Third-line ARVs problems in Zambia, the case of Ephraim Banda

Ephraim Banda

Before Zambia’s public health sector started providing free antiretroviral drugs (ARVs) to people living with HIV, Ephraim Banda, in the picture,  bought his own medication. But his supply was often interrupted and the available drugs changed frequently and he is now one of a growing number of HIV-positive Zambians who have developed resistance to both first- and second-line ARV drug regimens.

Third-line regimens are often unaffordable or unavailable to people living with HIV in developing countries. Banda spoke to IRIN/PlusNews about his experience of running out of treatment options.

“I started [taking] ARVs in 1999; my brothers were purchasing the drugs. I remember the cost was about 800,000 Kwacha [US$168] a month. Sometimes we didn’t have money and sometimes we didn’t know if it was the correct drug. My relatives were just buying for the sake that these were ARVs… we didn’t have more information.

“In March 2004, I started [on government-subsidized treatment]… I also got involved in sensitization and started working with support groups. TALC [the Treatment Advocacy Literacy Campaign] was the first group to train me in treatment literacy. From that point I understood that maybe looking back, [my] adherence was poor from the start.

“I was changed to second-line treatment in about 2006… until my CD4 count began dropping last year. I was put on [a new drug combination] and that went well but unfortunately I developed kidney problems… I almost had kidney failure. What I am taking [now] is second-line but it’s temporary – the third-line drugs we don’t have in Zambia.

“I’m at a CD4 count of 16… basically it’s a miracle to see me walk. When I am speaking to you like this, it sounds like I live a day-to-day life [but] there’s a component of looking for money for drugs, or for nutrition – looking to have a happy life.

“Do you know how frustrating it is to know that my health is going down every day? Maybe the drugs will be here Friday, or next month – no one is promising anything.

“I still have support from my family – my wife’s been too supportive and everybody, my children, they’ve been there for me, [and] the clinic where I work. Whenever I feel bad, if I’ve run out of cash or something, they’ll be there to help me and this is what frustrates me… I want to work, not just be dependent on people.

“I have an initiative dealing with the youth that has an HIV prevention component… implementation has been slow because of my illness. Now [at the clinic] they’ve also given me this ‘youth-friendly corner’ they want me to revamp. I’m hoping I will achieve that goal. I wouldn’t mind seeing the project move forward so I can leave a legacy; that at one time, people could say, ‘This was Ephraim’s project’.”


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21 Responses to "Third-line ARVs problems in Zambia, the case of Ephraim Banda"

  1. intellectual   March 21, 2012 at 15:42

    its just a sad ordeal i cant imagine the agony of people on haart wen the drugs r late n o, i am touched by mr bandas case all i can do is sympathise, may the Good Lord be with us.

  2. nsega deelu   March 10, 2011 at 17:18

    Almost three quarters of funding for HIV and AIDS in Zambia is from foreign donors, This includes the provision of ART. This is a very bad policy/approach were foreigners have a say on the lives of the diseased in Zambians,not only is it a a bad policy but its a security concern. What will happen to the people on ART if we differ with the sponsors/what if the sponsors want to use this weakness as a leverage on meeting there exploitative needs in our beloved country?, It should be noted that once you start this medication its for life.

    My suggestion is that over critical matters of lets fund ourselves local money(Zambian taxpayers money) and let them provide mosquito nets and circumcision tools things we can do without.

  3. ZIONIST   March 10, 2011 at 08:53

    Dokota wama Dokota,

    The prescription of three times is from Daniel 6:10 Now when Daniel knew that the writing was signed, he went into his house; and his window open in his chamber toward Jersusalem, he kneeled upon his knees THREE TIMES A DAY, and prayed, and gave thanks before his God. Day ( When things are okay), Afternoon (when things appear not very bad not very good – Average); Night (when the condition appears worse) continue giving thanks declaring still that Jesus is the Christ the Son of the Living God – I shall not die but leave and declare the works of God. Thats the purpose for living. Thanks

  4. Doctor wama dokota   March 10, 2011 at 01:37

    The pills are ok, but where is the evidence that you are to take them 3 times a day? Please supply me with the scriptures. For man shall not live by bread alone but by every word that issues from the mouth of God and you shall not add nor subtract from what is written in this book. Thank you.

  5. Doctor wama dokota   March 10, 2011 at 01:31

    Recently a paper was published which showed that low CD4 count has an effect on mortality and morbidity even after complete viral suppression in the first year. After so many years of viral suppression CD4 counts are irrelevant. You can check it out for yourself and all other interested people. Please insist on viral load otherwise Zambian ‘N0’ctors will take you off medication for no good reason.
    REF: Zoufaly A, an der Heiden M, Kollan C, et al; for the ClinSurv Study Group. Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy. J Infect Dis. 2011;203:364-371.

  6. Jinx Popo   March 9, 2011 at 17:53

    I sympathise with Ephraim. The tricky part is that the possible drugs you can use in 3rd line Rx for HIV include very expensive combinaions such as (Darunavir – DRV), (Etravirine ETR) and (RALTEGRAVIR – RLT) which cost over $2,000 per patient per year. Now before you can even access these drugs you have to undergo what we go resistance genotyping test which cost about K2m locally and viral load test which costs about K300,000 to K500,000. These two test are important because unlike the 1st line and 2nd line treatment, you need to know which drugs you are resistant to before you can be told which drugs will work. Besides, because of poor adherehce it is possible some of the durgs in the 1st and 2nd line may be found to be still useful (and be recycled). Make no mistake people, you need at least K13m to manage one client on 3rd line therapy whereas 1st line therapy is below $100 per patient per year. This is why with ARVs, it is adherence, adherence, adherence. However, in the case of Ephraim it not easy for the GOVT, or even family. Maybe we need windfall tax after all…….

  7. NAPAPA SANA   March 9, 2011 at 17:23

    i believe in the words of ZIONIST there is nothing impossible before God, He is the cure for all the diseases.

  8. ZIONIST   March 9, 2011 at 13:25


  9. Bonza   March 9, 2011 at 11:58

    Zig Zag you are childish and from the look of things you are so immature, HIV affects everyone, we all have relatives who are living with HIV/AIDS, i pity for your woman because i think you are a sacastic, selfish and good for nothing man…..

  10. Vincent Chowa   March 9, 2011 at 11:18

    Please lets use good language and stop stigma. Some of the People Living With HIV are not promiscuous. They may have gotten the virus through other means or their partners. Please be civil and empathetic. Tomorrow it will be you.

  11. Saddist   March 8, 2011 at 21:57

    The normal cd4 count is 600 to 1200,now he has 16.walking miracle though i have seen a patient who had 3,some the pentra machine was even failing to print results just producing xxx,please HIV is real,play safe.

  12. lubinda   March 8, 2011 at 19:58

    zig zag ur a proper dik,who tod u whoever has aids slept with prostitutes?infact mo women who r not prostitues are mo likely to be infected with hiv,atleast most prostitutes use condoms nowerdays,so think man,u useless piece of shit

  13. AnAppealToCommonSense   March 8, 2011 at 18:54

    Come on, people, demand better healthcare and more treatment options, while supporting better education on treatment adherence and transmission/reinfection prevention. Why aren’t more people asking this of those who wish to be elected or reelected? Also, more should be done with treatment monitors, like how people in Alcoholics Anonymous have their sponsors that they stay in touch with, people taking ARVs should be offered an adherence monitor, to help them be consistent with treatment even when they are feeling well and doing better. Anyway, I hope Mr.Banda’s health improves and he can start new treatment.

  14. Doctor wa ma dokota   March 8, 2011 at 16:42

    This is pitiful and I feel for the man, but what I cannot understand is why is he talking in the singular? Hasn’t he got a partner? If he has, is the partner on treatment? The commonest cause of resistance is re-infection during treatment, although erratic dosing plays a role too. In countries which are rich, people have lived on the same drug regimen for decades. Perhaps, it is his partners that need to be looked at.
    CD4 counts are no longer the most important factor in monitoring treatment. If you take CD4 counts in an individual over a period of 24 hours you will find very wide variations. What one must look at is his viral load. If it were possible, his HLA typing should be done. This will help his doctors to avoid certain drugs with their bad side effects. HIV itself causes kidney disease, but this is worsened in black people if they take Tenofovir.

  15. Lemekani   March 8, 2011 at 16:34

    ZIGZIG kwata amano, u failed to do it because u mbolo is useless 50pin was very cheap for two pussies. Make sure u move with condoms in your wallet when u go clubbing , anyway give me the numbers those pipo need business

  16. The Realist   March 8, 2011 at 14:29

    Zig-zag, your pseudo name says it all. Why give out the number and at the same time condemn illicit sex? You want to expose others to the risk of infection? Get real. Information is power. How many out there know that missing your timing 3 consecutive times opens you up to resistance? With the recent shortage there is no denying that a horde of people on ART will develop resistance. TALC, ZARAN and others must urgently work out something. If need be contact Barack Obama.

  17. The Dude   March 8, 2011 at 14:22

    Resistance is a big issue in our country. There are a number of factors leading to this. One of them is the purchase of ARVs from the briefcase dealers. There was no proper combination. The other factor is due to poor adherence as outlined in the article above due to financial challenges at that time. But also poor adherence due to patients stopping when they feel better and go back to their old habits. The other factor is due to people not using condoms while consistently taking the ARVs. Other people get infected with resistant srains, either while on ARVs or before even comerncing. Nowardays most infectios are taking place in stable relatios and homes, where condome use is a thing of the past. Alcohol abuse is just one issue that we need to deal with. Unfortunately we shall always find a scapegoat, the government when other things are our own making. Zambia was sensitized about the mode of HIV transmission in the 80s!

  18. Potent maxmus   March 8, 2011 at 13:18

    Sorry on the comment above i meant to say “and yet they are busy politicizing every thing they come across “

  19. Potent maxmus   March 8, 2011 at 13:11

    The emergency of first and second line ARV drug resistant hiv strains is one issue our politicians and MOH have to address urgently.Most health workers know that the emergency of these strains is inevitable,due to mutations and hiv recombinogenic properties among other issues like adherance.but what is moh and grz doing about this impending catastrophy.preaching about adherance alone helps but its not the only thing to do.i have patients who are good adherants and yet are developing resistance av different stages of treatment and this at less 10yrs of free art in the for mr banda,our prayers are with you are not the only. You speak for the masses yet they are busy everything they come across.

  20. ZIG ZAG   March 8, 2011 at 13:01

    SO kampala uyu anali kudya ma live?. Guys think before fucking these prosititutes.They are all over. The previous nite I was supprised,I proposed to have sex with two ladies in almost 30minutes time.All I was told by these ladies was that I should pay them 50pin.I had the mmoney but managed to sneak away from these me on my number so that I tell u where these prosetitutes can be found.

  21. Ndoda seshi banda   March 8, 2011 at 12:38

    Iwe AIDS, why did you come. We are devasted and finished, ARVs are just a temperal measure