Positive immigrants

Living with HIV in South Africa presents plenty of challenges: those most affected are often the poorest and lack access to jobs, housing and proper sanitation; the disease still carries a strong stigma and many prefer to carry the burden of their status alone rather than risk sharing it with friends and family. But since the government began rolling out free antiretroviral (ARV) treatment two years ago, and many people living with HIV are also accessing social grants, the possibility of living a more normal life is better than it was. Unless, that is, you are an undocumented immigrant, one of an unknown number - thought to be in the millions - who have flocked to the continent's wealthiest country, hoping to find a better life. Even without the complication of being HIV positive, they are often disappointed. They face a largely hostile local population, exploitative work situations if they find work at all, and none of the support from family and friends they could rely on at home. Women and children are especially vulnerable. Thuli [not her real name] came to South Africa from Swaziland with her mother and brother in 1999. Her mother worked as a cleaner in Germiston, to the east of Johannesburg, for R50 ($8) a week until she began suffering from a hacking cough a few years later. The local hospital told her there was nothing they could do and sent her home, but her condition worsened and a month later she died. "I think if she had had a [South African] ID, maybe it was going to be better," Thuli said. "She could have got a better job and maybe she would have got better." At the time of her mother's death Thuli was pregnant and sick. She had tested positive for HIV at the hospital but without documentation was not eligible for treatment. A social worker brought her to Nazareth House, a Catholic mission in the inner-city neighbourhood of Yeoville, where Thuli gave birth to a healthy baby. Since then she has been living at the hospice while working in the kitchen and receiving ARV treatment. "I think I was lucky to come here," she says. "My CD4 count [which measures the strength of the immune system] was 52 - I thought I was going to die." For someone in Thuli's predicament, Nazareth House is the sole option in Johannesburg. Only South African citizens and refugees with the appropriate paperwork can access ARV treatment at government hospitals and clinics. While some undocumented migrants are too fearful of arrest even to seek treatment, others are turned away without receiving any information about alternative options. The lucky ones are referred to Nazareth House, where the Southern African Catholic Bishops' Conference (SACBC), with funding from President Bush's Emergency Fund for AIDS Relief (PEPFAR), has been providing ARV treatment to anyone who needs it since early 2004. Countrywide, the SACBC is providing ARVs to about 7,000 patients. Sister Sylvia Simpwalo, who runs the ARV clinic at Nazareth House, estimates that out of 300 patients receiving ARV treatment there, 90 percent are non-South Africans. Even so, concedes Johan Viljoen, project manager for SACBC's ARV programme, "we don't have enough capacity and there is a waiting list; we're restricted by the amount of funding we get". That funding will only last for the next three years. While the American government is expected to renew its commitment, the SACBC is keen to expand its partnership with the South African government to achieve long-term sustainability, but transferring patients to the national ARV programme will mean the exclusion of undocumented immigrants. While Viljoen acknowledges everyone's right to access healthcare, as outlined in South Africa's Bill of Rights, he also recognises some of the obstacles to treating HIV positive immigrants. "It's very difficult to do patient follow-up," he pointed out. "You might have somebody who starts treatment and then moves back to their country and stops treatment. They may develop drug resistance." Many HIV positive immigrants do not know about Nazareth House. Bishop Paul Verryn, who shelters homeless illegal immigrants and asylum seekers at the Central Methodist Church in Johannesburg's city centre, said many of the hundreds of men and women who bed down each night on the floor of his church are HIV positive. He has no funding to assist them, and his only recourse is to call an ambulance for the seriously ill and hope they qualify for emergency treatment. "We've had four people that I know of who died in hospital because they were not given treatment," he commented. Pascal, 38, [not his real name], who arrived in South Africa from Nigeria 12 years ago, was almost another fatality. After he tried to access treatment at a local hospital and was told by staff to go home and die in his own country, Pascal became so sick that he had to abandon his business as a pavement hairdresser. Unable to walk or buy food, a friend eventually took him to Nazareth House. Despite a virtually non-existent CD4 count he responded to ARV treatment and is now well enough to start worrying about how he's going to get his business going again. "They really saved my life," he said.