The Zambian government is putting in place stringent measures aimed at ensuring a sufficient supply of anti-retroviral drugs. The drugs are essential for those infected with HIV/AIDS, but the medicine currently is in short supply. AIDS patients have had to travel more than 30 kilometers from their homes - often on foot - to reach clinics, where all too often they are told that the medicine has run out.
This is the second time this year that the more than 500,000 people living with HIV in Zambia have had to cope with what the Ministry of Health calls rationing of the drugs - a system that some patients here have been contending with for more than a decade.
It is a bitter pill to swallow, especially because obtaining medicine is not as easy as one would think. A check at some clinics in Lusaka shows that patients must turn up at 4 a.m. to queue services they will only receive hours later.
Zambia’s Ministry of Health admits there is a challenge regarding the stocks of ARVs in the country, which it refers to not as a shortage, but as "rationing."
Chikuta Mbewe is the deputy director of pharmaceutical services. He said part of the problem was an ongoing switch in Zambia and other countries from one drug, Truvada, to another, Atripla. Mbewe said complications with the switch have driven down the stocks of both drugs.
"I must hasten to say that there are a lot of planned shipments that have already started arriving in the country. We think now we are in the normalization curve, so to say. We hope we can get back to our normal levels,” he said.
Mbewe said the Zambia government wanted as many people as possible to be on [taking] Atripla, since an eight-month supply of the drug was expected to arrive in Zambia before the end of October.
Mbewe said the government’s strategy was to get 95 percent of people living with HIV using Atripla, to simplify the supply chain.
But Felix Mwanza, national director of the Treatment Advocacy and Literacy Campaign, believed the ARV situation in Zambia could have been avoided with proper planning.
“To us, when they say the situation will improve by October, I think justifies what we have been saying," said Mwanza. "I think there is more than what the naked eye actually sees. Because if the government were saying initially that it will take two weeks for the situation to improve, and they and they move on to say that it will improve in one month's time - and this time they are talking about October - then who is telling the truth? So people should actually be asking questions, [such as] 'Is there something amiss?'"
Whatever the cause, the shortage is real. Ackim Sakala, a primary school teacher who has been living with HIV for 12 years, is not happy that he has to go to the clinic every month to collect his ARVs, though he acknowledged the situation could be worse. His clinic is only a kilometer away.
“I can imagine for those that walk long distances, I know what they are passing through. From the experience that I have had some people have been rationed to two weeks and you can imagine every two weeks they have to get to the clinic to collect their drugs. For sure there is a shortage," he said.
One of the long-term interventions that Zambia’s Ministry of Health wants to achieve is to attract investors to set up a pharmaceutical plant that will not only manufacture ARVs in the country but other essential drugs as well.
In the meantime, all the people living with HIV have to face the grim reality of what the authorities are referring to as rationing, when the people that use the drugs call it a shortage.