Malawi: Success amid problems: The tale of ART
by Raphael Mweninguwe, Malawi Nation Online, 24 May 2006
Malawi: Stigma and discrimination remain formidable barriers to access to treatment, prevention, care and support to people living with HIV and Aids in many countries and more practical efforts to address them need to be made, according to a joint report published end March by the World Health Organisation (WHO) and the UNAids on “3 by 5” and Beyond.
The findings of this report agree with what many people in rural communities in Malawi have always been worried about—inadequate access to antiretroviral therapy (ART).
Esnat Amidu, 34, from Zomba District says a number of HIV-positive people are “failing to access the antiretroviral therapy because of fear of stigma and discrimination in the communities”.
“Many women are afraid of stigmatisation and discrimination once they come into the open and declare their health status. Some have lost their marriages and societies have condoned that. Men are not willing to go for voluntary testing and counselling (VCT) because they think by doing so they will be considered weak,” says Amidu, who is HIV-positive.
A mother of three, however, noted that there “is still light at the end of the tunnel”.
“With the help of donors and NGOs many people are now realising that having HIV and Aids is not the end of life. We are now able to have access to treatment and that some members of society are accommodating those who are living with HIV and Aids,” she says.
“Ensuring equitable access to treatment, prevention, care and support will be a particular challenge as the world works towards universal access, especially for women, children, those living outside major urban centres and marginalised groups such as men who have sex with men, injecting drug users and sex workers,” says the report.
HIV and Aids is destroying families and communities and is weakening the economic life of countries. The National Aids Commission (NAC) estimates that about 900,000 people in Malawi are HIV-positive with about 87,000 deaths a year.
Davie Nyirongo, National Association for People Living with HIV and Aids in Malawi (Napham)’s programme manager says: “On paper we are able to say that many people are receiving treatment but when you go to the communities on the ground you will discover that what we say and what is there are quite different. The facilities are not there and in some cases people have no means to travel to where they can access the drugs.”
He says the situation is worse during the food crisis when many people living with HIV and Aids have difficulties in accessing food.
“Even if they get the ARVs they may not live long because they do not have food. Lack of food exacerbates the situation they are already in and they die faster as a result of hunger,” he says.
Executive Director for Malawi Network for People Living with HIV and Aids (Manet Plus)
Anock Kapira says: “Access without monitoring the patients would not achieve the results.”
He says monitoring and evaluating equity in access to services need to be given higher priority as programs are scaled up. He says it is the responsibility of everyone in the family to ensure that those living with HIV and Aids are neither discriminated against nor stigmatised.
He says there was no reason for people to fail to access ART “considering that government is now getting funds from the Global Fund for HIV and Aids, Tuberculosis and Malaria. But the questions we should be asking ourselves are: What will happen after the Global Fund? Should we consider collecting some sort of HIV and Aids levies?”
WHO says user charges for treatment and related health services, such as laboratory monitoring, remain a significant barrier to access, and funding mechanisms need to be reformed in many countries to enable the elimination of user fees for HIV treatment and care at the point of service delivery.
“Policies and interventions that empower women and girls and reduce domestic violence are also needed to ensure equitable access for women and girls. Implementation of a public health approach, including decentralisation of services, is also a key strategy to enhance equity,” reads the report.
Kapira says domestic violence that people are talking about could be related to HIV and Aids in the homes.
“Spouses should be able to accept each other and forge ahead with their life for the sake of children and family members that are being supported. Those affected and infected with HIV need a lot of support and counselling,” he says.
He says there should be no embarrassment when one is living with HIV and Aids, saying people should not be discriminated against at work or denied employment because of their HIV and Aids status.
A volunteer at Tovwirane HIV and Aids Organisation in Mzimba Johnson Kinyua said in a recent interview that access to ART was being hampered by a number of factors. One of which he says was the delay in decentralising ART sites to rural areas.
“We have a number of people who need the treatment but our efforts are hampered by lack of resources. We cannot meet our targets and because of this problem we do advocate for home-based care,” he says.
He, however, says even in places where people have access to ART “there is also a problem of monitoring. These people need to be monitored on regular basis to ensure that treatment is effective”.
He says it is important to put in place effective systems that could be used to monitor the scaling up of antiretroviral therapy and other interventions.
According to the report Malawi had three sites providing ART by January 2003 but by December 2005 the number of sites was 69.
The report has realised the fact that the target of treating 3 million people by 2005 has not been achieved.
“Although the target of treating 3 million people by the end of 2005 has not been achieved, the declaration by WHO and UNAids of a global health emergency on treatment access and the launch of the “3 by 5” strategy have helped to mobilise countries, communities and individuals to address the overwhelming and urgent need to provide antiretroviral therapy,” reads the report in part.
It is estimated that in the past two years, the number of people receiving antiretroviral therapy in low-and middle-income countries has more than tripled, and access to antiretroviral therapy in the world’s hardest-hit region, sub-Saharan Africa, has increased by more than 800 percent.
Source: Nation Online
Malawi: Stigma and discrimination remain formidable barriers to access to treatment, prevention, care and support to people living with HIV and Aids in many countries and more practical efforts to address them need to be made, according to a joint report published end March by the World Health Organisation (WHO) and the UNAids on “3 by 5” and Beyond.
The findings of this report agree with what many people in rural communities in Malawi have always been worried about—inadequate access to antiretroviral therapy (ART).
Esnat Amidu, 34, from Zomba District says a number of HIV-positive people are “failing to access the antiretroviral therapy because of fear of stigma and discrimination in the communities”.
“Many women are afraid of stigmatisation and discrimination once they come into the open and declare their health status. Some have lost their marriages and societies have condoned that. Men are not willing to go for voluntary testing and counselling (VCT) because they think by doing so they will be considered weak,” says Amidu, who is HIV-positive.
A mother of three, however, noted that there “is still light at the end of the tunnel”.
“With the help of donors and NGOs many people are now realising that having HIV and Aids is not the end of life. We are now able to have access to treatment and that some members of society are accommodating those who are living with HIV and Aids,” she says.
“Ensuring equitable access to treatment, prevention, care and support will be a particular challenge as the world works towards universal access, especially for women, children, those living outside major urban centres and marginalised groups such as men who have sex with men, injecting drug users and sex workers,” says the report.
HIV and Aids is destroying families and communities and is weakening the economic life of countries. The National Aids Commission (NAC) estimates that about 900,000 people in Malawi are HIV-positive with about 87,000 deaths a year.
Davie Nyirongo, National Association for People Living with HIV and Aids in Malawi (Napham)’s programme manager says: “On paper we are able to say that many people are receiving treatment but when you go to the communities on the ground you will discover that what we say and what is there are quite different. The facilities are not there and in some cases people have no means to travel to where they can access the drugs.”
He says the situation is worse during the food crisis when many people living with HIV and Aids have difficulties in accessing food.
“Even if they get the ARVs they may not live long because they do not have food. Lack of food exacerbates the situation they are already in and they die faster as a result of hunger,” he says.
Executive Director for Malawi Network for People Living with HIV and Aids (Manet Plus)
Anock Kapira says: “Access without monitoring the patients would not achieve the results.”
He says monitoring and evaluating equity in access to services need to be given higher priority as programs are scaled up. He says it is the responsibility of everyone in the family to ensure that those living with HIV and Aids are neither discriminated against nor stigmatised.
He says there was no reason for people to fail to access ART “considering that government is now getting funds from the Global Fund for HIV and Aids, Tuberculosis and Malaria. But the questions we should be asking ourselves are: What will happen after the Global Fund? Should we consider collecting some sort of HIV and Aids levies?”
WHO says user charges for treatment and related health services, such as laboratory monitoring, remain a significant barrier to access, and funding mechanisms need to be reformed in many countries to enable the elimination of user fees for HIV treatment and care at the point of service delivery.
“Policies and interventions that empower women and girls and reduce domestic violence are also needed to ensure equitable access for women and girls. Implementation of a public health approach, including decentralisation of services, is also a key strategy to enhance equity,” reads the report.
Kapira says domestic violence that people are talking about could be related to HIV and Aids in the homes.
“Spouses should be able to accept each other and forge ahead with their life for the sake of children and family members that are being supported. Those affected and infected with HIV need a lot of support and counselling,” he says.
He says there should be no embarrassment when one is living with HIV and Aids, saying people should not be discriminated against at work or denied employment because of their HIV and Aids status.
A volunteer at Tovwirane HIV and Aids Organisation in Mzimba Johnson Kinyua said in a recent interview that access to ART was being hampered by a number of factors. One of which he says was the delay in decentralising ART sites to rural areas.
“We have a number of people who need the treatment but our efforts are hampered by lack of resources. We cannot meet our targets and because of this problem we do advocate for home-based care,” he says.
He, however, says even in places where people have access to ART “there is also a problem of monitoring. These people need to be monitored on regular basis to ensure that treatment is effective”.
He says it is important to put in place effective systems that could be used to monitor the scaling up of antiretroviral therapy and other interventions.
According to the report Malawi had three sites providing ART by January 2003 but by December 2005 the number of sites was 69.
The report has realised the fact that the target of treating 3 million people by 2005 has not been achieved.
“Although the target of treating 3 million people by the end of 2005 has not been achieved, the declaration by WHO and UNAids of a global health emergency on treatment access and the launch of the “3 by 5” strategy have helped to mobilise countries, communities and individuals to address the overwhelming and urgent need to provide antiretroviral therapy,” reads the report in part.
It is estimated that in the past two years, the number of people receiving antiretroviral therapy in low-and middle-income countries has more than tripled, and access to antiretroviral therapy in the world’s hardest-hit region, sub-Saharan Africa, has increased by more than 800 percent.
Source: Nation Online
posted by AIDS-Care-Watch at 10:09 pm
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