HIV and AIDS HIV Treatment Policy and Legislation Public Health & Health Systems

ART no incentive for displaced populations Living with AIDS # 300

Refugees, asylum seekers, economic and undocumented or illegal migrants all flock to South Africa for particular reasons. Often, locals believe that these are to steal away what belongs to South Africans, such as health care. Two refugees who benefit from the South African health care system explain that when they fled their countries of origin, it wasn’€™t to seek antiretroviral therapy.

KHOPOTSO: Monique is from Rwanda and speaks very little English. She speaks kiSwahili, one of the widely-spoken languages on the African continent. Blaise Nzuzi, also a refugee and champion for refugee rights through the Jesuit Refugee Service in central Johannesburg, translates for her.  

 

MONIQUE’€™S STORY: She left Rwanda in 2002. The reason why she left is that during the political instability’€¦ she was a victim of rape. She was raped by rebel people’€¦ And then she left. She decided to join her sister who happened to be here in South Africa since life in Rwanda was very painful for her to continue staying there’€¦ She asked her sister to take her to the hospital’€¦ She had so many symptoms’€¦ Later on she was advised by a medical doctor who was attending to her to have some blood tests and also an HIV test’€¦ maybe, she may be infected.

 

KHOPOTSO: That’€™s how Monique found out about her HIV-positive status. At the time her CD4 count was very low and she couldn’€™t access antiretrovirals, not even through the government programme. It didn’€™t exist at the time. The only alternative was through the private health sector, which she could not afford. But Monique survived and in 2005, two years after the government started its public ARV rollout programme, she started receiving treatment from Helen Joseph Hospital, in Johannesburg.                      

 

Another refugee, Marceline, fled her native Democratic Republic of Congo after losing her husband and three young children during the ethnic war in that country. She’€™s not on ARVs herself. Her last HIV test was before she left the DRC – and it came back negative. However, it was discovered one she arrived in South Africa that one of her three remaining children ‘€“ who is second – has HIV. From French, Nzuzi translates the challenges that Marceline encountered before her child could be allowed treatment at Johannesburg General Hospital.    

   

MARCELINE’€™S STORY: Some doctors were saying that ‘€˜the child is a foreigner; he doesn’€™t have the right to treatment… For that, the child was not allowed to get treatment. It was very hard. By grace, there was a doctor there who said that the child, ‘€˜we could still give him a chance to life’€™’€¦ The doctor decided to put the child on treatment. As from next month, the child will be having two years on treatment. From 0.39 CD4 count to 600, it’€™s like 60% improvement. From 24kg, (it’€™s) actually now 50. He was studying. Now he went back to school. Since he’€™s been on treatment, his skin has now resumed the initial state.  

 

KHOPOTSO: Marceline’€™s son turned 15 last week. The rollout of antiretroviral therapy in South Africa and other countries in the southern African region has led some to believe that a phenomenon of ‘€œantiretroviral migrants’€ might come about from those who live in countries where treatment is not available. But Laurie Bruns of the United Nations’€™ High Commission for Refugees (UNHCR), disputes this, saying that they have not seen people moving from, say, a refugee camp in Zambia to go to South Africa or to Namibia seeking treatment.

 

Dr Francois Venter, now President of the Southern African HIV Clinicians’€™ Society, says 15 years of working as a doctor in the Hillbrow area and surroundings has taught him that refugees do not move to South Africa for medical purposes. He says that that is a common myth perpetuated largely by health care staff. Venter says that when people move they do so for jobs and for economic reasons or when fleeing from conflict situations.    

 

Southern Africa is host to almost 300 000 refugees and asylum seekers. Dr Venter says that most of these come from countries with a lower HIV prevalence, such as the Democratic Republic of Congo and move to countries with a higher prevalence, like South Africa. As a result, their vulnerability to HIV infection increases upon arrival. But xenophobia lurks around everywhere in South Africa and other SADC countries. To counter a growing trend of health care discrimination, the Southern African HIV Clinicians’€™ Society and the UNHCR recently published a guidelines policy aimed at assisting doctors and nurses in the region to treat with compassion and understanding (foreign) nationals who present to public health facilities for AIDS care and treatment.

 

 

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