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A new outlook on fighting Aids in present-day Uganda

By Vision Reporter

Added 19th November 2002 03:00 AM

SIR— A recent Ministry of Health report says one million Ugandans are HIV infected. As 80% of us live in rural settings, we can assume 800,000 HIV positive Ugandans live in villages

SIR— A recent Ministry of Health report says one million Ugandans are HIV infected. As 80% of us live in rural settings, we can assume 800,000 HIV positive Ugandans live in villages

SIR— A recent Ministry of Health report says one million Ugandans are HIV infected. As 80% of us live in rural settings, we can assume 800,000 HIV positive Ugandans live in villages. On the other hand,

8 million Ugandans live on less than $1 (sh1,850/=) a day. Therefore almost the 800,000 villagers in Uganda and about 326,000 persons with HIV cannot buy anti-Aids drugs in the near future.

But without anti-retroviral drugs (ARVs), there’s an imminent local catastrophe. A clear case in point, which illumines the future without ARVs, is the story of a family headed by a child, according to The New Vision of September 23.

In the story, the children lost their father and mother in 1996 and 2001 respectively. If, however, the parents had swallowed ARVs, these children wouldn’t be going through this much at their age.

Indeed leading behavioural scientists at Harvard University now think most African nations are sitting on a time bomb of political chaos. They reason that uncared-for persons or those who are inappropriately parented, including the many Aids orphans, will easily get disgruntled, over issues which can be solved by peaceful dialogue.

At the same time, there have been many calls by Ugandans concerning access to ARVs. In his letter to The New Vision of August 20, “Scale down Aids drugs cost! They are still too high,” Nesta Kirindu urged the Government to avail the drugs free of charge. This is the way forward. The time for Government to provide ARVs for the one million people is now.

Though they are not a cure, nor do they prevent sexual transmission of HIV, they improve the quality of life, and provide many other advantages like reducing the number of patients going for counselling.

The benefits to the society, economy make provision of ARVs as an integral part of health services a cost-effective strategy. Urging manufacturers to forcefully reduce prices for the developing world to below the production cost is risking poor quality.

Since they are swallowed in combinations which have to be switched whenever need arises, the average cost per month of at least three different sets of ARVs is sh162,000/=. This means the cost of ARVs alone for one million Ugandans is US$1.05bn per year. This is about 571 times the 2000/01 government expenditure on medicines!

Should we give up? No. Here is what we must do. Let us introduce an anti-AIDS tax. If 15 million Ugandans paid sh11,100 a year, this would raise over 100% of the ARV budget.

Doctors can assess Aids patients using tests and assessments that give a rough picture of the state of the immunity. Waiting for expensive equipment and tests is costing us a lot.

In addition, health workers in the public service must integrate ARV treatment in their usual clinics. This business of desiring special clinics and additional pay isn’t nationalistic enough.

Instead of putting up a factory for condoms, government could organise to have a firm to make ARVs and this will further reduce the cost of treatment. Market oriented investors can’t think of this, given the state of our economy. Apart from sport, why can’t companies like Shell, Barclays, Agip, MTN, buy or donate equipment to assess the viral load or CD4/8 (test for immunity)? Let policy makers think of ways of raising funds for ARVs.

George Kibumba, MPS
Makerere University
Medical School

A new outlook on fighting Aids in present-day Uganda

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