[ This report does not necessarily reflect the views of the
JOHANNESBURG, 2 May 2006 (IRIN) - Living with HIV in South Africa
presents plenty of challenges: those most affected are often the
poorest and lack access to jobs, housing and proper sanitation;
the disease still carries a strong stigma and many prefer to
carry the burden of their status alone rather than risk sharing
it with friends and family.
But since the government began rolling out free antiretroviral
(ARV) treatment two years ago, and many people living with HIV
are also accessing social grants, the possibility of living a
more normal life is better than it was.
Unless, that is, you are an undocumented immigrant, one of an
unknown number - thought to be in the millions - who have flocked
to the continent's wealthiest country, hoping to find a better
Even without the complication of being HIV positive, they are
often disappointed. They face a largely hostile local population,
exploitative work situations if they find work at all, and none
of the support from family and friends they could rely on at
home. Women and children are especially vulnerable.
Thuli [not her real name] came to South Africa from Swaziland
with her mother and brother in 1999. Her mother worked as a
cleaner in Germiston, to the east of Johannesburg, for R50 ($8) a
week until she began suffering from a hacking cough a few years
later. The local hospital told her there was nothing they could
do and sent her home, but her condition worsened and a month
later she died.
"I think if she had had a [South African] ID, maybe it was going
to be better," Thuli said. "She could have got a better job and
maybe she would have got better."
At the time of her mother's death Thuli was pregnant and sick.
She had tested positive for HIV at the hospital but without
documentation was not eligible for treatment. A social worker
brought her to Nazareth House, a Catholic mission in the
inner-city neighbourhood of Yeoville, where Thuli gave birth to a
healthy baby. Since then she has been living at the hospice while
working in the kitchen and receiving ARV treatment.
"I think I was lucky to come here," she says. "My CD4 count
[which measures the strength of the immune system] was 52 - I
thought I was going to die."
For someone in Thuli's predicament, Nazareth House is the sole
option in Johannesburg. Only South African citizens and refugees
with the appropriate paperwork can access ARV treatment at
government hospitals and clinics.
While some undocumented migrants are too fearful of arrest even
to seek treatment, others are turned away without receiving any
information about alternative options. The lucky ones are
referred to Nazareth House, where the Southern African Catholic
Bishops' Conference (SACBC), with funding from President Bush's
Emergency Fund for AIDS Relief (PEPFAR), has been providing ARV
treatment to anyone who needs it since early 2004.
Countrywide, the SACBC is providing ARVs to about 7,000 patients.
Sister Sylvia Simpwalo, who runs the ARV clinic at Nazareth
House, estimates that out of 300 patients receiving ARV treatment
there, 90 percent are non-South Africans.
Even so, concedes Johan Viljoen, project manager for SACBC's ARV
programme, "we don't have enough capacity and there is a waiting
list; we're restricted by the amount of funding we get".
That funding will only last for the next three years. While the
American government is expected to renew its commitment, the
SACBC is keen to expand its partnership with the South African
government to achieve long-term sustainability, but transferring
patients to the national ARV programme will mean the exclusion of
While Viljoen acknowledges everyone's right to access healthcare,
as outlined in South Africa's Bill of Rights, he also recognises
some of the obstacles to treating HIV positive immigrants.
"It's very difficult to do patient follow-up," he pointed out.
"You might have somebody who starts treatment and then moves back
to their country and stops treatment. They may develop drug
Many HIV positive immigrants do not know about Nazareth House.
Bishop Paul Verryn, who shelters homeless illegal immigrants and
asylum seekers at the Central Methodist Church in Johannesburg's
city centre, said many of the hundreds of men and women who bed
down each night on the floor of his church are HIV positive. He
has no funding to assist them, and his only recourse is to call
an ambulance for the seriously ill and hope they qualify for
"We've had four people that I know of who died in hospital
because they were not given treatment," he commented.
Pascal, 38, [not his real name], who arrived in South Africa from
Nigeria 12 years ago, was almost another fatality. After he tried
to access treatment at a local hospital and was told by staff to
go home and die in his own country, Pascal became so sick that he
had to abandon his business as a pavement hairdresser.
Unable to walk or buy food, a friend eventually took him to
Nazareth House. Despite a virtually non-existent CD4 count he
responded to ARV treatment and is now well enough to start
worrying about how he's going to get his business going again.
"They really saved my life," he said.