18:00 02.07.2008 | All news from "AIDS/HIV"
Rwanda: When HIV Patients Have to Walk Days for Antiretrovirals
But that is not the end of her troubles. As she narrates her situation, the mother of two daughters - aged 17 and 19, takes a deep cough holding her chest - an indication of the pain she is facing. Her daughters have apparently refused to go for testing - so their status is not known.
Every mid-month, Daphroza has to walk to Huye district on a journey that takes her a whole day to pick her 15-days ARV dose. "I have to start my journey a day before, spend a night in Butare (Huye town) - in time for my appointment with the doctors at Kabutare (hospital)", she explains.
Daphroza is among up to 73 HIV positive patients in Nyanza sector of the same district - all grouped in the association Akabando k'Iminsi. As they speak, they sound rejected and forgotten. They include the elderly, girls and children.
Despite their varying conditions, they all have to walk to Huye district - about a two-hour drive away to have their bi-monthly dose of ARVs.
All of them are on the life saving medication as well as 3 children. However, 65 of Akabando k'Iminsi members are females. In Gisagara district, there are about 50 associations of HIV patients bringing together more than 1000 people. There are only two closest ARV centers - with the other in Kibirizi - hours away as well.
In Huye town - which is nearer, as they explain, those that go there have to get their doses from Kabutare hospital. The National University of Rwanda hospital is another place where people from other places visit for ARVs - among the few that are in the southern province.
The road to Gisagara heads to Burundi but it is rare that a vehicle is seen except for government cars or those owned by NGOs. People that have bicycles use them for their businesses or even individual transportation.
The medical team that distributes the ARVs moves down to Kibirizi health center - but this is farther than walking to Huye town, according to the association members, seated at an assembling place as they narrate to RNA.
According to the Treatment and Research for HIV/Aids Centre (TRAC), the government and donor funded agency charged directly with the ARV program, the difficulty with which rural areas have in accessing the much needed ARVs is known but can do little at the moment.
"We are very aware of the difficulties that those that take antiretrovirals but are living very far away from the certified health centers that prescribe and distribute the medication", explains Dr. Jules Mugabo - in charge of the program.
"But even now, we have expanded the program so fast from just four main provincial hospitals in 1999 to about 143 health centers currently", he says.
More than 53.000 on ARVs
Between 1999 and 2003, only eight-hundred (800) HIV positive patients - who were actually footing their own bills - were accessing medication. The ARV program was only at the National University of Rwanda hospital in southern Rwanda, the Kigali Main Hospital, the up-scale King Faisal hospital and the Kanombe Military hospital.
Latest figures from TRAC indicate that there are slightly above 53.000 patients country-wide on ARVs. Among them, about 5000 are children.
Kigali and the Western province have the highest figures of ARV recipients at 17.000 and 11.300 respectively. The Northern Province has the lowest number of people on ARVs. However, this province has the highest general population level.
TRAC officials say the numerical distribution of access centers depends on the number of HIV positive people in that province.
HIV prevalence in Rwanda now stands at 3% translating to about 290.000 patients. TRAC officials also say some 40 percent need the doses.
Treatment decisions are often based on Viral Load and CD4 count. Normal counts range from 500 to 1500. A normal CD4 count in a man without HIV infection will be approximately 400 to 1200 cells per cubic millimetre of blood, and 500 to 1600 in women, according to experts.Dr. Mugabo says the challenge is limited resources that do not permit the expansion of the program to the 'door steps of all the patients'.
"In the next two to three years, with the current commitment from government and its partners, patients should be having their doses from meters away", he says.
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