MOZAMBIQUE: Crossing borders for ARVs

MANICA, 2 July 2008 (PlusNews) - Zimbabwean Khuda Mutchato has to regularly cross a chain of mountains into Mozambique to improve her chances of survival.

After she was widowed in 2006, the 27 year old went to live with her deceased husband's relatives in Manicaland province, near Zimbabwe’s border with Mozambique, but they began to mistreat her when they learned she was HIV-positive.

“I was experiencing unbelievable discrimination. I was even thrown out into the street. They were scared of me because I was sick. They wouldn’t touch me or cook for me anymore,” Mutchato told IRIN/PlusNews.

Outside of the house, the situation was no better: Zimbabwe's economic crisis and out-of-control inflation made it difficult to obtain scarce food and antiretroviral (ARV) medication. Mutchato could only see one solution.

“I decided to risk the dangers of crossing the mountains at night and evading the border guards to get into Mozambique and obtain antiretrovirals.”

Although there are no official figures, it is estimated that more than 100 Zimbabweans are getting ARV treatment in the province of Manica, in central Mozambique.

Mutchato is one of them. She crosses the border to get her medication and then returns to Zimbabwe, where only about 100,000 of the estimated 321,000 people in need of ARVs are receiving them through the public health sector.

“I feel much better now, different from how I felt before I started taking the medication,” said Mutchato, who now stays at the home of a childhood friend in the Darlington neighbourhood of Mutare, Zimbabwe's eastern border town.

“There is an exodus of Zimbabweans who come in search of AIDS treatment in Mozambique, because our government makes the drugs available free of charge,” confirmed Aarão Uaquiço, Manica's HIV/AIDS coordinator.

“Although they’re foreigners, we attend to all patients who come to us without discrimination as to their origin,” said Inga Nicole, the head physician in the district.

We know that the arrival of the Zimbabweans places pressure on health services and on the economy, but we guarantee that there will never be a shortage of medication for anyone

Expansion of treatment

At a cost to the Mozambican government of US$50 per person per year, about 100,000 HIV-positive patients are currently getting free ARV treatment in the country, compared to 7,000 in 2005.

With an HIV prevalence of 23 percent, Manica district, in the province with the same name, is one of Mozambique's most affected areas.

This is partly a result of its location on a corridor that connects Mozambique to Zimbabwe, Malawi and Botswana - countries with infection rates that are among the highest in the world.

Health authorities in the district have sought to respond by expanding treatment services.

In May, the district opened four new satellite health clinics to make it easier for rural communities to access HIV testing and treatment services, without having to travel long distances to the Manica district hospital.

“It’s very bad for the chronically ill to have to travel dozens of kilometres to get to treatment services or to pick up their medication,” said Nicole. “This way, we’ll be able to attend to more people who need treatment.”

Crossing the border

The expansion of services is attracting ever greater numbers of Zimbabweans who live in the areas surrounding Mutare. The nearest of the new clinics on the Mozambican side of the border where ARVs are available is in Machipanda which is only 10 kilometres away.

According to migration statistics, the number of Zimbabweans crossing into Mozambique has been increasing since Zimbabwe and Mozambique waived visa requirements for each other's citizens starting in October of 2007.

Entry visas allow for stays of up to 30 days, but of the estimated 400 Zimbabweans who enter Mozambique every day, only about 85 percent return.

According to Alberto Limeme, chief of the Machipanda border post, by May of this year, more than 60,000 Zimbabweans had legally crossed into Manica, compared to fewer than 1,000 entries during the same period in 2007.

How many Zimbabweans cross the 500 kilometre-long border shared by Manica and Mutare is more difficult to determine. One of the longest borders in the region, it is controlled by just 60 guards, who often carry out their patrols on foot.

Lack of medical personnel

Manica district currently has 10 people with specialised training in ARV treatment, only two of whom are physicians. Meanwhile, in the Manica district hospital alone, more than 80 people seek ARV treatment every day, including about 10 children.

Despite the demand on under-staffed health services, local authorities say they will provide ARVs to everyone who needs them in this part of Manica.

“We know that the arrival of the Zimbabweans places pressure on health services and on the economy, but we guarantee that there will never be a shortage of medication for anyone,” said Uaquiço.

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Theme (s): Care/Treatment - PlusNews, PWAs/ASOs - PlusNews,

[This report does not necessarily reflect the views of the United Nations]