24 August 2010

Zimbabwe: Children Crossing Borders in Search of HIV Treatment

A new type of migration is taking place in Zimbabwe. While in the past people crossed the borders into South Africa and Botswana seeking work and fleeing from their repressive circumstances, now a silent migration of HIV-positive children seeking antiretroviral treatment (ART) is taking place.

The deep rural plains of Ndolwane, Plumtree in south-west Zimbabwe share a border with Botswana. And from here, a growing number of families are taking their HIV-positive children into Botswana and South Africa to seek ART. This, some faith-based organisations (FBOs) report, has been spurred by the long waiting lists for antiretrovirals (ARVs) in Zimbabwe where government programmes to provide free medication for HIV patients are reportedly failing to match demand.

"This is how desperate the people are to provide treatment for their children," said Khumbulani Khaphela, a pastor with an evangelical fellowship church working in rural Plumtree.

"Some families after hearing that others have sent their children across the border have approached us to assist them with going there as well," he said. The churches are expected to finance the medical trips as part of their contribution toward efforts to save the lives of HIV-positive children.

The people of Plumtree are no strangers to migration. Men and women have been forced to leave their poverty-stricken villages as the lack of access to running water, high unemployment, lack of medical care and a litany of woes hit the rural communities hard. Thousands left their homes to work in Botswana and South Africa while sending back a portion of their earnings to their families.

But this migration, HIV/AIDS researchers and local elders say, has contributed to the spread of the virus as husbands living and working away from their wives and families engaged in extramarital sexual relations and returned home HIV-positive. This resulted in the birth of a number of HIV-positive children.

The migration into bordering countries to seek medical attention for children has also been partially been driven by the growing number of HIV-positive urban residents who flock to rural areas for ART. They have sought out treatment in rural hospitals where waiting lists for ARVs are deemed shorter than those in large towns like Bulawayo. However, the FBOs say there have also been reports of parents from urban centres, like Bulawayo, who have also resorted to transporting their children to neighbouring countries for treatment.

"From what we are hearing, it is easy for children with tuberculosis and HIV to be treated in South Africa's government hospitals," said Josphat Dakamela, a village elder in Plumtree. "What can we do? Everybody knows there are no medicines in the country (Zimbabwe) so what is happening here is no surprise."

This is despite assurances by authorities that HIV infections continue to dwindle in this impoverished southern African country. While the Zimbabwean government offers free ARV treatment, this is hard to come by for many living with the virus as patients also have to undergo rigorous vetting before they are placed on long waiting lists for ART. According to a United Nations report, for the approximately 160,000 children living with HIV in Zimbabwe only one in 16 have access to the life-prolonging drugs.

Local AIDS activists say that Zimbabwean nationals working in neighbouring countries have shunned seeking treatment there because they have no legal status and fear deportation. But for young children the situation is different as the South African and Botswana governments attempt to provide free health care for all children under their own Millennium Development Goal commitments.

"Many know that children's treatment in the countries they settled is free and have taken advantage of this to send sick children there," said Khaphela.

These parents are helped by the existence of cross-border transport operators who for years have exploited porous border posts to transport Zimbabweans to South Africa as they search for work. Now they also assist HIV-positive children. "Moving people across the border has never been a problem, but taking children as young as six to South Africa for treatment is something new," says cross-border transporter Mongameli Sibanda.

He says some of the children he transports are visibly in poor health. This has added an urgency to his work as never before. Now his cross-border errands are critical as he races to get children to South Africa. "It is sad when we have children seeking treatment outside the country. These things must be done here (Zimbabwe)," said Sibanda.

In the past frontline health workers have complained that Zimbabwean parents have left it until too late to seek treatment for children living with HIV. But this is slowly changing in some rural areas. These dire circumstances are indeed magnified among rural populations like those in Plumtree who are responding to the crisis by crossing the border to seek treatment.

"There is little we can do," said Khaphela. "We cannot fold our hands and watch children die when their families have these rather desperate alternatives. We will keep helping."

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