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KENYA: Sharing ARVs puts patients at risk of resistance

16 Jan 2009 15:42:37 GMT
Source: IRIN

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KURIA, 16 January 2009 (IRIN) - June and Paul Nyangweso*, a married couple living in the Kuria district of Nyanza Province in western Kenya, both tested positive for HIV recently, but only June visits the hospital to collect her monthly supply of antiretroviral medication, which she brings home and shares with her husband.

"I do not want people to know that I am sick, so we just use her drugs and wait until it is time for her to go for another round," Paul told IRIN/PlusNews at their home.

The couple's improper use of the life-prolonging medication shows: Paul is thin and weak, and June also appears unwell. "At times the nurses who give me the drugs are suspicious that I might not be taking the drugs because they ask me why my health keeps on deteriorating, but I insist I have been taking the medicine," June said.

"We finish the drugs early, but then I wait until the date they wrote for me to go back for more. They have been asking me about my husband but I tell them he is away in Kisii town [a nearby town] working, and that he takes his medicine from there," she added. "But one thing I know is that by the time we finish lying, we will all be dead."

The local hospital teaches treatment literacy, and health workers counsel patients on the need to adhere to their ARV regimens, but Paul insists that he will never visit the hospital for treatment. June says although she knows what she is doing is wrong, she is too afraid of the consequences should she admit it to health workers.

Missing doses of ARV medication heightens the risk of patients developing resistance to the ARVs. To prevent the development of drug resistance, an adherence level of at least 95 percent is recommended for the duration of therapy.

According to Lillian Luseno, the Kuria district AIDS and sexually transmitted diseases coordinator, such cases are rampant because of the stigma associated with being HIV-positive, especially among men in the area.

"From our records, 90 percent of those who come for ARVs are women, yet they don't help them because their husbands insist on sharing the drugs with them," Luseno told IRIN/PlusNews.

"It happens here, and we know [about it], but the only solution would be to make follow-ups on those who take the drugs, but it would be difficult because we do not have the personnel to undertake it," she said.

Kenya has an estimated 25,000 nurses employed in the public and private sector, but an estimated 10,000 additional nurses would be required to efficiently serve the country's 38 million people.

According to Rose Age'ngo, a nurse at the Isibania Health Centre in Kuria, even if the human resources were available, following up couples like Paul and June would be easier said than done: "When you threaten to follow them up, then they disappear altogether and stop coming for the drugs," she said.

"I believe the only permanent solution would be to fight stigma amongst men - we have been collaborating with NGOs here to focus more on eliminating stigma," Luseno said.

A local women's group is trying to reach out to HIV-positive men and women with treatment literacy messages, but say it is an uphill task, particularly in view of the inferior position of women in their society.

Paul, for instance, feels entitled to June's drugs because he believes she is responsible for his HIV status. "She infected me with this disease, and infected our child and so it is her duty to go for the drugs just the way she went for the disease," he said.

Esther Onsongo, spokesperson for the local women's group, told IRIN/PlusNews: "Our work [is] even more difficult, given the fact that our network of volunteers is just women."

Nyanza Province is one of the poorest regions in Kenya, so food shortages, extreme poverty and illiteracy contribute to non-adherence to ARVs. The region is also the hardest hit by HIV, with a prevalence of 15.3 percent, more than double the national average of 7.4 percent.

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