In-depth: Winning the peace: The challenge of AIDS in post-war countries
BURUNDI: Reluctant HIV-positive refugees urged to return home
Photo: IRIN
Refugees at Nduta camp, Tanzania, enrolling for repatriation
BUJUMBURA, 7 February 2007 (IRIN In-Depth) - The United Nations refugee agency, UNHCR, is urging HIV-positive Burundian refugees in camps in neighbouring Tanzania to return home, where they will have better access to treatment and care.
After 13 years of civil war, Burundi held democratic elections in 2005 that ushered in a new government and brought hope for a return home to an estimated 400,000 refugees. About 152,000 of them are assisted by UNHCR in camps in Tanzania.
"We are strongly encouraging the HIV-positive refugees to repatriate, because we have organised programmes and access to ARVs [antiretroviral drugs] for them when they arrive," Dr Marie-Claude Bottineau, UNHCR's senior coordinator for health, nutrition and HIV in Burundi, told PlusNews.
"We have put together traditional mechanisms such as information, education and communication, nutritional elements and psychosocial support for them for the first three months," she added.
The only group encouraged to remain in the camps, at least in the interim, are pregnant HIV-positive women. "Prevention of mother-to-child transmission services are not strong in Burundi," Bottineau said. "We are asking them to stay there, give birth in hospitals where they have access to drugs, and remain there for a period of two months after the child's birth."
The NGO, Africa humanitarian Action (AHA), with the support of UNHCR, is providing ARVs to the refugees upon their arrival. They have a special arrangement with the national health service that ensures that on their return, refugees who are in need of immediate HIV care are able to access it from the university hospital in the capital, Bujumbura.
For refugees who are not HIV-positive or who do not know their status, AHA provides health education with a special focus on AIDS, and also gives counselling before and after HIV testing.
"Many of the services we are offering, especially ARVs, are not available to the refugees when they are in Tanzania, so they are much better off coming back home," Bottineau said.
However, some refugees in the camps are still unaware of the HIV services on offer at home, and are reluctant to risk the return journey unless some of their major fears are addressed.
Sometimes home isn't best
Innocent Ndayishimiye, 24, of the Consortium des Volontaires Pour Aider les Sideens (COVAS), a refugee association for people living with the virus, said most HIV-positive refugees did not have access to ARVs, but received treatment for common opportunistic infections like malaria and respiratory diseases from NGOs like the Norwegian People's Aid.
Despite the prospect of getting treatment at home, Ndayishimiye said most refugees living with the virus remained reluctant to return, not so much because of a fear of drug shortages, but because they were unsure of the availability of food in their home regions.
"They are not sure of assistance in obtaining special meals in Burundi," Ndayishimiye, who lives in a refugee camp in western Tanzania's Kigoma region, said. "In the camps, WFP [the UN World Food Programme] provides us with food, but we have no long-term guarantees at home."
He added refugees were also anxious they may not be back on their feet by the time the three months' ration of food provided by UNHCR ran out - unable to afford food on the market or grow enough crops. WFP recently cut HIV-positive people from its list of special feeding programmes in Burundi, which only compounds the refugees' worries.
Burundi is facing a severe land crisis, and many returning refugees have found themselves homeless and living in the open under plastic sheeting; far more than an issue of discomfort for HIV-positive people, who are vulnerable to opportunistic infections.
The refugees are also not confident of the security situation in their home country. There have been reports of arbitrary arrests and executions of people suspected to be allied to the Burundi's last active rebel group, the Forces nationales de liberation. The government is investigating the cases.
"People are still not sure that it is safe back home; they do not want to go home and be forced to live in fear," Ndayishimiye said.
In addition to these fears, refugees in Tanzania - many of whom have lived there since ethnic violence drove them from their home in 1972 - have formed strong community networks they are loath to relinquish. For people who are HIV-positive, these networks are useful during periods of illness, and without them, many refugees fear they would not cope.
"In the camps, they live close to each other and when one is ill, he is sure that a neighbour will bring food and look after him," Ndayishimiye said. "Back home the distances apart are greater and they can't be sure the new neighbours will help them as much."
Despite their fears, the refugees are aware that at some point they may have to return home, and sooner rather than later. The Tanzanian government and UNHCR are actively promoting repatriation.
"There is a lot of pressure from the Tanzanian Ministry of Home Affairs; they come to the camp and tell people to go home," Ndayishimiye said. "Nobody wants to remain a refugee, but a lot of obstacles need to be removed before we can willingly go home."
Kr/oa/he