Strength in adversity: A refugee's resilience to cope with HIV

When the 2015 political violence broke out in Burundi, Olive* and her children decided to flee their home. Unlike other refugees, Olive, however, carried a heavy burden that added to her refugee challenges – she was HIV positive.

Seeking safety and a new beginning, Olive and her children arrived in Rwanda, finding temporary refuge at the Nyanza transit centre before eventually settling in Mahama camp. Their arrival brought them hope, but Olive faced another obstacle – access to adequate healthcare for HIV-positive people.

Olive had discovered her HIV status a few years earlier during a routine prenatal visit back in Burundi. She was in her eighth month of pregnancy when she was diagnosed with the virus. She struggled to come to terms with the fact that she would live with the virus for the rest of her life.

“I was devastated when I found out that I was HIV positive. I isolated myself and could not digest how I contracted the virus. I felt like it was the end of my life,” she says.

When she arrived in Rwanda, humanitarian actors provided some assistance, but initially it was not enough, especially for people living with HIV who require regular medication.

“When we arrived here in Mahama camp, I had no medicines. I was worried about my health, and I was always chasing health personnel asking for medication,” the 43-year-old Burundian refugee recalls.

Following the emergency of Burundian refugees, UNHCR secured a grant to support refugees living with HIV in Mahama camp till 2018. Then, they were integrated into the national system.

With support from the government of Rwanda through Kirehe District Hospital and UNAIDS, UNHCR is currently able to assist HIV-positive refugees with antiretrovirals on a regular basis.  Other UN agencies also continue to provide their assistance to strengthen the resilience of refugees living with the virus.

In the first six months of being in the camp, Olive kept herself apart from others because she didn't want her fellow camp residents to learn about her HIV status.

“When I began taking antiretrovirals, I was concerned that my neighbors might discover my HIV status,” she says. “Whenever I encountered my neighbors on my way back from the health center and they inquired about my whereabouts, I would fib, claiming that I had been to the UNHCR office or elsewhere, so as to avoid revealing my condition. After consuming all the antiretrovirals, I would discreetly dispose of the medication containers.”

However, the anxiety faded away after receiving counseling. Since then, Olive has been able to openly tell her neighbors about her HIV status.

“I came to realize that continuing to isolate myself would likely lead to mental health problems,” she says.

Recalling her arrival in the camp, Olive remembers that refugees living with HIV were provided with assistance that included Tanganyika Sardine, potatoes, beans, porridge, and other nutritious foods intended to help strengthen their immune systems.

“My neighbors often asked where I obtained these food supplies, and I would tell them that I received them from the health center due to health issues. This way, I started to reveal more about my health condition,” she adds.

Refugees like Olive are invited to report to the health center every six months as per the established ARV treatment plans for stable HIV-positive patients. During the visit they can receive various types of support such as replenishment of ARV treatment for the next six months, discussion on treatment observance, screening for opportunistic infections including TB, mental health and psychosocial support, and laboratory follow up to sample viral load, kidney, and liver functions depending on the combination of drugs the person is having.

"In the past, we were able to afford basic food, but now the cost of living has risen significantly"

HIV-positive refugees also get monthly porridge rations from the World Food Programme (WFP) to support positive nutrition and a healthier diet. She adds that they also undergo a nutrition assessment once a year and are educated on how to prepare a balanced and healthy diet.

Despite this assistance, Olive notes that the financial assistance they receive is currently insufficient to afford all the nutritious food items required to bolster their immune systems, especially those living with the virus.

“In the past, we were able to afford basic food, but now the cost of living has risen significantly,” she explains. “As refugees living with HIV, we have become more vulnerable. You understand that we are struggling to maintain good health and well-being.”

As time has gone on, Olive has found the strength to break free from her self-imposed seclusion. Now, she is a community volunteer, dedicating herself to raising awareness among her fellow refugees.

“Taking the medicines regularly strengthens my immune system and I can take care of my family, she says, pointing out that she’s committed to helping those in need.

Olive reminds her fellow HIV-positive refugees in the camp about the importance of adhering to their antiretroviral medication schedule, ensuring they could lead healthy lives. She has also embarked on a mission to sensitize her neighbours about the importance of voluntary HIV testing. Through her tireless efforts, she encourages others in the camp to take control of their health and seek the necessary care.

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*Name changed for protection purposes