For typical Americans, especially those who did not live through the onset of HIV in the mid-80’s, HIV is an unfamiliar and often unspoken topic given that less than 0.25% of the U.S. population are HIV positive. It was not until I traveled to Zambia through my pharmacy clinical rotation that I became immersed in a culture where HIV is not only a common discussion topic, but one that must be understood in order to provide care. Approximately one in 17 people in Zambia are living with HIV/AIDS, with most new infections resulting in unprotected heterosexual sex and mother-to-child transmission. Fortunately, the prevalence has been declining in recent years greatly due to the expansion and access of antiretroviral therapy (ART) among infected and at-risk people. Yet, HIV/AIDS is still one of the leading causes of death in the country.
We spent a majority of our six weeks in Zambia at the University Teaching Hospital and its associated clinics. At least 80 percent of our time was dedicated either to dispensing ART to adults, children, and expecting mothers in the clinics, or to helping treat patients suffering from HIV-related infections in the hospital. While we briefly learned about HIV pathophysiology and treatment guidelines in school, this experience was the first time we witnessed the severity of the problem first-hand.
Zambia currently provides free healthcare to its citizens but is trying to implement a new health insurance program due to the unsustainability of its current system. However, this is quite difficult given the fact that over 60 percent of families live below the poverty line. Because of Zambia’s lack of resources, it relies heavily on foreign funding. Everywhere we looked, there was a sign or a plaque memorializing the help provided from the United States, United Kingdom, Japan, etc. I never realized the global reach of the U.S. and its citizens until traveling to a country that relies on its aid.
The United States donates a large amount of HIV medications to Zambia. This helps HIV-positive Zambians to get the necessary treatment free of charge. I have seen patients as young as 10 years old travel several miles alone to the clinic for their check-ups and treatment. As long as they can get to a hospital or clinic, they can get their medication. As a U.S. citizen and healthcare professional, I whole-heartedly support this effort. To eradicate an epidemic infectious disease such as HIV, global action and impact is crucial. However, based upon an observation by a Zambian pharmacist, it is within the U.S. where real problems with HIV treatment lie.
Through the Milwaukee Global Health Consortium, four Zambian pharmacists spent time within Milwaukee area hospitals in 2013. The connections they made during their time in Milwaukee provided us the opportunity to practice in Zambia. These pharmacists had plenty of stories to tell us about what they learned and incorporated into their practice when they returned to Zambia. One of the pharmacists told us of an experience he encountered at a local hospital. A patient arrived to the emergency department due to a recent possible exposure to HIV from his known positive significant other. The provider wrote him an outpatient prescription for post-exposure prophylaxis (PEP) treatment, which greatly diminishes the risk of transmission. PEP is most effective the sooner it is taken and must be started within 72 hours. Given that time is of the essence, the patient went to an outpatient pharmacy immediately to get the medication only to be told that the medication was not covered under his insurance and prohibitively expensive. This led to time wasted and unnecessary hassle for the patient. The pharmacist did not know if the patient ended up getting the medication.
After the pharmacist told the story, he posed an interesting question. Why is it that the U.S. will provide free medication to hundreds of thousands of Zambians, but not to its own citizens? Of course this topic appears much more complex and controversial to an American who sees healthcare debated daily, but it does exemplify a simple question. If a Zambian can walk right up to the pharmacy and get HIV treatment provided by the American people, why can’t an American?
Fortunately for those affected by HIV in the U.S., several resources exist for people who cannot afford or access treatment; however, many patients lack awareness. Much like my experience in Zambia, I believe that providing care and access in our communities is a multidisciplinary effort. As healthcare professionals, it is our responsibility to provide our patients not only with the necessary treatment, but also the resources needed to ensure successful treatment.
Amanda Bartosik is a Doctor of Pharmacy Candidate at Concordia University of Wisconsin. Throughout February and March 2018, she completed a rotation with a partner University in Zambia.