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Africans are dying of AIDS without pain relief

London Daloni Carlisle

Millions of people in Africa are dying of AIDS without any pain relief, despite oral morphine being one of the cheapest drugs in the world, a conference was told this week.

The conference, organised by the Diana Princess of Wales Memorial Fund and Help the Hospices and held in London this week, heard how legal obstacles made morphine hard to get, while lack of training of health professionals prevented prescribing of the drug at the level of the community.

The demand for oral morphine and other drugs to manage pain and to control symptoms emphasised the need for better palliative care services for nearly 30 million people with HIV or AIDS across Africa, the conference heard.

In South Africa, which carries 25% of Africa’s burden of the disease, five million people are in need of palliative care, including home support and pain relief. Yet only 250 000 of them receive it, said Liz Gwyther, chief executive of St Luke’s Hospice, Cape Town.

Meanwhile, research from Uganda, where 6% of the population is estimated to be HIV positive, shows that patients’ greatest need is for relief of pain and symptoms (BMJ 2003;327:192-4). The finding has since been replicated in five other African countries.

A survey of 48 palliative care services in Africa for patients with AIDS found that 94% reported challenges to their ability to deliver care. Their main problems were a lack of trained providers, stigma, and legal restrictions (Public Health 2003;3:33).

Lydia Mpanga Seburiya, director of clinical services and clinical education at Hospice Africa Uganda, said: "Oral morphine is very cheap, costing a few cents per milligram. It works. People’s lives are changed, and they are able to go back to work again." But myths about its effects and concerns about misuse limit its use, she said.

She added: "In Uganda we are working with communities to teach people about morphine and how to look after it and dispense it. Then the government comes in behind us with supplies." Uganda is currently supplying oral morphine free to patients while it reviews its prescribing laws to enable prescribing by community nurses.

Joseph O’Neill, medical director of the US government’s global AIDS programme and co-author of the Public Health study, said that better palliative care would meet a number of objectives. Quite apart from relieving suffering, the interdisciplinary model of team work—based on home care and involving the patient’s family—provided an effective bridge between social care and disease treatment.

He said: "You cannot get the best out of your prevention programmes without having care in place."

The US government had accepted this and set aside 15% of its $15bn (£9bn; €13bn) fund for AIDS relief to fund palliative care initiatives in 14 targeted African and Caribbean countries over the next five years, he added.
 
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Relevant Article

A good death in Uganda: survey of needs for palliative care for terminally ill people in urban areas

Ekiria Kikule
BMJ 2003 327: 192-194. [Abstract] [Full Text] [PDF]