, they cost 500
shillings [US $7] per month, but we realised that many patients were not
accessing drugs because of poverty, so we reduced it further to 100
shillings [$1.40]."

Nyabiage said when the cost of the drug was initially decreased, Kisumu
- the main city in Nyanza, which she said had an HIV prevalence of 15
percent, more than twice the national average of about six percent - saw
a two-fold increase in the number of people accessing treatment. "We
expect a further increase now that the drugs are completely free," she
added.

But it remains unclear how the free ARV scheme will be implemented.

"We have instructed the labs and clinics in the public hospitals to
stop charging people the ARV fees, but we have not heard from the
government about how we are meant to meet the laboratory costs, which is
what the nominal fee was being used for," she said.

"The fact that the ARVs are free will enhance their accessibility, but
we have to think about monitoring people's conditions, viral load tests,
CD 4 count tests - all these cost money and we don't know where it will
come from," said Ludfine Anyango, HIV/AIDS coordinator for the
anti-poverty non-governmental organisation, ActionAid.

Government has indicated that it would waive the laboratory fees as
well, and said an increase in the budgetary allocation for health would
meet the additional cost.

Nevertheless, health workers remain cautious about how much of an
impact the new policy will have, given the magnitude of other hurdles
HIV-positive Kenyans face in accessing ARVs. For instance, most people
who need the drugs live in rural areas very far from the public
hospitals where they can access them, and the transport costs are
crippling.

"The issue of distance is a big problem for most rural Kenyans,"
Anyango said. "There is more to accessing ARVs than just the cost.

"I have to pay about 200 shillings to travel from Bungoma to Busia
every month, but I have seven children and no income," said Pamela
Adhiambo (not her real name), an HIV-positive widow living in rural
western Kenya. She grows food on a tiny plot that is insufficient to
feed her large family of growing children - they survive on a daily diet
of maize and beans.

Sufficient amounts of food and good nutrition are essential for people
living with HIV/AIDS, both as a means of postponing the time when ARV
treatment becomes necessary, and in terms of the body's ability to
handle the powerful drugs.

"The ARVs improve my appetite, but I have too little food to satisfy
the hunger," she said, adding that she was often tempted to quit taking
the drugs to avoid this problem.

When Adhiambo does fall ill from opportunistic infections, she is
unable to reach a medical facility, as the nearest free clinic is more
than 20 km away from her home. She relies on a local community-based NGO
to giver her the bus fare when they can, and also to supplement her diet
when her children would otherwise starve.

Kenya has too few health facilities to reach everyone who needs help,
and this has affected HIV-positive people particularly badly. In rural
parts of the country, the existing facilities are often ill equipped to
handle serious health conditions and may not have staff who are trained
in