In 1999 when James Onyango walked into his doctor’s clinic and was told that he might have to start taking antiretroviral drugs, he knew he was a dead man. Earning a modest salary, it was not going to be possible for him to raise over Sh 60,000 required for a monthly dose of the drugs.
He left the doctor’s place heartbroken, having resigned to fate. Death for him was just around the corner.
“I thought whether to just commit suicide or not. But a friend of mine who was also HIV positive told me we should not lose hope and die because something might just happen on the pricing of the drugs,” Onyango recalls.
In the same year, Kenya declared HIV/AIDS a national disaster after many years of denial that the disease existed among our midst. The government had feared that any declaration to that effect would hurt the tourism industry, among other interests.
At that time, being diagnosed with HIV was the most devastating news. People would sell everything, resign from work or be sacked if the employers knew one was HIV positive. They would then spend all their savings knowing that they were going to die. The stigma around the disease was so intense that nobody wanted to be associated with HIV or those who had the virus.
But in 2010 and beyond HIV/AIDS is going to be treated more of a chronic disease than a death sentence. With increased access to ARV drugs, people like Onyango whose life has been lengthened since he started the drugs about nine years ago can now hope to live with the disease for another 20 or more years.
Getting infected with HIV is so longer a death sentence. If a person is diagnosed with the virus, the first thought that comes to their mind is not death, but how to live longer and positively. Thanks to the antiretroviral drugs and reduction in stigma about the disease. With the drugs, people can continue leading productive lives and providing for themselves and their families.
The miracles of the ARVs will make people accept the disease as a chronic illness like diabetes or high blood pressure that have to be managed over a lifetime. Effectiveness of ARVs have also made companies to come up with workplace policies after realizing that with good medication and nutrition, their valued employees can continue being productive.
People now openly talk about the disease, and it is not unusual to hear people introducing themselves in public forums as being HIV positive or saying their middle name is HIV/AIDS.
But it has not been easy to reach this far. People living with HIV and governments in developed countries have had to struggle and engage in war of words with pharmaceutical companies to bring ARV prices down. In 2000 before the Intellectual Property (IP) Act that allowed importation of generic drugs was in place, a monthly dose of ARV drugs was going for about US$ 830 (Ksh 58, 100), with less than 1,000 people using the drugs. The costs of the HIV tests were equally high. In private laboratories, costs for tests including CD4 count and viral load was more than US$ 286 (Ksh 20,000).
In a country where over 50 percent of the population is subsisting on less than a dollar a day, the prices were out-of-reach for those who needed them, with a huge number of people dying because they could not access treatment.
These prohibitive prices of drugs saw the AIDS activists launch an aggressive campaign against multinational pharmaceutical companies to bring down the prices, while at the same time advocated for importation of cheap generic drugs from Brazil. The pharmaceutical companies fought any attempts for such importation that would cut into their market of branded drugs.
In 2001, the Intellectual Property (IP) Act, which allowed Kenya to import cheaper generics ARV drugs from Brazil and India, was finally enacted. Although relatively cheap, the price remained a matter of concern to many people, resulting in very few people accessing treatment.
By 2002, only 3,000 people were accessing ARVs, the high cost of the drugs locking out a huge percentage of them.
Slowly, as time passed, the prices of the drugs started to tumble. From about Sh 60,000 a monthly dose, they went down to US$ 15 (Ksh 1,000) in public health facilities, bringing more people into the treatment fold. When the PEPFAR programmme entered the scene in 2004, more than 30,000 of the 200,000 eligible for ARV treatment were receiving the drugs.
The government on the other hand adopted the Kenyan National Clinical Manual for ARV Providers of April 2004, which indicated that generic drugs, Stavudine, Lamivudine, and Nevirapine or Efavirenz, should be used as first line regimen for adults. Stavudine, Lamivudine and Nevirapine or Stavudine, Lamivudine and Efavirenz was to be used as first line for children.
Life was steadily becoming bearable for those who were HIV positive and their families. By 2005, the cost of a monthly dose was about US$ 6.4 (Ksh 450), before dropping to US$ 2.8 (Ksh 200) a few months later in selected government hospitals. By the end of the same year, 1.3 million Kenyans were living with the virus and an estimated one million AIDS orphans were in need of care.
As the country enjoyed the fall in ARV drugs, another challenge emerged. Lack of enough health personal trained to dispense ARV drugs and monitor those taking the drugs. At that time, the Director of National Aids and STD Control Programmee (NASCOP) Dr Ibrahim Mohamed said the biggest challenge on scaling-up HIV treatment was lack of enough trained personnel who could manage people living with the virus.
In 2005, PEPFAR Kenya Country Report on Service and Staffing Gap Analysis indicated the need for an additional 2,241 full time equivalent doctors, clinical officers, nurse, counselors, and laboratory and pharmacy technicians to adequately staff all the Comprehensive Care Centre and do patient follow-up through the network of health centres and dispensaries.
The need for more staffs started to be given greater attention if the country was to put more people on ARV treatment and prolong their lives. As attention shifted to this issue, the number of people on ARV treatment grew. By 2007, an estimated 70,000 people of the 200,000 who needed immediate ARV treatment were on both government and non government ARV treatment programmes.
This translated to 65 percent unmet needs. There was a race to get more people to access the drugs, with an estimated 3,000 people coming onto the treatment programme every month.
Currently, over 250,000 people are accessing free ARVs drugs across the country, treatment centres located deep in the rural areas. The government and other ARV treatment programmes are recruiting a staggering 7,000 new HIV positive patients every month. In 2010, this number is likely to go up with the new rule that requires the threshold for starting a person on ARV therapy raised.
The new requirement wants HIV positive persons to be put on ARV treatment once their CD4 count falls below the 350 mark, which is higher than the current requirement of 200 CD4 count. With such huge numbers coming into the treatment fold, the government is going to be overwhelmed.
The stigma about the disease has too reduced significantly. The concern now is not about a person with HIV dying, but how to access the drugs and manage the side-effects that come with using them.
Still the country is not out of the woods. The HIV prevalence if still high at 7.1 percent, according to the 2007 Kenya AIDS Indicator Survey released last year. It is a prevalence government has to work hard to reduce this year.
The other challenge is, with more people becoming to first line drugs and shifting to expensive second line drugs or to those that have less side-effects, the cost of treatment is likely to be high the coming decade. This means for the country to manage the disease effectively, two things have to happen: ensure treatment and quality care for those currently living with HIV and reduce or eliminate new HIV infections through aggressive prevention programmes.
