When ARV therapy proves elusive

She, however, was not asked to have an HIV test. When visiting public institutions a sick person is usually invited to take an HIV test if they do not know their status. Those accompanying the sick relative are also encouraged to take the same test. This voluntary counselling and testing is meant to have everyone tested and know their status. Miriam said she had recurrent chest pains which were severe in the same year and went to see the same doctor. This time around it was an uphill task as she did not respond to medication. She said her aunt, who is a nurse, was worried when she saw her. She asked if she had ever taken an HIV test to which she answered no.

“My aunt advised that I go to the local clinic rather than the same doctor I had been seeing. She said I ought to know my HIV status first and from there would know what problem we were treating.” said Miriam.
Miriam said she first got angry with her aunt but understood her concern.

“My aunt opened up that she was living positively and therefore I had nothing to fear. She would be there for me if the need arose, this gave me confidence and the next day I visited my local clinic,” said Miriam.
Miriam said although the nurse did not say, ‘Hey you are HIV positive’ without the test results, she sounded more like that by merely looking at her. The nurse counselled me and in friendly terms said we could be ‘treating acne’ which is on the surface yet the real cause of acne was my poor diet, which in a way was a pregnant statement,” she said.

These days, it is no longer the heart-rending wait, as results come out while one waits. The rapid HIV testing therefore makes life bearable in that the results are announced in less than 10 minutes.
“On the day in question the clinic was not busy so the nurse first explained what happened if one was HIV positive and the reaction when one was negative. She even explained an inconclusive result which meant that the test had to be repeated, or one had to come back after six months. The nurse showed me the test line that appeared on the test kit and told me that if a second line appeared that confirmed that I was HIV positive,” she said.
Miriam asked the nurse what would become of her were she to test HIV positive. The nurse told her that she would be initiated on the national ARVs programme which was free.

Basing on that Miriam had hope and took the test. As advised Miriam’s test had a second line and she said she was shattered and wept.
The nurse as a trained counsellor allowed her enough time to cry and explained that at least they would be treating the cause and not applying foundation on an acne pregnant face.
“She therefore told me that the cause of my recurrent illness was a weak and compromised immune system. “She told me that I had to visit Harare Hospital where I would be initiated on ARVs before being transferred to my local clinic for easy access,” she said. Miriam is bitter, sad and worried. She has been to the referral centre where she undertook more counselling sessions. However, when she thought she was near to getting access to medication, she was told that there was a waiting list.

“The nurse at my local clinic where I took the VCT, promised me that I would get treatment. The system has failed me, I was told that if I tested HIV positive I would be commenced on ARVs. They did not tell me that there is a waiting list. It was better when I did not know, mentally this is killing me,” she said.
Nationally the waiting list has ballooned to 600 000 using the new WHO guidelines which stipulate that one has to be commenced on ART if one’s CD 4 count gets to 350. Miriam’s CD 4 count is even less it stands at 284 and she is now losing sleep.

“I am now stressed, in the past it was just my poor health but now I have stress to add which is unfortunate,” said Miriam.
Miriam has been put on the antibiotics (cotrimoxazole) prophylaxis in the meantime.
“ARVs are for life I cannot afford to begin taking them. I was told that if I start then there is no stopping. I am afraid I may default when I fail to raise the required amount every month, so I am not starting a fire which I won’t be able to put out,” she said.

Nationally people have gone to get tested but have been disappointed after failing to get on the rollout programme. As Miriam speaks to her friends, it therefore emerges that it would not make much sense to encourage her relatives to take an HIV test if they have to endure the long wait which amounts to torture. It will take longer to have Miriam’s faith back as she has lost a part of her life as she waits.

Miriam said the local hospital told her that pregnant mothers were a priority and these were initiated on ART, if they needed it.
“It seems they are now discriminating, they say pregnant mothers will be put on ART irrespective of the waiting list. Do they want me to fall pregnant so that I am initiated, that is irresponsible to say the least but that can be a possibility if it means they will put me on ARVs,” said Miriam posing the question with no answer. There has been a shift by major donors to focus on maternal and child health as a method to reduce and eliminate new HIV infections. Miriam asks what will become of her and others in a similar position.

A scientist speaking on condition of anonymity said the donors were creating a false and futile unhealthy scenario.
“More funds should be made available or if the funds are limited then they have to be logically shared. I work at a hospital and it is sad to see a needy person turned home because there is a waiting list,” he said.

He said more funds ought to be allocated to the health sector as a whole rather than withholding support from one needy area in favour of another. She plans to go to her rural home after learning that there was no waiting list.

“I will be going to Dotito because the mission hospital there is dispensing ART, otherwise I could die waiting for my turn in Harare,” she said.
So the statistics which say the rural HIV prevalence rate is going up are not a correct picture as Miriam and friends trek to their roots for survival treatment yet they are towns folks because treatment delayed is treatment denied.
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