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people living with HIV reported instances where they failed to access the triple combination from some pharmacies. The triple combination means one takes just one tablet instead of two or more separate tablets. In most cases pharmacies did not have that but had single drug entities these mainly being lamuvidine, zidovudine and nevirapine. In some cases they had a combination of only two still leaving a person to get the third drug as another unit.
The single units cost more and people living with HIV asked why they were not supplied with the triple combination which in most cases cost US$30 as compared to the single units whose combined cost was double.
The Retail Pharmacists Association responding in an interview pointed out that they were sorry for people on ART who encountered such problems but in most instances the blame did not lie with the pharmacy as the supply chain was complex. The treasurer of the organisation, Mr Portifa Mwendera said that it was imperative that anything that concerned people’s lives was of concern to them. He explained that pharmacies sourced their drugs from registered suppliers who are local or wholesalers who import and break bulk for the pharmacies who are retailers.
“Currently foreign manufacturers appoint local distributors as their principal distributors and only they are authorised to import into the country,” clarified Mr Mwendera
He said it was difficult therefore to switch suppliers in the event that the principal supplier did not have the required combination.
“This makes it difficult to switch suppliers, the local manufacturers only still make single units, that is stavudine, nevirapine, lamivudine and zidovudine as separates. They only make lamivudine+zidovudine and stavudine+ lamivudine+ nevirapine as the only combination drugs,” he added.
Mr Mwendera pointed out that all other ARV drugs were imports from either India or South Africa.
“Thus if the principal supplier is out of stock it is quite difficult to imagine where the retailer can get the required drugs from,” he said.
The association strives to have drugs available but at times the situation is beyond their control.
The association noted that an unfair business practice was creeping in as medical aid schemes selected pharmacies where their members could access medication.
“It is a patient’s right to choose which pharmacy they want to visit and it is not proper for a medical aid society to decide which provider they want to contract to assist their members. Invariably care may be compromised as not any one pharmacy will have all the members’ requirements at all given times,” said Mr Mwendera.
The chairman of the association also added his voice to the health concerns of the nation.
“As an organisation we are pro-patients, currently we are engaged in talks with Zima and NAC to make ART access open even to private patients the same way those on the Government programme access them,” said Mr Dought Ndiweni, the chairman of the Retail Pharmacists Association.
He said that they would like a situation where public hospitals were decongested.
“We are consulting widely to set up private/ public sector partnership (PPP) with the parent Ministry where we are in talks to decongest hospitals,” said Mr Ndiweni.
“We partnered with the Ministry of Health in the past during the outbreak of the H1N1 (swine flu) and people collected medication from selected private pharmacies free of charge. We are advocating for the same that the ARV drugs are dispensed in the same way,” said Mr Ndiweni.
He pointed out that like every other sector of the economy they too faced challenges in accessing drugs.
“Drug supply is not as reliable as we would like it to be, we are facing challenges like everyone in the country. The answer lies in local manufacturers – meeting the needs,” he said.
Mr Ndiweni said local producers needed to be capacitated – if these obstacles were to be overcome.
“For example Varichem which is a WHO prequalified plant needs funds to research and develop new products they need to register the new products and have quality checks, which is all capital intensive,” he said.
Mr Ndiweni pointed out that not all the drugs available from the public institutions are also available in the private sector.
“Some of the drugs within the public hospitals are not registered with the Medical Control Authority of Zimbabwe, hence needing special importation licences for private sector distribution, which is another bottleneck,” he said.
He pointed out that the misconception that pharmacies were expensive had to be done away with.
“The public has to be advised that ART like all other medication is accessible, most drugs are not expensive, it is wrong to think that all ART is expensive,” said Mr Ndiweni.
The organisation has in the past lobbied for the lowering of the price of Stalanev which was the mostly used first line drug to affordable levels.
“We lobbied that Stalanev (a locally produced triple combination drug) be priced at an affordable price and arrived at an exit price of US$11 to the patient from a local manufacturer which is reasonable to say the least,” he said.
On being asked when the country would phase out stavudine-based regimens which had some severe side effects in some people he said that as a developing country it would take time.
“Only new patients are not put on stalanev. Those who would have reacted badly are also changed but for those with no problems, they continue using the drug,” he said.
He said it was expensive to move everyone from stalanev to the recommended new drug.
Mr Mwendera said he was concerned with people on ART taking some herbal supplements that have flooded the country without having asked their health providers.
He pointed out that some supplements interacted with ART so much that they could cause danger to the taker.
“If anyone has to take supplements then they have to ask their doctors or take them to the clinic to see if they are suitable. What happens is that some of these supplements may interact with ART thereby posing a danger to the person taking them,” said Mr Mwendera.
Most of the supplements being sold from abroad are sold as medication yet they are not registered as such.
“Anything that is sold in a pyramid scheme style raises eyebrows and as RPA we do not condone the practice. There mostly is no scientific backing to the some of the herbs and supplements so they may pose a danger to society which as responsible professionals we could not shoulder,” explained Mr Mwendera.
Meanwhile, His Trust Team, a local Christian organisation that reaches out to communities for Christ through sport in their response in targetting to achieve an HIV-free generation, is holding an abstinence clinic for youths this school holiday. With most people urging the youths to condomise, His Trust Team believes cultivating morals is the way to go.
“This April, we are hosting a camp for ‘O’ and ‘A’ Level students called the Abstinence Academy. This is a camp for young people that will address the issue of sexual activity and the merits of abstinence through games, candid discussions and artistic workshops. Furthermore, we will also be incorporating life skills, grooming and etiquette as well as career guidance in the programme,” said Mrs Margaret Chivhanganye, Project Manager.
A young woman and journalist who also supports the notion, Melody Gwenyambira believes that it is the way to achieve an HIV-free generation. During World Aids Day (WAD) last year, she was among the 15 journalists who attended the Celebrity test at the New Start Centre in Harare where Munya Chidzonga of the Big Brother fame and US ambassador Charles Ray participated.
Among the 15 journalists she was the only one courageous to take a public HIV test. As a proponent of abstinence she says she is Christian and the Bible forbids sex outside marriage.
“I am a Christian and my upbringing brought me to believe in that. I am saving myself for the man who will marry me and I am also protecting myself from sexually transmitted diseases HIV/Aids included,” Gwenyambira said.
Gwenyambira admitted that her age mates sometimes poked fun at her but at the same time admired her.
“There are some who say its backward but there others who are honest and admire me for that, they come to say ‘how do you manage that?’ because they say they have lost a part of them they can never regain,” she added.
“Some people are angry with what they have done, they are bitter, so anger and bitterness keeps them getting back to the sin and having more and more sex,” she said.
“I tell them that they have done a wrong but it can be forgiven, God forgives, forgiveness is not enough alone, they have to repent. I tell them they have to practise secondary virginity which is abstaining even from that moment,” said Gwenyambira.
Melody’s maturity is unusual and she gives thanks to the Lord. She says she was orphaned at 15 and was left to take care of an 11 year old brother.
“My brother Tinashe is now 18 and is also abstaining not because of my pressure but he wants to. He is in Upper 6 now,” said Gwenyambira.
His Trust Team believes with correct moral values inculcated, youths can abstain but the message barraging them is that of using latex. Till then God bless you this Easter.
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