Botswana: HIV treatment for refugees, but for how long?

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JOHANNESBURG – Until just over a year ago, people living in Dukwi, a remote refugee camp about 200km from Francistown, Botswana’s second city, were burying other residents who had died from Aids-related illnesses at the rate of about five a month.
Botswana was the first country in southern Africa to roll out an antiretroviral (ARV) treatment programme, which now has almost universal coverage, but is among the last to include its relatively small refugee population.
After years of lobbying by the UN Refugee Agency (UNHCR), and local Aids and human rights groups, in April 2009 the government agreed to relax a policy that explicitly barred non-citizens from accessing treatment.
The revised policy stopped short of including HIV-positive refugees in the national treatment programme, but Botswana asked the US government to fund a parallel programme for the approximately 3,400 refugees at Dukwi, who are mostly from Zimbabwe, Namibia, Angola and Somalia.
So far, about 170 refugees have started ARV treatment and a further 65 are being monitored in a programme implemented by the Botswana Red Cross, with oversight by UNHCR and funding from the US President’s Emergency Plan for Aids Relief (Pepfar).
Prevention of mother-to-child transmission (PMTCT) services are now also available to HIV-positive pregnant women in the camp. From 2004 until 2009, a government-run clinic at Dukwi was only authorised to provide such services to local Batswana women.
Boitumelo Segwabanyane, coordinator of refugee health and psychosocial support at the Red Cross, said she was relieved that help was finally available to the HIV-positive people in the camp.
“I remember so many people that have died … (having HIV and Aids services) makes things easier,” she told Irin/PlusNews.
Previously, there had been little to motivate refugees to come for HIV testing and counselling, and stigma towards people with the virus was rife.
Although some camp residents still come for help very late, Segwabanyane said the number of people being tested has risen significantly since treatment became available.
A precarious situation
The logistics of regularly transporting the refugees over 200km to a private clinic in Francistown, where they receive medical care and ARV drugs, has proved challenging and there is no funding for patients who need to be hospitalised.
Segwabanyane also worries about the long-term sustainability of a programme that has initiated patients on life-long treatment. No one knows how long the US will keep funding treatment for the refugees.
“It’s kind of dicey being in a privately funded programme,” said Uyapo Ndadi, Acting Director of the Botswana Network on Ethics, Law and HIV and Aids (Bonela).
“They will be in a precarious situation if the funding ends.”
The government’s decision to allow refugees to receive ARVs was “a partial victory”, Ndadi said.
“We feel the government should have integrated them into their mainstream programme.”
Bonela has been lobbying the government to change its policy of excluding foreigners from Aids treatment and UNHCR is continuing its advocacy efforts.
Gloria Puertas, the agency’s senior regional HIV and Aids coordinator, said the government’s arguments for not extending treatment to include refugees – that it would attract more refugees to the country, and they were already struggling to provide treatment to their own people – were flawed.
She pointed out that Botswana hosts the smallest number of refugees in the region, and has one of the largest ARV programmes. Neighbouring South Africa, Zambia and Namibia have all extended ARV access to their refugee populations, while other countries in the region provide access on an unofficial basis.
– Irin/NewsPlus