Global Policy Forum

Concerns Over Cost of New HIV/AIDS Treatment Regime in Malawi

The Malawian government currently provides 250,000 HIV positive citizens with free antiretroviral therapy yet limited resources mean three times as many Malawians still go without. Despite the existing funding limitations, in line with WHO recommendations, the government of Malawi plans to adopt new improved medicines costing three times that of the existing treatment regime. Pledges to channel more governmental resources into HIV interventions have been made but, at a time when treatment needs to be scaled up, many feel it is likely that even fewer Malawians will be able to access free treatment.



By Claire Ngozo

July 10, 2010

As the Malawian government implements a new HIV/AIDS treatment regimen according to latest world standards, a major grouping of non-governmental organisations are concerned that the high cost of the new medication will mean government will no longer be able provide free treatment to as many people as before.

The Malawi Network of People Living with HIV/AIDS (MANET+) advocacy officer George Kampango told IPS that the new drugs, which cost three times as much as the current regime used, will be too expensive for government to manage providing free treatment to the poor and children.

MANET+ is worried that not everyone who needs the antiretroviral therapy (ART) will have access. "At the moment, not all people who require treatment are getting it. Government is failing to provide free treatment for many poor people and children including orphans who need it most," said Kampango.

Out of Malawi's 13.1 million total population, 65 percent lives below the poverty line of less than one dollar per day, according to the United Nations. The country is also home to about 560,000 AIDS orphans, most of whom are also HIV-positive, according to 2007 government statistics.

"The new drugs are even much more expenive and we fear that government will struggle even more to make them available even to those people who are already accessing treatment free of charge. Poor children are likely to be penalised from accessing the drugs because they are not usually a priority for treatment," Kampango said.

Currently the Malawi government provides free anti-retroviral drugs to about 250,000 people. There are up to one million people living with HIV and the HIV prevalence rate is at 12 percent, according to the Ministry of Health.

The country has been procuring the first line of the HIV course of therapy comprising of Stavudine, Lamivudine and Nevirapine at about 33 dollars but the new drugs will cost the government 100 dollars per month for every person, according to Principal Secretary for HIV and AIDS in the office of the president and cabinet, Dr. Mary Shawa.

"Malawi is changing the treatment in line with World Health Organisation (WHO) guidelines which are urging countries to phase-out the current first line of treatment which is blamed for increased side-effects," Shawa said.

WHO introduced new guidelines for the treatment of HIV and prevention of mother-to-child transmission (PMTCT) on Nov. 30, 2009. The U.N. indicates in the revised guidelines that countries also need to start providing treatment much earlier when the measure of immune system strength, the CD4 count, is at 350 cells per cubic millilitre or less and not at the current 200.

The new recommendation also guides countries to provide the therapy of either Zidovudine or Tenofovir even if the patient has not started displaying AIDS symptoms.

But MANET+ is arguing that there are still many people in the country who, at the moment, cannot access free HIV treatment because of lack of resources within government coffers and that adopting the new regimen will make the situation worse.

"It will be more challenging for government now to provide drugs to people infected with HIV because starting treatment earlier will translate into people being on the drugs for more years than before. This would mean much higher costs for the antiretroviral (ARV) drugs," worried Kampango.

Malita Luka, 35, from Nsalu in Lilongwe told IPS that the news that government is adopting a more expensive therapy is worrisome. She and her nine-year-old child have been waiting in vain to go on the ART provided free of charge by government, after they were diagnosed HIV-positive a year ago.

"My child and I are always falling sick and I think we should be put on therapy but the medical people say that we are not sick enough yet to access treatment," said Luka.

She said her cousin, a cross-border trader who makes good money and is also HIV-positive, has managed to go on the treatment through private practitioners after she failed to access it free of charge.

"I can't afford to do the same and I now fear that it will be even more difficult for my child and I to access the free drugs now that they will be more expensive even for government," worried Luka.

The Malawi National AIDS Commission (NAC), a public trust which coordinates national response to HIV and AIDS, has been complaining about lack of finances for the programme. NAC acting executive director, Bridget Chibwana, was quoted earlier this year in the local media that lack of funds is a major obstacle in adopting the new AIDS treatment. Other challenges include lack of enough infrastructure and shortages of health workers.

Malawi continues to seek more funding for HIV interventions from the Global Fund and other donors, according to NAC. Meanwhile, there might be hope for people like Luka, the Malawi government has added more resources to HIV interventions in the 2010/2011 national budget.

The country's finance minister Ken Kandodo said in his 2010 budget statement that in this financial year the health sector has been allocated a total of 300 million dollars. Of this, 75 million dollars has been allocated to the NAC "to combat HIV/AIDS pandemic".

Still MANET+ is planning on advocating for more resources and government commitment towards the fight against HIV/AIDS. "We are planning on an advocacy programme so that the new treatment guidelines should be well thought through before being implemented," said Kampango.


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