Africa, Development & Aid, Headlines, Health

HEALTH-ANGOLA: The Rich Fly to Lisbon, or Sao Paulo to Get Quality AIDs Care

Mercedes Sayagues

LUNDA, Sep 6 2002 (IPS) - Luisa Cruz* felt like she had won the lottery. She got her life back. But her windfall turned into a nightmare.

Earlier this year, Cruz, 22, was seriously sick in Luanda, the capital of Angola, with AIDS-related infections. Her weight was down to 39kgs. Bingo, she got a free trip to get free anti-retroviral treatment in South Africa, courtesy of the Angolan government.

Cruz says that Angolan embassy staff dumped her at a private hospital in Pretoria, South Africa. She lay semi-conscious for 45 days. When Cruz, who does not speak English, was discharged, her 30-day visa had expired. She had become an illegal alien.

Cruz had to return to South Africa in three months for a key check-up. But, having overstayed in her previous trip, she was denied a new visa.

An anguished Cruz pleaded with the South African High Commissioner and with South African Airways in Luanda. Weeks passed. Her supply of anti-retrovirals finished. She got sick again.

Eventually she was granted a visa, guaranteed by an 800-U.S.-dollar deposit. That is a lot of money in war-torn Angola. Cruz borrowed and besieged family and friends for help.

This time, Cruz brought back from Pretoria a six-month supply of anti-retrovirals. She looks and feels healthy, weighs 64 kgs, and works as an activist with Luta pela Vida (Fight for Life), a non-governmental organisation (NGO). She worries about her next visa.

Her story reflects the Angolan government’s way of dealing with AIDS in particular and health in general.

The health system has all but crumbled. The rich fly to Johannesburg, Lisbon or Sao Paulo to get quality care. The masses rely on foreign NGOs. And a few lucky ones win a ticket to health through the Junta Nacional de Saude (National Health Board).

Out of thousands of applicants, the Junta chooses a handful to go abroad for anti-retrovirals, bypass surgery or cancer chemotherapy at government expense. The well-connected get chosen first. But a handful of unconnected, poor people, also win this lottery. Among them was Cruz.

The system is unfair and unsustainable. The Junta receives “a shockingly high proportion of the limited budgetary resources available for education and health, despite the fact that the national health and education systems are severely under-funded and in a state of crisis,” says economist Tony Hodges in his book “Angola from Afro-Stalinism to Petro-diamond Capitalism.”

“This is not the best option for a public health strategy in terms of efficiency, equality or human rights,” says Dr. Alberto Stella, of UNAIDS in Luanda.

For an AIDS patient, each trip costs at least 5,000 U.S. dollars and must be repeated three times a year for control and adjustment of medication. When trips are delayed, and this often happens, as Cruz found out, treatment is compromised. New resistant viral strains can appear if the regime is not followed carefully.

With that money, Angola could set up a pilot project to treat 1,500 people — far more than the Junta flies to South Africa. If successful, the scheme could be expanded and replicated.

“This is a good time to start a strong project, based on international experience, with the help of aid partners and with a number of local professionals who are being trained,” says Stella.

Instead, the Angolan government mooted the idea last December of building a factory to produce generic anti-retrovirals, like Brazil.

This is a grand plan with no follow-up. A factory alone may help the rich who can afford the therapy but not the poor. Success in treatment requires a network of trained professionals, laboratories and support system, from voluntary testing and counselling to home-based care.

“It is easier to run a generics factory than to work with communities to prevent AIDS and care for those affected, and to train doctors and nurses on how to treat people with AIDS,” says Dr. Melanie Luick, of the UN Children’s Fund (UNICEF) in Luanda.

Seroprevalence rates are a modest eight percent, compared to an average of 25-30 percent in neighbouring countries. It is estimated that half a million people (out of a population of 13 million) live with HIV/AIDS in Angola.

“This is only the tip of the iceberg,” says Stella.

The data comes from an UNICEF study conducted in only three out of 18 provinces. However limited, it shows an alarming 250 percent increase in HIV infections among women at antenatal clinics.

Another study shows that one-third of sex workers in Luanda has HIV, one third has syphilis and two out of 10 have hepatitis B.

A nationwide survey by UNICEF and the Instituto Nacional de Estadisticas found that only eight percent of women know about AIDS adequately. Less than one percent of people use condoms during sex.

Few testing and counselling centres exist. Nevirapine to prevent mother-to-child transmission is not administered routinely.

Stigma runs high and drives the epidemic underground. Few people disclose their positive status.

Until now, war contained AIDS by limiting travel and trade. As the country opens up with peace, all the ingredients for an explosion are here. Four million people displaced, high poverty, low education, overcrowded shantytowns, no jobs.

At this week’s Summit on Sustainable Development in Johannesburg, UNAIDS Executive Director Peter Piot said that widening access to treatment through the state sector makes economic sense, even in countries with faulty health systems.

“We should measure the real impact of medical evacuations against a local treatment scheme,” says Stella.

Cruz agrees. She is lobbying parliamentarians and media with the idea. “I am alive because I got treated in time,” she says. “I want other Angolans to be as lucky.”

*Cruz is not her real name.

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