A bishop in Botswana plugs part of deadly gap in HIV assistance

FRANCISTOWN, Botswana, 1 December (UNHCR) - Weak, gaunt individuals approach staff of the UN refugee agency in Dukwi refugee camp, seeking help to go home for a final sight of their families. Some have left their decision too late and die before their repatriation can be arranged.

Although UNHCR staff do not ask why a refugee wants to go home, they know in Botswana HIV is often the answer. The scourge is relentlessly attacking the population of Dukwi, and the lack of access to the life-prolonging anti-retroviral therapy (ART) for refugees in Botswana means large numbers of deaths are inevitable.

Into the void created by the government policy of providing ART only to its own citizens has stepped the Roman Catholic Bishop Franklin Nubuasah of Francistown. Two years ago the Ghanaian-born bishop set up a programme to provide ART to those excluded from the government programme, including refugees.

"AIDS was discovered while I was here," said the bishop, who has spent a quarter century in the southern African country. "It was 1986 that we had our first case. "

The programme is treating 75 people right now. Of those, 14 are refugees who were included after UNHCR alerted the bishop that refugees were among those left out of government assistance. Unfortunately, that leaves 20 refugees on a waiting list. And Nubuasah estimates 200 residents of Dukwi - only part of those carrying the HIV virus - are in need of ART now.

"We would like to expand the programme but we cannot," he said. "Everyday we turn away people who come to the office because we have no more money. We are trying to find more funding but I don't know to what extent we will succeed. It's just a hope."

Those refugees lucky enough to get into the programme journey to Francistown, nearly two hours drive from Dukwi, where they are assessed by doctors and prescribed treatment. Once a month they come to the city, the largest in northern Botswana, to receive their medicine.

The need is extreme. Northern Botswana is one of the most heavily infected regions of a country that is among the nations showing the highest HIV-positive levels in the world.

"The UN says it is 40 percent (of the adult population) now in the north of the country," says the bishop, who hopes the country has turned the corner. "But the infection rate is very hard to judge. It will be another two years before we can see the real effect of our prevention programme."

But Nubuasah does know that those on ART stand a better chance of surviving: "What I have noticed is that there are fewer funerals, people are not dying as they were dying last year. The ART is working."

UNHCR has talked frequently with the government about extending ART to those among the 3,000 refugees in Botswana in need of help and plans further discussions since the bishop's programme can only plug part of the gap in coverage.

A major concern is that the government more than two years ago stopped refugee access to the programme for preventing the transmission of HIV from infected pregnant mothers to their children. The next generation is being infected.

Like the provision of ART, the Preventing Mother-To-Child-Transmission programme is open only to Botswanans, even at the clinic at Dukwi which treats both refugees and residents of the neighbouring Botswanan town. That means infected refugee mothers are passing on the disease to their children, new cases that could be prevented.

The latest UN report on the pandemic shows this is a major problem in the area where Dukwi is located. A survey reported in the latest UNAIDS report issued in November said 40 percent of pregnant women in the Francistown area were HIV-positive.

The high-risk of getting HIV and the subsequent difficulty in getting treatment in Botswana is a cruel fate for refugees, most of whom have arrived from countries where infection rates are lower. Somalis, the second largest group of refugees in Botswana, come from a country where infection rates among pregnant women are less than one percent.

The largest group of refugees in Botswana come from Namibia, which also has high infection levels. Not only do returning refugees receive ART like other Namibian citizens, but the Namibian government has extended the programme to all refugees in the country. Botswana is now the only country in southern Africa that explicitly excludes refugees from national ART programmes.

That has put additional pressure on refugees in Dukwi. UNHCR repatriates only those who wish to go home and no longer fear the reason they originally fled. But a refugee who faces a high risk of death because of the lack of ART in his country of sanctuary may face two unattractive choices. Confidentiality means the UNHCR staff may never know for sure of a refugee's dilemma, but they have their suspicions.

By Jack Redden in Francistown, Botswana