Undocumented immigrants living with HIV refused medication in South Africa

A Zimbabwean woman living with HIV had to be ‘rescued’ from jail in South Africa after spending the entire weekend without access to her medication.

Mai Tawanda was arrested and detained at the Maitland Refugee Reception Centre for being an ‘illegal’ or undocumented immigrant.

People Against Suffering Oppression and Poverty (PASSOP) intervened after police ignored Tawanda’s pleas for antiretroviral drugs (ARVs) to be delivered.

The South African constitution guarantees asylum seekers, refugees and undocumented immigrants access to health care services.

But civil society organizations are campaigning for a more humane way of dealing with deportees living with HIV that would minimize disruptions to their treatment.

Treatment Action Campaign says that treatment interruption can have serious health implications. A person could develop a strain of HIV that is resistant to their ARVs. Resistance occurs when the virus mutates and reproduces so that one or more drug is no longer effective.

According to the International Organization for Migration, over 10,000 Zimbabweans have been deported since a moratorium on deportations was lifted in October 2011. Due to the manner in which these deportations are carried out, it is feared that many deportees living with HIV could default or abandon treatment.

Paul Foreman, Head of Mission in Zimbabwe for Médicins Sans Frontières, said in the October 2011 People’s Magazine article ‘Zimbabweans cast out to die’: “About 300,000 people are on ART [antiretroviral treatment] in Zimbabwe according to the Global Fund, but over 600,000 qualify for ART based on the World Health Organization-recommended CD4 count threshold of 350.”

Deported Zimbabweans living with HIV have to join a waiting list for medication, with the fragile health system already under severe strain.

The country recently emerged from a cholera epidemic in 2008, but is now faced with a typhoid outbreak that threatens to be on the same scale. In this regard, deportees sent back to Zimbabwe face a very real risk of death.

Even in cases where people living with HIV have made contingency plans, it is impossible to have two-to-four weeks’ stock of ARVs on their person all the time. Deportations are sudden and law enforcement agencies often will not allow detainees access to their medication. Even if they do, medication might run out while they are still in detention.

Though most patients take their medication religiously, they may not be able to recall whether they are on d4T or AZT, nevirapine or efavirenz, 3TC or NNRTI. Referral letters are critical as they specify the regimen the person living with HIV is on to ensure continuation of the same regimen in the home country.

Sbusiso, a Zimbabwean person living with HIV in Johannesburg, claims to have bribed his way out of Lindela Repatriation Centre after being detained for two days without access to his ARVs. He is undocumented and faced deportation back to Zimbabwe.

Sbusiso’s medication is couriered to him by his mother through the informal courier network known as omalayisha from St. Luke’s Catholic Hospital in rural Matabeleland in Zimbabwe, over 1200 kilometres away.

He insists that as an undocumented immigrant, this arrangement serves him better because he doesn’t bother anyone and there is less risk of being ‘discovered’ by law enforcement agents.

When he was bed-ridden, his friends took him home and he was lucky to get immediate access to ARVs at St Luke’s. Nine months later, he was back in Johannesburg and his boss at a Greek restaurant in the suburbs took him back immediately.

Langton Mariyoga, an official at PASSOP, has called for “a humane process of deportation that considers the plight of HIV/AIDS deportees”.

His organization will push the South African government to ensure the protection of people living with HIV and other vulnerable groups of deportees during the deportation process.

Mariyoga said: “We believe that this is not the time to deport people back to Zimbabwe, thus we are completely opposed to deportations of people with HIV/AIDS to Zimbabwe.”