Denying Antiretrovirals To Migrants Hurts Us All

Original Source Interview with Joanna Vearey, Forced Migration Project, Univ. of Witswatersrand JOHANNESBURG, Jul 15 (IPS) – South Africa has become a destination for people from across the continent and beyond. But in spite of migrants having a legal right to free antiretroviral treatment (ART) for HIV, they are being turned away from government clinics. Ensuring the right to ART is upheld for foreign migrants living in South Africa would go a long way to helping them maintain a livelihood, which in turn would enable them to continue to make a contribution to the economy and the social fabric of the country. On paper, South Africa has a protective, integrative urban refugee policy, which affords particular rights through protective legislation to refugees and asylum seekers – but the practice is very different. Many refugees, asylum seekers and undocumented migrants struggle to access the rights to which they are entitled, including employment, housing and basic healthcare. The refugee policy facilitates freedom and protection through enabling the temporary integration of refugees into local communities. Displaced people are expected to become self-sufficient through earning a living and integrating with the community. Only a small — but important — number of migrants in South Africa are refugees or asylum seekers; the majority are in the country on visitor’s visas. But everyone in South Africa has access to basic health care, including emergency treatment. For a time it was unclear whether this included access to free ART, but this was clarified by a September 2007 Department of Health directive which stated that South African booklets are not required to qualify for free public sector ART. IPS reporter Kathryn Strachan spoke with researcher Joanna Vearey about the link between international migrants’ access to ART and their ability to sustain a survivalist livelihood, which Vearey finds is essential in enabling migrants to remain self-reliant and to integrating into urban life. IPS: Could you explain the relationship between HIV and migration? Joanna Vearey: There is a complex link between mobility and HIV, and it is evident that where there is mobility, there are clear trends towards the spread of the disease. While local governments have been concerned that international migrants may bring HIV with them, it is increasingly recognised that migrants may be more vulnerable to acquiring HIV infection than the local population. Migrants are at greatest risk to infection (and transmission) when they arrive in their new location as it is the time when their social structures change perhaps increasing their risk of infection, but most importantly in moving to an urban area they have moved from an area of low prevalence to an area of high prevalence. IPS: What has your research in the city of Johannesburg revealed? JV: All the interviews with HIV-positive migrant ART clients who are working in the informal economy reflected the importance that access to ART had on their ability to maintain or regain their survivalist livelihood. It was clear that ART access was an essential resource to their ability to support themselves and their dependents. The importance of starting ART early was also reflected. However, all of these people are accessing ART within the NGO sector. A key issue here is documentation, none of the individuals had received refugee status, most had asylum seeker permits or no documentation. The remainder use visitors permits that they renew periodically. Despite the Department of Health stating that people do not require a South African ID document in order to access ART, the research shows that non-citizens are denied treatment in the public sector. Some sites insist on the presentation of a South African ID before the person is seen. This shows that institutions are implementing their own policies that go against existing legislation. A wider study in Johannesburg has shown that 80 percent of non citizens access ART in the NGO clinics, where they are not asked for documentation. Denying migrants access to healthcare has consequences not only for the individual. In the long term it inceases public health problems — infectious diseases do not discriminate. IPS: Why is it important that cities, Johannesburg in particular, address this challenge? JV: As migration will continue, both from rural areas and from across borders, urban pressure will increase. Johannesburg, a city with a population of nearly 4 million, has grown by 20 percent since 2001. It is estimated that 6.2 percent of the city’s total population are international migrants. In certain inner city neighborhoods, over half of residents are non-nationals. They add in most cases to the ‘urban poor’, falling within the peripheries of health and social welfare provision and relying on survivalist livelihoods within the informal economy. Local governments need to plan for the increase and implement policies that protect urban poor groups, groups which include an increasing number of asylum seekers and refugees. Migration to urban areas places increasing pressure on the ability of local governments to respond to the public health and social service needs of urban populations. If local authorities create an environment that embraces refugees and asylum seekers, and upholds their rights, it will increase the likelihood of this group becoming an economic and social asset to the city they live in. Migrants can benefit their city only when they are allowed to pursue their rights to work freely and to integrate. The sooner we recognise the opportunity in that, the better it will be for everyone living in the city. IPS: What does rapid growth mean for a city with high HIV prevalence? JV: In the context of a country with the highest number of people living with HIV in the world (5.5 million) and where the adult prevalence rate is estimated to be 18.8 percent (UNAIDS 2007), migration to cities adds to the complexity. Prevalence rates are highest in cities, and this rate rises in informal settlements. Almost 60 percent of the South African population is estimated to be urban and adult prevalence rates are highest in urban areas: 9 percent in urban formal areas, rising to 18 percent in urban informal settlements. It has been said that “although cities have been the economic, social and cultural powerhouses of human endeavour, they are a bad idea in biological terms.” IPS: What are the barriers to migrant’s abililty to access their rights? JV: While there is a protective policy, government institutions are unable to convert legal entitlements into effective protection. The reasons include institutional failures, the denial of social services, and abuse from the police, which manifest as ignorance, xenophobia and legal discrimination. The main problem lies with the Department of Home Affairs as many migrants are unable to access official documentation because of inefficiency within the department. Whilst documentation cannot prevent discrimination or ensure social exclusion, not having such documentation affects a person’s ability to claim their rights.