The high cost antiretroviral (ARV) drugs and inadequate control mechanisms in Zimbabwe are driving a flourishing trade in fake ARVs by unlicensed dealers, activists have warned.

The Medicines Control Authority of Zimbabwe (MCAZ) recently issued a statement warning the public that the dealers were importing and selling counterfeit ARVs to unsuspecting HIV-positive people who needed the life-prolonging medication.

Undesignated and unhygienic points of sale, such as flea markets and hair salons, were being used as outlets for the fake drugs, raising the fear that patients' health was being compromised and many could develop resistance to genuine medication.

"This is a dangerous practice because the medicines may have been subjected to inappropriate and hazardous storage conditions, thus affecting the quality and effectiveness of the medicine. Such medicines may be counterfeited, adulterated and contaminated, thus rendering them ineffective and sometimes dangerous," warned the MCAZ.

Booming market for fake ARVs

The fake drug market is thought to be hugely profitable. An independent local weekly, the Financial Gazette, recently reported health minister David Parirenyatwa as saying that the government had invited other stakeholders to assess how widely counterfeits were being sold.

Chitiga Mbanje, training coordinator at The Centre, a non-governmental organisation (NGO) that assists people living with HIV/AIDS, said they were also in the process of gathering evidence on the sale of fakes.

"There are repeated reports of counterfeits being sold, but the most important thing is for stakeholders to obtain enough empirical evidence pertaining to where they are coming from, where exactly they are being sold, in what quantities, and who is involved, so that comprehensive strategies can be crafted and adopted," Mbanje told IRIN/PlusNews.

Tapiwa Bwakura, secretary-general of the Zimbabwe Medical Association (ZIMA), told IRIN/PlusNews: "We are indeed concerned by the reports of patients buying the fake ARVs, but we need quantitative, anecdotal reports for meaningful action to take place.

"There is a real danger of the whole issue being sensationalised, in which case we would be failing to reassure the patients if we just scream about fake drugs without arming ourselves with real facts."

John Madzima, 32, who lives in Harare, the capital, blamed mushrooming unlicensed surgeries for the growing practice of selling fake drugs. He was diagnosed HIV-positive five years ago and started taking ARVs two years later.

"With ARVs becoming increasingly scarce, I have been one of the victims of unscrupulous people who use illegal surgeries as selling points," Madzima, a former soldier who retired from the army on medical grounds, told IRIN/PlusNews.

He obtained medicine from a surgery run by a junior medical doctor who was deregistered for stealing drugs from a dispensary at a government referral hospital.

"I had no reason to suspect that the ARVs on sale were fake because the surgery looked genuine and the doctor seemed to know what he was doing; I jumped at the opportunity when I learnt that he had the drug in stock," said Madzima, who used to get his medication from the army dispensary.

When he visited the surgery, the "doctor" told him he did not have the type of ARV that had been prescribed for Madzima and persuaded him to buy another type, which was counterfeit.

His health soon started deteriorating and he approached an AIDS counsellor at his former workplace in Harare, who advised him to report the matter to the police. However, after learning of his impending arrest, the culprit hurriedly closed the surgery, which he had been renting from a doctor who had relocated to South Africa, and went on the run.

It is estimated that more than 300,000 Zimbabweans need ARVs, but well below that number are getting them. In 2006, the government announced that it aimed to have 300,000 people on ARV treatment by 2010. The health ministry said it had around 40,000 patients on ARVs by the end of 2006.

However, Human Rights Watch (HRW), which works to protect humanitarian rights internationally, said that by the second half of 2006 "only about 23,000 out of the 350,000 Zimbabweans in need of ART [antiretroviral therapy] are currently being treated with ARV drugs."

At the recent opening of parliament President Robert Mugabe said the government had managed to increase the number of people on the ARV rollout programme to 62,000, adding that the number could double by year-end.

Health sector collapses

The Zimbabwe Congress of Trade Unions (ZCTU), the umbrella body for labour unions that represents thousands of workers and has been agitating for increased access to ARVs for its members, described the sale of the fake drugs as a "big problem that requires urgent action".

"From our assessments, we have observed that the presence of fake ARVs is very widespread, and we are disturbed that thousands of infected people could have died or will die because of the fatal effects of taking the wrong drugs," said ZCTU president Lovemore Matombo.

He accused immigration authorities, the country's security system and health authorities of failing to do enough to stem the flow of imported fakes. "Clearly, the control system has collapsed, and that is the reason why the illegal dealers are managing to smuggle so many drugs into the country.

"We suspect that the whole monitoring system is riddled with corruption. The distribution of drugs is supposed to be supervised by quality controllers, but just how patients are still buying the imitation drugs from public places is a mystery," said Matombo.

Galloping inflation and a drought of foreign currency have crippled the health sector, creating shortages of drugs, medical equipment and even medical personnel, who have migrated in search of better salaries and living conditions.

ARV drugs cost up to Z$500,000 for a cocktail at government pharmacies, putting them beyond the reach of most patients, the majority of whom earn less than Z$3 million a month or are unemployed.

At private pharmacies the drugs can cost up to four times the price at subsidised public dispensaries. According to HRW, "many Zimbabweans accessing ARV drugs in the private sector were moving to the public sector to access subsidised government treatment programmes because they could no longer afford treatment in the private sector".

HRW said NGOs had told the organisation that "the limited capacity within the health sector for adequate medical follow-up of large numbers of HIV/AIDS patients due to massive emigration of trained healthcare staff" was also stunting an effective rollout programme.

Matombo pointed out that the high cost of ARVs meant patients easily fell prey to illegal dealers who offered the counterfeits at low prices; in desperation, some HIV-positive people were even resorting to taking drugs that were not prescribed.