Study refutes claims patients stopping ARVs for grant money

Treatment Action Campaign is an Atlantic grantee.

by JENNY GROSS

ALTHOUGH there have been reports of Aids patients refusing life-saving antiretroviral (ARV) treatment to lower their blood counts enough to qualify for social grants, a three-year study in Khayelitsha found no evidence that people give up their health for income, according to researchers from UCT and Yale University.

“Not a single individual in the sample reported an intention to trade off grant eligibility for their health…” the report said.

There is scant evidence that patients will interrupt treatment to ensure that their CD4 counts drop below 250 so that they receive grants, said Rebecca Hodes, head of policy, communication and research for the Treatment Action Campaign (TAC).

“People would need to be extremely desperate and beset by failing structures of social support to sacrifice their health and, potentially, their lives for the grant,” she added.

The temporary disability grant is R1 010 a month.

High costs associated with grave illness make it unlikely that people would stop taking ARVs to receive grants, but there has always been speculation, said Carol Cowburn, a general practitioner at a Gardens practice which treats people with HIV.

However, Gilles van Cutsem, the project co-ordinator for Médecins Sans Frontières in Khayelitsha, said the clinic sees many patients who seek treatment late when their CD4 counts are low, and the first thing they ask about is the disability grant. There were definitely people who default on treatment to qualify for grants, but it was impossible to know how prevalent it was because people just stopped showing up at clinics, he said.

About 10 Aids patients in Khayelitsha decided to stop taking ARVs to qualify for the disability grant, said Andile Madondile, the TAC’s Western Cape provincial secretary.

They said they could not take the treatment on an empty stomach because it made them dizzy and nauseous, he said.

“It’s really giving us challenges because we tell people to adhere to their treatment, but if they don’t have food on the table, it’s difficult.”

The Western Cape has among the highest recorded rates of ARV adherence, at 90 percent, according to a study in Khayelitsha.

“If groups of patients at clinics are defaulting on treatment, there is likely a problem with the availability of ARVs at clinics, the treatment preparedness programmes there or the local social grant system, not with the patients themselves,” Hodes said.

“It’s a good adherence rate, but the rate of patients defaulting treatment is increasing every year,” Van Cutsem said.

He said there are other reasons patients may default on treatment, such as inadequate support systems for adolescents who, with pregnant women, are more likely to default.

A solution is for the government to offer chronic illness grants, as opposed to temporary disability grants, said Marlise Richter, a researcher at the Reproductive Health and HIV Research Unit and a lecturer at the University of Witwatersrand.