The pill or the job

The pill or the job

… A hard choice for Basotho migrant workers…

MOHALE’S HOEK – HUNDREDS of HIV positive Basotho migrant workers in South Africa are defaulting on their antiretroviral treatment (ART), health workers say.
Most of the defaulters are from Mohale’s Hoek district, which is in the southern part of the country bordering South Africa’s Western Cape Province.
Many people from the district cross into South Africa to work on farms.
Health practitioners here think that the porous borders leading to Ceres farms in the Western Cape Province are a major contributing factor.

Health practitioners have also found that many Basotho migrants in the neighbouring country do not have access to ARVs in South Africa as they do not have transfer letters from their Lesotho clinics.
According to the health workers, this is turning into a health crisis for the country, which has the second highest prevalence of HIV in the world.
Sister Virginia Thaane, a nun in charge of the Holy Cross Health Centre in Mohale’s Hoek, said migration of their patients to South Africa in search for jobs has seriously affected HIV/AIDS tracking.
Thaane said in most cases, her patients return home worse than when they started ARV treatment in the country, after a few months of leaving the country.
“They come back on the verge of death and now we work harder to restore their health and those of their partners because re-infection is higher than when treatment is adhered to,” Thaane said.

Almost all health centres in Mohale’s Hoek have a problem with the migration of HIV/AIDS patients to South Africa who default on their medication.
The Morifi Health Centre is another health facility experiencing high default rates.
Mpotseng Khuto, a clinician at Morifi, said they lose track of their patients who are yet to be initiated and those already on ART to migration.
“A lot of our patients go to South Africa and they never come back to get their refills. This is worrying indeed because it becomes a challenge monitoring their health and the wellbeing of their loved ones,” Khuto said.
“Some are totally untraceable,” she said.

The countrywide statistics, according to a study conducted by Iyiola Faturiyele and others and published in 2018, there were 310 000 people living with HIV, of whom 290 000 were adults and 13 000 children (up to 14 years of age) in 2015.
There were about 73 000 orphans (aged up to 17 years) in Lesotho because of AIDS.
According to the Lesotho Population Based HIV Impact Assessment (LePHIA) Report 2016-2017, Mohale’s Hoek has the highest HIV/AIDS prevalence in the country sitting at 29.3 percent.
’Matieho Makhanya, the Mohale’s Hoek District HIV/AIDS Officer, said the impact of defaulting on ARVs is not felt by the patients alone but the Health Ministry as well.
Makhanya said treating defaulting patients is costly to the ministry.
“Their quality of life depreciates, they become resistant to the ARV drug they used to take, their CD4 count drops drastically and HIV related diseases take a toll on such a patient since their immune system is weakened,” Makhanya said.

The Iyiola Faturiyele research study on access to HIV care and treatment by migrants between Lesotho and South Africa reveal that out of 524 HIV-infected migrants enrolled in the study, 315 (60.1%) were from urban areas and 209 (39.9%) from rural sites.
Of these, 344 (65.6%) were women, 375 (71.6%) were aged between 26 and 45 years and 240 (45.8%) were domestic workers.
A total of 486 HIV patients (92.7%) preferred to collect their medications primarily in Lesotho than in South Africa.
Of the 506 people who responded to the questionnaire on preferred dispensing intervals, 63.1% ( 319 people) preferred 5–6 month ARV refills, 30.2% (153 people) chose 3–4 month refills and only 6.7% (34 people) opted for the standard-of-care 1–2 month refills.

A total of 126 (24.4%) defaulted on their treatment and the primary reason for defaulting was failure to get to Lesotho to collect medication (59.5%, 75/126).
The study says treatment default rates were higher in urban than rural areas (28.3% to 18.4%).
Service providers indicated a lack of transfer letters as the major drawback in facilitating care and treatment for migrants, followed by discrimination based on nationality or language, according to the study.
Service providers indicated that most patients preferred all treatment services to be rendered in Lesotho, as they perceive the treatment provided in South Africa to be different and often less strong or with more serious side effects.

Makhanya said these are some of the excuses or reasons that HIV patients have given on why they have stopped taking medication while in South Africa.
“Some say they are highly discriminated against by health practitioners in South Africa telling them that they are going to finish their supplies,” Makhanya said.
She said some simply fear going to a health facility because they do not have transfer letters or even legal documents that give them the right to live or work in South Africa.

A professional counsellor at Maputsoe Filter Clinic in Leribe said migrant workers also complain about transport costs to come to the clinic for refills.
She said they say they cannot afford to take days off work to avoid having their wages deducted.
“They are required (to produce) the legal documents and to provide reasons why they are in the foreign country when they want to access healthcare services,” she said.
“In most cases they do not have such documents.”

The Policy Framework for Population Mobility and Communicable Diseases in the SADC Region 2009 requires that States examine HIV and migration in an attempt to make meaningful and relevant legal and policy interventions for HIV mitigation.
There are various international and regional treaties and declarations in place that once signed and ratified/acceded, illustrate a country’s commitment to adhering to the spirit and provisions of the treaty, whether they are legally binding or not.

Lesotho National HIV and AIDS Strategic Plan (NSP 2006-2011) adopted by the cabinet in 2006 acknowledges that migrant workers, among other vulnerable groups, are highly vulnerable and need to have access to treatment and care levelled out for them.
The objective of the NSP in respect of migrant populations is to ensure that migrants access HIV and AIDS services for prevention, treatment, care and support, and impact mitigation.

But still, migrant worker’s vulnerability in the neighbouring South Africa is still a challenge 12 years on.
There is difficulty in accessing health services for communicable diseases when people cross borders.
The African Heads of States have pledged universal access to health care for all African citizens.
How this can be assured for nationals who cross borders has yet to be clearly articulated, according to experts.

Rose Moremoholo

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