HIV costs crippling the Bay’s hospitals
THE surge in the number of people dying from Aids and HIV-related illnesses is crippling Nelson Mandela Bay hospitals – and doctors say it will only get worse.
There are 24400 state patients in Mandela Bay on antiretroviral treatment (ART). But an increasing number of these patients default on their medication, resulting in drug-resistant strains of HIV.
One in every 10 residents – 125300 – is HIV-positive, according to Statistics SA, while for pregnant women the figure is one in three.
ART is necessary once a patient’s CD4 count drops below 200. In the Bay, 20% (about 25000) of HIV-positive residents need ART. Of those, 666 are on the waiting list for treatment, officials say.
ART patients in the city typically spend a day queuing once a month at a clinic or day hospital, waiting for a check-up and to receive their cocktail of ARVs.
But even a day in line does not guarantee that they will receive their life-saving medication.
“We queue with patients who are seriously ill and need to be attended to urgently by a doctor or nurse,” said HIV-positive Babalwa, 28, of Kwazakhele.
“By the time we get to the dispensary (which closes at 4pm) it is sometimes too late for us to get our medication and we are told to come back the next day.”
Another HIV patient, Bafundi, 24, of Kwazakhele, said sometimes not all the medication was given out at once. “When this happens, you have to come back the following week. Nurses will give you tablets to last you a week, then you have to come back again for the full medication which normally lasts a month.”
A recent report to the district health council shows Mandela Bay way behind its target of testing 200000 residents for HIV and Aids last year, reaching just 30%.
The number of people medically noted as dying from Aids and HIV-related illnesses in the Bay has risen from less than five a year in 1990 to 463 last year.
But clinicians and researchers say this is just a tiny fraction of the true picture, as most HIV- and Aids- related deaths are attributed to “opportunistic diseases” like pneumonia.
Despite the lack of firm statistics, research by the Acturial Society of SA’s Aids Committee suggests that the true number of Aids deaths in the Bay is closer to 8000 a year.
Provincially, according to Medical Research Council data, about 40000 people are recorded as dying each year from complications arising from HIV and Aids. Nationally, 314000 people were officially recorded as dying from Aids and HIV-related illnesses in 2009.
Specialists also say the city is far from reaching the national goal set in 2009 by President Jacob Zuma of giving ART to 80% of the people needing it by the end of this year, with only 30% of residents aware of their HIV status.
The Eastern Cape Health Department says the figure of people receiving ART is closer to 60%, with the 80% target “achievable”.
“We are seeing more deaths than 10 years ago because (HIV and Aids) sufferers have progressed in their stages of the disease (over the years of not receiving treatment),” said Dr Kas Kasongo, Mandela Bay office chairman of the Southern Africa HIV Clinicians’ Society.
“HIV prevalence has plateaued since 2005 and in the 15-to-25-year age group (the largest for new infections) there has been a real decline in new infections, but there is a lag between this and the decline in the death rate.”
Despite the infection rate plateauing, researchers warn that patients’ increasing habit of defaulting on ARVs is causing a new drug- resistant strain of the disease.
With a cocktail of about 20 ARV drugs available to sufferers, a shortage of staff and other resources amid sweeping departmental budget cuts has seen nurses unable to check up on patients’ ARV regimen.
Doctors say the result is that patients, whose CD4 count has risen to above 200 again due to the drugs, stop taking their medication and their CD4 count drops again. However, when they start ARVs again, they become immune to the cheaper and more widely used ARV dosage.
The CD4 count for receiving ART is due to be lifted from 200 to 300 by the state this year.
Kasongo said another poverty- related crisis which saw patients default stemmed from the R700 government grant for HIV/Aids sufferers with CD4 counts below 200.
“Clinicians are reporting that patients are defaulting on medication as soon as their CD4 counts rise above 200 in a desperate bid to retain their monthly grant.
“As more and more people default (on their ARV treatment), we will battle with a drug-resistant form of HIV,” Kasongo said.
State ARV patients are costing the government R400 monthly for their medication, although Kasongo said their specialist treatment by doctors and specially trained nurses, as well as the cost of the clinics, meant “more than just ARVs” added to the overall cost of patient care.
Additional reporting by Khanyi Ndabeni
