Supply shortages, poverty interrupt antiretroviral treatments in Swaziland

Health facilities in Swaziland are experiencing shortages in antiretroviral drugs and other medications despite insistence from the country's health department that the shortage has been resolved, IRIN/PlusNews reports.

According to officials with the Ministry of Health and Social Welfare, a shortage of antiretroviral supplies did occur in July and August but has been corrected. Derek Von Wissel, director of Swaziland's National Emergency Response Committee on HIV/AIDS, said that the country now has a "steady supply" of antiretrovirals, adding that there are people "using the drug issue to discredit government" as part of a "political agenda."

Maphangisa Dlamini, a home-based care nurse with the group Swaziland Positive Living for Life, said the shortages in the health facilities began three months ago and has forced some HIV-positive people to change their medication regimens because certain drugs were not in stock. Dlamini said patients are "complaining; you'll find someone has been on a regimen for four years and then they're changed to a new drug, which might cause side-effects, and they don't know whether to adhere or not." He added that a shortage of other medications and supplies to treat common infections associated with HIV/AIDS has been occurring since November 2007.

The high level of poverty in Swaziland hinders patients from buying the medications on their own, Dlamini said, adding that he is concerned that a resistant strain of the virus will develop from the interrupted treatment regimens in the country. "It'll be difficult to treat these drug-resistant strains because second-line drugs are more expensive and not available everywhere," he said.

According to IRIN/PlusNews, Swaziland has the highest HIV prevalence in the world, with 26% of its adults living with the virus, and a high default rate for antiretroviral therapy. Von Wissel said about 31% of patients in the country taking antiretrovirals stop receiving treatment within their first year on the medication. The government has been decentralizing antiretroviral treatments, with about 30% of the country's local clinics offering the drugs. Velephi Okello, antiretroviral therapy coordinator for Swaziland's National AIDS Program, said the issue of task-shifting to allow nurses to prescribe medications needs to be addressed to deal with the shortage of physicians in clinics around the country (IRIN/PlusNews, 9/18).