It was only a week in May, but it was a terrifying time for Elizabeth Nanyange. For a week, her clinic had none of the medicine she needed to prevent her from transmitting the AIDS virus to her unborn child.
"I was worried," she said. "I was afraid I would fall sick and die." stance
She soon had her supply of antiretroviral medicine restored, but it was a small example of the disruptions and shortages that plague the African health system. Even a short interruption can jeopardize the health of someone with HIV, because it can create resistance to the effects of the life-saving medicine. And for millions of Africans, the difficulties go far beyond short interruptions.d
The situation in Uganda is typical of the shortages across Africa. About 1.2 million Ugandans live with HIV, and half of them need antiretroviral medicine to keep them alive. Yet only about 300,000 are able to get medicine. And only about half of pregnant women are getting the medicine they need to prevent their babies being born with the virus.
"Tens of thousands of our babies continue to get HIV from their mothers every year, at a time when vertical transmission is a thing of the past in the developed world," said a report this year by Uganda's Coalition of Health Promotion and Social Development.
Uganda has accredited more than 400 health centres and hospitals to provide antiretrovirals, but only half of them are operational, and even the functioning clinics often run out of AIDS medicine due to shortages or distribution problems. Patients often wait an entire day to receive their supply, or are given medicine for just two weeks instead of a month.
Budget cuts are not the only reason. Uganda's procurement system is plagued by corruption and inefficiency, and funds for medicine are sometimes diverted or unspent.
"Stock-outs are mainly because of insufficient funding, weak procurement, poor distribution, irrational usage and illegal sale of medicines," the Ugandan AIDS Commission said in a recent report.
Because the shortages of antiretrovirals are so frequent, many Ugandans hoard as much as possible at home, which adds to the problem. "When people see that the drugs have arrived at a clinic, they all rush there and queue up and take it all in a few days," said Orkhan Nasibov, director of the Uganda office of Médecins Sans Frontières (Doctors Without Borders).
In the region of Mubende this year, people with HIV who had been receiving the medicine in their villages were abruptly told that they had to travel to a regional hospital instead. About 100 people missed their doses for months, while others rioted in anger.
For impoverished farmers and villagers, the journey to collect their medicine can be costly and arduous. Nuulu Nanfuka, a 41-year-old widow with seven children, lives at the end of a dirt road that becomes nearly impassable in the rainy season. It sometimes takes her two days to travel to the capital, Kampala, to pick up her monthly supply of antiretrovirals and to return home.
"I wish the services were closer, so I could get back home in time to take care of my children," she says. "It really pains me when I don't know how my children are doing."
Women often travel great distances to Kampala to get their HIV medicine because they face discrimination at their local clinics. They say they are sometimes criticized or insulted by clinic staff, especially at Christian-run clinics, if they ask for antiretrovirals when they are pregnant. Nurses tell them not to get pregnant if they have the virus – ignoring the reality that contraceptives can be difficult to obtain here, partly because Uganda's powerful churches are often hostile to family planning.
The shortages of HIV medicine could worsen in the future. The foreign organizations that supply the vast majority of Africa's antiretroviral medicine are facing cuts as donors reduce their contributions. They have told African governments to provide a greater share of the funds, but African leaders say they cannot do so in the next few years. With no agreement on who should pay, further cuts could be looming.
Geoffrey York