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Malawi: Our ARVs are on Johannesburg streets

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Posted By: Josephine Chinele

Prescription drugs plundered from Malawi’s public hospitals, including Antiretrovirals (ARVs) and powerful antibiotics and painkillers, are being smuggled into South Africa and are readily available from street traders, a joint Malawi News and amaBhunga investigation has revealed.

Interviews with traders in central Johannesburg said the main purchasers of the drugs are Malawians staying illegally in South Africa who fear being identified if they use the public health system.

Other “illegals” also buy – despite the fact that free ARV treatment is available in South Africa for foreigners.

At the root of the trade are poor management and security lapses in Malawi’s health system, which health workers and hospital pharmacists exploit.

Health Minister Peter Kumpalume said in an interview this week that about a third of medicines in the public health system go missing, resulting in the loss of K5 billion every year.

One million Malawians are living with HIV and half of them are on ARVs, according to the Health Ministry.

Malawi News and AmaBhungane spoke to two middle-aged women pavement traders selling Malawian foodstuffs such as dried fish, soya pieces and groundnut flour in the central business district of Johannesburg.

As the conversation took place in Chichewa, the traders appeared quite confident about discussing their hidden business.

They confirmed that they sold medicines, saying they buy bottles of 30 ARVs from Malawian health workers for about K2, 000 and resell them for about K6, 000 (R150).

Posing as a customer, this reporter purchased a bottle of Tenofovir (Lamivudine) Regimen 5A ARVs for R150 (K6, 000) and five Bactrim tablets (an antibiotic used for preventing opportunistic infections in People Living with HIV) for R15 (K600).

Amoxicillin (another antibiotic) and Indocid painkiller sell for R6 (K240) a tablet. The medication is sold without medical advice or verification of customers’ HIV status, and without knowing whether they qualify for the medication.

The traders, who are from Lilongwe but asked not to be identified, said they had been selling drugs in Johannesburg for more than seven years.

“Health workers have their own ways of taking them out (of the hospitals) without getting into trouble,” said one.

They said they ventured into smuggling the life-prolonging drug into South Africa in a bid to supply the “enormous” community of Malawians living with HIV.

They also revealed that they smuggle the drugs across borders hidden in foodstuffs, such as bags of rice, beans and dried vegetables.

They said they normally leave the ARVs and other prescription drugs in their Johannesburg flat and fetch them on request from customers. They said that Malawians referred other foreign customers to them.

South African health policy dictates that anyone seeking public medical treatment must produce valid identification. It appears that foreigners without valid documents who fear deportation choose to consume black-market drugs.

Deputy executive director for women’s reproductive Health and HIV institute at Wits University, Francois Venter, stressed that drugs sold on the streets are unsafe and ineffective.

Venter also pointed out that since 2005 foreigners have been able to access free HIV medication in South Africa.

“I was part of the group who fought for foreigners to get free HIV care,” he said.

“Our clinic in Hillbrow treats lots of foreigners for free and it’s a department of health clinic.”

South Africa’s health department spokesperson Popo Maja confirmed that ARV treatment is free to nationals and foreigners alike.

“We only need identification for our records and proper follow-up. ARVs are not a once-off medication but a lifetime treatment, so we need to note the details for the patients’ own good,” he said.

Maja said people who are buying black-market ARVs are missing out on regular viral load and other check-ups, as well as medical advice.

“They are also compromising their health because generally the traders have no expertise in medicine storage,” he said.

The revelation of ARV theft and smuggling coincides with a rash of media reports about thefts at public hospitals in Malawi.

Few of the thieves are caught and prosecuted. The Pharmacies, Medicines and Poisons Board said recently that between January and September this year just 28 people implicated in drug theft were arrested and charged.

Most are charged with being in unauthorised possession of drugs, rather than theft, which carries a lenient sentence.

Malawi Police Service spokesperson Nicholas Gondwa said no one in Malawi has ever been arrested for smuggling drugs abroad.

People had been arrested inside the country for stealing painkillers and antibiotics, or for operating illegal clinics stocking these drugs. But no one had been charged with selling ARVs, he said.

Gondwa said the major challenge the police face is that the thieves do not reveal their suppliers.

“They usually say they bought it from an unknown vendor at the border. This means they want to continue their business after their jail term, so they don’t want to betray their sources,” he said.

Kumpalume said this week that every year Malawi loses K5 billion of its K17- billion drug budget to theft.

“Hospital pharmacists are the ones perpetuating this,” he said. “This is a very big problem in Malawi, which relies entirely on donor funding for HIV treatment.”

He said he was shocked to hear that drugs are being smuggled out.

“The ministry has never received reports of this. Even our donor community has never raised such a concern.”

Kumpalume said the lack of a national identification system in Malawi has led to abuse, because those who were not entitled to treatment are accessing drugs – sometimes at several points in the health system.

Since 2003 ARV treatment in Malawi has been solely funded by the Geneva-based Global Fund to Fight Aids, TB and Malaria.

Early this year, the fund

questioned Malawi government’s diversion of its grants for unplanned expenditure including the purchase of off-budget vehicles.

For the first time, it asked President Peter Mutharika’s government to locally raise $8.5-million (K3.8 billion) for buying ARVs as a contribution to the final six months covered by its grant.

The fund also asked the government to repay about K1.4 billion because Malawi government abused funds in the previous budget. Malawi government promised to refund in installments through the national budget.

Last month the United States ambassador to Malawi, Virginia Palmer, slammed as “unacceptable” the rampant theft of drugs from public hospitals and their resale in markets.

She warned that if the trend continues, her government will stop supplying anti-malarial drugs and other medicines.

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