Widening Access to HIV/AIDS Drugs in Uganda

This report is on the availability, distribution, and use of antiretroviral drugs (ARVs) in Uganda where between 80,000 and 100,000 people receive the medicine free of charge, leaving, as reported here, at least another 100,000 HIV-positive Ugandans without access to these medicines. The report reviews the background of ARV distribution, including gaps in coverage, the financial challenges of ARV provision, and the efforts to stamp out corruption in the distribution system in Uganda.


Through interviews, the author provides information about the gaps in distribution of ARVs. For example, some people with disabilities cannot get information ARVs. The fact that information is not available in Braille is a barrier for those affected by blindness who might be HIV-positive. The chairman of the National Union of Disabled Persons of Uganda is seeking HIV and AIDS services in terms of testing, ARVs, counselling, and treatment with accommodations for disabilities.


Despite numerous educational and information campaigns, stigma is another issue that is a barrier for those who fear knowing their HIV status. Some fear that they will be shunned by their communities and work colleagues for immorality and accused of spreading the disease if they take HIV tests and register for medicine. Others want to take the test, but are deterred by the cost and time of travelling to a test centre. For example, an HIV-positive widow points out that a 15-kilometre journey by matatu (shared taxi) to a clinic will cost about SH2,000 Uganda shillings (US$2) - a sum equivalent to a rural family’s food and basic essentials, such as salt and soap, for a week. The testing itself can cost Sh23,000, a month’s earnings for some economically poor villagers.


Expenses for ARV-eligible patients mount further with the trips to clinics for the medicine. According to one interviewee, speaking on the 30-kilometre journey from home to clinic, "Apart from the long distances, the transport costs make it increasingly difficult for me, and other patients, to reach the health centre." The round trip by matatu costs Sh5,000 - equivalent to the cost of a week’s food.


Further, there are problems resulting from Uganda’s health infrastructure, described here as weak and disorganised, short of health workers, and lacking storage facilities, laboratories, equipment, medicines, and efficient data management. In the words of an HIV-positive activist, "...as long as centres don’t have enough storage facilities for the drugs or laboratories to carry out tests and there are no health workers to administer the drugs, we cannot achieve much." Sometimes mismanagement keeps drugs on the shelves so long that their use-by date expires; sometimes poor record-keeping means that too few drugs are ordered. A strategy used by one rural health centre was to involve the community in the planning process with district health officers for organising ARV availability.


In support of expanding networks of patient groups of people living with HIV, the International HIV/AIDS Alliance is training network members. It has agreed with the Ministry of Health that some drugs will be distributed through patient groups in order to reach as many patients as possible and reduce transport costs. The Alliance, which is funded by the United States Agency for International Development, is donating bicycles and motorbikes to make drug distribution easier.


However, as stated here, corruption influences the supply and distribution. "Some ARVs are sold on the black market or diverted to private clinics. A healthworker who preferred to remain anonymous for fear of dismissal admitted that "at the district level we have a big problem because procuring the drugs takes forever and, at times, when they come they don’t reach the people waiting for them." The report recognises that economic poverty, travel difficulties, poor administration, and other barriers increase the difficulty of ensuring that patients access the drugs that may extend their lives.


The article concludes with a note on the launch of Medicines Transparency Alliance (MeTA), which brings together government, business, and civil society organisations to share information and analysis about the problems around the supply of medicines in Uganda, including their quality, availability, price, and promotion, to work together to explore possible solutions. This is part of a global effort, initially funded by the United Kingdom Department for International Development (DFID) in collaboration with the World Health Organization (WHO) and the World Bank to encourage greater transparency and accountability around the procurement, supply, and use of medicines. MeTA works initially in seven pilot countries – Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda, and Zambia.