Panos | 30 June 2008

By Kristin Palitza

The recent flood of Zimbabwean refugees into South Africa has received much attention all over world because of the ensuing xenophobic attacks. There has been widely publicised concern about the human rights of foreign nationals and closely related issues of housing, employment, poverty and, of course, safety has been discussed extensively.

But there is one important aspect of being an immigrant in South Africa that has not found its way into the media as yet: that of an HIV-positive refugee relying on access to anti-retrovirals (ARVs), general health care and/or treatment of opportunistic diseases.

Refugees generally don’t have sufficient access to health care or social support in the countries they flee to. They face discrimination, are largely isolated from the communities they live in and are at high risk of rape, sexual violence and abuse. Access to condoms is another issue.

What makes matters worse is that refugees often have to survive in inadequate living conditions – overcrowding, poor nutrition, insufficient ventilation, lack of sanitation and little access to clean water - that pose health risks and expose them to diseases such as tuberculosis, which we all know is one of the primary opportunistic diseases HIV-positive persons contract.

Another difficulty is that refugees generally have little exposure to information on HIV and AIDS both in their home countries and in South Africa, as a result of illiteracy, lack of access to information and/or language barriers.

For illegal immigrants who are arrested and held in one of the country’s detention centres, the situation looks even bleaker. Requests for treatment are almost always denied or, if there is a clinic within the centre, ARVs or TB treatment are simply not available. This happens despite the fact that the South African government has an obligation to uphold refugees’ basic human rights, which includes the right to access health services.

South African NGOs like the Treatment Action Campaign have recorded cases where HIV-positive immigrants have started ARV treatment in their home countries but were unable to continue with their regimen because they were (illegally) refused treatment in South African clinics because they are foreigners. Since 1998, refugees have had the same rights to access health services as South African citizens, but many are not able to exercise those rights.

Instead of being prescribed treatment, they are told to bring along their lifesaving drugs themselves, a request I highly doubt many refugees will be able to fulfil. And what will happen if their medication runs out?

Yet, adherence is absolutely crucial for those who are on ARVs, and treatment interruption can have serious health implications and threaten the patient’s life. Apart from this, disruption of treatment can lead to the development of drug-resistant strains, which means that the HIV-positive person will stop to respond to any of the currently available anti-retroviral drugs.

As different HIV strains of the virus are passed on with every new infection, this is a consequence that will ultimately affect us all./2010 features/blog