Forty-five-year-old butcher Amadu* eagerly looks forward to his first visit to the Tamale Government hospital's new HIV/AIDS treatment and care centre in northern Ghana.

This time, he will not have to travel hundreds of kilometers south to get his life-enhancing antiretroviral drugs.

Last year, the only option for people living with HIV/AIDS (PLWHA) in northern Ghana was to travel south to the Okomfo Anokye Government Hospital in Kumasi, Ghana's second largest city. Patients could spend as much as four or five times the US $5 cost of the heavily subsidised drugs in traveling expenses just to get their medicine.

"It is like people with our condition in the north have received another lease of life. Now, I can virtually walk to the hospital from my home instead of being bogged down by extra expenses and a whole day wasted just to travel for my drugs," Amadu told IRIN.

"This makes the whole process simpler for us. I hope it will cut down on the unnecessary deaths among AIDS patients because the medicines are now virtually at our doorsteps," he said.

Costs cut survival

Last year, the Amsterdam-based Health Action International (HAI) conducted multi-country surveys on HIV/AIDS and its assessment of ARV treatment programmes in Ghana revealed that an unusually high figure of 33,000 AIDS-related deaths was recorded in 2004.

The survey cited the high costs incurred traveling to treatment centres and the cost of treating opportunistic infections at the hospitals as some reasons for the high mortality rates. It also found that some AIDS patients could not afford the ARVs.

"Most people who get sick of AIDS just stop working and move to their villages because of stigma and discrimination. Because they do not engage in any income generating activity, they rather tend to rely on people around them for support," Charles Allotey, HAI coordinator for the Ghana survey, told IRIN.

"If these support systems are not strong enough, it is very possible that people can genuinely not afford the subsidised cost for the drugs," he said.

Boost to treatment

However, this situation might be about to change. Ghana's Health Service has received a financial boost from the Global Fund, the World Bank and other donor agencies to increase the number of HIV/AIDS treatment centres - from five in 2005 to 32 across the country.

Most of the centres will be managed by the government health service while a few others will be managed by private clinics and faith-based organisations such as the Roman Catholic and Presbyterian churches.

As a result, the number of Ghanaians on ARV treatment is expected to increase from the June 2006 figures of 5,360 to 15,000 by the end of the year. These numbers are further projected to increase again in 2007 when Ghana's Health Service intends to further decentralise access to the life-prolonging drugs to cover 50 percent of smaller hospitals located in Ghana's 130 districts, according to the National AIDS Control Programme (NACP). About 71,000 Ghanaians need to be placed on ARV therapy, the Ghana AIDS Commission says.

"We do not envisage any logistical problems to come up with this increase. We have paid for supplies to last for the next two years and we are also training enough health workers to man the treatment centres," Kojo Asante, monitoring and surveillance officer with NACP, told IRIN.

Some still prefer travel

Although the increase in HIV/AIDS treatment centres spells good news for Ghanaians, as well as some PLWHAs from neighboring Cote d'Ivoire and Togo who cross the borders to have access to the centres, the NACP admits that it will have to grapple with an interesting phenomenon induced by stigma.

"We are noticing a peculiar trend where though treatment centres have increased, some PLWHAs still prefer to patronise treatment centres far from their home areas where people will not recognise them because of stigma and discrimination," NACP's Kojo Asante said.

"They do not want to be seen during treatment days in queues for the ARVs since people who know them will immediately identify their health condition," Asante said. "However, this is rather putting a strain on health workers at certain centres, which still have to cope with large numbers of people coming for treatment."

* Amadu is a pseudonym