KHOPOTSO: Reports of foreigners, particularly from other parts of Africa, being denied access to health care in South Africa abound. This, even when the country’€™s policy on the provision of health care to refugees and other immigrants is clear: that they also have the right to health care. The Clinical Guidelines on Antiretroviral Therapy Management for Displaced Populations, launched recently, aim to reiterate the South African government’€™s policy on the provision of health care to non-South Africans, according to the President of the Southern African HIV Clinicians’€™ Society, Dr Francois Venter.  

Dr FRANCOIS VENTER: (The) South African government’€™s policy is fairly explicit in terms of’€¦ anybody in South Africa can have access to emergency care; and you do not need to have an ID book or any form of identification to access primary care.

KHOPOTSO: Venter went on to say, however, that the policy has become a bit blurry over the years. It really does not address the issue of non-South Africans ‘€“ refugees, permanent residents as well as illegal immigrants with regard to accessing antiretroviral therapy.      

Dr FRANCOIS VENTER: To access antiretrovirals you need to be a South African citizen, a refugee… or a permanent resident. However, more recently, the national Department of Health have   had several issues of people not being given antiretrovirals. Children are particularly a problem’€¦ the mother dies and they haven’€™t got their ID books sorted out. So they don’€™t get care and die’€¦ So, the national Department of Health has actually issued a statement saying ‘€˜people do not need to have ID books to access antiretrovirals’€™. It’€™s put medical practitioners in a little bit of a difficult position because now they have to guess whether they’€™re South African or not.    

KHOPOTSO: He says the guidelines aim to address that same problem.    

Dr FRANCOIS VENETR: There’€™s quite hard ethical stuff here, which says ‘€˜your role as a health care practitioner, your ethical duty, is to treat the person in front of you as best you can within the legal framework. It’€™s not for you to run around and decide that you don’€™t like foreigners and therefore, you don’€™t want to treat them. It’€™s unethical and we want to make that absolutely explicit. We hope we’€™re going to be submitting them to the Health Professions Council of South Africa to see if they can be signed into ethical parameters and then, they’€™ll actually have the force of law behind them.        

KHOPOTSO: Laurie Bruns works with the South African office of the United Nations High Commission for Refugees (UNHCR). She spends a lot of time orientating health care workers on how to work with refugee communities.

LAURIE BRUNS: Largely, we found (that) it’€™s just their lack of familiarity and once you engage them and get them to talk they sort of do pull up their professional socks and provide the service that they are meant to’€¦ The difficulty in South Africa’€¦ is that refugees live freely in many communities, largely around urban centres, but really throughout the country. So, to train all health care providers ‘€“ from the intake clerk all the way to the final clinician ‘€“ is quite an undertaking’€¦ Where we have direct contact with institutions like Jo’€™burg Gen, Helen Joseph, Coronation, Goote Schuur in Cape Town, Addington (to some extent) in Durban and you sort of make personal relationships, then the door is wide open’€¦ But it’€™s a lot of work’€¦ It’€™s a lot of convincing’€¦ The first reaction is often: ‘€˜No to foreigners’€™.                  

KHOPOTSO: As a result, many foreign African nationals die silently. Blaise Nzuzi is the co-ordinator of the Jesuit Refugee Service, in Johannesburg’€™s inner-city.  

BLAISE NZUZI: (There are) 150 000 refugees and asylum seekers all in all. With such a great number, we believe that many of those people are infected and affected’€¦ From our statistics, only for this year, refugees who died – out of 15 ‘€“ at least, 13 were HIV-related cases. Some will come at a late stage. They will disclose to you, but when it is already too late for one to do something about it.        

KHOPOTSO: There have been reports in recent weeks of refugees crowding out health services in central Johannesburg. Dr Francois Venter of the Southern African HIV Clinicians’€™ Society says the guidelines on providing anti-AIDS treatment to refugee populations are absolutely necessary to help cast away assertions that the presence of immigrants in South Africa means a compromised quality of care for locals.          

Dr FRANCOIS VENTER: Even if this 150 000 is correct, if you do the math and you work out how many people need ARVs from the refugee community, it probably is, at the most, 2 000. At the moment, there are 450 000 South Africans who need antiretrovirals. It’€™s a tiny, tiny, tiny percentage of what we need to do’€¦ I work in these clinics in central Johannesburg and the population that they’€™re treating, the majority of them are South African. I’€™m telling you, it’€™s a handful. You actually know their faces because there’€™s so few of them’€¦ The other thing is that people are not eligible in central Johannesburg for antiretrovirals through the government programme’€¦ There are programmes run by Catholic Relief Services who actually make provision for their care. So, it’€™s not as if they’€™re stealing resources away. It’€™s a complete myth and I have no idea where these stories come from.