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UNHCR helps prepare new guidelines for HIV treatment in southern Africa

News Stories, 3 April 2007

© UNHCR/J.Redden
Monique Vitis, a Rwandan refugee who is receiving treatment for HIV in South Africa, addressed participants at the launch of new guidelines for the treatment of displaced people.

JOHANNESBURG, South Africa, April 3 (UNHCR) When Monique Vitis was diagnosed with HIV, the Rwandan refugee was rejected by her family, knew no one else to turn to and twice was forced to sleep in a park Today she is receiving treatment, considers herself healthy and is willing to speak out on her ordeal.

Vitis is a symbol both of the unique problems faced by refugees living with HIV and the importance of new guidelines that have been prepared for managing antiretroviral therapy (ART) for displaced populations in southern Africa. She described her experiences at a news conference last Friday where the guidelines initiated by the UN refugee agency and the Southern African HIV Clinicians Society and prepared by a special committee were unveiled.

"I was rejected by my family, who I was living with, when they found out I was HIV-positive. I had no access to the kitchen I had my own fork and spoon and was not allowed to touch other things," said Vitis, who was helped by the Jesuit Refugee Service a UNHCR partner to receive the free treatment available from the South African government.

"I am so grateful for all the support I have received here and all the advice from the doctor," she said, at one point crying. "In my community stigma is still very high ... there are so many people in the community who will not go for tests because they want to avoid the stigma."

The new guidelines are designed to help health workers in deciding the most appropriate treatment for displaced populations, including internally displaced persons, migrants, refugees and asylum seekers. The number of migrants in southern Africa is substantial but uncounted, while the number of refugees and asylum seekers in the region is estimated at 300,000.

"Displaced persons are a unique group with special needs. They are often stigmatised, marginalised and discriminated against, making them highly vulnerable and insecure in their host country," say the guidelines. Displaced people arriving in southern Africa often come from areas with much lower HIV rates than found in the host country and therefore face an increased risk of infection.

In southern Africa, only Botswana excludes refugees from access to ART treatment although there can be practical obstacles in other countries, such as shortages of medicine or discrimination from local health workers. The guidelines note the right to treatment is based on law and universal principles of medical care: "Providing HIV-related services to displaced populations is a difficult yet critical undertaking, which is firmly rooted in international human rights law."

"Those in need of treatment are often denied care," say the guidelines, prepared by an expert committee that included UNHCR, the Centres for Disease Control and Prevention, Médecins Sans Frontières and health specialists from South Africa. "However, since the roll-out of affordable antiretroviral therapy worldwide, there has been an international push to recognise every individual's right to treatment and to ensure universal access to ART," the guidelines add.

Although displaced persons often come from areas with lower infection rates than the host countries, a failure to provide HIV prevention and care to displaced persons can undermine a government's efforts to control the disease among its own population.

The guidelines cover many problems common to displaced people, such as the possibility of them moving again during treatment, the lack of friends or relatives to provide support and potential legal complications of treating unaccompanied minors.

They also refute some common myths surrounding HIV and displaced persons that have fed xenophobia. For example, rather than facing higher HIV rates from conflict, evidence suggests the harsh conditions faced by refugees have actually produced lower rates.

There have also been fears that providing access to ART would act as a magnet, drawing in those displaced individuals with HIV from other countries. But health workers at the launch of the HIV treatment guidelines in South Africa said they had never seen a patient drawn to their country by the promise of free treatment.

"Health workers should advocate for non-discriminatory medical practices and must play an active role in reducing discriminatory attitudes and dispelling myths regarding displaced persons," says the guide.

By Jack Redden in Johannesburg, South Africa

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HIV and AIDS

Read about UNHCR's provision of HIV and AIDS protection, prevention, treatment and more.

South Africa: Searching for Coexistence

South Africa is one of the few countries in Africa where registered refugees and asylum-seekers can legally move about freely, access social services and compete with locals for jobs.

But while these right are enshrined in law, in practice they are sometimes ignored and refugees and asylum-seekers often find themselves turned away by employers or competing with the poorest locals for the worst jobs - especially in the last few years, as millions have fled political and economic woes in countries like Zimbabwe. The global economic downturn has not helped.

Over the last decade, when times turned tough, refugees in towns and cities sometimes became the target of the frustrations of locals. In May 2008, xenophobic violence erupted in Johannesburg and quickly spread to other parts of the country, killing more than 60 people and displacing about 100,000 others.

In Atteridgeville, on the edge of the capital city of Pretoria - and site of some of the worst violence - South African and Somali traders, assisted by UNHCR, negotiated a detailed agreement to settle the original trade dispute that led to the torching of Somali-run shops. The UN refugee agency also supports work by the Nelson Mandela Foundation to counter xenophobia.

South Africa: Searching for Coexistence

South Africa's Invisible People

In March 2011, UNHCR initiated a project with the South African non-governmental organization, Lawyers for Human Rights (LHR), to tackle the issue of statelessness. The specific goals of the project were to provide direct legal services to stateless people and those at risk of statelessness; to engage government on the need for legal reform to prevent and reduce statelessness; to raise awareness about stateless people and their rights; and to advocate for the ratification of the 1954 and 1961 UN conventions on statelessness.

LHR had conceived the project a year earlier after noticing that large numbers of Zimbabwean-born asylum-seekers were telling its staff that they faced problems getting jobs, studying or setting up businesses - all allowed under South African law. They told LHR that when they applied for Zimbabwean passports, necessary to access these rights, they were informed by consular officials that they were no longer recognized as Zimbabwean citizens. This effectively made them stateless.

Since the project's inception, LHR has reached more than 2,000 people who are stateless or at risk of statelessness. These people came from more than 20 different countries. It has identified numerous categories of concern in South Africa, both migrants and those born in the country.

The following photo set portrays some of the people who have been, or are being, helped by the project. The portraits were taken by photographer Daniel Boshoff. Some of the subjects asked that their names be changed.

South Africa's Invisible People

Surviving in the City: Pretoria, South AfricaPlay video

Surviving in the City: Pretoria, South Africa

Living in Pretoria as a refugee or asylum-seeker is challenging. Most either live rough on the streets or in cramped apartments in townships. There are also tensions with locals because of the perception that foreigners get a better deal than South African citizens.
Top business partners renew supportPlay video

Top business partners renew support

Executives from Manpower, Young & Rubicam, PricewaterhouseCoopers and Microsoft visit UNHCR operations in South Africa, Mozambique and Namibia.
Zimbabweans in South AfricaPlay video

Zimbabweans in South Africa

While Zimbabwe's main political rivals have agreed to hold power-sharing talks, there are continued reports of instability and violence in the country. The flow of Zimbabweans seeking asylum in neigbouring South Africa is growing, rather than ebbing. The UN refugee agency reports that there are more and more women and children joining the exodus.