Almost every day, Mumba, who is HIV-positive, and has been placed on indefinite sick leave by his employer, makes the roughly six-kilometre trip from the middle-income suburb of Hatfield to the city centre, where he joins hundreds other people jostling to withdraw the maximum Z$500,000 – worth less than US$2 – from his bank. Last week the maximum amount an individual could withdraw was only Z$50,000 or US20 cents. A month’s supply of ARVs can cost up to Z$20 million (US $50).
"When the maximum withdrawal limit was $50,000 I stopped coming to the bank because that was the amount that I needed to travel into the city centre," he told IRIN/PlusNews.
"I am on a cocktail of antiretroviral [ARV] drugs that should be taken after eating. However, I am sometimes forced to take my medication on an empty stomach because I would have failed to withdraw enough money for food. The little that I sometimes manage to keep spare is spent on food items that are hardly nutritional, and I guess that is the reason why my condition keeps on deteriorating."
The Reserve Bank of Zimbabwe (RBZ) has introduced a system that allows patients to apply to their banks for bigger amounts of cash to buy medication. Some patients have benefited from the scheme, but Mumba complains that the application takes long to be processed and, when approved, the banks give them the money in small amounts.
He has "enough money in the bank to buy medication for six months, but it is painful that I am slowly degenerating simply because I cannot take out as much of it as I need".
Tonderai Chiduku, advocacy coordinator for the Zimbabwe National Network of People Living with HIV and AIDS, pointed out that "Nutrition is central to the longevity of the life of a person living with HIV and AIDS and even if one might have all the drugs needed, it would be difficult to keep in good shape."
Taking drugs on an empty stomach because one could not afford food caused side effects that might lead to patients defaulting on ARV treatment, he warned.
Chiduku, who is HIV positive, said cash shortages were forcing patients to buy drugs on an "ad hoc" basis, mostly in small quantities, "but that creates further problems because the quantities might not be the prescribed ones, and our members … tend to develop virulent strains of HIV".
The inflation rate, officially estimated at 231 million percent, made the situation worse for people living with the virus because "Prices are changing on a daily basis, and that further reduces the ability to buy drugs and food."
Although antiretrovirals are available free of charge on the government’s treatment programme, medication for opportunistic infections is harder to come by.
Tabeth Maruziva, 36, who is also HIV positive, has had cotrimoxazole, an antibiotic drug that helps keep opportunistic infections at bay, prescribed for her by a doctor. But she finds it difficult to buy the medication as well as food because most of the suppliers are charging for the drug in foreign currency.
When the antibiotic is available in local currency, she has to visit the bank for two days to get enough money to buy it, but the amount she can withdraw leaves her with nothing for transport, food or anything else after she has bought the medicine.
To buy foreign currency on the black market, she first has to get enough local currency. "That means a double burden. I hardly have the energy to stand in a bank queue and even when I get the cash, it is not enough to buy the foreign currency, for which I am forced to hunt at the risk of being arrested by the police," she said.
A single mother with three children to care for, Maruziva suspects she contracted HIV when she was a sex worker. She is now often bedridden and cannot work.
It is the second month since cotrimoxazole was prescribed to her that she has been unable to buy it; in desperation she has resorted to untested traditional herbs that she has been told will have antiretroviral effects.
Martha Tholanah, the Zimbabwe AIDS Network’s humanitarian programme officer for people living with HIV, said patients in the countryside were in a worse situation than those living in towns and cities.
"People living with HIV in rural areas find it extremely difficult to raise the transport fare to travel to the nearest bank to withdraw cash," she told IRIN/PlusNews. "The transport itself is unreliable and at times non-existent, meaning that patients are forced to forego treatment."