Israel: Undocumented migrants living with HIV receive drugs no longer administered to Israelis

Undocumented HIV carriers in Israel receive treatment ‘worse than third world countries,’ if any at all

Those treated by the Health Ministry program speak of severe side effects, and doctors note drugs they receive are no longer administered to Israelis.

Hundreds of undocumented HIV carriers in Israel receive inadequate treatment and outdated medications that sometimes cause severe side effects. Moreover, they are unable to access treatment for their condition and related infections or receive sufficiently close monitoring. Carriers are admitted to the Health Ministry’s treatment program only after their condition deteriorates, and their immune system is already dysfunctional.

One source familiar with the situation said the plan suffers from “quality of treatment and a management level worse than third world countries.”

According to the latest Health Ministry data from 2019, 130 out of 430 new carriers diagnosed that year were undocumented and without health insurance.

Doctors and professionals in the field say the treatment regimen for undocumented HIV carriers is very narrow, and far removed from the quality provided to Israeli carriers, who enjoy treatment that is among the most advanced in the world. As a result, physicians often find themselves helpless when treating patients.

D., 50, is an undocumented migrant who arrived in Israel from Ethiopia about 25 years ago. She was diagnosed HIV-positive 19 years ago, when she was five months pregnant. In 2016, after years of being treated on a voluntary basis, she started to receive treatment from the Health Ministry, in the course of which, she said, she was given medications that weren’t suitable for her and caused multiple side effects.

“My body does not react well to the pills,” she related. “They cause me pains, exhaustion and an accelerated heartbeat. When I take them I am afraid to leave the house and I simply prefer to forgo that on certain days.”

D. said that she asked for medications appropriate for her but her request was denied because they are not included in the program. “I was told that if I want to buy them privately it will cost me 6,000 shekels [$1,850] a month. I don’t have that amount.” Now she is being treated irregularly. “The doctor gave me what there is, what she manages to get hold of,” she said, referring to the more expensive medications. “I don’t know which medication I will be receiving in another month or two. Sometimes I just switch treatment.”

D. is also ineligible for regular follow-ups. Undocumented persons are entitled to a test that monitors their immune system activity only once a year, whereas Israeli patients are entitled to a quarterly test. In the meantime, neither D. nor her attending physician know how effective the treatment is. In addition, she is not entitled to treatment to be treated for for side effects and accompanying complications.

“I don’t have a regular job and have no way to pay for private treatments,” she said. “I go to clinics in Jerusalem’s Old City because it’s cheaper there. I want to live, but I am not getting what I need.”

“It’s not just a difference between life and death. It’s a difference between life and death in agony,” said Dr. Itzik Levy, director of the AIDS clinic at Sheba Medical Center, Tel Hashomer. “The treatments currently given to undocumented carriers are ones that are no longer used – not even in third world countries.” In 2016, after a protracted struggle, the Health Ministry decided to offer treatment to undocumented HIV carriers. “The problem is that the quality of care and its administration is worse than in third world countries,” Levy claimed.

Levy said undocumented carriers are only entitled to outdated drugs that cause a long list of side effects, absent in the latest medications. “These are drugs that are not currently administered to any Israeli carriers – drugs with lower efficacy that lead to many side effects, such as anemia, weakness, increase in blood lipids, diabetes, and neuropsychiatric symptoms,” he asserted.

In addition, the program does not cover treatments for other complications and AIDS-related illnesses, which are caused by the disease or the side effects of its treatment. “They do not receive other drugs, including preventive ones. If you need to prevent disease or administer complex antibiotics – they aren’t eligible,” he said. “I face patients I cannot help. I have carriers who have fallen ill because of the drugs’ side effects or other reasons and had nothing for them. Their immune system deteriorated. In one case, a patient had a stroke and remained disabled for life. Another patient had lymphoma and died. These are things that could have been prevented with better treatment for HIV suppression.”

Dependent on leftovers

In 2016, the National Program for the Treatment of Undocumented HIV Carriers was launched, led by the Health Ministry’s department of tuberculosis and AIDS, designed to handle immigrant carriers, many of whom come from endemic countries, including refugees and migrant workers from Africa and carriers from the former Soviet-Union who overstayed their tourist visas and became undocumented migrants in Israel.

The program is designed and budgeted for the treatment of about 400 HIV carriers aged 18 and over who are in Israel for at least six months and lack health insurance. Candidates for the program were required to appear before a medical committee. S., 60, emigrated from Ethiopia in 1995 and was diagnosed HIV positive three years later. In 2006, he also fell ill with tuberculosis and a brain infection. He suffers from neural and bone damage. In his case, too, the treatment he’s getting through the program is insufficient.

“My treatment depends on what the doctor can get hold of,” he said. “The other medications I buy myself, costing me about a thousand shekels a month.”

K. 70, arrived in Israel from Ethiopia about a decade ago and was diagnosed as a carrier shortly afterward. She said that one of the two medications she receives as part of the program causes severe side effects. “The medication causes vomiting, loss of appetite, exhaustion and a serious rash all over the body,” she said. “That’s in addition to a chronic lack of iron. The new medications are better and don’t produce side effects, but I don’t know which medication I’ll get, or in what quantity. The pills will run out in another month and a bit, and I’m already stressed. I don’t know what will happen.”

One of the drugs that treats a significant proportion of undocumented carriers is called Zidovudine (AZT), approved for use in 1987. Another drug used on this group of patients is efavirenz (Stocrin). Both drugs cause severe and often fatal side effects. For these reasons, these drugs have been discontinued in most countries, including Israel.

“These are drugs with a lot of side effects that Israeli carriers have not received for more than a decade. Israeli carriers are treated with new-generation drugs that have almost no side effects, are effective against resistant viruses, but are more expensive,” said Levy. “This situation is forcing me to perform poor medicine. I have a patient in her sixties for whom I found a donation of two boxes of medicine that she needs and is not entitled to. Once she runs out her fate will be sealed unless we find more.”

Other senior AIDS physicians identified with the situation described by Levy.

“Treatment for Israeli citizens is second to none, including in Europe. Israeli carriers receive the most advanced, expensive, and unlimited treatment. We are talking about drugs that cost between NIS 4,000 and NIS 5,000 per month per patient. Cost is certainly a consideration,” said Dr. Hila Elinav, director of the AIDS medicine unit at Hadassah, and a board member of the Israeli AIDS Society. “Most patients do fine with the old drugs, but some have severe side effects or have developed resistant strands. We have no solution for them.”

She said this situation creates the need to source leftovers from Israeli patients. “This is a very problematic method, and I am constantly under pressure,” she said. In cases in which they don’t manage to obtain the right medications, she said, “I have to change the treatment, and that is absolutely not good.”

Other sources agreed that the existing treatment is problematic, but stressed that before the program got underway undocumented carriers received no treatment at all.

According to Dr. Dan Turner, Director of the AIDS Center at Ichilov Hospital, and Chairman of the Israeli AIDS Society, “The treatments given to undocumented carriers are the same treatments given to Israeli patients previously. We are talking about a relatively large number of pills and with a very high percentage of side effects.”

Looking back, he said, many Israeli patients who received the obsolete treatment survived and coped with the side effects. “Our big problem is the fact that a few dozen patients can’t receive the old treatment, whether due to resistance or because of various side effects, and we have no solution for them,” he said. “In some cases this reaches a condition that poses an immediate danger to their life.”

‘Scandalous’ threshold

Another problem professionals point out is the entry threshold to the program. Unlike Israeli carriers who are treated upon diagnosis, an undocumented carrier who tests positive will only be monitored and treated after their immune system activity falls below the set threshold. “The threshold for entering the program is a scandal and that is something that must change,” Elinav said. “It’s not just that people are at risk of developing a disease. They can infect others and this counters the goal of lowering the overall morbidity. Beyond that, untreated carriers come to hospitals with AIDS, and then their condition is much more difficult.” According to Turner, research shows that the earlier the treatment of carriers begins, the more their life expectancy increases, and the more AIDS-related illnesses and comorbidities decrease.

And yet, some professionals believe the program should be judged more broadly. “It is true that there is criticism of the program, but it should also be welcomed. The situation before was terrible. Today, the program helps most patients but needs improvements,” Turner added. “The program is welcome but there is still a lot to do.” According to the Ministry of Health, more than 500 carriers have been treated to date under the program. There are now about 350 people in the program, only a few of whom are being monitored, as they do not yet meet the criteria.

“The program is vital and helps hundreds of HIV carriers a year receive life-saving treatments. The number of undocumented carriers being treated has more than doubled since it was launched,” said Noga Oron, chairwoman of the Committee for the Struggle Against AIDS. “There is an urgent need to add new generation drugs to the program for those patients whose drugs don’t suit their needs.” A more effective program will reduce the burden on the health system because of unnecessary infections and hospitalizations. It is also proven that the HIV carrier that is treated optimally is not contagious at all, and therefore it is recommended that every person who is HIV-positive be treated as soon as possible,” said Oron.

The Health Ministry commented: “The use of medications other than those stipulated in the guidelines would raise the cost of the program by several million more shekels or would bring about a significant decrease in the number of patients who can benefit from the program. Israel is one of the few countries in the West that provides free antiviral monitoring and treatment for non-citizens without health insurance. The program operates on a strictly medical and humanitarian basis only. The medications are those recommended by the World Health Organization.”

It added: “At the same time, there is a small number of carriers whose treatment in the program is unsuitable (due to resistances), and they receive the medications in other tracks. This year again, the tuberculosis and AIDS department requested a special budget for which authorization has not yet been received. All told, the program is essential, both in terms of public health and on humanitarian grounds. However, the program is operating under challenging budgetary constraints, especially in the past few years.”

Andorra: People refused entry to the country for a variety of health reasons, including HIV

A doctor’s complaint against the Andorran government for the ‘grave violation of human rights’ of immigration medical services

Translated from Spanish via Deepl.com; Scroll down for the original article in Spanish.

Ricardo Villanueva, a doctor who worked for three years in a hospital in Andorra, has filed a complaint against the government of the Principality. The doctor claims that people have been refused entry to the country for various health reasons: HIV, hepatitis, diabetes, myopia, obesity, anxiety and deafness.

‘The objective is purely economic, as vulgar as that’, he denounces, adding: “an HIV-positive patient is going to be an economic burden for them in the future, and for an obese patient the capacity to develop illnesses is going to be much greater, which is going to have repercussions on their coffers”.

In this sense, the doctor highlights a fact: ‘The average life expectancy in Andorra is 90 or 91 years, more than anywhere else in Europe, this is due to the fact that “sick, no thanks”’. ‘When they have an illness or whatever, the Andorran service automatically takes away their residence permit, and if they don’t have a residence permit, they have to go to their country of origin,’ he laments.

Moreover, Villanueva assures that ‘this situation has not changed nowadays’, according to what he has heard ‘from doctors who continue to work in Andorra’, to which he adds that ‘what has happened is that there is better surveillance in the flow of data referring to these problems’.

La denuncia de un médico al Gobierno de Andorra por la “grave violación de los derechos humanos” de los servicios médicos de inmigración

Ricardo Villanueva, un médico que trabajó tres años en un hospital de Andorra, abandera una denuncia contra el Gobierno del Principado. El doctor asegura que han denegado la entrada al país por diferentes cuestiones de salud: VIH, hepatitis, diabetes, miopía, obesidad, ansiedad o sordera.

“El objetivo es meramente económico, así de vulgar”, denuncia, tras lo que añade: “un paciente seropositivo va a ser para ellos el día de mañana una carga económica y para un paciente obeso la capacidad de desarrollar enfermedades va a ser mucho más amplia, con lo que eso va a repercutir en sus arcas”.

En este sentido, el doctor destaca un dato: “El promedio de vida en Andorra son 90 o 91 años, más que en ninguna parte de Europa, esto es debido a que ‘enfermos, no gracias'”. “Cuando tienen una enfermedad o lo que sea, automáticamente el servicio de Andorra les quita el permiso de residencia, y si no tienen permiso de residencia, tienen que irse a sus países de orígenes”, lamenta.

Además, Villanueva asegura que “esta situación no ha cambiado en la actualidad”, según lo que le llega “por parte de médicos que siguen trabajando en Andorra”, a lo que apostilla que “lo que ha ocurrido es que hay una mejor vigilancia en los flujos de datos que hacen referencia a estos problemas”.

Nepal: How critical HIV medicine reached a traveler stranded in Nepal during the pandemic

Stranded in Nepal without HIV medicine

Wang Tang (not his real name) had never been to Nepal before, but at the end of March 2020 it was one of the few countries that had not closed its borders with China. Since he was desperate to get away from Beijing after having had to stay at home for months after the coronavirus outbreak spread throughout China, he bought a ticket.

But days after he arrived, while he was staying in Pokhara, the fourth stop on his trip, the local government announced that the city would be shut down. He heard that the lockdown would not last longer than a month.

As someone who is living with HIV, he had brought along enough HIV treatment to last for a month. However, he soon learned that the re-opening of the city was to be postponed, which meant that he was at risk of running out of the medicine he needed to take regularly in order to suppress his HIV viral load and stay healthy.

Mr Wang swallowed hard while counting the remaining tablets. He had no idea how to get more.

As the lockdown dragged on, it seemed that no end was in sight. Mr Wang started to take his medicine every other day so that his supply would last a little bit longer.

He contacted his friends back at home, hoping that they could send medicine to Nepal, but they couldn’t. The country was under lockdown—nothing could be imported.

Then, Mr Wang contacted his friend Mu-Mu, the head of Beijing Red Pomegranate, a nongovernmental organization providing volunteer services for people living with HIV. It was with Mu-Mu’s help that Mr Wang learned how to obtain HIV treatment after he was diagnosed as living with HIV. Having known each other for many years, Mu-Mu had the trust of his friend. Mu-Mu contacted the UNAIDS Country Office for China to see if it was possible to deliver medicines to Mr Wang. A UNAIDS staff member quickly got in touch with the UNAIDS Country Office for Nepal.

Everything happened so quickly that Mr Wang was shocked when he received a message from Priti Acharya, who works for AHF Nepal and had been contacted by the UNAIDS Nepal office, saying that she would bring the medicine to him.

The next day, Ms Acharya rode her motorbike for 15 km on a dusty road before reaching the place where she would meet Mr Wang. When he came down from the mountains to meet her, Ms Acharya, drenched in sweat, was waiting under the midday sun.

“I was so happy and thankful for her hard work. She gave me a sunny Nepalese smile in return, as well as detailed instructions on the medicine’s dosage,” said Mr Wang.

They took a photograph together, then Mr Wang watched Ms Acharya as she left on her motorbike. Her image, disappearing in the distance, is carved into his memory. To attend the five-minute meeting, Ms Acharya had to ride a round trip of more than 30 km.

“For half a month or so, I had been suffering from pain and anxiety almost every day due to the lack of medication and the loneliness of being in a foreign country on my own. I could not believe that I got the HIV medicine in such a short time,” said Mr Wang. After the trip, he wrote to thank Ms Acharya, explaining how important the medicine he now had in his hand was: “it’s life-saving.”

At the end of his stay in Nepal, Mr Wang wanted to do something for UNAIDS. As he is an experienced photographer, he volunteered to carry out a photo shoot for UNAIDS’ Nepal office.

The subject he chose was former soccer player Gopal Shrestha, the face of an HIV charity in Nepal and the first person living with HIV to reach the summit of Mount Everest. After his HIV diagnosis in 1994, Mr Shrestha launched the Step-Up Campaign and spent many years climbing mountains worldwide, hoping to give strength and hope to people living with HIV.

In 2019, Mr Shrestha reached the peak of the world’s highest mountain, Mount Everest, recording a historic breakthrough for people living with HIV. “If 28 000 people have already climbed Mount Everest, why can’t I?” he said. “By climbing the highest mountain in the world, I want to prove that we are no different from anyone else and that we can all make a difference.”

“The moment I saw him, I could tell he was a sophisticated man,” said Mr Wang. Without instructions, Mr Shrestha posed naturally in front of the camera. He displayed confidence and charm. His eyes, content and clear, reflected nature’s beauty. “The eyes surely are the window to the soul,” Mr Wang said.

Mr Wang is looking forward to his next trip to Nepal. After the pandemic, Pokhara’s lakeside will be flooded with tourists, and he looks forward to seeing the mountain town bustling with people like it used to.

Egypt: UNAIDS helps non-nationals in Egypt to get supplies of antiretroviral therapy

UNAIDS supporting people stranded in Egypt to access HIV treatment

Hundreds of thousands of people around the world have been stranded abroad due to the bans on flights and border closures imposed to stop COVID-19. As elsewhere, thousands of non-nationals have been stranded in Egypt indefinitely.

Travel restrictions have had many repercussions on the daily lives of non-nationals, putting significant economic pressure on them and potentially putting their well-being at risk.

The UNAIDS Country Office for Egypt has been working on COVID-19 from the start of the pandemic in the country, establishing a direct line of communication with the National AIDS Program and working with it to ensure the continuation of HIV treatment by everyone on it and to help non-nationals in Egypt to get supplies of antiretroviral therapy.

Sophia Bianchi (not her real name) is an Italian tourist stranded in Sharm El Sheikh. “I ordered my antiretroviral treatment in late April from Italy via a courier service. Unfortunately, the shipment was stuck at the airport customs in Cairo for weeks. I contacted UNAIDS and they have been very helpful, following up daily with the Egyptian Ministry of Health and Population to get approval for releasing the shipment and checking on me and my health. They kept pushing through the Eid holidays and it all got resolved in two weeks. It was a stressful time but now I am relieved,” she said.

Antiretroviral therapy is available in Egypt free of charge to all nationals and registered refugees. However, as there is no community-based dispensing, nor private market purchase of antiretroviral medicines, gaps remain in ensuring that non-nationals can access treatment. For this reason, UNAIDS’ work during the COVID-19 pandemic has been essential in bridging the gaps.

There are strict rules on the dispensing of antiretroviral therapy in Egypt—only close family members are able to collect it from the dispensing centre. For Fatima Ahmed (not her real name), a refugee from Yemen who because of chronic illnesses that put her at higher risk from COVID-19 cannot leave her house, this was a significant barrier to accessing her HIV treatment. UNAIDS got in contact with the Egyptian Ministry of Health and Population to get an exceptional approval to dispense her medicine through a nongovernmental organization.

“I have not left the house for more than three months. My family has not been able to support me financially, so I was left without revenue. Thanks to the support of the National AIDS Program and MENA Rosa, a nongovernmental organization, peer supporters have delivered three months of antiretroviral treatment to my doorstep,” said Ms Ahmed.

However, much still remains to be done in reaching out to the most in need in Egypt. UNAIDS in Egypt has been advocating for the right to health and universal health coverage for everyone and is working in partnership with the Egyptian Ministry of Health and Population to ensure treatment for all nationals and non-nationals in the country.

“We believe in the absolute right of everyone to have access to their basic right to health. Ensuring access to antiretroviral therapy during these exceptional times is therefore our upmost priority. We are working relentlessly with our governmental and nongovernmental partners to build long-term policies to ensure treatment and care services for people living with HIV during times of emergency,” said Walid Kamal, the UNAIDS Country Director for Egypt.

Lesotho: The power of community leaders in HIV awareness and support

Improving HIV testing, disclosure and treatment for migrant communities

In the busy town of Maputsoe, in Lesotho on the border with South Africa, a hairdresser recounts how her engagement with an IOM change agent led to important shifts in her knowledge about family planning, provided pivotal counselling, and helped facilitate HIV testing and treatment for herself and her new boyfriend.

Now pregnant, Palesa, is aware of and accessing a prevention-of-mother-to-child-transmission (PMTCT) service and shares sexual and reproductive health and rights (SRHR) and HIV information and commodities with her own clientele.

She first learned about the SRHR-HIV Knows No Borders Project two years ago, through a door-to-door visit from one of the change agents, Thuso, a well-known counsellor, pastor and traditional healer. Thuso came to her small hair salon on multiple occasions, to provide her with information on SRHR, HIV and family planning. Palesa, 30, had a four-year-old daughter when she began a new relationship with Refiloe, a man she met in Maputsoe.

She had no plans to have more children but was unaware of locally available family planning options, and how to access services.
Palesa was reluctant to tell her boyfriend about her HIV positive status for fear he would no longer want to be with her. Thuso encouraged her to open up to him and offered to speak with the couple about the issue and provide any information they needed.

With Thuso’s support, they went for HIV testing, where Refiloe, to his surprise, also tested positive. The couple is still together and receiving treatment and support. Armed with her knowledge about SRHR-HIV issues Palesa began to reach out and share what she had learned with her friends and family.

She keeps a steady supply of condoms at her hairdressing salon to distribute to clients, with whom she also shares her experience. She acknowledges that many migrants passing through Maputsoe may not feel comfortable accessing formal health services for basic information about SRHR. Her salon, along with many others identified by the project in major border towns, have become hubs for delivering information, initiating referrals and distribution of condoms.

Engaging known leaders within the community helped build the rapport necessary when engaging with the multiple sensitive health and relationship issues that Palesa’s circumstances raised. The knowledge and support she received from the programme are now having ripple effects, as she continues to share what she learned.

IN A BOX

The SRHR-HIV Knows No Borders Project was launched in early 2017, as a collaborative effort between the International Organization of Migration (IOM), Save The Children (SC) Netherlands, and Witwatersrand School of Public Health (WSPH).

This consortium aims to implement a holistic, regional approach to improve sexual and reproductive health and HIV (SRH-HIV) related outcomes amongst migrants (including migrant adolescents, young people and sex workers) as well as non-migrant adolescents, young people and sex workers and others living in migration-affected communities in six countries in the Southern African Development Community (SADC) region, namely Eswatini, Lesotho, Malawi, Mozambique, South Africa and Zambia.

The project relies on community-based change agents who have been identified in collaboration with community leaders to promote sexual and reproductive health and HIV and assist individuals and communities to realise their rights and access basic services. By engaging known leaders within the community as change agents, the project has been able to build trust with individuals within the communities it aims to reach. This trust is particularly important when addressing sensitive issues such as SRHR and HIV.
*(all names have been changed in this story)

This story was written by Abibo Ngandu, IOM Southern Africa’s Public Information Officer.

South Africa: African migrants face dual challenge of navigating HIV care and social stigma

The social management of HIV: African migrants in South Africa

HIV is the most common chronic illness in South Africa. One in every five is infected and one in every 13 takes antiretroviral drugs daily. Managing HIV medically has become more of a part of normal life.

Amid this public health emergency, some 2.5 million foreign-born African immigrants live in South Africa. They largely come from countries with the highest HIV prevalence rates in the world, such as Lesotho. Yet their access to health care and services is limited, because they are vulnerable in various ways. Though entitled to inclusion and care in South Africa, they may face deportation, xenophobia, exploitation, language barriers, cultural estrangement and social isolation.

In spite of these challenges, migrants do manage HIV medically. But we do not really know how they manage socially in communities where the stigma of the disease affects all dimensions of life. HIV is often referred to today as a “manageable” chronic illness, but it is not just a medical condition. It is also very much a social condition as living with HIV comprises both clinical features of care and experiences of stigma and social angst.

Understanding how migrants manage this social dimension of their condition matters because it shapes the landscapes and outcomes of their care. It directly influences when and where people seek treatment, and how well they adhere to it if they do. This in turn affects critical issues such as drug resistance and prevention of transmission.

In a recent journal article, I unravel complexities of stigma and perceptions of HIV in Mozambican migrant communities. My research exposes layers and shades of stigma across different social networks and locations, which influence how HIV is managed socially. It shows how an individual’s HIV status determines how other community members are regarded and interacted with in daily life.

Perceptual contrasts

Nowhere in South Africa is the migrant population as dense as in inner-city Johannesburg. In their urban enclaves, community members inevitably lead lives entwined with those of people receiving care for HIV, whether aware of their infection or not.

HIV is spoken of here in ways that acknowledge, perpetuate and replicate stigma. For instance, Mozambicans may allude to HIV as “stepping on the mine”, as “being poisoned” or as “getting stung”. Open conversation about HIV is avoided, which in turn creates an anxiety that motivates secrecy. This is so because disclosure of HIV serostatus may put social life at risk.

I explore perceptions of HIV among two groups of Mozambican migrants in Johannesburg: one consisting of patients receiving care for HIV in a hospital; and the other of community members unaware of their own serostatus.

The contrast between how these two groups perceive of each other is staggering. The patients apprehensively conceal their status for fear of what others might think of them. But these others express mostly empathy and understanding for their condition.

I identify two reasons for such stark perceptual contrasts. The first lies in a transformation of identity, which results in a division between an “us” and a “them”, between the HIV-positive and the HIV-negative.

This process creates a schism between “patienthood” and “personhood”. When a person tests positive for HIV, fears of physical death in the future transform into fears of social disruption in the present. Loneliness and isolation then result from the person keeping her HIV status secret.

As the identity of a community member shifts from personhood to patienthood, as she receives counselling and care, she comes to associate disclosure with her own (and others’) social death. Her serostatus then becomes a secret in her life, while her notion of others’ perceptions of HIV becomes confined to the realm of the suspected and nervously anticipated. Expecting social misfortunes should others learn of her status, she opts for concealment as a strategy of survival in the community.

Secondly, I find that stigma is tied to location, because of the ways in which location is tied to social networks. In different social networks such as family at home, friends, work colleagues, acquaintances in the community or the nightlife, the stakes of disclosure vary considerably.

For instance, one focal point of stigma is the local HIV clinic. It is supposed to care for its patients, but at the same time it also estranges them, because others might recognise them there and so become antagonists rather than fellow patients.

In fact, Mozambicans largely prefer to avoid clinics in South Africa and go home to Mozambique for treatment. The stakes of disclosure, involving livelihoods, partners and identities, are far too high to risk being seen receiving care in South Africa. Disclosure may be less hurtful in certain locations where social networks are more sympathetic.

This may further complicate the therapeutic journey of migrants in terms of costs, retention in treatment or simply having to explain away the true purpose of one’s absence.

Medicalised, not socialised

HIV may have become easier to manage medically, but stigma continues to cause distress and remains severely challenging to manage. This is also a challenge for health care provision, as it sways choices of when and where to seek care: a South African clinic, for example, or a distant, socially safer treatment option.

HIV may have been medicalised, yes, but not socialised.

Venezuela: Over 7,700 Venezuelans in need of HIV/AIDS treatment have left their country

A chance to live: The quest of Venezuelan refugees and migrants with HIV/AIDS

A chance to live: The quest of Venezuelan refugees and migrants with HIV/AIDS

By Marta Martinez in Lima. Also available in: Français (French), Español (Spanish), عربي (Arabic)

Over 7,700 Venezuelans in need of HIV/AIDS treatment have left their country and face additional challenges in their journey to safety and medical care.

Sitting on a crowded bus about to reach Lima, Peru, after seven days on the road and thousands of kilometres away from his home country of Venezuela, Arturo* started to feel terrified. The 47-year-old wondered about getting access to human immunodeficiency virus (HIV) medication: “Will I die in this country where I do not know anyone?”

Over three million refugees and migrants have left Venezuela to date. The lack of medicine has forced thousands – especially those with chronic illnesses such as HIV/AIDS – to search for treatment and hope in other countries.

For people living with HIV/AIDS, having access to antiretroviral treatment means not only a chance to survive, but to lead a normal life. Over 7,700 Venezuelans live with the condition outside of their home country and are in need of antiretroviral therapy, according to UNAIDS.

Arturo was diagnosed in 2000. He had a comfortable, healthy life as a hair and make-up stylist in  Caracas, Venezuela until about two years ago, when access to antiretroviral medication was shrinking.

“I was really scared of not having any medication.”

To get the daily pills he needed, he was forced to resort to friends who were doctors. But soon it became even more cumbersome. Arturo felt he only had one option.

“This marked my decision to leave,” he says. “I was really scared of not having any medication.”

Since he left less than six months ago, Arturo says that five of his friends with HIV/AIDS who remained in Venezuela have died.

Countries like Peru and Mexico have recognized some cases of Venezuelans with HIV as refugees. However, there is no regional response in Latin America that guarantees access to antiretroviral medication for Venezuelan refugees and migrants with HIV/AIDS. Their access to treatment depends on each of the countries’ policies, and they vary greatly from one country to another.

UNHCR, the UN Refugee Agency, and UNAIDS are providing technical support to national NGOs working to establish a regional network that will allow people with HIV to safely contact clinics, hospitals, shelters and other organizations providing humanitarian assistance to those searching for treatment outside Venezuela.

“Refugees and migrants from Venezuela living with HIV need access to life-saving antiretroviral treatment and care in host countries as well as consistent access to targeted HIV prevention information, education and communication, voluntary counselling, testing and condoms,” says UNAIDS regional programme adviser Alejandra Corao.

Not providing easy access to antiretroviral treatment can develop into a public health issue because it can increase the risk of HIV antiretroviral resistance and the number of new HIV infections, Corao adds.

Refugees and migrants may avoid going to the hospital for fear of being discriminated due to their condition or – if they do not have legal residence – of being deported. That increases the risk of transmission in host countries.

To his surprise, it only took Arturo 20 days to start treatment in Lima. “The medical attention was wonderful,” he says. “I immediately got into treatment. Everyone was very respectful.”

In Peru, access to antiretroviral medication is free. However, availability and effective access are not always guaranteed. UNHCR’s partner organization PROSA reported three cases of Venezuelans with HIV/AIDS they have been monitoring who died because they did not get timely access to retroviral treatment. Civil society actors report eight cases in total.

“As soon as I told them about my condition, they asked me to leave. They said I could infect others.”

In addition, most refugees and migrants do not have access to the public health system – for instance, when it comes to treatment of other conditions developed from HIV.

“We demand universal coverage,” says Julio Rondinel, a Peruvian psychologist who supports Venezuelan refugees and migrants with HIV in his therapy group at CCEFIRO Association. “Consuming antiretroviral medication for long periods of time generates metabolic syndromes, like diabetes or high blood pressure.”

Due to their uniquely vulnerable condition, Venezuelans with HIV/AIDS can apply for  extraordinary residency in Peru. To qualify for it, they need to provide a medical exam and go through some health controls, which can amount to some 170 soles (US$50).

“Ensuring broader access to health care is essential for the most vulnerable, like refugees and migrants with HIV/AIDS, whose lives depend on it,” says UNHCR acting Representative in Peru, Sabine Waehning.

Willy’s arrival in Peru was not as positive as Arturo’s. The 22-year-old was diagnosed with HIV in September 2017 in Venezuela, and the doctor was blunt in his recommendation: “If you stay here, you will die.”

After some months in Colombia and Ecuador, Willy made it to Peru’s capital in August. He spent his first 10 days in a shelter. “As soon as I told them about my condition, they asked me to leave,” Willy recalls. “They said I could infect others.”

Thanks to non-profit organizations such as PROSA and AHF, he was able to undergo the necessary medical exams to access treatment. When it comes to antiretroviral therapy in Peru, Willy has only praising words. The medical attention was “top notch” and he quickly started treatment.

“Here you feel safe.”

Willy is now trying to complete his medical tests, so that he can apply for extraordinary residency. “If you don’t have it, it’s very difficult to find a job,” he says.

Darwin, 29, feels like he is now contributing to helping others as a volunteer with AIDS Healthcare Foundation (AHF) in Lima. He advocates for access to treatment and support for both Peruvians and Venezuelans, and accompanies newly arrived Venezuelans with HIV/AIDS to the hospital and supports them in their quest to access antiretroviral treatment.

If he had stayed in Venezuela, Darwin would have died. After three months without medication – because antiretrovirals were impossible to find in hospitals and too expensive to buy in the black market – he got very sick with a stomach virus. He became so weak that he could not walk. He lost 34 kilograms in four months. Darwin said to himself, “I am not going to surrender, I want to keep living.”

Darwin found safety in Peru a year ago. For him, host countries should be more conscious of the fact that anyone can become a refugee: “It’s like HIV. We are all exposed. No one is safe from that risk.”

Arturo recently got his extraordinary residency. He is now taking eight pills a day and works as a hair stylist in Lima. Leaving his home was hard, but he is thankful to Peru. “It is not easy because when you come you’re lacking so many things,” Arturo says. “But here you feel safe.”

Israel: Expulsion threatens lives of HIV-positive Eritrean and Sudanese migrants receiving treatment in Israel

Israel AIDS Task Force demands asylum seekers with HIV not be deported

The Health Ministry is currently treating 184 Eritrean and Sudanese migrants for HIV.

The Israel AIDS Task Force is imploring the government to allow Eritrean and Sudanese migrants with HIV to remain in treatment in Israel amid the pending April 1 mass expulsion of 20,000 unmarried African men of working age.

Out of a total population of 38,000 African migrants in Israel, the Health Ministry estimates there are approximately 400 with HIV.

According to Israel AIDS Task Force’s coordinator, Tal Aberman, 207 have been identified and 184 are being treated via the ministry’s National HIV Prevention and Treatment Program for Immigrants.

Among the patients in treatment, Aberman estimates that 30 are slated to be deported to an unnamed country, widely believed to be Rwanda or Uganda.

“When we learned on January 1 that the Interior Ministry decided to deport asylum seekers from Sudan and Eritrea, we contacted the government and demanded that people living with HIV not be deported,” she said on Tuesday.

“We also contacted UNHCR and tried to get all possible information to learn if they do get deported to Rwanda if they will get medical treatment, and the conclusion was that they will not. So, the bottom line is that the government is deporting people getting treatment in Israel and living a healthy life and sending them to their deaths.”

Aberman said the NGO has yet to receive a response from the Interior Ministry.

“It has been radio silence so far,” she lamented.

To date, Aberman said all African HIV patients have been given letters from UNHCR stating their condition, and informing the government that they will not receive treatment in Rwanda.

Asked if she was concerned about whether the stigma of having HIV would create more anti-African migrant sentiment, Aberman noted that 207 people out of 8.7 million should not be cause for alarm.

“We are allowing these people to live a healthy life and get medication, so why not let them stay here,” she said. “Also, we are past stigmatization, because the press and government already call them ‘cancer,’ ‘terrorists,’ and ‘criminals,’ anyway.”

In the meantime, Aberman said the Israel AIDS Task Force has received ongoing support from UNHCR, multiple NGOs, and the Health Ministry, which is providing medication and treatment at no cost.

“I think that it is very important to say that we are getting a lot of help and support, which is helping us in reaching out to the African community to get tested and find treatment.”