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the above. For countries depending on donor funding the story is thus different. However, there are guidelines set by the World Health Organisation which give a framework and stipulate the regulatory methodology to ART dispensing recently given.

WHO last month issued new guidelines at the 7th International Aids Society Conference on Pathogenesis Treatment and Prevention that took place in Kuala Lumpur, Malaysia.

The Global Network of People Living with HIV (GNP+), the International HIV/Aids Alliance (the Alliance), and Stop Aids Now! (SAN!) welcomed WHO’s new guidelines on the use of a ART for the treatment and prevention of HIV.

They called on governments, multilateral and bilateral agencies and donors to ensure that communities are meaningfully engaged as countries implement these new guidelines.

The guidelines recommend that people living with HIV can start ART with a CD4 count of 500 cells/mm3 or less compared with a CD4 count of 350 cells/mm3 or less previously (2010 WHO ART Guidelines).

Starting treatment earlier has shown to slow clinical progression, also reduces the chance of life threatening conditions such as tuberculosis and has the added benefit of reducing the risk of HIV transmission.

The guidelines also recommend offering treatment regardless of CD4 count (immediate treatment after HIV diagnosis) to pregnant women, people living with TB or hepatitis B, children under five years old, and people in relationships where one partner is living with HIV and the other is not (discordant couples).

Tendai Westerhof, regional co-ordinator of Women’s Health, HIV and Aids Southern Africa (WHHASA) who attended the conference, said the news was welcome but needed to be weighed on a country by country basis.

Speaking last week in Harare, Westerhof said that positive health, dignity and prevention must be at the forefront as we ensure that quality of life is ensured.

“We welcome the new WHO guidelines. We also demand positive health, dignity and prevention to be enforced. Nutrition plays a big part in positive living and this has to be scaled up. It is also critical that as a country we talk of prevention and aim to have zero new HIV infections. For positive living, re-infection must be emphasised because it is not only a matter of one being on treatment but also not getting re-infected,” said Westerhof.

She said needs differed from country to country even if found in the same region.

“We need to have a country audit, we are different from Mozambique or South Africa even if we are in the same region.

“We have had people on treatment for a couple of years now and for them their viral load is now undetectable. This means a different machine is needed for the care of such a patient.

“We surely need CD4 count machines but today in the same vein we also talk of the need for viral load diagnostic equipment at point of care centres. This is not the case, so instead of rushing to implement new guidelines a thorough Zimbabwe-based audit has to be taken so that we make informed decisions,” said Westerhof.

With the 2010 WHO guidelines Zimbabwe has 593 000 people waiting to be initiated on ART.

The main ART funding in Zimbabwe is donor driven. We have the Aids Levy which is a domestic harness of funds. Of a gainfully employed taxable income (3 percent of PAYE) is levied to the fund.

Last year the levy collected US$32 million.

The fund has other partners who make it possible to provide ART to those in need and these are the Global Fund, PEPFAR, MSF, UNAids, the Melinda and Bill Gates Foundation, the Elizabeth Glaser Foundation which specifically deals with the prevention of HIV from mother to child transmission. These and various stakeholders not mentioned have made it possible for Zimbabwe to provide ART to nearly 600 000 people. Zimbabwe has a population of 12 million and of these 1,2 million are HIV positive.

The guidelines recognise the constraints of health systems to deliver the optimal standard of care in resource poor settings and gaps remain in treatment coverage. For this reason governments and donors must ensure strategic investments that support and scale up effective community based interventions such as peer outreach workers, community based testing, treatment literacy projects, community advocacy that improve people’s ability to know their HIV status, and to access quality treatment and care that they need to stay healthy.

A doctor speaking on condition of anonymity said that the new recommendations needed to be weighed on patient to patient understanding and requirements.

He said that he would not rush to place a patient with a CD4 count of 500 on ART as this would result in other challenges.

“ART is for life I would not rush to put a patient with a CD4 count of 500 on ART.  This means the patient is going to take medication for life.

“There is a real danger that one person who had no problems can default on taking their medicine if they have severe reactions to the medicine.

“If this happens then there is the danger that the person has to be moved to second line which is expensive. As a country we ought not to take this wholesome. In a bid to save lives we may end up with a catastrophe on our hands,” he said.

The doctor also said that he feared overloading the body as medicines would be taken for a longer period.

“I would rather start a patient on ART when they are in need. There is a danger of drug toxicology and these can damage the internal organs.

Liver test has to be done regularly and when the liver is overloaded because a patient was prematurely put on lifelong drugs, this would be an injustice of medicine. Patients trust doctors and for me that is not proper,” he said.

Mrs Amilla Chani, who has never been tested before, said the new guidelines were welcome. She said she always feared being told that you are not yet eligible for ART in case she tested HIV positive.

“I am going to get tested now. I was scared that were I to test HIV positive and be told that you are not yet eligible for ART would I be in a position to handle the situation.

“So I think this is a relief to many who were scared of getting tested. I now know that I can be started on medicine before I am sick,” said Mrs Chani.
Julia, who only preferred to be called by her first name, said for the youths this was indeed welcome.

“I feel empowered because I now know that in the case that I test HIV positive I am in a position to get treatment before I am ill,” she said.

She said she had read that in the First World people get on treatment before they are ill and always longed for such a scenario.

Hoping that as a country we weigh and audit the risk and benefits of the new guidelines before wholesome changes.

l Email: [email protected]