Dr Lisa Thorley By: Dr Lisa Thorley
Teaching Fellow- Global Development
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09 Apr 2020 : Access to ARVs, yes please.

I mentioned in my April 7th post that people were concerned about being able to access treatment for pre-existing health conditions, (myself included) well it’s happening. No, not in the UK, though of course there may be some people who are having issues, what I’m taking about are people in Sub Saharan Africa (SSA), namely South Africa. For years the likes of WHO, UNAIDS, PEPFER and the Global Fund (to name few) have provided ARVs  to the people of South Africa,(be this directly or indirectly) which let’s be honest it great, because after all we really can’t have people dying. However, the issue with South Africa is how positive people engage with their treatment and importantly how they access the vital ARVs that they need to lead normal lives (we can save the debate of what is normal for some other time). Unlike in the UK where people like me are given a 6 months supply, the majority of people who use ARVs in South Africa are given only one month’s supply. This isn’t something new, its been like this for years.

Having to trapes down to the clinic once a month before Covid 19 was already an issue, it was/is an issue because clinics are busy, but most importantly if you have to go and collect your meds once a month it can mean having to take time off work. If your employer is sympathetic, then bingo, you’re good to go. However, if they aren’t, what are people expected to do? Also due to the ongoing issue of stigma, people simple don’t want to talk about their status, let alone tell their boss. As with what is normal, I’ll come back to this at another time. The issue now is how are people who already have restricted access to ARVs supposed to access their medication when there is a draconian lockdown in place  and one that is being enforced through violence (and their we were thinking the days of police brutality were over in South Africa, er yes, OK)? How indeed? Well get this, news flash, they aren’t, they aren’t, because they can’t.

Ok, so what, I mean is it really an issue if people who are positive have to wait a while until they can access their meds? Yes, it bloody well is. If a person stops taking ARVs their viral load will rebound to pre-treatment levels within a week, what this means is that their HIV will no longer be under control. Not only will their own health be at risk, (resistance may occur) but if someone is in a sexual relationship and  their viral load becomes detectable, they’ll be a risk to their partner. So, gone will be the days of not being able to infect a sexual partner. If you’re new to this, when a positive person is on medication and their viral load is undetectable, they can’t transmit HIV. I know, how cool is that. Anyway my point is, access has been an issue for a while, however the bright sparks at UNAIDS have finally cottoned on that it might be better if people were given 3, or if possible a 6 months supply of meds when they go to their clinics. It would be great to know who had this lightbulb moment. Being given more than a months’ worth of meds is something that should have happened years ago. Why has it taken a pandemic to wake up the powers that be? In going forward, this is something that really needs to be addressed and addressed quickly. So, lets sort this, UNAIDS and co, make the pledge that once this is over (because there’s no way it will happen now) lets ensure that people are given a 3-6 months supply of meds and not the usual one. This requires everyone to work together, and yes that means you Matamela Cyril Ramaphosa. Access is a right, and access needs to be something that works around peoples lives.

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