01 October 2007

how the dying get drugs and the healthy get dying

The trial of our friend who was recently diagnosed with HIV/AIDS has given us a new insight into how the system here works and why it is so frustrating.

She goes to the hospital every couple of weeks and they do a blood test to find out her level of some cells that are apparently a reliable indicator of health.

The government policy (as agreed to by donor countries like the US) is that only the most critical patients get issued life-prolonging Anti-Retroviral Drugs (ARVs). This is judged by a single number. If your “count” is over 300, you get issued ARVs at no cost. Anything less and you are simply treated for whatever symptoms may arise.

So our friend, a single mother of three young children, goes to the hospital and gets tested. She scores a 270, right on the cusp of being eligible for ARVs. They tell her to come back in two weeks and, irrationally, to hope that her condition has worsened enough to become eligible for drugs.

This week, she returned to the hospital (remember that this is no small task – one must find transportation or make an hour walk and then miss a whole day of work while leaving one’s children unattended all while enduring the small humiliation of admitting to the world again that one is infected) to find that her count had dropped into the low 100s.

She felt no healthier. Her situation had become no less dire. Yet a number says she cannot have ARVs. And in the queue, a man with no family, no dependents, scores a 441 and gets given ARVs.

The problem there is that this man’s health is probably beyond the help of drugs at that point. Yet, he receives them. All the while, relatively healthy people are told to wait until they are deathly ill before they will be given drugs that will come to late to help anyway. All of this on top of the fact that familial situation is not even taken into account.

We’re confronted with AIDS everyday. We are beginning to see all of the little issues that coalesce to make AIDS such an enormous problem.

Tomorrow, we’ll give another.


  1. Not that it's all that important, but I was under the impression that the policy was that your CD4 count had to be below 200 in South Africa to merit receiving ARV's. Maybe the policy changes depending on whatever hospital system you're in. The thing is, the lower the CD4 count, the sicker you are. If you have a CD4 count of 2, you're on death's door. Do you think that this particular hospital only gives medication to those who are likely to get better?

  2. Ya...I was totally upside down. The principle is the same, but my numbers were backwards. Stef corrected me too.

    So, her count was too high for drugs and some dude with a CD4 of 2 is getting drugs.

    Thanks for the clarification.

    As a side note (a really positive one), our friend tested again and will begin receiving ARVs at the end of October. She's been very sick though, so we hope she makes it to that point...