Zimbabwe’s Ministry of Health and Child Welfare is letting crucial HIV/Aids drugs expire in government hospital pharmacies as thousands of desperate patients battle to access the life-prolonging drugs, a Daily News on Sunday investigation has established.

An investigation on the anti-retroviral (ARV) drugs distribution network in Harare and Chitungwiza has established that many people living with HIV/AIDS were resorting to getting drugs on the black market, while tonnes of drugs are expiring in government pharmacies.

Minister of Health and Child Welfare Henry Madzorera admitted that hospitals were stocking expired drugs, but said this was done for accounting purposes.

“What I can say is that it is possible for expired drugs to be found in government hospital pharmacies. They can even take years in storage until officials from the Ministry of Finance board come and audit their value,” he said.

“The reason is that the finance ministry is the one which gives us funds to procure drugs. This may take long, because of capacity,” said Madzorera, adding that his ministry would investigate any cases of people diverting such drugs.

An estimated 1.2 million adults and children live with HIV/AIDS in Zimbabwe, according to Medicins Sans Frontieres, which operates HIV/AIDS programmes in health clinics around the country.

Of the 1.2 million people, 600 000 are in urgent need of ARVs but only half of these are receiving drugs on the government programme.

The situation for many of these people is dire, as one of the drugs that has been given to thousands of patients is being phased out.

At the moment, the rights of people living with HIV/AIDS are not adequately recognised in the country’s laws, although they are covered under the constitutional provision of the right to health.

However, HIV/AIDS activists have been calling for an expanded bill of rights in the new constitution with provision for non-discrimination, equal protection before the law, free and uninterrupted antiretroviral therapy, adequate food and access to qualified medical professionals.

Our investigation discovered a skewed distribution channel which is not user-friendly, prone to corruption, generally slow, and insensitive to the needs of people living with HIV/AIDS.

Thousands of patients are forced to wake up early in the morning to congregate at the many distribution centres, only to be served late in the afternoon.

Due to the shortage of drugs, the system is also affected by corruption which results in those who can pay their way getting the drugs first.

Health workers told the Daily News on Sunday in separate interviews that tonnes of expired ARV drug Stavudine which the World Health Organisation (WHO) phased out last year, are finding their way to the patients, most of whom are poor and desperate.

These are often given away to the patients by either relatives of the patients working in the hospitals for onward distribution or some unscrupulous health workers who sell them at giveaway prices.

ARVs drugs are sold for about 15 to 20 US dollars a course in pharmacies but health workers are selling them for between 1 and 5 dollars.

Stavudine was phased out by WHO after it was deemed to have serious life-threatening side-effects. It has since been replaced by Tenofovir.

Tenofovir is used with other medications to help control HIV infection. It helps decrease the amount of HIV in one’s body making the immune system work better. It also lowers the risk of getting HIV disease complications, such as new infections or cancer.

According to organisations fighting for the rights of people living with HIV and AIDS, the new drug is more expensive than Stavudine.

Zimbabwe started implementing the new WHO guidelines in April last year, prescribing the phasing-out of the drug Stavudine.

Some of the most common side-effects of Stavudine are headaches, diarrhoea and nausea. In most cases, however, the side-effects are minor and can easily be treated by healthcare providers. although in Zimbabwe such treatment is not readily available.

Other side-effects include yellowing of the skin or eyes, and signs of an allergic reaction, including an unexplained rash, hives, itching, unexplained swelling, wheezing, or difficulty in breathing or swallowing.

Our investigations traced the expired drugs to hospital staff, especially those manning Opportunistic Infection (OI) units.

Most of those falling victim are bedridden AIDS patients who are no longer able to visit health care centres to collect their supply.

Caregivers have also been identified as culprits in this life-threatening development, as they are administering expired drugs. Some of them say they have no option but to distribute the drugs, as they are always inundated with desperate patients.
Various reasons have been cited for the use of expired drugs by AIDS patients.

“I used to collect my ARVs in Chinhoyi, where I was living with my niece before she relocated to Chitungwiza last year,” Nyaradzo Mutandwa (not her real name) who tested HIV positive five years ago and went on ARVs two years later, said. “Unfortunately, somewhere in the relocation process, my hospital records were misplaced and as a result I could not access my treatment supplies which dried up soon after arriving here.

“As a new person in Chitungwiza who had no treatment records, I found it prudent to get the drugs from another patient in the neighbourhood, which I was to replace once I got my supply. We are both using Stavudine,” she said.

Davison Mugandani of Glen-Norah suburb, who takes care of his HIV-positive bedridden brother, said queuing for drugs at Parirenyatwa Hospital was “tiresome”. He now prefers the shortcut of sourcing the life-saving drugs from the parallel market.

“Inasmuch as I would like to take care of my brother, whom I have been looking after for the past four years, the tough thing is queuing for the drugs when getting resupply. The problem which makes it difficult for me to access the drugs is time. I am a self-employed person, and losing a minute means losing a dollar in my life, so I find it easy to just get the drugs from friends who I know have access to them without hassles,” he said.

A woman who identified herself as Amai Ngorima from Chitungwiza said, “My husband has vowed that he would never set foot at an OI clinic again. citing the lack of privacy and congestion at the place.

“The rudeness displayed by some nurses, the fact that one has to wait in a shed waiting for one’s file to be called out, and the late opening times of the pharmacy – all combined – made him lose interest. He therefore buys the drugs from a man in our street who has connections.”

Chitungwiza Hospital chief executive officer Obadiah Moyo could neither deny nor confirm that expired ARVs were being leaked from the hospital by some unscrupulous health workers.

“What I can say is that there is no shortage of the drug at our hospital, and I find no reason why such things could happen,” Moyo said.

“Furthermore we have gone an extra mile of even giving patients a supply of up to three months upon request, like say a patient wants to travel out of town for some time and fears he might not get the drug. To answer your question on the leakage of expired drugs, I would not know what might be happening in clinics around Chitungwiza because we have decentralised ARV distribution to ease congestion,” he said.

One street dealer in the drugs, who preferred anonymity, was clear on his supply source – “I get my supply from the hospital guys. I do not manufacture them in my back yard. Every month I get a consignment, and I am saving many lives in the process.”

National Aids Council Communications officer Orirando Manwere said they were not aware of the development and promised to investigate.

“Since we are not on the ground when it comes to drug dispensing, we will share this information with the Ministry of Health to investigate,” Manwere said. “Patients are always advised to adhere to proper treatments guidelines at hospitals or through home-based care programmes, but there are always people who prefer shortcuts.

“We may not be aware where these expired drugs are coming from, but obviously it could be from the same patients who access them from hospitals or from private outlets.

“We call upon people to avoid buying drugs from the black market because that puts their health at risk,” he said.

He warned against sourcing ARVs from relatives or any other sources, except from hospitals which are registered to do so.

Published March 4, 2012 in the Daily News, Zimbabwe.

This investigative report was produced under the Strengthening Media Reform and Civil Society Transition in Zimbabwe project, a partnership between IWPR, the Humanitarian Information Facilitation Centre and the Media Centre in Harare.