ACCESS TO TREATMENT BY PEOPLE LIVING WITH HIV IN ZAMBIA Presented by: Kunyima Lifumbela Banda Network of Zambian people living with HIV/AIDS (NZP+)

Introduction l Government with support from Co- operating partners has been providing free ART in public health institutions in l The number of public and private facilities providing related services such as CD4 counts has also grown l There has also been an increase in the supply of HIV-related services in both rural and urban areas

Cont… l Increase in access to medication for prevention and treatment of opportunistic infections such as TB

Overview of ART Situation l 1 million people living with HIV in Zambia l 368,821 PLHIV accessing treatment l 57% are women l 31% are Men l 27,419 children 0 – 14 years

Cont… l 96% on 1 st Line treatment l 4% on 2 nd line treatment l Under 1% on 3 rd Line treatment l 69% urban l 31% rural l 54% receive care at health centre level

Facilities Providing HIV related services l About 1,800 health facilities in Zambia (Government, private, NGOs) l 1,468 provide VCT l 1,253 provide PMTCT l 484 provide ART l 297 provide pediatric ART

Conti… l 150 facilities provide CD4 l 3 sites provide PCR testing – UTH, Kalingalinga and Arthur Davies Hospital l 2 sites provide viral Load – UTH and Kalingalinga

Facilities soon to provide Viral Load and PCR l Chipata General Hospital l Ndola Central Hospital l Mansa General Hospital

NZP+ Survey on Access to Medical services l NZP+ conducted a survey access to medical services by people living with HIV in 12 districts. l Survey was conducted among people living with HIV l Objective was to get experiences from PLHIV on access to treatment

General Information l 59% of people interviewed were women l 98% were above the age of 30 l 60% single (unmarried or widowed)

Information on ART l 98% where on ART l 40% did not know the name of drugs they were taking l Less than 1% were on second line treatment l 66% did not frequently get a CD4 test done l 60% did not know their CD4 count l 19% get information from the support groups l 24% from medical staff

Cont.. Reason for testing l 62% tested after a long illness l 11% referred after TB treatment Distance to ART centres l 12% within 10km l 75% above 20km

Access at health facilities l 70% indicated 3 hours as minimum time before seeing medical personnel l 48% saw a clinical officer on appointment days and 25% say a nurse l 60% felt that time spent with the medical personnel was not enough but generally expressed satisfaction with the ability to express themselves.

Cont… In the PLHIV Stigma Index study: l 8.4% of respondents reported being denied health services (including dental services) l 9.7% of the respondents reported having been denied family planning services as a result of their HIV status l 11.8% indicated that they had been denied sexual and reproductive health services.

Challenges Departure – DemandTravel – LinkagesArrival – Supply side Stigma Traditional and culture beliefs Religious beliefs Inadequate knowledge and information on treatment and other services Poverty Gender based violence Stigmatisation of young PLHIV Geographical features such as islands, plains, floods in the rainy season, sand, mountains Long distances of 45Km – 100 Cost of travel – resources shared between travel and those remaining at home, accommodation Few centres providing ART services Long queues, long waiting hours Missing files, missing results Inadequate information given to patient Inadequate staff to attend to patients Stand alone services

Challenges Departure – DemandTravel – LinkagesArrival – Supply side Physical challenges – tiredness, stress, fatigue Vulnerability of women when travelling Limited referral within facilities for different services Stigmatisation of young PLHIV by health personnel Long waiting time to access results especially for children

Our Role in increasing uptake of services l Advocacy for increased ART l Community Mobilisation l Community preparedness Information provision Treatment literacy l Community Referral l Contribution at health facilities Pre and post test counselling Adherence support Referral Record keeping l Linking PLHIV to business development services

l Scale up access to treatment as close to people as possible l Need for integration of services - HIV, TB, MCH, SRH services l Scale up testing and treatment for children and adolescents l Scale up availability of pediatric formulae l Scale up support to community initiatives l Promote treatment as prevention Our Recommendation