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Myths on HIV: Is there special ARV pills for rich people?

YEARS ago, people with HIV did need to take a lot of pills. Now, most people starting on HIV treatment take one to four pills daily. You may be able to take medicines that combine two or three drugs in a single pill.

The amount of pills that people living with HIV/Aids must take, has stuck around, largely driven by how long a cure for the disease has taken. When people are discussing the virus, the common assertion I’ll; you’ll have to take dozens of pills every day.

This month, Zimbabwe joined the world to mark World Aids Day, December 1. As Zimbabwe joins the global community in commemorating World AIDS Day, results from the second Zimbabwe Population-based HIV Impact Assessment survey (ZIMPHIA 2020), released today demonstrate the nation’s continued progress towards achieving HIV epidemic control by 2030.

ZIMPHIA 2020 found that 86.8 percent of adults living with HIV were aware of their status and of those aware of their status, 97.0 percent were on antiretroviral treatment. Among those on treatment, 90.3 percent achieved viral load suppression.

As of October 2020, the rate of annual new HIV infections among adults in Zimbabwe was 0.38 percent (0.54 percent among women and 0.20 percent among men) or approximately 31,000 persons over a year. The prevalence of HIV among adults was 12.9 percent, which corresponds to approximately 1.23 million adults in Zimbabwe living with HIV in 2020.

Generally, HIV prevalence is higher among women than men (15.3 percent vs. 10.2 percent) in Zimbabwe. In the coming decade, Zimbabwe is well-positioned to achieve the UNAIDS goal to end the AIDS epidemic by 2030, as it continues to intensify its efforts to expand HIV testing services and access to life-saving treatment.

The ZIMPHIA 2020 summary sheet is now available on the PHIA website at CLICK HERE.

Led by the Government of Zimbabwe through the Ministry of Health and Child Care (MoHCC), the survey was conducted between November 2019 and March 2020. ZIMPHIA 2020 was conducted with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical assistance from and partnership with the U.S. Centers for Disease Control and Prevention (CDC), and implementation by ICAP at Columbia University and national institutions.

The health ministry says everyone in Zimbabwe who needs ARVs, no matter the type of drugs needed depending on their viral status, is getting them free of charge, even when these medicines are highly expensive.

But then, is everyone accessing the same medicines, or there are some taken by rich people? One of the supposed myths out here is that there are medicines taken by rich people, whereby they swallow a single pill for months.

“This is a nationwide service; there is no Rwandan who buys their own HIV medication. The government buys for everyone who needs it,” said Air Commodore, Dr. Jasper Chimedza, Permanent Secretary, Ministry of Health and Child Care (MoHCC).

“The treatments we have in Zimbabwe are World Health Organization approved standards. It is the same medication being given elsewhere.”

Available ARVs in Zimbabwe

According to the UNAIDS, despite dozens of antiretroviral therapies developed, “Different classes of antiretroviral medicines work against HIV in different ways and when combined are much more effective at controlling the virus and less likely to promote drug-resistance than when given singly.”

Here, combination is made with at least three different antiretroviral medicines which most scientists consider as a ‘standard treatment’ for all people newly diagnosed with HIV.

In Zimbabwe, the list of ARV medications available is shown below. The ARVs available in Zimbabwe are classified in four types, as:

  1. Nucleoside reverse transcriptase inhibitors (NRTI): Tenofovir (TDF), Abacavir (ABC), Lamivudine (3TC), Zidovudine,…
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Efavirenz (EFV), Nevirapine (NVP).
  3. Protease inhibitors (PI): Atazanavir(ATV), Darunavir(DRV), Lopinavir/ritonavir(LPV/RTV)
  4. Integrate inhibitors (II): Raltegravir, Dolutegravir

The combination, as to which type and how many tablets a person takes, depends on their viral status and age.

Dr Chimedza explained: “For example, a person recommended to take Tenofovir(TDF)-Lamivudine(3TC)-Dolutegravir(DTG), is given a single tablet that combines all these named. The person takes that single pill daily at a specific designated time.”

However, there are some patients, considering their situation, who could be put on a regiment where they take 2 tablets daily at a specific time.

To illustrate further, we identified case of a young person or child. Depending on a host of other factors mainly their weight, that child will be required to take 1 tablet or two.

“There is no uniform prescription for everyone. Each person requires individualised treatment plan which has to be monitored constantly, as it could reach a stage where it has to be changed,” said Dr Chimedza.

Does the state cover all treatment costs? YES!

Dr Chimedza explains: “It doesn’t mean that even though people get this medications free of charge, then they are cheap. Government spends lot of money on these medications. I think people can vividly remember the period, not long ago, when HIV treatment was not available for everyone.”

In recent months, there have been developments about new research on the therapies due on the market. In the UK, the government is scheduled to approve an injection.

Cabotegravir (also called Vocabria and made by ViiV Healthcare) and rilpivirine (also called Rekambys and made by Janssen) are given as two separate injections every two months, after an initial phasing-in period, reported the BBC.

However, the treatment is only suitable for those who have already achieved undetectable levels of virus in blood while taking tablets.

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