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ICEHA's Programs
Difficulties in Providing Antiretroviral (ARV)
Medication to HIV-infected Healthcare Workers in
Harare, Zimbabwe
J. Hakim1, M. Charles2, T. Flanigan3, I Gudza4,
B. Boyle5
1University hospital of Harare, Harare, Zimbabwe;
2International Center for Equal Healthcare
Access (ICEHA), New York, NY, United States; 3
Miriam Hospital, Brown University, Providence, RI,
United States; 4University Hospital of Harare, Harare,
Zimbabwe; 5NY Presbyterian Hospital, Cornell-Weill
Medical College, New York, NY, United States
Issues: Zimbabwe has an adult HIV prevalence rate
of 24%. Healthcare provision in Zimbabwe is increasingly
hampered by HIV-infected healthcare workers becoming
ill or succumbing to AIDS. Most healthcare workers
lack the financial resources required for ARV therapy
and health insurance is available to only 20% of
the population.
Description: To stem the loss of healthcare workers
in Zimbabwe due to HIV/AIDS, a program was instituted
to provide free ARV therapy to HIV-infected healthcare
workers while they remain in the care of their physicians.
There were funds available to procure ARV therapy
for 10 individuals per year commencing in January,
2003. By December, 2003, generic ARV drug supplies
had been procured and 5 HIV-infected healthcare
workers had been screened. To this date, however,
despite active efforts to recruit participants,
only 4 individuals have been admitted to the program
and provided with ARV therapy. Those individuals
enrolled are doing well and are back at work. Information
collected to date indicates that enrollment of HIV-infected
healthcare providers into the program has been hampered
by stigma, fear of disclosure of HIV status and
job loss, program publicity and the possible impact
on the reputation of the hospital.
Lessons learned: The provision of HIV therapy in
developing countries, even if provided for free,
may be significantly hampered by fears of HIV-infected
individuals regarding the social and economic impact
of their disclosure of their HIV status even when
these HIV-infected individuals have a solid understanding
of the medical system and of the value of treatment.
Recommendations: Further studies are needed to
assess the reasons why HIV-infected individuals,
including healthcare workers, refuse ARV therapy
in developing countries. Preliminary data indicate
that fears of stigmatization are a major reason
for refusing to disclose HIV status. Efforts need
to be made to improve acceptance of ARV therapy,
including efforts to stress privacy and overcome
stigmatization.
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