Streamlining ARV provision for refugees

The United Nations refugee agency, UNHCR, has launched a new policy to ensure that HIV-positive refugees and other displaced people around the world have access to life-prolonging antiretroviral (ARV) medication.

The policy, designed to offer guidance to UNHCR and its partners as well as host governments, aims to integrate ARV provision as part of a comprehensive HIV/AIDS programme for refugees that includes prevention, care and support.

"In certain situations, for example in camps, the refugees have had difficulty accessing ARVs, and even those in urban areas sometimes failed to get treated within the national programmes of the host countries," Paul Spiegel, UNHCR's senior HIV/AIDS technical officer, told IRIN/PlusNews on Monday. "The way many of them have been accessing the drugs is innovative, but has largely not been standardised."

In line with international human rights and refugee law, the new policy calls for ARVs to be planned for and included in "the earliest possible stages of an emergency response to forced displacement".

It also outlines interventions for refugees who were on ARVs in their countries of origin; for those who had not yet started a regimen before their displacement; and for those participating in voluntary repatriation to their home countries.

For instance, where repatriation is considered imminent, UNHCR said it "must be agreed that in exercise of their freedom of movement, returnees should be allowed and assisted to return to areas where continuation of ART [antiretroviral therapy] can be secured".

Refugees, the policy document points out, often live for years in relatively stable settings, making it practical to roll out the drugs in the medium to long term. The strategy deals with both long-term ARV provision as well as shorter-term measures such as, for example, post-exposure prophylaxis in cases of sexual assault, and prevention of mother-to-child HIV transmission.

Spiegel stressed that UNHCR was aiming for equity with host populations in terms of access to ARVs for refugees, rather than special treatment for them: in Ghana, for instance, both refugees and the host population had equal access to low-cost ARVs, while countries like South Africa and Zambia included refugees in their national policies.

"We'd like to see refugees able to get the drugs the same way local populations do," he said. "We are advocating for governments to include refugees' ARV needs in their proposals for funding, for example, from the Global Fund [to fight AIDS, Tuberculosis and Malaria]."

UNHCR estimates that refugees make up between 25,000 and 35,000 of the approximately 6.5 million people around the world who need ARVs.

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