ACCESS TO TREATMENT BY PEOPLE LIVING WITH HIV

ACCESS TO TREATMENT BY PEOPLE LIVING WITH HIV IN ZAMBIA Presented by: Kunyima Lifumbela Banda Network of Zambian people living with HIV/AIDS (NZP+)

Introduction l l l Government with support from Cooperating partners has been providing free ART in public health institutions in 2006. The number of public and private facilities providing related services such as CD 4 counts has also grown There has also been an increase in the supply of HIV-related services in both rural and urban areas

Cont… l Increase in access to medication for prevention and treatment of opportunistic infections such as TB

Overview of ART Situation l l l 1 million people living with HIV in Zambia 368, 821 PLHIV accessing treatment 57% are women 31% are Men 27, 419 children 0 – 14 years

Cont… l l l 96% on 1 st Line treatment 4% on 2 nd line treatment Under 1% on 3 rd Line treatment 69% urban 31% rural 54% receive care at health centre level

Facilities Providing HIV related services l l l About 1, 800 health facilities in Zambia (Government, private, NGOs) 1, 468 provide VCT 1, 253 provide PMTCT 484 provide ART 297 provide pediatric ART

Conti… l l l 150 facilities provide CD 4 3 sites provide PCR testing – UTH, Kalinga and Arthur Davies Hospital 2 sites provide viral Load – UTH and Kalinga

Facilities soon to provide Viral Load and PCR l l l Chipata General Hospital Ndola Central Hospital Mansa General Hospital

NZP+ Survey on Access to Medical services l l l NZP+ conducted a survey access to medical services by people living with HIV in 12 districts. Survey was conducted among people living with HIV Objective was to get experiences from PLHIV on access to treatment

General Information l l l 59% of people interviewed were women 98% were above the age of 30 60% single (unmarried or widowed)

Information on ART l l l l 98% where on ART 40% did not know the name of drugs they were taking Less than 1% were on second line treatment 66% did not frequently get a CD 4 test done 60% did not know their CD 4 count 19% get information from the support groups 24% from medical staff

Cont. . Reason for testing l 62% tested after a long illness l 11% referred after TB treatment Distance to ART centres l 12% within 10 km l 75% above 20 km

Access at health facilities l l l 70% indicated 3 hours as minimum time before seeing medical personnel 48% saw a clinical officer on appointment days and 25% say a nurse 60% felt that time spent with the medical personnel was not enough but generally expressed satisfaction with the ability to express themselves.

Cont… In the PLHIV Stigma Index study: l l l 8. 4% of respondents reported being denied health services (including dental services) 9. 7% of the respondents reported having been denied family planning services as a result of their HIV status 11. 8% indicated that they had been denied sexual and reproductive health services.

Challenges Departure – Demand Travel – Linkages Arrival – Supply side • Stigma • Traditional and culture beliefs • Religious beliefs • Inadequate knowledge and information on treatment and other services • Poverty • Gender based violence Stigmatisation of young PLHIV • Few centres providing ART services • Long queues, long waiting hours • Missing files, missing results • Inadequate information given to patient • Inadequate staff to attend to patients • Stand alone services • Geographical features such as islands, plains, floods in the rainy season, sand, mountains • Long distances of 45 Km – 100 • Cost of travel – resources shared between travel and those remaining at home, accommodation

Challenges Departure – Demand Travel – Linkages • Physical challenges – tiredness, stress, fatigue • Vulnerability of women when travelling Arrival – Supply side • Limited referral within facilities for different services • Stigmatisation of young PLHIV by health personnel • Long waiting time to access results especially for children

Our Role in increasing uptake of services l l l Advocacy for increased ART Community Mobilisation Community preparedness • Information provision • Treatment literacy Community Referral Contribution at health facilities • • l Pre and post test counselling Adherence support Referral Record keeping Linking PLHIV to business development services

Our Recommendation l l l Scale up access to treatment as close to people as possible Need for integration of services - HIV, TB, MCH, SRH services Scale up testing and treatment for children and adolescents Scale up availability of pediatric formulae Scale up support to community initiatives Promote treatment as prevention