Governments in southern Africa are still failing to honour their own commitments to scale up access to antiretroviral therapy despite the growing availability of international donor support to do so, according to a new report from the Southern Africa Treatment Access Movement (SATAMo).
The Southern African Treatment Access Movement, a network of community-based activists in eleven countries, is calling on regional leaders to keep the promises they made towards provision of HIV treatment by committing the necessary resources.
The call was made in The treatment barometer, a survey by SATAMo on access to AIDS treatment within Southern African Development Community (SADC) countries.
Key findings from the survey are:
- More than 80% of SADC governments have not honoured the Abuja Declaration more than seven years after the commitment to devote 15% of national budgets to health services to meet the challenge of infectious disease. They have also failed in most cases to set targets for antiretroviral coverage beyond 2008.
- Common barriers to treatment include inadequate human resources, long distances to the nearest health facility, poor access to key diagnostic tests, and stigma;
- Reports of stigma and discrimination by healthcare workers remain high, particularly in countries where there is good access to treatment, e.g. Botswana, Mauritius and the Seychelles, threatening to erode the effectiveness of potentially good programmes and their long-term sustainability.
- Stock-outs, particularly of drugs for opportunistic infections, are common in more than 80% of the countries surveyed, including those with strong ART programmes, e.g. Botswana. Other countries reporting stock-outs include Malawi, Swaziland, Zambia and Zimbabwe.
- Most countries are struggling to provide first-line treatment to those who need it, with eight countries in SADC below 35% coverage and only two exceeding 75% coverage. The longer-term issues around second-line regimens have yet to be addressed in the region.
"Southern Africa continues to be the epicentre of the AIDS epidemic despite the various commitments and declarations made by our governments. Statements by SADC leaders recognise health as a fundamental human right. We call on them to show stronger leadership in the fight against AIDS by putting their money where their mouth is," said Regis Mtutu of the Treatment Action Campaign (TAC) and chairperson of SATAMo.
The report also notes that major barriers to treatment remain unresolved. These include stigma by healthcare workers, unaffordable/high transport costs and the concentration of health centres in urban areas, thereby neglecting the rural majority.
In order to improve access to treatment, SATAMo recommends:
- The establishment of a peer-review mechanism through which SADC governments and civil society monitor and encourage countries to meet treatment targets and honour commitments made.
- SADC needs to invest in boosting the capacity of pharmaceutical companies in member countries to supply the region with WHO pre-qualified, generic drugs. This would help to establish greater competition in the pricing of drugs in the region and reduce stock-outs of key medicines.
- SADC and member states must invest in improved supply-chain management systems to ensure more efficient and reliable provision of medicines in national antiretroviral therapy (ART) programmes.
- SADC member states need to institute laws and policies that protect the rights of PLWHA and vulnerable populations, and to provide clear and accessible mechanisms for reporting and addressing rights violations. This will help to address the stigma and discrimination that PLWHA face, particularly in the health sector when trying to access treatment.
- Governments should bring treatment closer to the people through decentralisation of services - including mobile clinics.
"In the absence of concrete actions and increased funding, the outcome of these meetings and declarations remain mere promises and wishful thinking while lives are being lost needlessly," warned Matilda Moyo, who collated the report.
The report can be downloaded at http://www.arasa.info/news.php?article=84