Distribution of Antiretroviral drugs in Zambia : An ethical investigation

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Chomba, Crispin
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There were about 40.3 million people living with HIV/AIDS in the world by the end of 2005, and approximately 95 per cent of them live in developing countries. During 2004 alone nearly three million people died of AIDS related illnesses in the world and a similar number of deaths were experienced by the end of the year 2005. Sub-Saharan Africa is by far the worst affected in the world by the AIDS epidemic. This region accounted for about 64 per cent of all people living with HIV by the end of 2005. In Zambia 920,000 adults and children were living with HIV and AIDS by the end of 2004.Many of these deaths can be prevented by providing access to adequate treatment with antiretroviral drugs (ARVs) for opportunistic infections The Zambian government declared its commitment to provide antiretroviral drugs for all people in Zambia who need them. However, despite government commitment, antiretroviral drugs are accessible only to a minority of those who need these drugs. Currently there are about 200,000 people in Zambia who need antiretroviral drugs. However, as of January 2005, only about 15,380 of those people who need ARVs were put on treatment. This means that only a few of those who need ARVs have access to them and this raises the question of how these scarce drugs ought to be fairly distributed among the many people who need them. On the basis of this background, the main objectives of this study are firstly to assess the current government distribution policy of antiretroviral drugs in Zambia from an ethical point of view and secondly to suggest ways in which this distribution mechanism could be improved. In order to achieve these aims the dissertation is designed as follows: chapter one highlights the current HIV and Aids situation in Zambian in relation to antiretroviral treatment and shows that even though there are many people who are infected and need antiretroviral treatment, only a small number of these patients are put on treatment. The second chapter explains how ARVs are currently distributed in Zambia. Its main finding is that there is no written policy on distribution of antiretroviral drugs in Zambia. However, a mechanism of distributing these drugs exists. In chapter three an attempt is made to critically evaluate the Zambian mechanism of distributing ARVs. Its strength and weaknesses are explained in a detailed way. The main strengths with Zambian mechanism of distributing antiretroviral drugs are that currently these drugs are distributed to patients free of charge. The distribution of ARVs is demand driven and thus prevents wastage of these drugs. The other strength is that each patient is given equal rights in receiving ARVs. The major weakness with the system is the lack of a specific policy of distributing these drugs. The other weakness is the use of first-come-first-served principle in distributing ARVs to patients. It has also been established through the study findings that the Zambian ART distribution system has largely used the clinical and lacks ethical considerations in administering of these drugs. In the last chapter, a number of recommendations are made on how the current system of distributing antiretroviral drugs could be improved. These suggestions are based on analysis of various distribution principles.
Antiretroviral agents , HIV/AIDS -- Zambia , Ethics , Retroviruses , Antiretroviral agents