1. Home
  2. Africa
  3. Southern Africa
  4. Botswana

HIV treatment for refugees, but for how long?

At the border fence: Peter is a “transporter”, helping Zimbabwean migrants across the border. He says people swallow their fear because they have no alternative. Click here for more.. 270220082.mp3
(Shervorn Monaghan/IRIN)

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 authorized 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/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 hospitalized. Segwabanyane also worries about the long-term sustainability of a programme that has initiated patients on life-long treatment.

''It's kind of dicey being in a privately funded programme. They will be in a precarious situation if the funding ends''

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/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 told IRIN/PlusNews. "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/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.

See also: BOTSWANA: No refuge from HIV/AIDS in Dukwi camp


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

Share this article
Join the discussion

Right now, we’re working with contributors on the ground in Ukraine and in neighbouring countries to tell the stories of people enduring and responding to a rapidly evolving humanitarian crisis.

We’re documenting the threats to humanitarian response in the country and providing a platform for those bearing the brunt of the invasion. Our goal is to bring you the truth at a time when disinformation is rampant. 

But while much of the world’s focus may be on Ukraine, we are continuing our reporting on myriad other humanitarian disasters – from Haiti to the Sahel to Afghanistan to Myanmar. We’ve been covering humanitarian crises for more than 25 years, and our journalism has always been free, accessible for all, and – most importantly – balanced. 

You can support our journalism from just $5 a month, and every contribution will go towards our mission. 

Support The New Humanitarian today.

Become a member of The New Humanitarian

Support our journalism and become more involved in our community. Help us deliver informative, accessible, independent journalism that you can trust and provides accountability to the millions of people affected by crises worldwide.