Zuzimpilo not making the numbers Living with AIDS # 303

Late last November, the first subsidised, low-cost HIV and AIDS care clinic, opened in Johannesburg. Five months later, clinic management is concerned that demand for the service hasn’€™t quite reached expectations.

KHOPOTSO: Zuzimpilo (meaning, ‘€œgain health’€) Medical Centre was opened amidst some fanfare late last year. Based on the corner of Joubert and Jeppe Streets in Jo’€™burg’€™s central business district, the centre is geared at people who can’€™t afford medical aid or loathed the idea of going onto a free public health sector programme, but could afford to pay something towards good health care. For R350 per month, the clinic offers a doctor’€™s consultation, a set of blood tests, including CD 4 and viral load tests, antiretrovirals, and an unscheduled visit in case of complications or if further counselling is needed. That is about a third of what a patient would pay in the private health sector. However, Johannesburg residents have not responded in large numbers to the more affordable service provided by Zuzimpilo. Dr Tinyiko Khosa is the clinic Director.


Dr TINYIKO KHOSA: We have enrolled 510 patients in the clinic. We have done 220 voluntary counselling and testing. And we have got 135 patients who are on ARVs’€¦ Those who are on pre-ART care, we have got 180 of those patients’€¦ We are looking into getting 700 patients on ARVs by the end of the year and 800 on pre-ART care. With VCT, we will definitely reach 800 by the end of the year.


KHOPOTSO: Dr Neil Martinson of Wits University’€™s Peri-natal HIV Research Unit and the brain behind the centre, says research prior to the establishment of the centre had showed that there would be quite a demand for the service.      


Dr NEIL MARTINSON: We have been a bit slower than we expected here’€¦ A concept like this, according to our research, requires large populations to support (it). We did what’€™s called a demand survey, which looked at what people were willing to pay for ARVs. And about 20% of people are willing to pay R350 for ARVs. Now, if you apply that to the population of Jo’€™burg, say there’€™s three million people in Jo’€™burg, half of whom are adults, of those 1.5 million 30% are HIV-infected, of that 30% maybe half know their status, of that half that knows their status 20% are willing to pay. So, you really need a very large base population to be able to support a clinic like this.                                          


KHOPOTSO: Zuzimpilo is targeted at a working class population that earn less than R12 000 per month and cannot afford medical aid. While this pool of people does exist, five months of the clinic’€™s existence has shown that fewer people are willing to part with R350 a month for the improvement of their health.


Dr NEIL MARTINSON: We’€™re not competing with other people who’€™re providing ARVs: we’€™re not competing with GPs, we’€™re not competing with hospitals. We think that we’€™re competing with what people do with their disposable income’€¦ We’€™re competing with a new cell-phone. We’€™re competing with going to the movies. We’€™re competing with going to Gold Reef City, buying a glass of alcohol. That’€™s what we think we’€™re competing with.


KHOPOTSO: Martinson believes that the country’€™s recent history of politicking around anti-AIDS treatment could also be influencing people’€™s decisions.      


Dr NEIL MARTINSON: That may be a result of some disinformation that occurred around ARVs. It may be as a result of people not knowing what ARVs are all about’€¦ It’€™s a slightly scary concept that even though you may be buying eight (to) 15 years of life’€¦ half of people don’€™t seem that they want to buy that.                              


KHOPOTSO: But even so, Martinson is not fazed. He still reckons that this type of centre has a purpose to serve.  


Dr NEIL MARTINSON: I think that a setting like this is desperately needed. The clinic at Chris Hani Baragwanath has recently been temporarily closed for new admissions. The clinic at Helen Joseph is now on 15 000 and I’€™m not sure how many more they can take. That means that even though there is this enormous government rollout programme, there’€™s a limit to the capacity of the government rollout programme. And a lot of the people who are currently in the government rollout programme, for example, of those 15 000 at Helen Joseph’€¦ is the entire group of 15 000 all poor people who can’€™t afford to pay for any of their care? We don’€™t think so.


KHOPOTSO: The notion of charging people for ARVs while they can access it freely through the public health system is one for debate. But clinic Director, Dr Tinyiko Khosa, says the charge is justifiable.


Dr TINYIKO KHOSA: Patients in the private sector pay about R1 200 to R1 500. We have more than 10% who are transfer(s)-in from the private sector to Zuzimpilo ‘€“ looking at the cost. It’€™s like a third of what they would normally pay… For a person who is on ART care, you pay R350. That’€™s doctor’€™s consultation. If you need an X-Ray it’€™s also included there. It’€™s for everything, including treatment of opportunistic infections’€¦ You don’€™t have to pay extra.  


KHOPOTSO: Zuzimplio is supported by the United States’€™ AIDS Agency, USAID, with funding from PEPFAR, the American President’€™s Emergency Plan for AIDS Relief.



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