[pronut-hiv] Tanzania: Policy Indecision, Staff Shortages Jeopardise PMTCT Programmes

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

Tanzania: Policy Indecision, Staff Shortages Jeopardise PMTCT
Programmes
UN Integrated Regional Information Networks 

July 5, 2006
Dar es Salaam

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."