HEALTH-KENYA: Tight Deadline for a Noble Initiative

By IPS Correspondents Reprint | | Print |

Joyce Mulama

NAIROBI, Jan 28 2005 (IPS) - Just 338 days. That is the amount of time that remained, Thursday, to meet the World Health Organisation’s goal of getting millions of HIV-positive people in developing countries on anti-retroviral treatment by the end of the year.

This goal is articulated in the ‘3 by 5’ initiative, launched in December 2003 by the global agency (or WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). It aims to get three million AIDS sufferers on anti-retroviral drugs (ARVs) by 2005.

But, a report issued Wednesday shows that the WHO does not only face a race against time to reach this target. A substantial increase in “political will” is also needed – along with more funding – to build on the gains of the past six months.

According to the ‘”3 by 5″ Progress Report’, the number of people in sub-Saharan Africa on ARVs doubled in the second half of 2004 to 310,000 (globally, the number of treatment recipients increased from 440,000 to about 700,000 during this period).

About a quarter of people who need ARVs in Botswana, Namibia and Uganda are now being supplied with the drugs, the document adds. Botswana has the world’s second highest HIV-prevalence rate (37 percent). Swaziland, with a prevalence of 39 percent, has the highest infection rate.

However, more than 90 percent of the four million people in sub-Saharan Africa who need treatment still go without. Two-thirds of all people who are HIV-positive – about 25 million – live this region, even though it contains just 10 percent of the global population.

Overall, about 12 percent of people who should be receiving ARVs – 5.8 million – are doing so.

Speaking at the Kenyan launch of the report, Assistant Health Minister Gideon Konchella said his government was currently supplying ARVs to 28,000 patients – up from 9,000 in 2003.

“In 2005 we intend to have 95,000 on treatment, and 140,000 by 2006,” he added. (The global launch of the report took place at the World Economic Forum, a gathering of the world’s political and business elite in Davos, Switzerland.)

AIDS organisations say far more needs to be done, considering that over 200,000 of the estimated two million people living with HIV in Kenya are in need of ARVs. They also question the efficiency of government’s efforts to provide treatment.

“I get calls from patients living in Kisumu (western Kenya), Mandera (in the north-east) and many other places, asking me where to go for treatment. If the government is really providing ARVs to patients across the country, then how come these callers do not know how and where to access treatment from?” asks Asunta Wagura, executive director of the Kenya Network of Women with AIDS.

In addition, activists point out that the drugs are too expensive for many, even though the cost of treatment has fallen considerably in recent years.

Government health facilities charge just under 6.5 dollars a month for ARVs, down from almost 20 dollars two years ago. Fifty-six percent of Kenya’s 30 million people live below the poverty line of a dollar a day.

“The introduction of the ‘3 by 5’ initiative created hope among PLWA (people living with AIDS). However, the drugs are not sufficient to those who need them,” says Inviolata M’mbwavi of the Network of People Living with HIV/AIDS in Kenya. “Many PLWA are on the waiting list. They cannot afford the monthly dose.”

Twenty-five year old Patricia Kagore, who was diasnosed with HIV four years ago, is one of those for whom treatment is out of reach.

“My CD4 count is 110. I feel weak. I have been having opportunistic infections, like now I am coughing. Last month I had a terrible skin rash,” she told IPS at the launch of the ‘3 by 5’ update.

“I cannot say the government is serious until I get the drugs,” Kagore added, soothing her four-year-old son, Simon – also ill.

A CD4 count measures the strength of a person’s immune system by assessing the number of T cells that a person has in their blood. T cells, which build immunity in various ways, are killed by the human immunodeficiency virus (HIV) that causes AIDS. Normal CD4 counts range between 400 and 1,500 per cubic millimetre of blood.

The cost of being tested and monitored to ensure that ARVs are correctly administered makes treatment still more expensive.

“The price of diagnosis needs to be reduced too, and political will translated into action. The issue of nutrition is also of concern,” said Teguest Guerma, the WHO’s associate director of HIV/AIDS, Wednesday.

But, Kenya’s government claims this issue is being addressed.

“We have embarked on a half-a-million dollar feeding project where we have started giving porridge mix to patients who are three to six months into the disease. We also encourage them to keep gardens and grow vegetables, which are quite useful,” said Mary Wangai, ARV programme coordinator at the Ministry of Health.

Of concern is the fact that two billion dollars in extra funding will be required to help the WHO meet its ‘3 by 5’ target.

“Governments can…be encouraged by the flexibility and creativity already displayed by major donors in making money move to where it is needed most, but their efforts must now be taken to the next level,” notes Wednesday’s progress report’.