At least nine Free State clinics have run out of antiretroviral medication in the last three months. And a rising number of patients are bearing the brunt.

One patient from the Pilomoni Clinic in Mangaung district in the Free State told us: “I haven’t had my ARVs in four months. When I go to the clinic they tell me they are out of stock, I’m afraid, I’m afraid that my condition will deteriorate, and I will get very ill.”

The consequences are long-term too: “I’m also afraid that when I present at the clinic with those infections, I will be labelled a defaulter when in fact it’s not my fault, I’m just not accessing my ARVs,” said the patient, who asked not be identified.

Medications to local clinics are provided by the Department of Health. The failure to provide adequate access to medicines, particularly ARVs, is not only deeply disturbing — it is life-threatening. To be effective, the HIV response requires consistent adequate access to HIV medication.

We know the crisis is not only in Mangaung but widespread throughout the province. Ritshidze data revealed that from July to August 2022, about 40 patients reported stockouts of HIV medicine. Nine clinics reported sending patients home without the medication they needed because of stockouts.

Those 40 patients are 40 too many if it means unnecessary deaths to the people of this country where access to healthcare is promised and guaranteed constitutionally.

It is not surprising that the province is behind with regard to the 95-95-95 testing and treatment targets, particularly the last target of having 95% of individuals on ART virally suppressed.

The Tembisa model estimates that the Free State province has only 67% of people on ART who are suppressed. A key reason for low numbers of people not being suppressed is mainly caused by poor management of HIV, which could also be attributed to the inconsistent supply of ARVs, among other barriers.

For some people, stockouts mean out-of-pocket expenditure because they have to procure their supply from private pharmacies, but for other public healthcare users without additional funds, the stockouts mean they are unable to access any medication.

Many people living in South Africa, unfortunately, have to face the reality of staying home with their condition as they rely solely on the public healthcare system to provide medicine. Stockouts sometimes last short periods, but sometimes they take months, leading to complete discontinuation of treatment.

When it comes to HIV treatment, stockouts don’t only lead to deterioration of the person’s health, but essentially cause resistance to the medicine and when the patient restarts, their body no longer responds.

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Once you are resistant to one regimen of HIV drugs you have to be initiated on secondary regiments, treating you becomes more complex and the drugs get more toxic – all of which can be avoided.

In order for the HIV response to be effective and lead us to the achievement of the 95-95-95 global goals, we need consistent adequate access to HIV treatment among other things. Stockouts are a major setback as they contribute to treatment interruption, and this causes regression in the progress of having 95% of HIV-positive people on treatment.

The Department of Health boasts about high levels of stock availability. Our experience tells another story. And, while the number of clinics without medication might be a small percentage of the national tally, that is cold comfort for the patients currently struggling to access essential medication.

The Department of Health needs to take urgent actions to address the stockouts in the province, and to monitor the situation to ensure that all healthcare facilities have adequate stock of HIV medicines and other essential drugs.

It will be critical for the department to take all necessary steps to ensure communities have access to their treatment and to implement a communication strategy that will alert communities if there are challenges and advice on alternative routes to access their medication in the interim.

The government’s inaction continues to cause pain and suffering among poor communities, particularly People Living with HIV (PLHIV). If this continues, the Free State will see more people disengaging from care, more Aids deaths and an increase in new HIV infections due to high viral loads among PLHIV.

Stockouts should be eliminated. We have and continue to call for six-month refills of ARVs for those who are stable on ART, as this will reduce the need to go to the facility and enhance adherence to treatment.

By acting swiftly, the department can ensure we remain on track to end Aids as a public health threat by 2030. DM

Makhosazana Mkhatshwa is the Treatment Action Campaign’s Research Officer. Communities can help end stockouts by reporting stockouts experienced at local facilities by whatsapping or sending a missed call to 084 855 7867.