Third-line ARVs problems in Zambia, the case of Ephraim Banda
Before Zambia’s public health sector started providing free antiretroviral drugs (ARVs) to people living with HIV, Ephraim Banda, in the picture, bought his own medication. But his supply was often interrupted and the available drugs changed frequently and he is now one of a growing number of HIV-positive Zambians who have developed resistance to both first- and second-line ARV drug regimens.
Third-line regimens are often unaffordable or unavailable to people living with HIV in developing countries. Banda spoke to IRIN/PlusNews about his experience of running out of treatment options.
“I started [taking] ARVs in 1999; my brothers were purchasing the drugs. I remember the cost was about 800,000 Kwacha [US$168] a month. Sometimes we didn’t have money and sometimes we didn’t know if it was the correct drug. My relatives were just buying for the sake that these were ARVs… we didn’t have more information.
“In March 2004, I started [on government-subsidized treatment]… I also got involved in sensitization and started working with support groups. TALC [the Treatment Advocacy Literacy Campaign] was the first group to train me in treatment literacy. From that point I understood that maybe looking back, [my] adherence was poor from the start.
“I was changed to second-line treatment in about 2006… until my CD4 count began dropping last year. I was put on [a new drug combination] and that went well but unfortunately I developed kidney problems… I almost had kidney failure. What I am taking [now] is second-line but it’s temporary – the third-line drugs we don’t have in Zambia.
“I’m at a CD4 count of 16… basically it’s a miracle to see me walk. When I am speaking to you like this, it sounds like I live a day-to-day life [but] there’s a component of looking for money for drugs, or for nutrition – looking to have a happy life.
“Do you know how frustrating it is to know that my health is going down every day? Maybe the drugs will be here Friday, or next month – no one is promising anything.
“I still have support from my family – my wife’s been too supportive and everybody, my children, they’ve been there for me, [and] the clinic where I work. Whenever I feel bad, if I’ve run out of cash or something, they’ll be there to help me and this is what frustrates me… I want to work, not just be dependent on people.
“I have an initiative dealing with the youth that has an HIV prevention component… implementation has been slow because of my illness. Now [at the clinic] they’ve also given me this ‘youth-friendly corner’ they want me to revamp. I’m hoping I will achieve that goal. I wouldn’t mind seeing the project move forward so I can leave a legacy; that at one time, people could say, ‘This was Ephraim’s project’.”