Nigeria's fee-based provision of antiretroviral therapy at government hospitals is a significant barrier to ARV access, according to a Doctors Without Borders study. "Nearly 50 percent of the patients live on less than $36 per month, yet they are paying between $8 and $67 per month for a recommended package of care," DWB's Dr. Jens Wenkel said Tuesday in Abuja, Nigeria, at the 14th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa.
The study, conducted in Lagos between August and November, found that a lack of money resulted in 44 percent of patients enduring multiple treatment interruptions or taking insufficient ARV dosages. To pay for ARVs, 39 percent of patients borrowed or begged for money, and 18 percent sold their property. Similar trends tied to fee-based therapy were observed in Kinshasa.
"The patients are more vulnerable to AIDS-related infections such as pneumonia or tuberculosis, so forcing people to pay and thereby raising treatment interruptions can make life-prolonging treatment less effective," said Wenkel. "If we want people to survive on treatment, we have to ensure access to free care."
The public-health approach is responsible for approximately 500,000 people with HIV/AIDS in sub-Sahara Africa receiving ARVs by June -- triple the number who had access a year earlier -- said Jim Yong Kim, director of the HIV/AIDS Department at the World Health Organization. Between June 2004 and December 2005, 50 countries doubled the number of HIV patients on ARVs, he said.
"In Africa, simplified approaches are particularly important because they provide us with ways to scale-up treatment without the need for expensive infrastructure in place," said Kim. "We are finding that treatment is also a key to improving HIV prevention. Countries such as Botswana, Swaziland and Uganda are showing that improved access to treatment increases demand for HIV counseling and testing as well as other prevention services."