Bahrain: New health insurance restricts migrants’ access to healthcare

Bahrain’s new health insurance law designed to leave migrants in precarity while ill

Bahrain’s mandatory health insurance programme for migrants came into effect on 31 October 2026. While the government presents the reform as a major step towards a more efficient and sustainable healthcare system, the new programme restricts migrants’ access to Bahrain’s public hospitals, introduces significant limits on coverage, and increases cost of health care for the lowest- income migrant workers.

Bahrain began implementation of its National Health Insurance Programme for Residents this month. 

Article 2 of the Supreme Council of Health Decision No. 66 of 2026 on the mandatory health insurance packages for residents stipulates that migrants in the following categories — who were issued work or residence permits before 31 October 2026 — will be covered when their permits are renewed and the mandatory health insurance contribution is paid:  

  • Migrant workers employed by an employer.  
  • Non-Bahraini individuals who employ workers. 
  • Workers authorised to work without an employer. 
  • Spouses and children under 24 who are financially supported by migrants in the above categories. 

Sponsors/employers of migrant workers must pay the health insurance premium when processing work permits through the Labour Market Regulatory Authority (LMRA). The current fees are BD 90 (USD 240) for a one-year work permit and BD 180 (USD 480) for a two-year permit, with the premium expected to increase further next year. The LMRA then transfers the premiums to designated private insurance companies to provide coverage. 

When a migrant worker transfers to a new employer, the new sponsor becomes responsible for their health insurance. A new policy is issued alongside the new work or residence permit, while the previous policy is cancelled. The LMRA has also established a mechanism to refund– Opens in new tab the health insurance fees corresponding to the remaining validity period of the work permit when a worker transfers to another employer. 

The cost– Opens in new tab of health insurance coverage for family members of migrant workers in the private sector is borne either by the employer or the worker, depending on the terms of the employment contract. 

The new health insurance law raises major concerns over high co-payments, low coverage ceilings and extensive exclusions, including treatment for sexually transmitted infections, organ transplants, immunotherapy, and injuries or illnesses resulting from war, natural disasters, epidemics and pandemics. Work-related injuries are also excluded where costs are covered by employer liability or government social insurance, raising questions about protection for self-sponsored workers who are not tied to a single employer or covered by social insurance. 

A citizens-first approach to healthcare 

Bahrain’s Health Insurance Law No. 23 of 2018 established a broad legal framework for compulsory health insurance, but its implementation has been delayed until this year. In practice, employers continued to meet healthcare requirements for migrant workers through government healthcare fees, which enabled workers to access public health centres and hospitals, or insurance for private healthcare facilities. Under this previous arrangement, migrant workers could access public healthcare by paying relatively low consultation fees, with treatment costs also generally more affordable than those in the private healthcare sector.  

The new insurance scheme offers a defined package of healthcare benefits, with access to services provided through an approved network that includes private healthcare facilities. It also specifies the scope of coverage, applicable contributions, and conditions governing access to healthcare. 

Government-sector employees and their dependents are still covered by the government healthcare facility. The law is silent on the inclusion of domestic workers, though the 2018 Health Insurance Law states that the government is obliged to pay the mandatory health insurance premiums for domestic workers who work for Bahraini citizens.  

Solidarity Bahrain is currently the main health insurance provider. In August 2026, it signed an agreement– Opens in new tab with the Supreme Council of Health as part of the implementation of the programme. The Supreme Council also stated that mandatory coverage would ultimately be provided through standardised insurance packages and a consortium of accredited health insurance companies. 

According to the Chairman of the Supreme Council, Dr. Sheikh Mohammed bin Abdullah Al Khalifa, the shift towards an insurance-based model aims to contribute to reducing the pressure on government health facilities and reducing appointment waiting times. Bahrain’s public healthcare has faced severe operational issues for several years, with a lack of funding not only resulting in long wait times, but also months of unpaid wages for migrant nurses in public hospitals.

Since 2024, the Bahraini government has restricted migrant women’s access to public hospitals for childbirth in certain cases. This year, the government has also begun paying private hospitals to perform operations for Bahraini patients facing long wait times in Salmaniya Hospital, Bahrain’s main public hospital. 

Before the implementation of the new decision, Dr Noor Dhaif, director of the operations directorate at government hospitals, announced– Opens in new tab that migrants would no longer receive treatment at Salmaniya Medical Complex, under the new compulsory health insurance scheme. She added that “the move is expected to free up beds, ease overcrowding and leave Salmaniya treating mainly Bahrainis.” 

There is currently no blanket ban on migrants receiving treatment at Salmaniya Hospital, but the fee for migrant visits to Salmaniya has increased from BD 7 (USD 18) to BD 25 (USD 66). Though they have not formally been excluded from the hospital, the substantial increase in fees makes access to treatment unaffordable for many low-income migrant workers. Migrant workers continue to have access to public clinics, where they are charged a BD 5 (USD 13) consultation fee. 

Medical cost coverage ceiling  

For migrant workers covered by the programme, the mandatory package provides an annual overall treatment limit of BD 15,000 (USD 39,650) per insured person per year. While the amount might seem adequate, the package contains a number of separate sub-limits:  

  • Pre-existing and chronic conditions share a combined annual limit of BD 2,000 (USD 5,320). (The definition of a pre-existing condition is also broad, covering an illness, injury or related condition that existed before enrolment, whether or not the person was aware of it.) 
  • Outpatient medicines are capped at BD 500 (USD 1,330), while outpatient kidney dialysis is capped at BD 500 annually. 
  • Maternity coverage is limited to BD 500 (USD 1,330) for a normal delivery and BD 800 (USD 2,127) for a Caesarean section. Pregnancy coverage also operates within specified age and service conditions. 
  • Cancer treatment is covered up to the applicable annual insurance ceiling, while newborn healthcare is covered for the first 30 days following birth under the specified benefit provisions. The package also provides up to BD 1,000 (USD 2,660) towards repatriating the remains of a deceased insured person. 
  • While emergency treatment is covered at 100 percent, without a patient deductible or co-insurance, it is subject to the BD 15,000 (USD 39,650) annual limits. The 2026 law is not clear on how much the worker must cover if treatment exceeds this amount.

These sub-limits mean that while the migrant worker with a serious chronic illness could technically have BD 15,000 (USD 39,650) of annual overall coverage for healthcare issues related to pre-existing or chronic illness, only BD 2,000 (USD 5,230) is available for treatment in a given year.  

Tiered co-payments and out-of-pocket costs 

The new health insurance system groups healthcare providers into four tiers; the higher the provider tier, the larger the patient’s share of eligible costs of treatment.  

  • Tier 1 – Bronze: 20% patient contribution 
  • Tier 2 – Silver: 30% patient contribution 
  • Tier 3 – Gold: 45% patient contribution 
  • Tier 4 – Platinum: 60% patient contribution 

Insured workers can visit the Supreme Council of Health’s designated website– Opens in new tab to view the list of approved healthcare providers and their respective tiers. Currently, the network includes seven hospitals in the Bronze tier, two in Silver, three in Gold and thirteen in Platinum. 

A general-practitioner consultation carries a fixed BD 5 (USD 13) deductible. The charge is waived when the patient returns to the same doctor for the same condition within seven days, subject to the applicable conditions. Outpatient diagnostics and radiology also involve patient contributions ranging from 20 percent to 60 percent.  

For non-emergency inpatient admissions and daycare treatment at Bronze facilities, patients pay 20 percent, subject to a BD 50 (USD 133) maximum per visit and the applicable annual limit. As per Decision No. 66, the equivalent inpatient contribution caps do not apply in the Silver, Gold and Platinum tier facilities. 

While low-income migrant workers are likely to rely primarily on Tier 1 facilities, even a 20 percent co-payment and out-of-pocket costs of up to BD 50 may remain unaffordable for many. This is particularly significant given that 71 percent of migrant workers in Bahrain’s private sector insured under the Social Insurance Organisation earn less than BD 200 (USD 530) per month. 

Medicines are another area where patients continue to contribute. For approved generic medicines, the insurance covers 80 percent, leaving the patient responsible for 20 percent. For branded medicines, the insurance covers 60 percent, leaving the patient responsible for 40 percent. Both are subject to the package’s formulary and the overall outpatient medicine limit of BD 500 (USD 1,330) per year. Again, for a low-paid migrant worker, a 40 percent contribution on medication can become a significant expense, particularly where a prescribed medicine is not available as an approved generic or where treatment continues over a long period. 

Extensive exclusions from the mandatory health insurance package 

The new insurance law contains extensive exclusions that run to eight pages of the law. Among them are routine medical check-ups, most non-emergency dental treatment, as well as genetic and hereditary conditions. Except for emergencies, most mental health treatment — including anxiety, depression and dementia — is excluded.  

Treatment for HIV/AIDS and other sexually transmitted infections is excluded, which is not surprising given that the Bahraini government regularly deports migrants who are HIV positive without providing care. Most forms of hepatitis, organ transplants and related medication, and immunotherapy are also excluded.

The new law also explicitly excludes treatment for injuries and illnesses resulting from war and natural disasters, as well as officially recognised epidemics and pandemics. This is particularly concerning given the ongoing risk of renewed conflict in the region and the potential consequences for migrant workers living in Bahrain, as well as the experience of the COVID-19 pandemic earlier this decade. Under the package, workers may be left without insurance coverage for medical conditions or injuries resulting from such events. 

This exclusion is particularly egregious, as during times of crisis employers renege on their obligations and workers are often not paid fully or partially, making it impossible for them to cover such costs. Countries of origin and individual families then have to handle the aftermath of events that occurred while working in Bahrain. 

Importantly, work-related injuries are excluded from the insurance package where the costs are already covered by an employer’s liability and/or government social insurance, in order to avoid double compensation. This raises questions about the protection available to workers under the self-sponsored Labour Registration Programme (previously known as Flexi-Permit). Although their permits include health insurance for doctor visits at public health clinics, it is unclear whether this provides coverage for work-related injuries, since these workers are not tied to a single employer or included in social insurance.  

More time is needed to assess the new health insurance law. A private hospital administrator told MRRORS that it will take several months for the decision to take effect for many migrants as they renew or issue new work permits. However, as it stands, the provisions of the law suggest that the exclusions have less to do with “raising the efficiency of the use of healthcare and resources”, as government officials claim, and more to do with limiting migrants’ access to public healthcare services to make room for more Bahraini patients, rather than adequately funding public hospitals. Given the exclusions, coverage ceilings and high contributions, the scheme is likely to place an additional burden on low-income migrants and further restrict their access to healthcare.

Australia: Australia’s HIV response leaves queer migrants facing barriers to prevention and care

Australia’s HIV success isn’t reaching everyone. The overlooked barriers for queer migrants.

Australia has made extraordinary progress against HIV. But new research reveals how racism, Medicare eligibility and social connections can shape access to prevention and care — and why making medication available is only part of the challenge.

When Youngjoon first visited a sexual health clinic in Australia, he had been looking forward to it.

A gay man who had migrated from Asia and was living in Queensland, Youngjoon understood sexual health clinics to be a familiar part of Australian gay life. Visiting one offered another way to participate in a community he was getting to know.

“I feel like I’ve just finally joined the club,” he told researchers.

His account appears in a study published in October 2026, which examined how 11 Asian-born gay migrants in Queensland navigated relationships, racism and HIV prevention after moving to Australia.

For Youngjoon, visiting the clinic offered a sense of belonging. Other participants described a more complicated welcome within predominantly white gay social and sexual networks.

Brian, another man interviewed for the study, experienced exclusion within a gay sporting group. Yet it was through members of that same group that he learnt about HIV testing and PrEP, a medication used to prevent HIV.

Their experiences reveal something national HIV statistics can’t easily capture: how the communities people find, or struggle to find, can shape their access to prevention and care.

According to the Kirby Institute’s latest national surveillance figures, Australia recorded 753 HIV diagnoses in 2025, a quarter fewer than a decade earlier. Preliminary estimates also suggest the country has achieved the United Nations’ 95-95-95 targets for diagnosis, treatment and viral suppression.

Yet more than half of gay and bisexual men diagnosed with HIV in Australia in 2025 were born overseas.

Between 2016 and 2025, annual diagnoses among Australian-born gay and bisexual men fell from 442 to 229, almost halving. Among overseas-born men, they declined more slowly, from 316 to 255.

And over the past five years, 49 per cent of diagnoses among gay and bisexual men born in Southeast Asia were classified as late, compared with 23 per cent among Australian-born men.

These figures tell an important, if incomplete, story. The comparisons focus on gay and bisexual men, offering little insight into how trans and non-binary migrants are experiencing Australia’s HIV prevention progress.

And being born overseas, of course, doesn’t tell us where someone acquired HIV, how long they’ve lived in Australia or what access they’ve had to healthcare

Still, the disparities are difficult to ignore. And behind the national figures are experiences that rarely make it into a surveillance report.

Finding community, encountering racism

The Queensland study, led by researcher Satrio Nindyo Istiko, explored how 11 Asian-born gay migrants formed social and sexual relationships in Australia, and how those connections shaped their experiences of HIV prevention.

Some participants associated moving to Australia with greater freedom to explore their sexuality and form relationships. However, some also described feeling unwelcome in predominantly white gay communities.

Brian described a clique of younger white Australian men in his sporting group who avoided eye contact or ignored him during conversations. He found himself speaking mostly with older white men.

Other participants encountered racialised sexual stereotypes and fetishisation. The researchers also documented accounts of sexual violence, including non-consensual sexual activity and condom removal without consent.

Yet the same social spaces could also provide a route to sexual-health information.

Despite the exclusion Brian experienced, the sporting group introduced him to conversations about PrEP, HIV testing and sexual healthcare.

The contradiction is striking. The relationships through which someone encounters discrimination may also be the ones through which they discover support.

The study involved just 11 university-educated men interviewed in 2021 and 2022, so their experiences cannot represent those of all Asian-born gay migrants. But they offer a revealing glimpse into the importance of social connections, particularly when it comes to finding information about HIV prevention.

The gap between wanting PrEP and taking it

Knowing someone who takes PrEP might seem like a small thing. But when it comes to navigating Australia’s sexual healthcare system, those connections can be valuable.

A February 2026 study published in AIDS and Behaviour found that people who wanted PrEP but had never started taking it were less likely to know someone already using the medication.

A friend on PrEP could recommend a clinic, explain how to get a prescription or simply make the process feel less unfamiliar. For someone new to Australia and its healthcare system, those conversations may be particularly useful.

The researchers drew on a 2023 national online survey of gay, bisexual and queer men, including trans men, and non-binary people. They compared 947 current PrEP users with 228 respondents who were willing to use it but never had.

Recently arrived migrants from countries outside the study’s high-income English-speaking category were more likely to be among those willing non-users. Among recently arrived participants in that group, 87.5 per cent had no Medicare coverage.

PrEP (pre-exposure prophylaxis) reduces the risk of acquiring HIV through sex by around 99 per cent when taken as prescribed. Since 2018, eligible people with Medicare have been able to access the medication at a subsidised price through the Pharmaceutical Benefits Scheme.

Those without Medicare have historically faced higher costs and a more complicated process, sometimes relying on private prescriptions or importing generic medication.

The study identified other differences, too. People who wanted PrEP but hadn’t started were more likely to be younger, live outside major cities or identify as bisexual, queer or another sexuality rather than gay.

They were also less likely to be in paid employment and reported less recent sexual activity than those already taking PrEP.

Finances, personal circumstances and perceptions of HIV risk may all influence whether someone starts. And while knowing another PrEP user doesn’t necessarily mean someone will start taking the medication themselves, the research raises questions about how easily people outside established prevention networks can find their way into care.

The survey also highlights some of the gaps in our understanding. Although trans men and non-binary people were included, they represented a relatively small proportion of respondents.

Australia’s national PrEP guidelines recognise PrEP as an option for trans and gender-diverse people where clinically appropriate. But there’s still limited research into how trans and non-binary migrants experience access to prevention, particularly when Medicare eligibility and unfamiliar healthcare systems are part of the picture.

When access depends on Medicare

Australia has begun addressing one of the biggest barriers to PrEP access.

Under a $26 million federal funding agreement, states and territories are expanding access to PrEP for people without Medicare.

In NSW, eligible international students, temporary visa holders, working holidaymakers and people seeking asylum can now access the medication free through participating public sexual health services.

It’s a significant change. People without Medicare have historically been excluded from PBS-subsidised PrEP, leaving many to navigate private prescriptions and other options at their own expense. The new programme offers eligible people another way to access the medication, free of charge. But making PrEP free doesn’t automatically mean everyone who could benefit knows where to get it.

Someone navigating an unfamiliar healthcare system may have questions about confidentiality, struggle to find information in their preferred language or worry about whether seeking care could affect their visa.

Others may be looking for services that understand their sexuality or gender identity, particularly if previous experiences of discrimination have made approaching healthcare more difficult.

The NSW HIV Strategy 2026–2030 acknowledges these challenges, calling for more culturally responsive services, multilingual health promotion and stronger partnerships with migrant communities.

And Australia’s HIV response has long been shaped by queer communities themselves. Decades of activism, peer education and collaboration with health services have made prevention and treatment far more accessible.

But the networks built through that work may be less familiar to someone newly arrived in Australia, living outside major queer communities or encountering the local healthcare system for the first time.

Making medication affordable is one part of closing the gap. Making sure people know where to find it, and feel comfortable accessing it, is another.

Bringing sexual healthcare into everyday life

For an international student unfamiliar with Australia’s healthcare system, a conversation about sexual health might be easier to have on campus than in a specialist clinic.

That’s the thinking behind a programme developed by Sydney Local Health District and the NSW Multicultural HIV and Hepatitis Service, which has been bringing sexual health information and support into universities, student accommodation and services students already use.

Between January 2024 and March 2026, the programme reached more than 5,000 international students through health promotion activities, according to an evaluation published in Sexual Health in August 2026.

It also trained 106 student peer leaders, bringing sexual health conversations into student communities. 

At the University of Sydney in October 2025, the initiative went a step further, setting up a one-day sexual health screening clinic on campus.

Twenty-two students received testing, identifying one previously undiagnosed case of syphilis, while around 500 others spoke with staff about sexual healthcare and navigating local services.

Student peer leaders and multilingual health workers helped answer questions about sexual health and navigating a healthcare system many students were still getting to know.

For some newly arrived students, those conversations were their first contact with the NSW health system.

It’s a small but significant shift: rather than expecting students to find their way to sexual healthcare, the programme brought it into their everyday lives.

Beyond Australia’s HIV success story

Australia’s HIV response is one of the country’s great public-health achievements. But the latest figures are a reminder that its progress hasn’t been experienced equally.

When the Kirby Institute released its findings, epidemiologist Dr Skye McGregor highlighted the need for more timely testing, particularly among heterosexual people and gay and bisexual men born in Southeast Asia.

Scott Harlum, president of the National Association of People with HIV Australia, also drew attention to the period between newly arrived overseas-born men entering Australia and becoming connected to healthcare and support.

A late HIV diagnosis can mean years spent living with the virus unknowingly, without treatment that protects someone’s health and prevents sexual transmission once their viral load becomes and remains undetectable.

Expanded free PrEP access is a significant step forward. But removing the financial barrier doesn’t necessarily remove the social and practical ones. People still need to know where to find prevention, understand how to access it and feel comfortable approaching the services available to them.

That’s the thread running through the research. Racism can complicate the search for community. Friendships and social networks can shape someone’s introduction to HIV prevention. And for some international students, a conversation on campus may be their first encounter with Australia’s sexual healthcare system.

For Youngjoon, visiting a sexual health clinic offered a sense of belonging. Brian found information about HIV prevention through a sporting group where he didn’t always feel welcome.

Their experiences are different, and neither can speak for every queer migrant. But both reveal something the national figures alone cannot capture: how much the journey to care can be shaped by the people and communities around us.

Australia’s achievements against HIV were built through decades of work by people living with HIV, LGBTQ+ communities, health professionals, researchers and advocates.

The question now is how to build on that community-led success while reaching people who aren’t already connected to the networks that helped create it.

How to access free PrEP in NSW without Medicare

If you live in NSW and don’t have Medicare, you may be eligible for free PrEP through participating public sexual health clinics or the NSW Sexual Health Infolink.

This includes eligible international students, temporary visa holders, working holidaymakers and people seeking asylum. Access is based on your circumstances and clinical suitability, not your sexual orientation or gender identity.

You don’t need to know whether PrEP is right for you before getting in touch. A nurse or doctor can talk you through your options.

For advice, clinic locations and telehealth options, call the NSW Sexual Health Infolink on 1800 451 624 (option 5), Monday to Friday, 9 am–5.30 pm.

If you’d prefer to speak in another language, call TIS National on 131 450 for interpreting support.

Find out more: NSW Health — Free PrEP if you don’t have Medicare.

US: Tennessee HIV provider sues over new immigration verification requirements

Tennessee to impose immigration checks in HIV/AIDS safety-net program

Nashville CARES is seeking immediate court intervention to stop the Tennessee Department of Health from requiring immigration status checks for low-income HIV-positive patients in the federally-funded Ryan White program.

In August, Tennessee organizations that aid low-income individuals living with HIV received a surprise memo from the state’s health department:

“Effective immediately,” the memo said, “no patients without documentation of citizenship or legal residency may be newly enrolled” in many of the services provided through the federal Ryan White HIV/AIDS program or a companion program known as HOPWA, or Housing Opportunities for People with AIDS.

The federal government does not require immigration status checks as a condition of receiving services through HOPWA or Ryan White, a program that has served as the cornerstone of the U.S. government’s response to HIV/AIDS for more than 30 years. Even as the Trump administration has sought to exclude immigrants from an array of public benefits, federal law explicitly exempts immigration status checks in federal programs for the treatment of communicable disease.

Attorneys for Nashville CARES, one of the state’s largest providers of Ryan White services, immediately filed an administrative challenge to the new rules laid out in the memo, and the Department of Health rescinded it days later. Nashville CARES is represented by the Tennessee Justice Center.

But, in its place, the Department of Health has imposed an even broader immigration verification mandate on agencies serving low-income Tennesseans living with HIV/AIDS.

In a memo dated Oct. 1, the department is now requiring all agencies that serve patients via the Ryan White program to amend their existing contracts to require “eligibility verification for each potential beneficiary/recipient.”

The memo cites Tennessee law that requires verifying anyone seeking federal, state or local benefits is lawfully present in the United States; an amendment to the law this year imposes criminal penalties on healthcare and other public benefit providers who fail to report immigrants without legal status to the Tennessee Department of Safety.

On Monday, Nashville CARES filed suit in Davidson County Chancery Court seeking to declare the contract changes invalid. 

Nashville CARES argues the state rules violate federal law and is seeking an immediate injunction barring the new contract language from taking effect while its legal challenge is ongoing. 

Ryan White covers the cost of medical care, drug assistance, home health care, case management, financial assistance for health insurance premiums and hospice care for low-income individuals living with HIV.

The new contract language “threatens access to medically necessary HIV-related services for otherwise eligible low-income individuals, frustrates (Nashville CARES) organizational mission, disrupts continuity of HIV treatment and support services, and places burdensome verification” requirements that have never before been required and are not supported by federal or state law, the lawsuit said.  

“Individuals who lose access to those services face increased risk of worsening HIV disease, transmission of HIV, progression to AIDS and other serious health consequences,” it said. 

The contract amendment could directly impact hundreds of Nashville CARES’ patients and clients. Among then are at least 129 patients with HIV who receive financial help to cover health insurance costs, 150-160 individuals whose mental health and medication management care is paid for by Nashville CARES and 80-100 individuals who receive healthcare at Nashville CARES clinics, according to figures cited in the lawsuit.

Additionally, patients who are U.S. citizens but unable to provide documentation could also be impacted, the lawsuit said.

Lawyers for the nonprofit have sought further clarity from the department about the new contract requirements, but received none, the legal petition said. In legal filings, the lawyers noted that the new contract language may or may not extend to  core Ryan White services, including medical treatment and medications;  the Tennessee law cited by the department references federal exclusions for these services.

But, the lawyers noted, even if that is the case, one critical component of Ryan White funding is financial assistance that enables individuals to purchase private insurance that gives them to access healthcare, a benefit the amended contract language puts at risk for those who cannot provide proof of citizenship or legal immigration status. 

A spokesperson for the Department of Health did not respond to a request for comment about the lawsuit on Monday. The department, earlier this month, provided the Lookout copies of the memos sent to Ryan White providers, but has not responded to a subsequent request for details about impacted recipients of the contract changes.

Monday’s lawsuit is the second this year to challenge efforts by the health department to impose immigration status verification requirements in public safety-net health programs for low-income patients. 

In July, the department agreed to temporarily halt a new policy requiring the reporting of sick and disabled children to a state immigration enforcement office while a legal challenge brought by three doctors to the policy remains ongoing. About 400 children with chronic and, in some instances terminal illnesses, have remained enrolled in the state’s Children’s Special Services program as a result. 

France: Fear of deportation is keeping people living with HIV away from healthcare in Mayotte

Whilst the number of HIV cases in Mayotte has been rising in recent years, several doctors have highlighted barriers to testing and access to care. Among these is the fear of deportation for undocumented migrants.

The HIV epidemic is spreading rapidly in Mayotte, but screening and access to care are being hampered by the fear of police checks amongst undocumented migrants, warn doctors and charities. According to the Epimay 2025 study by the Regional Health Agency (ARS),five in every 1,000 adults are living with the virus, compared with one in 1,000 in 2019.
Our territory has the “highest positivity rate of all French departments”, as highlighted by Santé publique France in a report published in 2025. Dr Mohamadou Niang, head of the infectious diseases department at the Mayotte Hospital Centre (CHM) in Mamoudzou, has observed this acceleration. Until 2021, he recorded “between 20 and 30” new positive cases per year. “In 2025, the figure stood at 139,” he warns, with around a hundred new cases already recorded by the end of August 2026.

The infectious diseases specialist identifies numerous obstacles to screening, explaining that 20 per cent of patients only discover their condition at a very late stage. In addition to the cost of transport in a department where 77 per cent of the population lives below the poverty line, fear of the police deters those who are ill. Nearly 48 per cent of residents are foreign nationals, according to the 2017 INSEE census.

Workarounds

Dr Alain Prual, head of the Free Centre for Information, Screening and Diagnosis (CeGIDD) in Mamoudzou, shares this view. “The main obstacle is the PAF”, the border police, he asserts, referring to screening checks on the outskirts of the hospital. Dr Abdon Goudjo, Director of Maternal and Child Protection (PMI), observes for his part that his patients devise “strategies” to “get round the police” and manage to see a doctor.

In June 2024, the Defender of Rights confirmed the existence of “police checks in the vicinity of the Mayotte hospital, which are likely to hinder access to healthcare for undocumented migrants”. This group is the most affected. In 2024, 65 per cent of new HIV diagnoses in Mayotte were among nationals of Madagascar and the Comoros, and 22 per cent from sub-Saharan Africa, in a “regional context marked by a resurgence” of cases.

Withholding of care

To overcome these obstacles, testing is being decentralised. The CeGIDD has opened branches in Longoni, Iloni and Petite-Terre. Mobile units are also travelling across the island. In Dembéni, Israël Mundi, the health mediator for the Nariké M’sada association, offers rapid tests from a van, with results available “in a matter of minutes”. This mobile approach allows them “to get as close as possible to the population”, emphasises his colleague, prevention officer Ahmed Hassani.

If the test is positive, patients are referred to the CHM. In Dr Niang’s department, “more than half” of the 600 patients being treated are undocumented migrants. Without health insurance, until recently they had to visit the hospital every month to collect their antiretroviral treatments. Frightened, some patients turn back. Others are “often” stopped near the hospital and then placed in an administrative detention centre pending their deportation, laments the infectious diseases specialist, as residence permits for medical treatment remain “difficult” to obtain.

The virus is more detectable in the blood in Mayotte than in mainland France

These interruptions in treatment explain why the virus is undetectable in the blood in only 80 per cent of patients being treated in Mayotte, compared with over 95 per cent in mainland France. When taken without interruption, antiretrovirals prevent the virus from multiplying to the point where it becomes undetectable: the person can then no longer transmit it sexually. To limit risky travel, the doctor explained to AFP that treatments are now being dispensed for three months at a time.

Furthermore, an operational committee set up in April 2026 by the prefecture and the Regional Health Agency (ARS) plans to secure testing centres with the help of the police. When contacted by AFP, these institutions did not respond. In this context, prevention is paramount. During a campaign on the north-east coast in Bandraboua at the end of September, Raissa Ali Baco, a sexual health officer at the Red Cross, distributed free condoms. She points out that this is the “only means of protection against all STIs”, sexually transmitted infections.

“Le principal obstacle, c’est la PAF”, la peur des expulsions éloigne les malades du VIH des soins à Mayotte

Alors que le nombre de cas de VIH à Mayotte se multiplient ces dernières années, plusieurs médecins pointent des freins au dépistage et à l’accès aux soins. Parmi eux, la peur des expulsions pour les étrangers en situation irrégulière.

L’épidémie de VIH progresse fortement à Mayotte, mais le dépistage et l’accès aux soins se heurtent à la peur des contrôles de police chez les étrangers en situation irrégulière, alertent médecins et associations. Selon l’étude Epimay 2025 de l’Agence régionale de santé (ARS), cinq adultes sur 1.000 vivent avec le virus, contre un sur 1.000 en 2019.
Notre territoire affiche le “taux de positivité le plus élevé parmi l’ensemble des départements français“, soulignait Santé publique France dans un bilan publié en 2025. Chef du service des maladies infectieuses au Centre hospitalier de Mayotte (CHM) à Mamoudzou, le docteur Mohamadou Niang constate cette accélération. Jusqu’en 2021, il recensait “entre 20 et 30” nouveaux cas positifs par an. “En 2025, on est à 139“, s’alarme-t-il, avec déjà une centaine de nouveaux cas à la fin du mois d’août 2026.

L’infectiologue identifie de nombreux obstacles au dépistage, expliquant que 20% des patients découvrent leur maladie à un stade très tardif. Outre le coût des transports dans un département où 77% de la population vit sous le seuil de pauvreté, la peur des forces de l’ordre dissuade les malades. Près de 48% des habitants sont étrangers, selon le recensement de l’Insee en 2017.

Des stratégies de contournement

Responsable du Centre gratuit d’information, de dépistage et de diagnostic (CeGIDD) de Mamoudzou, le docteur Alain Prual partage ce constat. “Le principal obstacle, c’est la PAF“, la police aux frontières, assure-t-il, mentionnant des contrôles filtrants aux abords de l’hôpital. Directeur de la Protection maternelle et infantile (PMI), le docteur Abdon Goudjo observe de son côté que ses patientes élaborent des “stratégies” pour “contourner les forces de police” et parvenir à consulter un médecin.

En juin 2024, le Défenseur des droits a attesté l’existence de “contrôles de police aux abords du centre hospitalier de Mayotte, susceptibles d’entraver l’accès aux soins des étrangers en situation irrégulière“. Cette population est la plus touchée. En 2024, 65% des nouveaux diagnostics de VIH à Mayotte concernaient des ressortissants de Madagascar et des Comores, et 22% d’Afrique subsaharienne, dans un “contexte régional marqué par une recrudescence” des cas.

Renoncement aux soins

Pour contourner ces freins, le dépistage se décentralise. Le CeGIDD a ouvert des antennes à Longoni, Iloni et en Petite-Terre. Des unités mobiles sillonnent également l’île. À Dembéni, le médiateur en santé de l’association Nariké M’sada, Israël Mundi, propose dans un camion des tests rapides offrant un résultat “en quelques minutes“. Cette itinérance permet “d’aller au plus proche de la population“, souligne son collègue agent de prévention Ahmed Hassani.

Si le test est positif, les patients sont orientés vers le CHM. Dans le service du docteur Niang, “plus de la moitié” des 600 patients suivis sont des étrangers sans-papiers. Sans couverture sociale, ils devaient jusqu’à récemment se rendre mensuellement à l’hôpital pour récupérer leurs traitements antirétroviraux. Effrayés, des patients font demi-tour. D’autres sont “souvent” interpellés près de l’hôpital, puis placés en centre de rétention administrative en vue de leur expulsion, déplore l’infectiologue, les titres de séjour pour soins restant “difficiles” à obtenir.

Un virus plus détectable dans le sang à Mayotte que dans l’Hexagone

Ces interruptions de traitement expliquent que le virus ne soit indétectable dans le sang que chez 80% des patients suivis à Mayotte, contre plus de 95% dans l’Hexagone. Pris sans interruption, les antirétroviraux empêchent le virus de se multiplier jusqu’à le rendre indétectable : la personne ne le transmet alors plus par voie sexuelle. Pour limiter les déplacements risqués, le médecin explique à l’AFP délivrer désormais les traitements pour trois mois.

Par ailleurs, un comité opérationnel créé en avril 2026 par la préfecture et l’ARS prévoit de sanctuariser les lieux de dépistage avec les forces de l’ordre. Contactées par l’AFP, ces institutions n’ont pas répondu. Dans ce contexte, la prévention prime. Lors d’une action sur la côte nord-est à Bandraboua fin septembre, Raissa Ali Baco, chargée en santé sexuelle à la Croix-Rouge, a distribué des préservatifs gratuits. Il s’agit du “seul moyen qui protège contre toutes les IST“, les infections sexuellement transmissibles, rappelle-t-elle.

New Zealand: Government expands access to HIV prevention tools to all, regardless of visa status

Burnett Foundation Aotearoa welcomes the decision to expand access to HIV prevention tools

The Government’s decision to expand access to HIV prevention tools to all people in New Zealand, regardless of their visa status, is a great step forward for common-sense and evidence-based HIV prevention.

The change, enabled by The Healthy Futures (Pae Ora) (Eligibility) Regulations 2026, will come into effect on 1 December, quite appropriately, on World AIDS Day.

Under the new rules, publicly funded HIV prevention medicines will be available to anyone in New Zealand who meets the same clinical criteria already used for funded pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). This means eligibility will be based on a person’s risk of exposure to HIV, rather than their visa or immigration status.

In addition to providing access to the medicines themselves, the regulation change also provides for the associated lab testing required to prescribe and monitor treatment.

Burnett Foundation Aotearoa CEO Liz Gibbs says the change removes a longstanding and unnecessary barrier to HIV prevention. “As we learned with COVID-19, viruses do not check passports, visa categories or immigration status. If we are serious about ending HIV transmission in Aotearoa, everyone who could benefit from prevention tools should be able to access them.”

“PrEP is one of the most effective HIV prevention tools we have. Expanding access will help protect individuals, reduce new transmissions and strengthen New Zealand’s overall public health response.”

The Foundation has long advocated for the removal of eligibility barriers to HIV prevention services and welcomed the change as an important step towards New Zealand’s goal of zero locally acquired HIV transmissions by 2030.

Research and international experience show that making HIV prevention tools widely available is one of the most effective ways to reduce new infections. Ensuring that people can access PrEP based on risk rather than visa status will improve equity, reduce preventable HIV transmissions and help New Zealand maintain progress towards ending HIV transmission.

The change is particularly important given the mobile nature of communities across Aotearoa and the wider Pacific. Ensuring everyone at risk can access prevention services benefits both individuals and the broader community.

While welcoming the announcement, Burnett Foundation Aotearoa says further action is needed to ensure access to PrEP is practical and consistent.

“We’ve removed one important barrier, but there are still others,” says Gibbs.

“We also need funding to enable pharmacists to supply PrEP under appropriate clinical arrangements. This would make access faster and easier, particularly for people who may not have a regular GP, fear stigma in small communities, or who face long waits or long trips for appointments.”

Burnett Foundation Aotearoa will continue working with Health New Zealand, primary care providers and community stakeholders to ensure the benefits of the new regulations translate into real-world improvements in access to HIV prevention services.

“This shows what can be achieved when public health policy follows evidence,” says Gibbs.

“World AIDS Day is an appropriate day for these changes to take effect. It’s a reminder that ending HIV transmission is possible, but only if everyone who needs prevention, testing and treatment can access it.”

Greece found in violation of human rights over treatment of HIV-positive asylum seeker

European Court of Human Rights Condemns Greece for Violating Rights of HIV-Positive Asylum Seeker

European Court of Human Rights condemns Greece over delayed access to treatment and degrading and inhuman living conditions of HIV-positive asylum seeker in Moria camp.

The European Court of Human Rights has found that Greece violated the rights of an HIV-positive asylum seeker by failing to ensure timely access to essential antiretroviral treatment and by subjecting her to inhuman and degrading conditions in the Moria camp on Lesvos.

In its judgment concerning R.M. (application no. 48822/20), the Court found that Greece violated Article 3 of the European Convention on Human Rights, which prohibits torture and inhuman or degrading treatment. R.M. was represented by HIAS Greece.

R.M., a woman from Cameroon born in 1986, contracted HIV as a result of rape. She arrived at Moria in December 2019 and informed the Greek authorities of her HIV-positive status. Although the authorities knew that antiretroviral treatment was unavailable on Lesvos, she was kept on the island under “geographical restriction”, a containment policy confining asylum seekers to the Aegean islands. Her HIV diagnosis was confirmed in March 2020 and she was referred to a specialized infections unit in Athens. Although the restriction was subsequently lifted, she did not begin antiretroviral treatment until July 2020 — more than four months after her diagnosis — because of significant and unjustified delays in processing her transfer to the mainland. During this period, her health deteriorated significantly.

The Court found that, given R.M.’s vulnerability and her dependent position as an asylum seeker within the reception system, the more than four-month delay in providing essential HIV treatment could not be regarded as a mere administrative inconvenience. The authorities had therefore failed to ensure timely access to the medical care she required, in violation of Article 3.

The Court also found that the conditions in Moria — overcrowding, lack of access to necessities, lack of heating, inadequate access to sanitary facilities, inappropriate and inadequate food, lack of access to medical care — amounted to inhuman and degrading treatment in violation of Article 3.

The ruling follows the Court’s 2023 judgment in E.F. v. Greece, concerning another Cameroonian HIV-positive asylum seeker who had contracted HIV as a result of rape. In that case, the Court found a violation of Article 3 following a six-month delay in access to antiretroviral treatment while the applicant was dependent on the Greek reception system.

The Court awarded R.M. €8,000 in non-pecuniary damage.

Reflecting on the judgment, R.M. said:
“The decision of the European Court of Human Rights fills me with joy and emotion. To me, it represents much more than a judicial decision: it is the recognition of the value and dignity of human life, as well as an essential affirmation of the protection of human rights. After all this ordeal, this decision represents immense recognition and deep relief. I sincerely thank all the people who contributed to ensuring that this truth was heard and to defending these fundamental rights. Thank you from the bottom of my heart.”

 

France: Right to residence for medical treatment: figures for HIV and viral hepatitis

Translated with Deepl.com – Scroll down for original article in French

Since 2017, the French Office for Immigration and Integration (OFII) has been responsible for granting permission to reside for medical treatment.

In its 8th report on medical assessment in the context of the right to residence on health grounds (2024 data), the OFII has published figures concerning people living with HIV and those with viral hepatitis B or C. What are these figures and what do they reveal?

Medical assessment entrusted to the Ministry of the Interior

The Act of 7 March 2016 significantly overhauled the system for granting residence permits for medical treatment. Until then, this had been the responsibility of the regional health agencies (ARS), whose medical inspectors assessed applications. The overseeing ministry was the Ministry of Health.

Under the 2016 Act, from January 2017 onwards – despite opposition from a significant section of civil society, particularly organisations defending the rights and health of foreign nationals – this assessment was entrusted to the French Office for Immigration and Integration (OFII), which falls under the Ministry of the Interior. Two different settings, two different approaches.

It is the responsibility of this body to issue an opinion on the applicant’s state of health and access to healthcare in their country of origin. From a regulatory perspective, the OFII issues a medical opinion on the foreign national’s application, taking into account two cumulative criteria: whether the person’s state of health requires medical care, the absence of which could have exceptionally serious consequences for them; and whether, given the availability of healthcare and the characteristics of the healthcare system in the person’s country of origin, they would be unable to effectively receive appropriate treatment there. In other words, is the person applying for a residence permit on health grounds at serious risk if they do not receive treatment? And if so, is the treatment they require available to them in their country of origin? If the answer to both questions is ‘yes’, the person will not be entitled to a residence permit on health grounds.

A complex and dissuasive procedure

‘In practice, once the admissibility of the application has been verified (civil status, nationality, domicile, habitual residence), a blank medical certificate is issued to the applicant, who has one month to submit it, together with any supporting documents they deem relevant, to the OFII’s medical service. On this basis, the OFII’s doctor draws up a detailed medical report which is forwarded to a panel of three doctors appointed by the OFII. If deemed necessary, the OFII’s doctor or the panel of doctors may request further information from the doctor who issued the medical certificate or drew up the medical report, request further examinations or summon the foreign national for an interview’, the Ministry of the Interior states in a response (published in the Official Journal on 16 June 2026) to a written question from a far-right MP addressed to the government in February of the same year. “Within three months of the foreign national submitting the medical certificate to the OFII, the Medical Board issues a detailed opinion on the basis of which the Prefect makes their decision. The Prefect may disregard a favourable opinion on grounds relating to public order and refuse to issue the residence permit,” the Ministry adds in its response, explaining: “This new procedural framework has resulted in a sharp fall in the number of applications submitted and in the number of first-time permits issued.”

What do the figures show?

Overall, the number of residence permits issued for medical treatment fell very sharply between 2016 and 2025: a 60 per cent drop in first-time issuances in 2025 compared with 2016. Indeed, for first-time applications, 7,118 residence permits for medical treatment were issued in 2016 (based on recommendations from the regional health agencies), compared with 3,063 in 2024 and 2,817 in 2025 (based on recommendations from the OFII for these last two years). In its response to the far-right MP, the Ministry of the Interior also emphasises that ‘the data for 2025 confirm this trend.’ The figures are falling.

Figures can also be found in the OFII’s 2024 Report on the procedure for granting residence permits for medical treatment; this is the eighth report of its kind submitted to Parliament, as required by law. This report covers data collected for the year 2024. The document was produced by the OFII’s medical service. It shows a “significant decrease” in applications, with the number falling from 24,858 in 2023 to 22,328 in 2024 – a drop of 10 per cent. Of the applications in 2024, 37.4 per cent were first-time applications (known as ‘primo-demandes’) from adults; 62.6 per cent were renewals. The approval rate rose very slightly, reaching 64.3 per cent compared with 63.1 per cent in 2023. It stood at 44.7 per cent for first-time applications from adults. Taking into account cases concluded in 2024, 80 per cent of applications ‘involve at least one diagnosis’ of infectious diseases (a figure down by 2.9 percentage points), diseases of the circulatory system, endocrine and metabolic diseases, and cancers. Since 2017, some 228,275 applications for residence permits for medical treatment have been submitted, with, as the OFII points out, a ‘gradual decline in the number of applications over recent years’. ”

In its 2024 report, the OFII states that 53.1 per cent of applications (first-time applications or renewals) are from men and 46.9 per cent from women. Over 90 per cent of applicants are adults. The countries with the highest number of applicants, in order, are: Algeria, Ivory Coast, the Comoros, the DRC, Cameroon and Georgia, etc. The OFII has also estimated the cost of medication. This is reported to be 119,742,000 euros; an average annual cost per patient of 6,643 euros.

Figures relating to people living with HIV

In 2024, 3,759 applications in which the medical file indicated an HIV/AIDS infection were finalised, representing 17.3 per cent of the total in 2024, compared with 19.4 per cent in 2023. Of these applications, 99.8 per cent concerned adults, 58.6 per cent of whom were women. The approval rate was 81.3 per cent. The average age of applicants was 45. Of the 21 main countries of origin, 20 were on the African continent (Côte d’Ivoire, Cameroon, DRC, Congo-Brazzaville, Guinea, Mali, Gabon, etc.), in the Caribbean region (Haiti) and on the South American continent (Suriname, Peru, Brazil); only one country was in Europe: Georgia. Looking at the nature of the applications: 86 per cent were renewals; 14 per cent were first-time applications. 59 per cent of the applications were submitted by women. For HIV, 81 per cent of the decisions issued were in favour of a residence permit for medical treatment. In its comments, the OFII emphasises that France “treats HIV-positive patients who did not have access to treatment in their country of origin”; and has been doing so since 1997, thanks to the residence permit scheme for medical treatment, but it is quick to point out that “[access to HIV treatment] has improved considerably since then.” In other words, the significant progress in low- and middle-income countries noted by UNAIDS itself would justify a more restrictive application of the right to residence for medical treatment in the context of HIV. This is not explicitly stated as such, but is largely implied by the analysis in the two pages of the report devoted to global progress. But does this analysis still hold water today, given the ongoing deterioration in access to care, prevention and treatment since Donald Trump’s return to office and the withdrawal of donor countries from the Global Fund?

Figures concerning people living with viral hepatitis

In 2024, 1,604 applications where the medical record indicated viral hepatitis were closed, representing 7.4 per cent of the total in 2024, compared with 7.9 per cent in 2023. Guinea, Côte d’Ivoire, Mali, Cameroon, Georgia, Senegal, the DRC, etc., were, in order, the countries with the highest number of applications. Renewals accounted for 67 per cent of applications, and 71 per cent of adult applicants were men. For HBV (1,388 cases), the approval rate was 59.2 per cent, compared with 55 per cent for HCV (156 cases). The average age of applicants living with hepatitis was 42.

When they are not seeking to do away with the AME, the far right and a significant section of the right are attacking residence permits for medical treatment. In his question to the Ministry of the Interior (February 2026), the far-right MP Michel Guimiot made no attempt at nuance, referring to ‘the granting of tens of thousands of residence permits for medical treatment’. ’ This is a caricature that is debunked by the OFII’s figures. The RN MP (Oise) also asks what the ‘cost’ of this is to the State ‘at a time when the country is facing a 25 billion euro deficit in its health insurance system. ’ Unlike the OFII, which puts forward a figure without citing its sources or explaining how its estimate was calculated, the Ministry of the Interior is more cautious in its response to the MP: ‘As regards the cost incurred by the provision of healthcare to sick foreign nationals, the Ministry of the Interior does not have any figures. In fact, holders of healthcare permits are covered by the universal health cover scheme (PUMA) just like anyone else residing in France on a stable and long-term basis. It is not currently possible to isolate their healthcare expenditure.”

Droit au séjour pour soins : les chiffres pour le VIH et les hépatites virales

Depuis 2017, l’admission au séjour pour soins est la prérogative de l’Office français de l’immigration et de l’intégration (Ofii).

Dans son 8ème rapport sur l’évaluation médicale dans le cadre du droit au séjour pour raison de santé (données 2024), l’Ofii publie des chiffres concernant les personnes vivant avec le VIH et celles avec une hépatite virale B ou C. Quels sont-ils et que disent-ils ?

Une évaluation médicale confiée au ministère de l’Intérieur

C’est la loi du 7 mars 2016 qui a largement remanié le dispositif d’admission au séjour pour soins. Celui-ci était jusqu’alors aux mains des agences régionales de santé (ARS), dont les médecins inspecteurs-rices examinaient les demandes. Le ministère de tutelle était celui de la Santé. Avec la loi de 2016, cette expertise est confiée, à partir de janvier 2017, malgré l’opposition d’une part importante de la société civile, notamment des associations de défense des droits et de la santé des personnes étrangères, à l’Office français de l’immigration et de l’intégration (Ofii), sous tutelle du ministère de l’Intérieur. Deux salles, deux ambiances.

À charge pour cette instance de rendre un avis sur l’état de santé de la personne demandeuse et l’accès à l’offre de soins dans le pays d’origine. D’un point de vue réglementaire, l’Ofii rend un avis médical sur la demande de la personne étrangère en prenant en compte deux critères cumulatifs : si l’état de santé de la personne nécessite une prise en charge médicale dont le défaut pourrait avoir pour elle des conséquences d’une exceptionnelle gravité et si, eu égard à l’offre de soins et aux caractéristiques du système de santé dans le pays dont la personne est originaire, elle ne pourrait pas y bénéficier effectivement d’un traitement approprié. Autrement dit, la personne qui fait la demande d’un titre de séjour pour raison de santé est-elle exposée à un risque majeur en absence de prise en charge ? Et si oui, les soins dont elle a besoin sont-ils disponibles pour elle dans son pays d’origine ? Si c’est oui aux deux questions, la personne ne pourra pas bénéficier du droit au séjour pour raison de santé.

Une procédure complexe et dissuasive

« Concrètement, après que la recevabilité de la demande a été vérifiée (état civil, nationalité, domicile, résidence habituelle), un certificat médical vierge est remis au demandeur qui dispose d’un délai d’un mois pour le transmettre, accompagné des pièces qu’il jugera utiles, au service médical de l’Ofii. Sur cette base, le médecin de l’office établit un rapport médical circonstancié qui est transmis à un collège de trois médecins désignés par l’Ofii. S’il le juge utile, le médecin de l’Ofii ou le collège de médecins peuvent demander des informations complémentaires au médecin ayant établi le certificat médical ou le rapport médical, solliciter des examens complémentaires ou convoquer l’étranger pour un entretien », rappelle le ministère de l’Intérieur dans une réponse (publiée au Journal officiel, le 16 juin 2026) à la question écrite d’un député d’extrême droite adressée au gouvernement en février de la même année. « Le collège de médecins établit, dans un délai de trois mois à compter de la transmission par l’étranger du certificat médical à l’Ofii, un avis circonstancié sur la base duquel le préfet prend sa décision. Le préfet peut s’écarter d’un avis favorable pour des motifs liés à l’ordre public et refuser la délivrance du titre de séjour », complète le ministère dans sa réponse, expliquant : « Ce nouveau cadre procédural a eu pour conséquence une forte baisse des demandes présentées ainsi que des premiers titres délivrés. »

Que disent les chiffres ?

Au global, les délivrances de titres de séjour pour soins ont diminué très fortement entre 2016 et 2025 : une baisse de 60 % en 2025 de primo délivrance par rapport à 2016. En effet, en première demande, 7 118 titres pour soins ont été délivrés en 2016 (avis émis par les agences régionales de santé), contre 3 063 en 2024 et 2 817 en 2025 (avis émis par l’Ofii pour ces deux dernières années). Dans sa réponse au parlementaire d’extrême droite, le ministère de l’Intérieur souligne d’ailleurs que « les données de 2025 confirment cette tendance. » Cela baisse.

Des chiffres, on en trouve également dans le Rapport 2024 de l’Ofii portant sur la procédure d’admission au séjour pour soins ; c’est le 8ème du genre rendu au Parlement, comme le prévoit la loi. Ce rapport porte sur les données recueillies sur l’année 2024. On doit le document au service médical de l’Ofii. Il établit une « diminution significative » des demandes puisque l’on passe de 24 858 demandes en 2023 à 22 328 en 2024, soit une baisse de 10 %. Sur les demandes de 2024, 37,4 % concernent des premières demandes (dites primo-demandes) de personnes adultes ; 62,6 % portent sur des renouvellements. Le taux d’avis favorables est en très légère hausse, il atteint 64,3 % contre 63,1 % en 2023. Il est de 44,7 % pour les premières demandes concernant des adultes. Lorsqu’on prend en compte les dossiers clôturés en 2024, 80 % des demandes « présentent au moins un diagnostic » de maladies infectieuses (un chiffre en baisse de 2,9 points), de maladies de l’appareil circulatoire, de maladies endocriniennes et métaboliques et de cancers. Depuis 2017, ce sont quelque 228 275 demandes de titres de séjour pour soins qui ont été déposées, avec, souligne l’Ofii, une « diminution progressive du nombre de demandes au cours de ces dernières années. »

Dans son rapport 2024, l’Ofii indique que 53,1 % des demandes (premières demandes ou renouvellements) concernent des hommes et 46,9 des femmes. Plus de 90 % des demandeurs-ses sont des adultes. Ce sont, dans l’ordre, pour les pays suivants que l’on compte le plus de demandeurs-es : Algérie, Côte d’Ivoire, Comores, RDC, Cameroun et Géorgie, etc. L’Ofii a aussi réalisé une estimation du coût des médicaments. Il s’agirait de 119 742 000 euros ; soit un coût moyen par patient-e de 6 643 euros annuels.

Les chiffres concernant les personnes vivant avec le VIH

En 2024, 3 759 demandes dont le dossier médical faisait était d’une infection à VIH/sida ont été clôturées, soit 17,3 % du total en 2024, contre 19,4 % en 2023. Sur ces demandes, 99,8 % concernaient des adultes, dont 58,6 % étaient des femmes. Le taux d’avis favorable était de 81,3 %. L’âge moyen des demandeurs-ses était de 45 ans. Sur 21 principales nationales concernées, 20 pays étaient sur le continent africain (Côte D’ivoire, Cameroun, RDC, Congo Brazzaville, Guinée, Mali, Gabon, etc.), dans la région Caraïbes (Haïti) et sur le continent sud-américain (Suriname, Pérou, Brésil) ; un seul pays était en Europe : la Géorgie. Si on regarde la nature des demandes : 86 % étaient des renouvellements ; 14 % étaient des premières demandes. Les demandes émanaient de femmes à 59 %. Pour le VIH, 81 % des avis rendus étaient favorables au titre de séjour pour soins. Dans ses commentaires, l’Ofii souligne que la France « soigne des patients séropositifs au VIH qui n’avaient pas accès aux traitements dans leur pays d’origine » ; et cela depuis 1997, grâce au dispositif de titres de séjour pour soins, mais c’est aussitôt pour rappeler que « [l’accès aux traitements VIH] s’est considérablement amélioré depuis. » Autrement dit, les avancées significatives dans les pays à revenu faible et modéré constatées par l’Onusida elle-même justifieraient une application plus restrictive du droit au séjour pour soins dans le cadre du VIH. Ce n’est pas explicitement écrit comme cela, mais largement sous-entendu par la démonstration dans les deux pages du rapport consacrées aux progrès mondiaux. Mais cette analyse tient-elle encore la route aujourd’hui avec la dégradation continue de l’accès aux soins, à la prévention et aux traitements depuis le retour de Donald Trump et le désengagement des pays donateurs vis-à-vis du Fonds mondial ?

Les chiffres concernant les personnes vivant avec une hépatite virale

En 2024, 1 604 demandes dont le dossier médical faisait était d’une hépatite virale ont été clôturées, soit 7,4 % du total en 2024, contre 7,9 % en 2023. La Guinée, la Côte d’Ivoire, le Mali, le Cameroun, la Géorgie, le Sénégal, la RDC, etc. arrivaient, par ordre, des pays pour lesquels il y avait le plus de demandes. Les renouvellements concernaient 67 % des demandes et 71 % des personnes adultes demandeuses étaient des hommes. Pour le VHB (1 388 dossiers), le taux d’avis favorables était de 59,2 %, contre 55 % pour le VHC (156 dossiers). L’âge moyen des demandeurs-ses vivant avec une hépatite était de 42 ans.

Quand il ne s’agit pas de tordre le cou à l’AME, l’extrême droite et une partie significative de la droite attaquent les titres de séjour pour soins. Dans sa question au ministère de l’Intérieur (février 2026), le député d’extrême droite Michel Guimiot ne fait pas dans la nuance évoquant « l’attribution de dizaines de milliers de titres de séjour pour soins. » Une caricature que démontent les chiffres de l’Ofii. Le député RN (Oise) demande d’ailleurs le montant de la « charge » que cela représente pour l’État « alors que le pays affronte un déficit de 25 milliards d’euros de son assurance santé. » Contrairement à l’Ofii qui avance un chiffre sans citer ses sources, ni les modalités de calcul de son estimation, le ministère de l’Intérieur se montre plus prudent dans sa réponse au député : « S’agissant du coût occasionné par les soins apportés aux étrangers malades, le ministère de l’intérieur ne dispose pas de chiffres. En effet, les bénéficiaires de titres pour soins bénéficient de la protection universelle maladie (PUMA) comme toute personne résidant en France de manière stable et durable. Isoler leurs dépenses de santé n’est pas réalisable pour le moment. »

Africa: Xenophobia and documentation barriers restrict migrant women’s access to healthcare

Africa: For Migrant Women, The Right to Healthcare Does Not Always Mean Access

Mombasa, Kenya — Over the past year, South Africa has witnessed several incidents in which migrants, asylum seekers and undocumented people have reportedly faced barriers to essential healthcare, including maternal and child health services.

For many migrant and refugee women, vulnerability does not end when they reach South Africa. But those who have been forced to leave their countries due to conflict, persecution or political instability may encounter new forms of exclusion and uncertainty when they arrive, reports Mail & Guardian.

In some communities, hostility towards foreigners can make accessing basic services even more difficult. Migrants may be asked to show their documentation when trying to access healthcare, education, employment and other essential services.

These barriers may be especially serious for women.

A pregnant woman might delay antenatal care because she is afraid of being asked for documents she cannot produce. A woman seeking contraception, HIV prevention or treatment, or support after gender-based violence might fear that seeking help could expose her immigration status.

Nowhere is this clearer than in maternal healthcare.

One woman from Malawi gave birth in an open space inside a deportation holding area, surrounded by strangers, with no medical professional present and no access to the care and testing needed to protect both mother and child.

South Africa has policies and laws that recognise the right to healthcare and protect human dignity. Yet for migrant women, the reality on the ground can look very different.

“It’s about their rights, it’s about protecting their human dignity,” said human rights activist Tsakani Mabasa, whose research examines how migrant women can better access sexual and reproductive health services in South Africa. Mabasa’s research exposes a troubling gap between what exists in policy and what happens when a migrant woman walks through the doors of a health facility.

Mabasa said her work with young people had increasingly led her to focus on protecting vulnerable groups, including migrant women living in South Africa.  She said that access to SRHR services is fundamentally a human rights issue, particularly for women who are pregnant or experiencing gender-based violence.

“It’s not like you are doing a favour when a woman who is eight months pregnant walks into a facility and says, ‘I need support, I need Antenatal care (ANC) services,'” she said.

She also placed migration within a broader African context, arguing that movement across borders is a reality of the continent and that health systems need to account for people who cross borders rather than treating migration as a reason for exclusion. The question becomes particularly urgent for migrant women whose need for healthcare does not disappear because they lack documentation. Mabasa said the focus should instead remain on ensuring that women are treated with dignity and can access the services they need.

That vision, she said, is already written into South African law. She pointed to the Constitution as the starting point, alongside the National Health Act, the Refugees Act and a body of sexual and reproductive health policies that together protect access to care and human dignity. “Our constitution is very explicit in terms of how we need to provide services to the vulnerable population,” she said.

The Constitution guarantees access to healthcare services and states that no one may be refused emergency treatment. The National Health Act extends free care to all pregnant women, lactating mothers and children under six, a category that explicitly includes asylum seekers, undocumented migrants and stateless people, regardless of nationality. The Refugees Act adds another layer of protection.

Yet those protections have been tested repeatedly in practice.  In December 2025, the Gauteng High Court ordered the authorities to allow unhindered access to the Yeoville and Rosettenville clinics in Johannesburg to people without South African identity documents. This came after vigilante groups had blocked them from entering. In 2025, a Malawian mother of a one-year-old child said Operation Dudula members prevented her from reaching Alexandra clinic before the child later died. Operation Dudula denied instructing anyone to block her. Gauteng Health MEC Nomantu Nkomo-Ralehoko called the blockades unlawful and demanded they stop. The Economic Freedom Fighters ( EFF) laid criminal charges against former Operation Dudula leader Zandile Dabula over the child’s death.

Operation Dudula argued that its actions respond to a health system under strain.

“In our operations we are saying, ‘Put South Africans first,'” one of its members, Tholakele Nkwanyana, told the Associated Press. She argued that the number of foreign nationals seeking care outstrips available medication and staff. Public health researchers dispute that framing. Collective Voices Against Health Xenophobia, a coalition of civil society groups and healthcare workers, has said migrants are being scapegoated for failures that have little to do with them. They argued that “migrants have been made scapegoats for a public health system in crisis” shaped by mismanagement and years of underinvestment.

However, the court recognised that even undocumented foreign nationals have a right to primary healthcare. The incidents show how legal protections can exist on paper while migrants continue to face barriers when they try to access healthcare.

“The law doesn’t say whether you’ve got documentation, you’ve got a passport,” Mabasa said. “These policies, as good as they are in black and white, don’t translate to equitable access.”

The court case did not end the problem. In March 2026, SECTION27, representing the Treatment Action Campaign, Médecins Sans Frontières and Kopanang Africa Against Xenophobia, returned to court after monitoring found that vigilante groups were still present, particularly around Rosettenville clinic. The parties subsequently reached a settlement requiring state authorities to take steps to ensure safe and unhindered access to both clinics.

Mabasa said documentation should not determine whether a migrant woman is treated with dignity. “Those things are not relevant,” she said. “It’s about making sure that human dignity is respected.”

But legal protections do not necessarily translate into easy access to care.

Similar findings to those of Mabasa were found in research conducted in Ekurhuleni, where barriers reported by migrant women and health care workers included language, discrimination relating to migration status, and challenges in relation to documentation and referrals. The study also highlighted challenges faced by health care workers themselves when providing SRHR and HIV services to migrant women.

Mabasa also identified several barriers confronting migrant women.

Migrants whose permits or other documents have expired may find themselves unable or unwilling to seek care because of uncertainty over their status. “Some are sitting somewhere with expired documents, and that becomes a barrier,” she said.

The challenges facing migrant women do not exist in isolation.

Language can create another layer of exclusion, particularly when women struggle to communicate with healthcare workers or understand the services available to them. One woman told her plainly: “Sometimes I don’t understand what the nurse is trying to say.”

The health system itself can also be a barrier, Mabasa said, with facilities sometimes lacking the capacity to meet demand.

South Africa’s public health system is already under pressure, with healthcare workers expected to serve large numbers of patients with limited resources. “Sometimes we don’t have enough capacity,” she said.

For migrants without legal documentation, simply walking into a health facility can carry its own risks.

Mabasa said the inconsistency is also evident in how individual facilities apply the rules. At one clinic, a nurse might demand a passport and ask about visa status before offering care; at another nearby, staff assists without question. “Someone would say, ‘ No, before I assist you, I need to see your passport,” she said. “And then you go to another place… someone is willing to say, ‘ Let me provide a service without even asking that information.”

For migrants already facing economic hardship, private healthcare may not be a realistic alternative. Mabasa rejected the assumption that foreign nationals can simply turn to medical aid or private facilities. “Someone is in an economic crisis. They can’t even afford private services,” she said.

Fear can be an equally powerful barrier. Migrant women with expired documentation may worry that visiting a health facility could expose them to authorities and result in deportation.

“My documents have expired; I’ll be deported to my country,” Mabasa said, describing the fear that can keep migrants away from health facilities. For pregnant women, the consequences of delayed care can be particularly serious. She said fear of stigma and discrimination could discourage women from seeking antenatal services early in pregnancy, leaving some to arrive at facilities only when they are close to giving birth.

Distance and transport costs add another obstacle, particularly for migrant women living far from healthcare facilities. She also pointed to another challenge: the mobility of migrant communities.  Women and families who cross borders or provinces for work could have implications for access to healthcare, education and support networks.

If a woman is on HIV treatment, contraception, antenatal care or other services, she may find herself in a different province and health facility, and this may disrupt continuity of care.

Leaving no one behind

Denying migrants healthcare can have implications far beyond the individual. Some may feel pressured to disclose their HIV status in an effort to access care, breaching their confidentiality and exposing them to stigma and discrimination. Delayed access to treatment can worsen illness and increase the risk of transmission of infectious diseases such as HIV and TB, and preventable complications can place additional strain on an already-overburdened health system.

The impact can be on livelihoods, as untreated illness can mean migrants are unable to work or run businesses, affecting their families and communities.

It’s about dignity, it’s about equality. Turning people away when they need care most risks deepening vulnerability and undermining the values South Africa’s Constitution seeks to protect.

Mabasa cautioned against placing the entire burden on healthcare workers.

She called for standardising facility-level protocols so that access doesn’t depend on which nurse is on duty; training healthcare workers not just clinically but on migrants’ actual legal rights, so that staff aren’t the ones improvising immigration policy at the point of care; integrating services so women aren’t forced into multiple costly visits; and building coordination between health departments, home affairs and civil society rather than leaving each to work in isolation.

South Africa has made progress toward the UNAIDS 95-95-95 HIV targets, but gaps remain. Mabasa said that excluding migrant women from healthcare also threatens progress made in the wider HIV response.

“We need to make sure that we leave no one behind,” she said.

South Africa: Documented migrants are also fleeing SA, unable to access care and treatment

Doctors Without Borders (MSF) has raised concern about the growing number of documented foreigners fleeing South Africa, saying the “self- repatriation” process cannot always be described as voluntary.

The humanitarian organisation says many Malawians, Mozambicans and Zimbabweans with valid documentation have been left with little choice but to return to their home countries after facing intimidation, violence and threats linked to anti-illegal migrant sentiment in parts of South Africa.

“The narrative that the so-called ’self-repatriation’ process is always voluntary is questionable, as many fearful Malawians, Mozambicans and Zimbabweans insist that they are documented but have little choice other than to flee for their safety,” the humanitarian organisation said.

MSF has expressed concern about interruptions in health care among people living with HIV, TB, diabetes, hypertension and mental health conditions, as defaulting on treatment can have serious and, in some cases, life-threatening consequences.

The government established a Temporary Repatriation Processing Centre (TRPC) in Musina on July 1 after consolidating operations from several sites around the country. The interministerial committee on migration said they have seen a tremendous increase in the number of foreigners who have been deported or repatriated.

Its medical tent is located some distance from where people queue daily to board buses back to their home countries, making it difficult for health care workers to reach those in need of medical assistance.

MSF said while the system appears efficient, it warned that vulnerable people may be missed because they are reluctant to leave queues to seek medical care or because they move on before receiving assistance.

Further, the organisation said many migrants continue travelling through informal routes.

“More than 100,000 people fleeing or being displaced are the sort of numbers MSF sees in hot conflict areas, not relatively stable democracies such as South Africa,” said MSF emergency medical team member Caroline Masunda in Musina. “With so many displaced people, we call on governments in the region to step up collaborative efforts to ensure continuity of care for patients.”

MSF counsellors across the border in Beitbridge are concerned about the trauma their patients are experiencing.

*Nobuhle, who had been living in Soweto, Johannesburg, and working as a chef, was devastated to return home from work on July 17 to find her house had been burnt down. Her three children were away at the time.

“I lost my passport and permit, all my clothes and furniture, my children’s birth records and birth certificates. I have nothing with me. All I have is this small handbag. I do not even have a change of clothes,” she said.

Nobuhle said she has lost hope.

“I thought having a passport and permit would save me, but no, I was wrong. I wanted to kill myself. I have lost hope, and I do not know what I will do,” she said.

Passing through Musina, *Joseph, a 49-year-old Malawian from Pietermaritzburg who has been working as a tailor in South Africa since 1995, had to leave his antiretroviral (ARV) medication as he fled his home.

He said people came to his house telling him to go.
“I ran away and went to hide with my friends. Then I went to Durban. I [was] staying there at the bus station; it was raining, but we were outside. I left my [HIV] medication there in the house. I don’t worry about that or the clothes; if I am still alive, I can get it. I haven’t taken the medication in a few weeks. It is a relief; I got my medication from MSF,” he said.

*Freedom Moyo, a 46-year-old Zimbabwean, moved to South Africa in 2009, where he has been working as an electrician and plumber.

Treated at Beitbridge, he said he was forced to leave South Africa after his health deteriorated because he had been unable to access his ARV medication.

“I defaulted on my medication for three months because of the xenophobic attacks in South Africa. I could no longer access the clinic as I used to, and my condition worsened. Before all this, the nurses in South Africa would not take it lightly if we missed the day for collection of our ARVs. Now everything has changed; they no longer want us.”

He said he had to be admitted to hospital in Zimbabwe.

“When I arrived on the Zimbabwean side, I was admitted for four days because I had lost a lot of weight, my leg was swollen, and I was feeling very weak. I am happy because I received a one-month supply of ARVs and was referred to a local clinic in Gweru for continued treatment.”

MSF said their teams are also treating many patients who do not have access to their chronic hypertension medication.

The organisation noted that, left untreated, high blood pressure can lead to serious complications, including strokes, heart failure, blood clots and even death.

*Joyce, a Malawian from Boksburg North near Johannesburg, was also treated by the MSF team in Musina.

Joyce said her blood pressure reading was 214/95, and she was not going to the clinic, as she was afraid.

When she fled her home, Joyce travelled to Musina after sleeping outside for two days.

“We are seeing a trend in Musina of patients who have been unable to access life-saving HIV and TB treatment for months after being turned away from South African health care facilities because they are migrants, increasing their risk of treatment failure and, in some cases, developing drug resistance,” Masunda said.

MSF cited the example of *Munyaradzi, who was exposed to a toxic chemical while working in a Zimbabwean gold mine six years ago and still struggles with debilitating pain.

He had not had access to his chronic pain medication for seven weeks while he travelled from Dennilton, a rural town straddling the Limpopo-Mpumalanga border, to the repatriation centre.

“That chemical affected me in 2020, and I started taking tablets from that year until now. I know they don’t like us here in South Africa, so I got my mind to go back home, but the police caught me before I went. They took me to the police station. I told them about my situation, that I am taking tablets. They didn’t take me to a clinic until now,” he told MSF. “My body has got so much pain.”

Zimbabwe: Virtual health platform helps to prevent treatment interruption among returning migrants

Digital tools help Zimbabwe’s HIV migrants stay in care

As droves of Zimbabweans return home from South Africa in a wave of deportations and anti-immigrant sentiment, health experts warn that disruptions to HIV treatment could leave many at risk unless returnees are quickly reconnected to care.

The South African government says more than 53,000 foreign nationals have been processed for deportation or repatriation as part of a crackdown on “irregular migration” following weeks of violent anti-immigration protests. Most of the returnees are from Malawi, Zimbabwe and Mozambique.

According to Statistics South Africa, Zimbabweans constitute one of the country’s largest migrant communities, with an estimated one million living there.

“We know that displacement, whether planned or sudden, can disrupt treatment, resulting in missed medication, poor health outcomes and increased risk of opportunistic infections.”

Tatenda C. Makoni, executive director, ZNNP+

Research in South Africa’s Gauteng province, which carries the country’s largest HIV burden, found HIV prevalence among international migrants to be around 10 per cent.

For many migrants living with HIV, sudden displacement presents immediate risks. Medication may be left behind, treatment records lost, and patients may struggle to navigate health systems on their return.

“The disruption is not just about the medicines,” Efison Dhodho, research coordinator at Zimbabwe’s Biomedical Research and Training Institute, told SciDev.Net.

“Many returnees may have lost their treatment records, some fear accidental disclosure of their HIV status when they return to their communities, while others are dealing with the psychological stress of suddenly losing their livelihoods.”

Health authorities in Zimbabwe, which has one of Southern Africa’s largest HIV treatment programmes, say they are responding through a combination of digital health and patient-centred care models designed to prevent treatment interruptions among mobile populations.

Owen Mugurungi, director of the AIDS and TB unit in Zimbabwe’s Ministry of Health and Child Care, said the ministry was working with the Zimbabwe National Network of People Living with HIV (ZNNP+) and others to make sure everyone who needs antiretroviral drugs can accesses them.

The Zimbabwe National AIDS Council (NAC) urged returning migrants with HIV to enrol immediately into Zimbabwe’s HIV treatment programme upon arrival.

“What I know, and what I want to encourage, is for people living with HIV who are returning, when they get to their respective homes, to go to the nearest health facility and be absorbed into the very robust HIV treatment programme which we have in Zimbabwe,” said NAC chief executive officer Bernard Madzima.

“We have capable health workers at every facility in the country, from clinic level up to the highest referral hospitals, so there should be no problem in terms of them being integrated into this system.”

‘Omalayitsha’ network

Madzima noted that many Zimbabweans working in South Africa had been accessing six-month supplies of antiretroviral medicines from Zimbabwe through an informal cross-border transporter network known as “omalayitsha”, allowing them to remain on treatment while living abroad.

However, he said more people are now returning permanently and need to be fully integrated into local HIV services.

Mental health challenges, stigma and the practical realities of displacement can all affect adherence to treatment, said Dhodho, who has worked on Zimbabwe’s HIV care strategies for migrant populations.

“If your life is suddenly disrupted and you’re forced to leave, your medicines may be left behind,” he explained.

“Even a short disruption in routine can affect adherence. HIV treatment works best when people maintain viral suppression, which protects both their own health and helps prevent onward transmission.”

Dhodho said the country had already developed approaches, including the omalayitsha model, which could help returning migrants reintegrate into care more effectively.

However, he added that omalayitsha depends on predictable travel patterns and stable living arrangements, both of which have been disrupted by the recent wave of deportations.

Telehealth solutions

To bridge that gap, ZNNP+ has expanded the use of Kutabila, a virtual health platform that links returning migrants with HIV treatment and care services.

“The recent increase in the number of Zimbabweans returning home from South Africa, coupled with reports of deportations and heightened anti-foreigner sentiment, raised concerns about the continuity of HIV treatment among people living with HIV,” said Tatenda C. Makoni, executive director of ZNNP+.

“We know that displacement, whether planned or sudden, can disrupt treatment, resulting in missed medication, poor health outcomes and increased risk of opportunistic infections.”

Through telephone-based counselling and referral services, trained counsellors assess callers’ treatment needs, direct them to the nearest health facility and provide adherence counselling and psychosocial support.

Between 1 June and 8 July, the platform received more than 300 calls from returning migrants, according to Makoni. He said most were seeking help on restarting treatment, replacing lost medical records, transferring HIV care from South Africa or accessing medicines after treatment interruptions.

Since its launch, Kutabila has handled more than 10,500 client interactions and successfully linked over 7,300 people living with HIV to treatment and care services, he added.

Empathy approach

Zimbabwe is also applying lessons from Uzwelo, meaning empathy, a person-centred approach developed after the COVID-19 pandemic to re-engage people who had interrupted HIV treatment.

Rather than focusing only on tracing people who miss clinic appointments, Uzwelo encourages healthcare workers to understand the individual circumstances that caused treatment interruption and develop care plans tailored to each patient’s situation.

According to Dhodho, who helped develop the approach, Uzwelo helped recover nearly a quarter of patients who had fallen out of care within just three months after being introduced in pilot districts.

“The health worker meets the client with empathy instead of judgement,” he explained.

“The question becomes, ‘How do we make treatment work for your circumstances?’ rather than ‘Why did you default?’”

Makoni believes such innovations offer lessons that extend beyond Zimbabwe.

“Migration is a regional issue, and ensuring continuity of HIV treatment requires regional solutions,” he said.

“Continuity of HIV treatment should not stop at national borders.”

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.