Returning migrants struggle to pay for AIDS treatment

Two years ago Moumoumi Guira fled ethnic attacks and civil war in Cote d'Ivoire. He got back safely to his native Burkina Faso, only to discover he was HIV positive. Now, having left everything behind in the rush to escape, he must find a way to pay for the antiretroviral treatment that he desperately needs. "We have nothing. We couldn't get any luggage onto the truck that brought us. To feed everyone at my house is a big enough problem but to find the cash for my medication too, well it's impossible," he told PlusNews in the southwestern town of Bobo Dioulasso. The 47-year-old turned to REVS+, a local association set up to help people with AIDS. It hands out life-prolonging antiretroviral treatment for free to around 80 people. But there were already another 700 people on the waiting list, so Guira had to take his place in the queue. He was not ready to give up though. "He kept coming back again and again, knocking on the door to ask for help," recalls REVS+ director Martine Somda. "He really didn't have anything so in the end we put some work his way as an ad-hoc mechanic." Guira, who worked as an agricultural labourer on a cocoa plantation in Cote d'Ivoire, freely admits he isn't an expert in the trade. But he says he repairs the bicycles that come his way and gets by. If he's lucky he can earn about 10,000 CFA (US $20) a month, half of which will be swallowed up by paying for subsidised ARV treatment. During the lean months, he relies on the goodwill of friends and family to help him through. Sometimes the funds just aren't there. The father of 10 is one of more than 365,000 Burkinabe migrants who returned home after September 2002 when war erupted in Cote d'Ivoire and many Burkinabe were accused of sympathising with the rebels who seized control of the north. The migrants left Cote d'Ivoire, the region's economic engine, and arrived in Burkina Faso, a country ranked by the United Nations Development Programme (UNDP) as the third-poorest in the world. "They came here with nothing so how can they have access to treatment?" Somda said. Guira is one of the luckier ones. Many others cannot even contemplate buying the expensive drugs. And more and more people are falling prey to secondary diseases like tuberculosis and pneumonia. "What we're seeing now is that the opportunistic illnesses are increasing substantially and that in turn causes more problems for people with families to support," Somda said. Higher prevalence rates? Another worry for aid workers is that the mass of new arrivals from Cote d'Ivoire, which has the highest HIV prevalence rate in West Africa, might push up Burkina Faso's own rate, reversing a falling trend. "We cannot deny the fact that contamination is possible as a result of the population moving from places with a high prevalence rate," said Mamadou Sakho, the coordinator of UNAIDS in Burkina Faso. "It's a serious problem when it comes to HIV transmission." In Cote d'Ivoire, the last government survey put the HIV prevalence rate at 9.5 percent although humanitarian workers say it is probably closer to 11 percent, particularly in rebel-held border areas. In Burkina Faso, UNAIDS figures show that the prevalence rate at the end of 2003 was 4.2 percent down from 6.5 percent in 2001. But in Bobo Dioulasso, the second city which lies 120 km from the Ivorian border, Somda says there has been a marked increase in the number of people coming to her clinic since war broke out in Cote d'Ivoire. "At the association level, we have noticed an enormous surge in the number of people turning up at our doors. Two years ago we had about 300 patients coming to us. Now it's 1,075," she told PlusNews. The UN Office for the Coordination of Humanitarian Affairs (OCHA) estimates that more than 600,000 migrants from across West Africa have fled Cote d'Ivoire for home. And so it is not just landlocked Burkina Faso, which lies to the northeast of Cote d'Ivoire, where there are concerns about the knock-on effect on health issues. In Mali, where the national HIV prevalence rate is currently 1.9 percent, experts are also worried about the influx of more than 100,000 returning migrants. "Taking account of the prevalence rate in Cote d'Ivoire, it is reasonable to fear that a similar percentage of migrants have come home with the virus," said Jean-Louis Ledecq, the coordinator for UNAIDS in Bamako. "We don't know where they've gone and it's a source of concern because they are very vulnerable people," he said. "They are a strain on the families that have welcomed them back, they're often mobile and susceptible to risky behaviour." One aid worker recalls overhearing a group of Burkinabe girls giggling about how they had put a dishy Ivorian man "in quarantine" to see how healthy he was. He didn't fall ill during the first month, so one of the girls decided it was safe to sleep with him. And while widows coming from Cote d'Ivoire are often made to take an HIV test by their in-laws before they are allowed to marry their husband's brother, in conformity with local tradition, returning males are not subjected to such screening. Even the government-run body, the National Committee to Fight AIDS (CNLS), acknowledges that the migrant problem exists. But they also know it is a tricky one to tackle. "We know that returning migrants have been more exposed than other people, but we can't set up special initiatives because that would point the finger at them as well as stigmatise another country," said Didier Dakouan of the CNLS in Ouagadougou. The CNLS estimates that 300,000 of Burkina Faso's 12 million population are infected with the HI virus and already the illness is often dubbed "the Cote d'Ivoire disease". For Somda at REVS+ the solution is to step up education campaigns and improve access treatment across the country. For example, there are only about 50 centres in Burkina Faso where people can get an HIV test. "We need to continue to improve things at the national level and then that will help the migrants without singling them out," Somda said.