Earlier this year, when the Pilani health clinic suffered a shortage of the medication used to treat HIV, patients in the village of Ntshilini had to take an hour-long bus ride on a bumpy, mountainous road to the nearest hospital.
"We ended up paying so the nurse could get someone to go and fetch our drugs," said Boniwe Gxala, a 36-year-old HIV patient from Ntshilini, who had to go weeks without her supply of the life-prolonging drug.
The shortage reportedly occurred because of delayed deliveries from the provincial department of health in South Africa's Eastern Cape region.
People are dying here and we have to say, 'Sorry, we have no medicine'.
Improving access to treatment and care is the World Health Organization's focus for the campaign marking the 2013 World AIDS Day, which takes place on December 1. Nowhere is that message more relevant than in South Africa, a country with the one of the highest rates of HIV/AIDS infection in the world.
More than 5.5 million South Africans are living with the disease, comprising 11 percent of the population. Among women of reproductive age, a staggering 20 percent are HIV-positive.
Public health facilities throughout the Eastern Cape, one of the country's least developed areas, have experienced severe shortages of essential medicines and medical supplies in the past year. A report published on November 5 by the Eastern Cape Health Crisis Action Coalition details what it calls the "crisis in healthcare" in the region.
According to the report, mismanagement by the municipal health department has resulted in stacks of the antiretroviral (ARV) drugs used to treat HIV infection lying in storage while patients are turned away from clinics. "People are dying here and we have to say, 'Sorry, we have no medicine'," said Selena Arends, an assistant nurse at the Pilani clinic.
"The impact on [HIV] patients from not taking their medication is huge," said Marcus Louw of the Treatment and Action Campaign, an NGO that is part of the Eastern Cape Health Crisis Action Coalition. "If you do not take your ARV pills for weeks, your body develops resistance to the drug and you are also at a high risk of HIV-opportunistic illnesses."
South Africa's Department of Health said it is unfair to compare the situation in rural parts of the Eastern Cape to the rest of the country. Minister of Health Aaron Motsoaledi pointed out that South Africa distributes more ARV drugs than any other country, with more than 600,000 people per year registering to receive the medication.
"Our health facilities and supplies systems are exploding," said Motsoaledi. "The yearly increase [of people registering for ARV] cannot come without any problems, so we will see logistical problems."
According to South Africa's National Treasury, the government spent 22.2bn rand ($2.17bn) on HIV in 2012/13. Five billion rand ($491m) came from donors.
Some data show that South Africa's ARV distribution programme is improving. For instance, according to the National Antenatal Survey, the number of people receiving ARV drugs has increased in the past four years from 923,000 to 2.4 million people, while the number of clinics and hospitals offering the medication has climbed from 490 to 3,540 facilities countrywide.
Yet distributing the drugs has been a challenge. In one case, corrupt health officials at the Esselen Street clinic in Johannesburg stole ARV pills - which are meant to be available to patients at no cost - and sold the medication to them instead.
The HIV medication has also been used as an ingredient in a street drug called "nyaope" or "whoonga". This cheap, potent mixture of heroin, marijuana and crushed ARV pills has become popular in impoverished townships, according to some accounts. Recently, armed heroin addicts broke into a doctor's office in Soweto to steal ARVs.
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"Two men came in with guns, ordered me to close my eyes, kneel down, emptied my pockets and they said they do not want my car - all they want is the key to the medication cabinet," said Dr Mngoma Zulu, adding that he is not the only doctor in the area to have such an experience.
However, Cathy Vos of the South African National Council on Alcoholism and Drug Dependence said the story of people getting high on ARVs has been blown out of proportion, and that heroin use is a much bigger problem.
Drug addicts are not the only ones trying to get their hands on ARVs for illicit purposes. Smugglers are on the prowl, too. Cross-border syndicates deal in a variety of medications, including ARVs, selling them in neighbouring countries such as Mozambique, Lesotho and Zimbabwe, according to a spokesman for the premier of Kwazulu Natal province.
The South African government has made major investments to provide ARV pills to the many people who rely on the drug for their survival. Progress has been achieved, but as the international community marks another World AIDS Day, there are still many HIV patients who cannot be sure that next month they will have their medication.