HIV Patients Forced to Pay Up or Go Without  

PlusNews

October 5, 2010

Zimbabwe

Rampant corruption in the provision of life-prolonging antiretroviral (ARV) drugs and other HIV services is threatening Zimbabwe 's national AIDS response according to a recently released report by a local human rights group.

Commissioned by the Zimbabwe Lawyers for Human Rights (ZLHR) in March 2010, the report - Corruption Burns Universal Access to Treatment - found that 73 percent of HIV-positive respondents had been asked to pay bribes by health workers. Most of those unwilling or unable to pay were turned away or given inadequate services.

Nurses at government hospitals and clinics were identified as the chief culprits, but support staff, including nurse aides and administrative personnel, were also implicated; doctors were rarely involved.

The findings were based on interviews with 1,024 people living with HIV in the provinces of Masvingo, Harare , Bulawayo and Manicaland. Most of the respondents lived in urban areas and 89 percent had a family income of less than US$100 a month.

Of the 747 respondents who had been asked for bribes, 57 percent were trying to access drugs, mainly ARVs; 24 percent needed diagnostic services; and 19 percent were asked for money to be enrolled in HIV programmes. The authors noted that the long waiting lists for enrolment at many hospitals drove desperate patients to pay bribes as high as $100.

HIV patients were often asked to pay for services that were supposed to be free; sometimes they were told that certain drugs were unavailable or that diagnostic equipment was broken until they paid a bribe, after which the equipment was declared functional and the service was given.

About a third of the respondents who were asked for bribes refused to pay them, mainly because of poverty; as a consequence, 63 percent were denied the service and had to pay for drugs or diagnostic tests in the private sector, or on the black market, or go without.

"The research findings reinforced the view that corruption in healthcare discourages treatment, testing, and other health-seeking behaviour," the researchers concluded.

"In these circumstances, the general attitude has been observed to shift towards resentment and resignation by [people living with HIV], who then give up on accessing essential medicines and diagnostic services."

Call for action

Martha Tholanah, an HIV/AIDS activist and member of the Zimbabwe Network of Positive Women, said the report shed light on a problem that HIV-positive Zimbabweans had been experiencing for "quite some time".

She told IRIN/PlusNews that there was a need for a system that would electronically record when patients collected their ARV medication. "This will weed out corrupt elements among health workers, and among people living with HIV."

The programme manager of the HIV/AIDS, Human Rights and Law Project at ZLHR, Tinashe Mundawarara, said: "The danger of these practices is that they create disincentives to invest in public health." He added that health workers were engaging in corrupt activities partly to subsidise their low salaries, but this should not be an excuse for government not to take action.

The report called for the government, civil society and Zimbabwe 's Anti-Corruption Commission to take urgent measures to curb corruption in the health sector.

"If treatment is made conditional on corrupt practices, it could well be that the lives of those who cannot afford to pay bribes will be endangered," the authors noted, adding that the issue was even more pressing in Zimbabwe which has an estimated adult HIV prevalence of 14 percent.

Health minister Dr Henry Madzorera told IRIN/PlusNews he could not comment until his ministry's own investigations had confirmed any reports of corruption. "As a matter of policy our ministry will look into this matter thoroughly, and we urge members of the public to assist us by reporting to the police any corruption." 

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