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HIV treatment in Covid times

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Sakina Mdala of Liwonde Township in Machinga District was diagnosed with HIV in 1995.

Billy Msokera of Kasungu District got to know about his HIV status in 1992 while Dorothy Mtwana, who lives in Blantyre, tested positive for the virus in 2007.

When Mdala’s family learned about the news, their expectation was that her life would be cut short due to myths about the epidemic.

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Across the country, an HIV-positive diagnosis was once being seen as a death sentence.

Mtwana recalls that she thought she had developed malaria before knowing her HIV status because she was feeling feverish, had shaking chills, a headache, muscle aches and felt tired.

In Msokera’s case, her sister had a spleen disorder and needed a blood transfusion.

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“I donated my blood once to save my sister’s life but the second time I was told I could not for reasons hospital authorities could not disclose. Then my sister informed me that I was HIV positive,” Msokera said.

The challenges that the three faced as people living with HIV ranged from limited access to hospitals that provided treatment, lack of money to buy antiretroviral (ARV) drugs and inadequate counselling.

On limited access to hospitals that provided treatment, Mdala remembers having had to travel to Chiradzulu District Hospital to buy ARVs.

“There were only two hospitals that were offering treatment for HIV patients and these were Chiradzulu District Hospital and Light House in Lilongwe.

“I for one had to travel to Chiradzulu from Liwonde to buy ARVs which were being sold at K7,000 per bottle which lasted for a month. Those days, ARVs were not free in the country and that K7,000 was a lot of money,” she said.

Msokera admitted that he could not have survived to this day had it been not for a pen friend in the United Kingdom.

“I had a friend by the name Telford who used to send me multivitamins as an alternative for ARVS. I could not afford the drugs so he used to send them through Post Office. He could also encourage me to have a balanced diet,” Msokera said.

When the world woke up to news of the Covid pandemic three decades later, Mdala and other nearly one million adults living with HIV in Malawi might not have foreseen the impact the contagion would have on their access to treatment.

Non-governmental organisations working in the HIV space say challenges HIV-positive people face were enormous at the peak of the Covid pandemic.

Executive Director of Malawi Network of People Living with HIV/Aids, Lawrence Khonyongwa, said the major constraint was the diversion of resources both monetary and otherwise from HIV and other conditions associated with it to Covid treatment.

“It was a tall order for most HIV-positive people and it still is to some measure. Most of them had problems having their viral load checked and accessing some family planning produces such as condoms.

“Then there was the issue of defaulting on medication with some people being reluctant to go to the hospital to get their medication due to rumours that they would be tested for Covid,” Khonyongwa said.

He added: “The other obstacle was the demand which was being made by health personnel over risk allowances during the pandemic. This also made it extremely difficult for HIV-positive people to get treatment.”

Some people living with the virus such as Mtwana concurred with Khonyongwa on the problems they were facing at the peak of the Covid pandemic.

Some of the challenges are reportedly still there.

For instance, they also indicate that shortage of antibiotics such as Bactrim in public health facilities has affected their adherence to treatment.

“Bactrim helps us a lot because it keeps opportunistic infections in check. Health authorities used to give us this for free on top of ARVs but nowadays the case is different,” Mtwana said.

She further appealed to the Ministry of Health to come up with a system that will allow HIV-positive individuals to access tuberculosis (TB) testing services in their locations.

National Aids Commission (Nac) spokesperson, Karim Msiska, said Nac foresaw the impact Covid would have on HIV treatment and started engaging community-based organisations on the matter.

“These are organisations which were pioneers in the fight against HIV when it first emerged around 1985. We wanted to deal with myths that surrounded the Covid pandemic just as was the case with HIV during its first years,” Msiska said.

He added that Nac increased the quantity of ARVs clients receive from public hospitals as a way of minimising physical contact at the facilities.

On the other hand, Msiska admitted that antibiotics have been in short supply in public hospitals thereby affecting the power of treatment.

He also indicated that on the part of Nac, there was no diversion of resources meant for HIV response to other activities such as those to do with Covid care.

On her part, ART Coordinator for Blantyre Rural Margaret Chigona admitted that antibiotics were in short supply particularly at the beginning of this year and that people on treatment were affected.

“We were directed to be giving Bactrim to certain types of patients such as those who had recently been diagnosed with the virus, HIV-positive children aged between six and 15 years, pregnant women and breastfeeding mothers who are HIV positive. We are adhering to this directive up to now,” Chigona said.

Asked if the shortage of Bactrim would not affect the health of clients who were removed from the list, Ministry of Health spokesperson Adrian Chikumbe said the decision was reached on the basis that those with improved immunity were at minimal risk of opportunistic infections.

On TB testing for HIV-positive individuals, Chikumbe said out of 653 public health facilities in the country, 450 have the capacity to test for the disease.

He also indicated that Malawi has surpassed the World Health Organisation recommended testing capacity for TB with every facility testing a population of 20,000 and above.

Chikumbe said those without the ability to travel to health facilities have specimens taken and sent to laboratories for testing.

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