JOHANNESBURG, South Africa- According to a “Stop the Stock-Outs” report by several NGOs released just three days before World AIDS Day, one in five South African clinics are experiencing shortages of life-saving HIV/AIDS medications. Shortages are estimated to affect half a million South Africans.
On average, stock outages are lasting 30 days, causing some patients to go weeks without the antiretroviral (ARV) drugs that rely on adherence to a strict schedule to be effective. Missing doses can have deadly affects; the body builds up resistance to the drugs, making them ineffective at combating the disease, and patients are at heightened risk for developing other HIV-opportunistic illnesses.
South Africa has one of the highest rates of HIV/AIDS in the world, with more than 5.5 million people in the country living with the disease. Nearly 20 percent of women of reproductive age in the country are HIV positive.
The South African government, which distributes more ARV drugs than any other country, has struggled to keep up with increasing demands. Although there have been huge distribution increases within the past four years—the number of people receiving ARVs rose from 923,000 to 2.4 million people, and the number of clinics and hospitals offering the medication went from 490 to 3,540—there are still millions of people who do not have access to live-saving medications. There are simply not enough drugs.
Health care staff borrow medication from other facilities when stocks are low, and ration available supplies among patients. The result is that many who cannot afford it are forced to pay additional travel costs to make more frequent trips to clinics and health centers. Many patients are turned away, with no medication, after making the trip. This can leave many unable, or frustrated and unwilling, to continue treatment, and destroys the trust between medical professionals and their patients.
In addition to shortages, the rise in popularity of a cheap but potent street drug, known as “nyaope” or “whoonga,” that mixes crushed ARV pills with heroin and marijuana has caused medical center break-ins and thefts. Drug smugglers are also invested in getting their hands on the medications, which the South African government provides for free, so they can sell them for a profit in neighboring countries. Some corrupt medical professionals have also taken to selling the drugs to desperate patients.
Differing definitions of what constitutes a “stock-out” also hurt patients. Because the Department of Health only classifies a complete absence of drugs as a stock-out, many facilities are left to deal with extremely diminished supplies for long periods of time without assistance. This arbitrarily limiting definition of “stock-outs” may have also skewed the scale of the problem in previous reports on shortages.
It is clear that in addition to more medication, better oversight of the financial and distribution processes is necessary, said Thokozile Madonko, head of the civil society Budget Expenditure Monitoring Forum.
“Without sound internal financial control, an environment of abuse, misuse, and corruption can flourish,” Madonko said. “It is without a doubt that the financial control environment within these provinces is a contributing factor to the poor delivery and supply of medicines.”
The South African government must address these oversight issues or its people will continue to suffer. However, even perfect regulations cannot make up for devastating drug shortages. Stock-outs remain a principal barrier to maintaining effective treatment programs. The problem is complicated, but making huge strides towards a solution is simple—first and foremost, South Africa needs more ARV drugs. Check out the South African-based organization Treatment Action Campaign, which works towards improving prevention and treatment of HIV/AIDS, and donate to save lives today.
– Sarah Morrison
Sources: Al Jazeera, Business Day, The Pharma Letter, The South African Health News Service, Stop Stock-Outs Report, Treatment Action Campaign
Photo: South Africa Aids Foundation