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Africa: Ensuring real access to treatment, day by day

AJAN decided to focus its first research and advocacy campaign on access to ART and essential related services after shared discernment about the most urgent needs facing the people living with HIV whom we serve.

Despite massive steps to scale up treatment, millions of people eligible to take ART still do NOT have access to this life-saving medication in sub-Saharan Africa. The impressive rollout rates mask big national gaps in access. In 2012, close to 9.7 million of people living with HIV had access to ARVs in middle and low-income countries. This represents 61% of people eligible for treatment according to the 2010 WHO guidelines, and only 34% according the 2013 WHO guidelines.

While many people diagnosed with HIV do not ultimately receive the services they need, others who initially access services are not retained in care. Jesuits and their co-workers, who run a range of AIDS ministries in some 20 countries across sub-Saharan Africa, attest to this reality. They witness first-hand the challenges that stand in the way of people living by HIV to access comprehensive care and prevention services.

Jesuit programs step in to fill the care gap insofar as they are able to with limited resources. Programs run by or closely associated to the Jesuits in Burkina Faso, Burundi, Congo, Kenya, Madagascar, Togo, Uganda and Zambia either purchase individuals’ medication for opportunistic infections and pay essential tests and hospital bills or themselves provide testing, ART and treatment for TB. Encouraging people with HIV to adhere to their ART regimen is high on the agenda of all the projects.

Here is a glimpse of how some AIDS projects run or supported by the Jesuits help their clients to access and to continue taking ARVs and essential related healthcare:

St Joseph’s Uzima is a faith-based program that offers support to people living with HIV in Kangemi community on the outskirts of Nairobi. Uzima forms part of the Jesuit parish of St Joseph the Worker. The program reaches 144 people with HIV and has 19 community health workers – including some who are HIV-positive – to reach out to the community.

While the program is not a health facility, it networks with health centres in Kangemi to ensure access to ARVs. Uzima identifies facilities that offer this treatment and approaches them to network. Uzima lets its clients know from where they can get their ARVs and they choose which facility they prefer to attend.

Like many other Jesuit AIDS ministries, Uzima invests plenty of time and resources in encouraging people with HIV to adhere to their ARV regimen through talks, peer sharing in support groups and individual counselling. Food baskets are available for weak clients and those starting TB treatment, and medical prescriptions and transport to hospital are paid for some.

The home-based care (HBC) program of Chikuni Parish, which covers a huge sprawling territory in southern Zambia, has over 1000 clients. Most get their ARVs from the Chikuni Mission Hospital and some must go a distance of more than 50km just to go to collect their medication. Testing is done at the hospital too.

The HBC works closely with Chikuni Hospital through an outreach program that focuses mainly on adherence. Caregivers are trained in adherence and a vehicle takes a nurse from the hospital to the villages three times a week to do health check-ups.

Chikuni has been supporting clients’ access to ART by listening to them and mapping the challenges they face to access treatment. Chikuni HBC piloted the questionnaires to be used in the AJAN campaign and is consequently advocating a more decentralised and community-based approach to delivery of ART at local, regional and national level.

The HBC also raises awareness on the community radio station and in public activities. One example is campaigns against the abuse of alcohol, which has been found to be a major reason why some people with HIV stop taking their medication.

The Service Yezu Mwiza (SYM) run by the Jesuit Region of Rwanda-Burundi in Bujumbura is a recognised centre for ART. Based at a centre fully equipped with a day hospital and laboratory, SYM also has a mobile clinic that takes healthcare and education to people living in rural areas around the capital.

In 2013, SYM had 1,247 clients, including 210 children. Roughly half were on ARVs. Around 190 people were put on ARVs in that year, including 56 pregnant women on a program of prevention of mother-to-child transmission (PMTCT).

The SYM regularly organises sessions about healthy nutrition and about adherence to ARVs that have helped its clients to continue taking their medication and to stick to first-line treatment for as long as possible. Poor people on ARVs are given food packages.

Parlons SIDA is a program for AIDS care and HIV prevention that forms part of Christ the King Parish in Kisangani, Democratic Republic of Congo. The people with HIV who go to seek help from Parlons SIDA are usually very poor, in a weak state of health and abandoned by their nearest and dearest.

Parlons SIDA collaborates with doctors and five hospitals and clinics in the city to facilitate access to ARVs. However this is not nearly enough because beneficiaries cannot afford to pay for lab tests including CD4 count, haematology and x-rays, which cost some $10 to $15 each. They also need help to buy drugs for opportunistic infections. Parlons-SIDA spends between $1000 and $1200 per month to pay for prescribed medication and tests. Another expense met by Parlons SIDA, insofar as its limited resources allow, is hospitalisation bills. In July 2013, there were 12 appeals for help to pay these bills – Parlons SIDA could only respond to five and two people died.

In common with other Jesuit AIDS ministries, assistance to access healthcare is flanked by other services to give a comprehensive package of care to people with HIV. A key element is affordable and nutritious food, essential for those on ARVs. Parlons SIDA prioritises newly diagnosed patients who are already weakened by AIDS-related complications – this is the case for many people who come for help. The parish project also runs home-based care and self-help groups and offers psychosocial and pastoral support.

After more than a decade of serving people with HIV, Parlons SIDA is about to start the construction of a stand-alone Maisha Centre to house its activities and an educational component as well. Funds to build the medical block of the centre were generously donated by the Barker family from Australia.

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