Tommy had only been in Paris for two months when he discovered he was HIV positive. In a political climate increasingly hostile to immigrants, he is fighting to stay in France legally and get on a treatment programme.
Like most of the 20,000 HIV-positive foreigners, mostly from Africa, the 25-year-old Cameroonian was unaware he was positive when he arrived at the beginning of the year. "After about two months I started to experience pain when I urinated, so I went to the doctor and that's when I discovered I was positive."
People with a long-term illness are entitled to stay on a residence visa and can qualify for medical treatment, but it is a long procedure and Tommy has been waiting for five months. So far he has only been granted a temporary six-month visa, and is getting anxious.
"Here people are more open. In Africa we are often rejected by friends and family when we test positive for HIV. Here I have a network of good friends who don't care whether I'm [positive]," he said.
Immigration regulations have been tightened recently, making it harder for HIV-positive Africans to qualify for that vital residence permit, which guarantees access to social services and provides some sense of stability.
"I stayed seven months without a proper visa before receiving two temporary ones," said Patricia, 32, from the Central African Republic, who was finally granted a one-year residence permit. Short-term visas do not entitle their holders to work or ordinarily allow them state benefits.
Advocacy groups warn that the clampdown on immigrants and so-called "medical asylum" seekers will force HIV-positive people underground, further threatening their health and that of wider society.
"Illegal migrants have so many difficulties that even if they wanted to take care of their health, it can't be their first priority. Their morale is low because everything is focused on their visa," said Dr Christine Etchepare, a medical consultant with the Association for Research, Communication and Action for Access to Treatment (ARCAT).
"There is this belief that there is an invasion of sick people," said Arnaud Veisse, director of the Medical Committee for Exiles (COMEDE). He said just 16,000 people held visas for medical reasons in 2004, representing only 0.5 percent of migrants living in France.
He added that 95 percent of those living with a chronic infection like HIV or hepatitis only learnt of their condition once in France. Although the evidence suggests medical asylum is a myth, the authorities are responding to political demands for more action to slow immigration.
"In the last year or two, people have been hearing that they can't apply for a residence visa even if they meet the criteria. They are told that they are here only for treatment and that they'll get sent home. That's discriminatory," said Elodie Redouani, legal counsel to ARCAT.
Officials responsible for approving permits on medical grounds "feel they can't make too many concessions in terms of granting visas. Their decisions become quantitative rather than taking into consideration the best interest of the patient and public health policies," she added.
Noel Ahebla, president of the African Positive Association (APA), which offers help to HIV-positive Africans in France, recounted the case of a woman who was granted visas on three occasions, but the fourth time was denied. "The authorities refused, saying that she wasn't sick anymore ... when she had AIDS."
The biggest deterrent to care can simply be the threat of being picked up on the streets. A pamphlet circulated in February warned that the authorities would be doing random checks at hostels for migrant workers, emergency shelters and refugee centres, and questioning people.
Despite interior minister Nicolas Sarkozy clarifying that checks would not be done in medical centres, the rumour had an effect on the migrant population. HIV-positive patients can be repatriated if they do not have the proper papers; if they have omitted their medical condition on their applications, or simply due to an overly complicated application procedure.
"Africans are afraid of going to the hospital to be tested because of more frequent checks," said Ibrahim Fofana, of the Bureau for the Reflection and Action of African Communities (URACA), which provides psychological support to HIV/AIDS patients.
Antonin Sopena, of the activist group Act Up, said the "hunt for illegal migrants" prevented people from seeking medical help. "They go to the hospital only when symptoms appear. Some go anonymously, and only from time to time."
Nevertheless, especially in Paris where a strong NGO support network exists for those living with HIV, help can usually be found for people in need of treatment but who have failed to get state aid.
Several organisations offer HIV-positive migrants hands-on help in navigating the treatment bureaucracy, and provide advice on how to avoid expulsion. "We counsel them to keep a medical testimony stating they are HIV positive on them at all times, which will protect them long enough to take the next steps in the application process," said Ahebla of APA.
Not all migrants want to stay in France. Discouraged or sick, many wish to return to their home countries, especially if comprehensive national treatment programmes are available. "When they come from stable countries where treatment is accessible, some hope to go home one day to be reunited with their families, while at the same time receiving treatment," said Dr Etchepare.
According to the United Nations, only 17 percent of the estimated 26 million Africans living with HIV/AIDS have access to antiretroviral treatment.
The Central African Republic is an example of a country where treatment is almost non-existent. It is "expensive and there are always shortages in stocks, and regular medical check-ups aren't possible," said Patricia. "But if there was a comprehensive treatment programme there, I would be the first to leave and go home."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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