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Difficulties in Providing Antiretroviral (ARV) Medication to HIV-infected Healthcare Workers in Harare, Zimbabwe

J. Hakim1, M. Charles2, T. Flanigan3, I Gudza4, B. Boyle5

1University hospital of Harare, Harare, Zimbabwe; 2International Center for Equal Healthcare Access (ICEHA), New York, NY, United States; 3 Miriam Hospital, Brown University, Providence, RI, United States; 4University Hospital of Harare, Harare, Zimbabwe; 5NY Presbyterian Hospital, Cornell-Weill Medical College, New York, NY, United States

Issues: Zimbabwe has an adult HIV prevalence rate of 24%. Healthcare provision in Zimbabwe is increasingly hampered by HIV-infected healthcare workers becoming ill or succumbing to AIDS. Most healthcare workers lack the financial resources required for ARV therapy and health insurance is available to only 20% of the population.

Description: To stem the loss of healthcare workers in Zimbabwe due to HIV/AIDS, a program was instituted to provide free ARV therapy to HIV-infected healthcare workers while they remain in the care of their physicians. There were funds available to procure ARV therapy for 10 individuals per year commencing in January, 2003. By December, 2003, generic ARV drug supplies had been procured and 5 HIV-infected healthcare workers had been screened. To this date, however, despite active efforts to recruit participants, only 4 individuals have been admitted to the program and provided with ARV therapy. Those individuals enrolled are doing well and are back at work. Information collected to date indicates that enrollment of HIV-infected healthcare providers into the program has been hampered by stigma, fear of disclosure of HIV status and job loss, program publicity and the possible impact on the reputation of the hospital.

Lessons learned: The provision of HIV therapy in developing countries, even if provided for free, may be significantly hampered by fears of HIV-infected individuals regarding the social and economic impact of their disclosure of their HIV status even when these HIV-infected individuals have a solid understanding of the medical system and of the value of treatment.

Recommendations: Further studies are needed to assess the reasons why HIV-infected individuals, including healthcare workers, refuse ARV therapy in developing countries. Preliminary data indicate that fears of stigmatization are a major reason for refusing to disclose HIV status. Efforts need to be made to improve acceptance of ARV therapy, including efforts to stress privacy and overcome stigmatization.