Getting a million people on treatment — impossible without 6 month supply
Government wants more than a million people to start or get back onto treatment by the end of 2025. But the truth is that treatment for all is impossible without making it easier for people to collect HIV treatment. This must include decongesting clinics by providing a 6 month supply to people doing well on their treatment.
Today in South Africa around 2 million people living with HIV are still not on lifesaving ARVs — some people not knowing their HIV status, others knowing their HIV status but not having started treatment, and worryingly many many people having started on treatment and then stopped. Why? Because our HIV response is being undermined by the dysfunction in our health system. Our clinics are still in crisis.
We leave home in the early hours of the morning, only to wait all day to be seen. Our files take hours to find or go missing completely. For those who are late for their appointment date, when we return to the clinic we are shouted at and sent to the back of the queue to wait all day as punishment. Often staff are openly hostile to people from the LGBTQIA+ community, people who use drugs, and sex workers — and if you don’t have an ID when you go to collect your treatment or a transfer letter when you move from one clinic to another, or if you are a member of a key population you might be refused ARVs and sent away.
Some people living with HIV continue to suffer these daily indignities. Yet frustration and fear of this unwelcoming environment means some people stop going, or are scared to go back to the clinic after they are late for or miss an appointment, even though often this is for unavoidable reasons. One thing is clear: No-one wants to go to the clinic more often than necessary, especially just to pick up your medicines.
There is a simple solution to improve this situation — for people who are collecting ARVs to get a longer supply of medication.
A longer supply of ARVs would mean fewer trips back to the clinic. It would make it easier to stay on treatment by reducing the cost of getting to the clinic and the hours spent waiting there four to six times every year. Importantly it would also reduce congestion and overall waiting times for everyone using the clinic — and reduce the burden on already overstretched healthcare workers. There is strong evidence that shows that longer ARV supplies help people to stay on treatment. In the context of South Africa’s treatment retention crisis, this is essential.
National guidelines already recommend that people living with HIV who are not sick get a 3 month supply of ARVs at a time. This was a positive step forward but must be implemented for everyone, not only people stable on treatment. Getting a longer supply will help people to become more stable. Next we want all people stable on their treatment to get a 6 month supply of ARVs. This is called “6MMD”. This would mean going to your clinic just twice a year for clinical review, rescript, and collecting your next 6 month supply of pills.
However, it’s now December 2024 and while more people are getting a 3 month supply, there is no public implementation plan in place for getting people a 6 month supply. This is an extremely simple intervention with big gains for people living with HIV, and the public health system more broadly. More than 6 million people across Africa are already getting a 6 month supply with good results, so why not here in South Africa where we have the biggest HIV burden in the world?
The health department says it wants more than a million people to start or get back onto treatment by the end of 2025. But the truth is that treatment for all — and reaching the UNAIDS 95-95-95 targets — is impossible without making it easier for people to collect HIV treatment. This must include decongesting clinics by providing a 6 month supply to people doing well on their treatment.
We have been calling for a 6 month supply for many years, yet the health department keeps asking us if people living with HIV really want it. As people living with HIV, we can tell you, we really want it! Follow our social media channels (X, facebook and instagram) and website over the next few days as we hear from people living with HIV across the country as to why they want a 6 month supply of ARVs.
#MoreARVPillsNow
