Highlands Hope advisor Muhingo Rweyemamu reflects on the war against AIDS in Tanzania

This AIDS pandemic: We are not well organized
By Muhingo Rweyemamu

Much of what I wanted to say in this series has been well said by the Dar es Salaam Regional Commissioner, Abbas Kandoro.

When marking the World's AIDS Day in the Dar es Salaam Region, Kandoro started by condemning some of the AIDS control institutions for failing to do their job.

But Kandoro explained that his region has already contributed more than TShs. 1billion approximately US$1million one million dollars to empower such institutions. However, he said that he is very surprised that figures of HIV infected people are still high. There are 469 NGOs dealing with just one issue of fighting against AIDS.

I will quote a fraction of his speech: "I have tried to visit the stalls in these grounds and I have noticed many things. There are many NGOs, but they are dealing with petty issues and also I have realized that there is no harmony among these groups. Now, mates, let's wake up and get to work, because this pandemic does not belong to one person only."

He concluded his speech by saying that if things continue at this pace then donors who donated funds for raising awareness of the scourge will be discouraged.

Maybe what Kandoro was not aware of is the fact that there are signs that some of these donors have started getting tired of providing funds. Those who continue to donate monies are businessmen only who would not want to see the end of AIDS.

Another thing that needs research before one delivers their speech and a rally is to look at the fact that the more money pours into the country for the AIDS campaign the better the lives of people who involve themselves with the HIV activities become and they richer they become. Had the Regional Commissioner done his homework he would have not been astonished by something that is widely known; AIDS funds do not reach the targeted people.

AIDS reports have been extensively written. Reports that NGOS dealing with HIV and AIDS campaign do not deliver have been published at length. In Tanzania, leaders have vehemently condemned the embezzlement of AIDS funds. The question that one has to ask themselves is, why is that these NGOs do not change, are not afraid and are not concerned?

Another person could respond by asking concerned about what? Why should these NGOs be worried while things from the highest level in the war against the scourge are disorganized?

In his speech while marking the AIDS Day nationally in Tabora Region, President Jakaya Kikwete said that the war against AIDS is tough and that the pace has to be increased.

He said that there are two objectives of this campaign against the pandemic: the first one is to intensify efforts of control the infection and the second one is to offer better care to those living with HIV and AIDS.

Do the people at the forefront of this campaign know the methods of preventing new infections? It is possible that they know this because most of them are experts. But do they implement what they preach?

I would not like to say much about the issue of the care for people living with HIV and AIDS, because it is such a wide topic. How can we assist this is person? By offering anti-retroviral drugs (ARVs)? And that is it? How many people have died after being given ARVs and how many would not have died if they were not supplied with these drugs? How are we, as a country prepared to deal with the side effects from these anti-retroviral drugs?

From my understanding and little knowledge on health issues is that when one is found that they are HIV positive after being tested, what follows is to investigate how much have the virus destroyed his immune system. This is when the machines are needed to measure the person's CD4 Counts.

Why is it necessary for the person to be tested before being given ARVs? A person is supposed to be tested for obvious reasons. But the one who has the virus is supposed to use the drugs only when their CD4 counts are less than 300. Normally a health person whose immune system has not been infected has between 800 and 1,500 CD4 Counts is their body.

Because we do not have enough machines many patients, CD4 counts are not tested. There are people with 1,250 CD4 counts who are already on ARVs. When one starts to use the drugs has keep on doing that continuously everyday throughout their life.

But the one with CD4 1250 could have stayed for three to four years without using the drugs and could start the treatment when their immune system starts to drop.

So putting this patient on ARVs is to causing a huge loss to the nation and also to himself/herself because the process of taking the drugs on a daily basis is not as easy as it is written in newspaper pages.

Why is that people are not tested for their CD4 Counts before they embark on ARV therapy? Is it because of stupidity or is it because of personal reasons? May be the experts at the Ministry of Health and Social Welfare could explain this to us why there are only 20 CD4 count machines in the whole country and make it impossible for many infected people reach this service? Well, because they are unable to speak out, I will speak on their behalf.

The world is full CD4 testing expertise. But in Tanzania we have agreed to go into marriage partnership with an American company, Becton & Dickinson (BD). This company produces FacsCount CD4 machines using a very expensive technology. In order to test CD4 Counts the government has to use about US$40 per test. This means this equipment requires one person to pay about TSh.45,000.

Other countries such as Malawi, Zimbabwe, Nigeria, Mozambique, Sudan and Kenya, use a different technology. The equipment used in these countries is CyFlow machine. They are German machines. One test costs US$2. It means that one patient will need about TSh. 2,500. But using the American machines the patient will need TSh. 45,000. Two people are required to operate the machines that we Tanzanians have decided to use. Either your country has to be filthy rich to use these machines or some of your experts have to be totally stupid. We are not rich.

And to demonstrate what type of people we are, we have allowed the German machines to be used in private hospitals. So the technology that costs TSh. 2,500 per test have been allowed to be used in private hospital, where the government does not pay anything except workers' salaries; and the technology that costs TSh. 45,000 per test is used in government hospitals. We are told that the test is for free. But we are not told that it is the government that carries the burden of the cost by using donors' funds and taxpayers' money. Ask the experts why they have failed to provide every hospital and dispensary the CD4 Count machines, and you will here their political rhetoric.

Recently we heard about Bugando Referral Hospital which has bought a new technology for testing the HIV status of infants under five months of age.

This is the first technology of its kind especially for testing children in the country. I would like to commend Bugando Hospital.

At the moment, only 18 month old toddlers can be tested for HIV. The Minister of Health and Social Welfare Professor David Mwakyusa who was present during the inauguration of the machine said that the technology has come at the most opportune moment as it is in parallel with the Voluntary HIV Counseling and Testing campaign.

I would like to congratulate Bugando Hospital because this technology will help children.

But I would like to ask Mwakyusa this question: Do you remember four years ago when this programme was to start in the country including testing of CD4 counts and to know the CD4 counts of toddlers which even the Bugando new machine has not yet started testing? Should we say that any HIV programme in Tanzania has to be supported by American donors?

Because it shows that without the American hand, nothing in the war against AIDS can be done without any hindrance. People have been made to believe that even Salama condoms are only safe when the Americans are involved. Which direction are we heading to in this campaign against AIDS if the Americans are privatizing this war? Or is it because of the money from Bush and his PEPFAR? Efforts by Bush are good, but its goodness should not allow them to go overboard to the extent of deceiving and luring us to use only goods from his country. That is business not services to the community.

The President's and Kandoro's concern is that despite all these efforts to fight the scourge, we still have more new infections. One of the reasons why the infection rate is still high is that we are not well organized. Let's first start with allowing competition in acquiring the technology to fight the scourge. We should not allow monopoly which will benefit a few people, who unfortunately are well known.

I keep on asking myself how the new Bugando technology can work if it would not be able to determine the CD4 count of an infant! Or will they be using FacsCount machines and A Lymphocyte and compute? But whatever they do they should remember that if the Ministry of Health had allowed competition, the technology to help children so that they could start treatment when their status is confirmed is available in the world outside the United States of America.

What is needed is to allow another technology to work in competition with the American machines. If this is allowed to happen, the child who is HIV positive could know his CD4 count in 15 minutes. Donors do not scare us because we have the power to fight against AIDS without getting a single cent from foreign countries. Our contemporaries fight this war without using a lot of money.

On the World's AIDS Day, I was one of the people who were invited to the Austrian Parliament. This parliament highly respects and honours this Day and many times it invites people who have made some contribution in the war against AIDS from various countries in the world. I was one of them.

I have learnt a lot. One is managing finances. The Parliament Hall did not have any decorations. There were some leaflets which were made with the help of funds donated by students of Kenyogasse Secondary School. There was a vital message to their young contemporaries.

They said that the leaflets were made from affordable type of paper because the most important thing was the message it carried. They did not ask for any money from anyone. They did not have any T-Shirts and everyone wore their own casual outfit. The only costly thing was the candles which everyone brought with them.

They said that it is the patients who need the money and clothes. The President of the Parliament, Barbara Prammer was the one who addressed the gathering, saying that each HIV infection was a headache to Austrian leaders. There are 300 infections annually in the country. But this rate terrifies everybody. However, she thinks that her country owes a lot to developing countries, because her nation has not yet started to contribute towards the Global Fund.

Account from people living with HIV and AIDS from several African countries were very moving, because many believe that a huge amount of donated money ends in the pockets of people who are in offices dealing with this scourge.

I agree with them and their explanation. I did not want to go very far from what is happening in my own country, Tanzania.

I remember in 2005 on the World's AIDS Day which was nationally marked in Songea, in their speech to the guest of honour, the then CCM Presidential candidate Kiwete, Tanzania Commission for AIDS Control, TACAIDS, said that they had organized to start a HIV registry for the whole country. The cost of that registry was TSh. 2 billion shillings (US$2m). Some of us laughed because we knew where the money would be channeled to.

I would like to conclude by quoting Charles MacCormack of Save the Children. His confidential Memo which he wrote in 1993 was grabbed by a book author Michael Maren and published it in the book titled, "The Road to Hell". The Memo said: As communities often receive a small portion of the sponsor's contributed dollar, they are obviously going to ask questions about where the money goes. All the explaining in the world would not make this question go away or our own strategy look good in an investigative report.