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Charity’s story is common among many people who after testing HIV positive  are determined to get well. They adhere to the stipulated medical regime and in no time regain lost ground.
It is usually when one is ill that one sets a strict adherence timetable but as the years go by, some people relax. Charity being an early bird, decided that she would take her medication at 5am and 5 in the evening. She would make sure that she had a plate of steaming hot porridge before she took her medication in the morning.
“I started ART sometime in 2006 and then I was determined that I must get well. I woke up early and prepared some porridge before I would take my ARVs. In a few months, I was no longer ill and had regained some weight,” said Charity who refused to have her second name published.
Charity said that she adhered and never missed on taking her medication for the first three years but as the years went by, she got comfortable and would miss the set times. She even said she doubted if she really was HIV positive.
“I no longer woke up early enough to prepare the porridge so in the end I just took the tablets on an empty stomach which is not recommended. I did not mind since I had gained more weight than what I used to be. I feel it did not matter to take the food aspect seriously, I did not need to gain any more weight,” she said. Charity said she even skipped taking her tablets and in one instance she did not go to collect her supply on time.
“I would travel out of town and fail to come back home, when this happened I did not take my tablets since I would have left them at home. That is how I first defaulted on a small scale,” she said.
Since she did not get ill after defaulting for a few days, she got comfortable and even told herself that she no longer needed the drugs.
“One time I ran out of tablets when I was in Mozambique for business. I had gone there to buy used clothes and I had not secured the stuff I needed on time. I needed to bring in baby clothing and men’s shoes so I stayed a bit longer than anticipated and thus how I ran out of medication,” said Charity.
When she finally came back home, she did not bother to go to the clinic to report that she had defaulted.
“I resumed taking my tablets as if nothing had happened. I had missed taking tablets for two weeks and when I had finished using the supply and called at the clinic that is when the nurse realised that I should have collected some ARVs long back. The nurse was mad with me,” she added.
She asked Charity to go back for counselling since she did not understand the condition well. Charity was not on medication for a further week as she was re-counselled.
“The nurse said I needed to undergo re-counselling so would not get my re-supply. She even said I could have grown some resistance to the drug and needed to have the combination altered.
“She referred me back to the counsellors who would then refer me to the doctor when satisfied that I had learnt well enough not to default,” said Charity.
Charity said she could not stand the re-counselling sessions which on the first session was more of a reprimand lesson, so she just stopped coming altogether.
“I stopped attending the sessions so I never got to see the doctor in the set time. It was then that I started losing weight,” she said. She said she did not go to the same hospital this time around. She went and pretended to be a new patient at her rural hospital.
“I thought I could beat the nurses at their game. I went to Chiweshe and went to Howard Mission Hospital where I was tested and treated like a new HIV patient,” she said.
Charity thought her problems were over as she was prescribed the same tablets and went home smiling again.
“Despite the fact that I was taking my ARVs correctly now, I kept feeling under the weather. I had a mild stroke and was taken back to my first clinic which is nearer my home. There they had my file and saw that I had defaulted,” she said. “The health staff were not amused. They asked where I had got the re-supply and my sister told them that I was now getting them from our rural hospital. That is when I was told that I had developed some resistance to the first line drug and needed re-counselling. After that they said would change my drugs,” said Charity. Charity said she is lucky to be recuperating today as circumventing the ARV channel — it nearly cost her life.
“I was put on the second line which is expensive and was told that if I were to default again then the clinic would not afford to change the line.
“I was touched to learn that the new drug regime cost more. I even cursed myself when I was told that five more patients could be catered for on the first line had I not defaulted and have my drugs changed,” she said with understanding.
Charity is attending some physiotherapy sessions as she learns to walk again.
Cosmas Makwere is another man who walked in the shadow of death after having defaulted. Makwere (36), who lives in Mabvuku suburb in Harare, said he is grateful that his mother came all the way to South Africa and had him put back on ART.
“I had been on ART for some years and when I got well I just relaxed and stopped taking the medication,” said Makwere. He said that he just got comfortable and stopped taking ARVs when he was working in Sofiatown in South Africa.
“In South Africa they have a database, so they kept phoning and sending me messages to come but I ignored.
“I suddenly fell ill and was no longer able to go to work. My nephew who I lived with contacted my mother who came all the way from Harare and took me back to the hospital where she begged them to treat me as a matter of urgency,” said Makwere.
“Like all defaulters, one is taken back to counselling and it took me two weeks after my mother had pleaded that the one month that I had to take was too long.
“She needed to get back to Zimbabwe where she had left other children. That is how I managed to be put back on ART,” said Makwere.
Makwere was given a transfer later and today a year after his homecoming he is recovering from a severe bout of TB.
Adherence is the cornerstone of positive living, so is eating healthy food, exercising, getting enough sleep and avoiding unnecessary high stress levels.
When one begins to take ARVs they must fully adhere or comply with the set regime. Unlike other medicines which can be taken without adhering to a strict timetable, that is not so with ARVs.
Locally, depending with one’s doctor, one is advised to take them at stipulated times, say 6am and 6pm each day.
So keeping time is a factor that is reiterated in one getting back on the road to full recovery.
A doctor speaking on condition of anonymity said it was better for one not to even start taking ARVs than to default. He said that it was a dangerous minefield that never need be traversed.
“Adherence minimises the risk of the HIV virus from getting resistant to that medication,” said the doctor.
“When the virus resists ARVs the virus adapts to the medication and this results in the medication being ineffective. The virus therefore multiples and is difficult to contain,” he added.
Mr Richman Rangwani the founder of Simbarashe Network of PLHIV said the problem of defaulting was a result of a person not having disclosed status.
“If one has disclosed to any family member, it is difficult to default because someone will ask you if you have taken your tablets.
“So with a defaulter, I see characteristics of someone living in a closet,” he said.
For those on ARVs, if there is anything they do not understand and need clarification, then they should ask their health providers rather than make fatal conclusions to their lives.
May you get understanding.

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