Zimbabwe Short of AIDS Drugs

When they named their daughter Progress, the parents showed a touching faith in the future. But six years later, she has lost them both to AIDS.

With no one willing to care for her, Progress Sibanda lives in a nursing home filled with terminally ill AIDS patients in Bulawayo, Zimbabwe’s second-largest city.

The girl has no visitors and few possessions -- the clothes she stands in and a comb her father gave her before he died this year. She never shows any emotion, the staff says.

The medical staff says Progress displays symptoms typical of AIDS, but because of their lack of resources she has never had an HIV test, let alone lifesaving antiretroviral medicines. Treatment at a private clinic costs an average of $50 a month, according to the United Nations.

Zimbabwe has one of the highest HIV/AIDS rates in the world. About 1.8 million people between the ages of 15 and 49, more than 20% of the population, are infected. That’s down from 24% two years ago, a recent U.N. study found, partly because of changes in sexual behavior.

The country’s economic collapse, with hyperinflation of more than 500% and unemployment estimated by trade unions at 70%, has left critical shortages in all basic areas. Food and fuel are scarce, and so are medicines -- particularly antiretroviral drugs that can save the lives of AIDS patients.

According to the World Health Organization, 95% of Zimbabweans who need antiretrovirals cannot get them.

Zimbabwean health officials blame the lack of antiretroviral medicines on the country’s shortage of foreign exchange. The currency shortage has prevented a local manufacturer from importing components of the drugs, they say.

In addition, Finance Minister Herbert Murerwa said recently that most equipment at state hospitals was out of order or obsolete.

Despite Zimbabwe’s high HIV/AIDS rate, the country has not received much international aid for the crisis -- until recently, it amounted to $4 per HIV-infected person a year, compared with $74 for the rest of southern Africa. (The U.N.’s Global Fund to Fight AIDS, Tuberculosis and Malaria said Zimbabwe’s application for aid was initially rejected because it did not meet requirements.) In April, the Global Fund announced a $10.3-million grant for AIDS programs, followed by an additional $62 million in October.

Zimbabwe’s economic crisis and the AIDS pandemic have left the nation with one of the lowest life expectancy figures -- 38 years -- in Africa; only Swaziland and Lesotho fare worse. Since 1990, Zimbabwe has seen the steepest rise in mortality rates for children younger than 5: a 50% surge to 113 deaths per 1,000 boys and 133 per 1,000 girls. According to UNICEF, one child dies of AIDS every 15 minutes in Zimbabwe.

Nurse Priscilla Mac-Isaac said Progress Sibanda’s relatives rejected her three months ago, knowing that keeping her would soon mean unaffordable medical bills, and probably funeral costs down the line.

“My granny used to come, but she’s no longer coming. No one’s coming. I’m not even thinking about my granny,” the child whispered. “I don’t want to see her.”

Thembelihle House, where Progress lives, is a charity institution set up in 2003 as a halfway house for HIV patients referred by the city’s hospitals. But it has become a largely terminal-care facility. Few patients recover and go home, because they can’t afford the antiretroviral medicines that might save them.

A ward full of dying people is no place for a child. Progress recently fell ill with pneumonia, and doctors fear she will get other AIDS-related infections unless she gets the antiretrovirals.

Asked about the child’s future, Mac-Isaac looked grave and shook her head.

“It’s only that I can’t afford it, otherwise I would adopt her,” she said. “All she needs is somebody to take her in and provide for her. But people cannot afford nutrition for their own children.

“She needs to be commenced on antiretrovirals, before something very bad happens to her. But we are unable to do that at the moment,” she said, explaining there was no staff available to escort Progress to and from a treatment clinic.

Thembelihle House, which relies on private donors, can accommodate 70 patients but can afford only a skeleton staff to care for only 17 people.

“It’s extremely difficult working here. Each patient has a unique story which is quite heartbreaking,” Mac-Isaac said. “There are just a few who have a straightforward life and everybody around them.”

Thin and frail, Tsepi Ndlodu, 18, another patient at Thembelihle, became infected with the human immunodeficiency virus when she was raped in 2003. She didn’t report the crime, terrified of taunts and shame.

Her mother died in 1999, and she has no father. When she fell ill and sought treatment at hospitals and clinics in Bulawayo last year, no one told her about antiretroviral drugs and what they could do. Like most people, she has no way to buy the medications.

Mark Dixon, a doctor at Mpilo Hospital in Bulawayo, said that there was a six-month waiting list for AIDS treatment and that many patients arrive at his facility so ill they die before they can be admitted.

“There are only so many people you can see each day. Usually when we lose people it’s in the first couple of months, and they’re usually coming in too late,” he said. About a quarter of those getting treatment are health workers or their families, who get priority.

About 16,000 people are on antiretroviral drugs in Zimbabwe, according to the World Health Organization.

“But if you look at the need, we are still only treating a tiny percentage of those who need treatment,” Dixon said. The U.N. AIDS agency estimates that of the 1.8 million Zimbabweans who are thought to be living with HIV, which causes acquired immune deficiency syndrome, 308,000 have reached the stage where they need antiretroviral medicines.

Zimbabwe has seen so much political and economic turmoil in recent years and international donor funding has been so short that doctors are wary of starting antiretroviral programs unless they are sure the treatment will be sustained. By the time the international funding arrives and treatment is expanded, it will be too late for many who are sick or dying now.

Mac-Isaac said it was hard to predict which of her patients would survive.

“It depends on whether they have got money for medication and whether they have got anyone to support them,” she said. “And it depends on ARVs,” the antiretroviral drugs.