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Botswana: No refuge from HIV/AIDS in Dukwi camp

Health, 12 June 2006

[This report does not necessarily reflect the views of the United Nations]

DUKWI CAMP, 12 June (PlusNews) Dukwi refugee camp sprawls for 20sq.km into the Botswana bush along the road between Francistown, the capital, and the Zambian border to the north, but there is little to show that 3,000 individuals from 14 countries, mostly Somalia, Angola and Namibia, are living here.

The haphazard jumble of small brick buildings interspersed with shacks and huts may look temporary, but has been here for 30 years and some people have raised their children and even their grandchildren in Dukwi. Despite its seeming isolation, the inhabitants often receive permission to live outside the camp while they pursue casual labour, mingle with and sometimes even marry people in the surrounding villages.

The downside to this freedom of movement is that the refugees are as vulnerable to HIV infection as anyone else in a country with an adult prevalence rate of 37 percent.

Vistor Moukweloi, from the Caprivi Strip in northeast Namibia, and his girlfriend found asylum in Botswana eight years ago. He is one of an unknown number of Dukwi's residents who are HIV positive. After his girlfriend's death in 2003 from an illness he describes only as "diarrhoea", he became sick last year while working outside the camp, but has no legal right to the life-prolonging antiretroviral (ARV) treatment that has been available to Botswana citizens for the past four years.

Botswana is the only country in the region that explicitly bars refugees from its national treatment programme. South Africa, Zambia and, most recently, Namibia have all extended ARV access to their refugee populations, while other countries in the region provide access on an unofficial basis. If or when Botswana eventually brings its policy in line with the regional approach, it will be too late for many of Dukwi's residents.

How many of the 54 deaths in the camp last year were due to HIV/AIDS is unknown, but Eric Letshwiti, who coordinates a home-based care programme for the Botswana Red Cross, confirmed that at least 23 died from AIDS-related illnesses.

"A lot of them do piece-work [casual labour] outside the camp. When they get very, very sick their employers dump them back here and it's too late to really do anything," he said. By the time Moukweloi returned to the camp earlier this year, he was in a desperate situation: "I didn't know anything," he recalls. "I just hoped to be transferred to Zone 10 [the name residents give to the camp cemetery]."

In March this year, Bishop Frank Atese Nubuasah of Francistown made 13 slots available to refugees in an ARV treatment programme he manages on behalf of the Southern African Catholic Bishops' Conference. The programme helps those who don't qualify for the national programme, either because they are non-citizens or lack the proper identification.

Moukweloi is one of five camp residents who have started treatment. Another eight have spaces reserved for them and will begin on the drugs when their CD4 count, which measures the strength of the immune system, drops to 200.

According to Boitumelo Segwabanyane, project coordinator for the Red Cross at Dukwi, the level of stigma towards HIV in the camp is so great that even the possibility of life-prolonging treatment is not enough to persuade many of the refugees to come forward for testing. "The myths are still there," she said, despite a UN-funded HIV/AIDS education and training initiative in the camp last year.

A belief that witchcraft can cause HIV, and traditional medicine can cure it, stops people from coming to the camp's clinic for testing. Prevention efforts have been complicated by a belief that condoms themselves can carry the virus.

The assortment of languages and cultures co-existing in the camp has also posed particular challenges to educating residents about HIV and AIDS. "We do have interpreters, but sometimes there's a need for one-to-one conversations and then it becomes difficult," said Letshwiti.

Funding from President George Bush's Emergency Plan for AIDS Relief (PEPFAR) has been earmarked for a project to mobilise camp communities to disseminate prevention messages targeted at their specific cultures and languages. In the meantime, said Segwabanyane, "It's hard to penetrate these communities. The Somalis, especially they don't participate in any of the education programmes because their culture stops them from talking about sexual activity."

Juweria Daud, one of the few Somali residents who has volunteered for HIV training with the Red Cross, noted that "most Somalis don't believe in HIV/AIDS, or they believe you can only get it through 'illegal sexual behaviour', and it's only the women who test when they're pregnant and then they're too scared to tell their husbands".

According to figures from the clinic, only 11 refugees have come for voluntary counselling and testing so far this year. Another 100 were tested as part of Botswana's policy of routine testing, from which people can 'opt out'. Clinic staff did not say how many were positive, but Segwabanyane pointed out that there was no more space in the Bishop's programme. "We just document them and hope that other opportunities will come along," she said.

HIV-positive pregnant women have no access to medication for prevention of mother-to-child transmission (PMTCT). Citing resource constraints, the government stopped providing anti-AIDS drugs to pregnant refugee women in 2004. Clinic and Red Cross staff can only educate them about the dangers of breast-feeding and provide them with baby formula.

Laurie Bruns, regional HIV/AIDS coordinator for UNHCR, the UN's refugee agency, considers the Bishop's programme "a fantastic short-term solution", but no substitute for a change in the national policy of excluding refugees from treatment. She noted that initial government concerns about creating a 'pull factor' for asylum seekers were no longer warranted, as most countries in the region now have treatment programmes. Given the relatively small numbers of HIV positive refugees, she also doubted that the cost of providing treatment would be prohibitive.

Voluntary repatriation is an option for HIV positive refugees from countries with treatment programmes, but the process is too lengthy for those already at a late stage of the disease; others are unwilling to return to countries they still associate with conflict or persecution.

Moukweloi is relieved to have avoided this difficult decision. To the amazement of those who are not accustomed to seeing people recover from the illness they do not name, his health has improved rapidly since he began ARV treatment. "People are surprised to see me looking so well," he smiles. "Before there were advising me to save my mealiemeal [maizemeal] for my funeral."

Source: IRIN PlusNews: HIV/AIDS news service for Africa UN-OCHA Integrated Regional Information Networks

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