GLOBAL: Fear and hope for HIV-positive illegal immigrants
http://www.plusnews.org/Report.aspx?ReportId=75151
Photo: Anthony Kaminju/IRIN
Second-line ARVs are not yet available in Angola

LISBON, 5 November 2007 (PlusNews) - The large window in Margarida
Martins' office looks out over José Luís Champalimaud Square in a
central Lisbon neighbourhood where many immigrants reside. It's not
uncommon to find her attention drawn to African women with their
children in their arms, standing across the street with a look of
desperation on their faces, afraid to enter the building.

Martins is the president of the non-governmental organisation (NGO)
Abraço, an association to support people with HIV/AIDS. "It's very
painful to see these people, who come here with absolutely nothing,
looking for antiretrovirals [ARVs]," she told IRIN/PlusNews.

Portuguese legislation stipulates that illegal immigrants with life-
threatening diseases, such as AIDS, for which treatment is available
in their own countries, may stay for one year of medical care; after
this they are obliged to leave Portugal.

If there is no treatment in their country of origin the immigrants
may remain longer, as is often the case of HIV-positive children who
need ARV medication, or Angolan adults in need of second-line ARVs,
which are unavailable in their home country.

The same policy applies to patients suffering from life-threatening
conditions, such as kidney failure. If dialysis equipment is not
available in the patient's country of origin, the immigrant may also
stay in Portugal.

"There has been greater openness on the part of the Portuguese
government in the last year regarding these cases," remarked António
Rodrigues, a social worker and counsellor at Abraço.

Today, some 50 Angolans, besides patients from other Portuguese-
speaking African countries, are receiving treatment through
Abraço. "Many HIV patients who begin antiretroviral treatment in
Angola say that sometimes there are shortages of drugs there, or that
they're worried about the lack of confidentiality," Martins
commented.

Lack of familiarity with the law

The problem is that most immigrants "are not only unfamiliar with the
legal mechanisms, they also don't know that there are institutions in
Portugal that can help them navigate the bureaucracy," said Flora
Silva, president of Olho Vivo, an NGO that helps immigrants adjust to
living in Portugal. "But the fear of being identified as illegal and
of being deported still keeps many from asking for help."

Laws passed in 1998 and 2003 make it clear that an immigrant with a
disease that could be life threatening, but whose own country does
not offer treatment, can begin the legalisation process in Portugal
by presenting a medical declaration, with proof of residence and
means of subsistence.

If the request is accepted by the Foreigner and Border Service, the
immigrant will have his or her situation sanctioned and will be given
access to health and social security services.

For many HIV-positive illegal immigrants, the process begins at the
National Immigrant Support Centre (known by the Portuguese acronym
CNAI), to which they are referred by hospitals where they have
received emergency care. Nurse Amélia Carvalho, of the CNAI's health
department, said the Centre usually tried to "integrate" these
immigrants into the National Health Service.

The first step is to direct the patient to the health centre in his
or her residential area for a preliminary check-up. Once in the
National Health Service, the patient is exempt from paying for HIV-
related treatment provided in a hospital setting.

This sounds simple in theory, but is difficult to implement. "There
are still doctors and state health institutions that don't want to
provide care to HIV-positive patients, and that's where Abraço comes
in," said Sara Carvalho, a social worker at Abraço's Home Support
Centre.

After medical evaluations, the patient is often sent to an immigrant
assistance centre such as Olho Vivo. "We take care of the
regularisation process from start to finish: we establish contact
with the doctor who will be taking care of the patient and we
organise the paperwork," said Silva.

When the process has been completed, "the social security payments
kick in and the immigrant can benefit from the same support as a
Portuguese citizen," she said. The fact that 80 percent of the
immigrants who come to the Abraço office are from Lusophone Africa
has led the organisation to address the problem at its point of
origin.

"We're negotiating a cooperation protocol with Doctors of the World,
Portugal, and we hope to have initiatives before the end of the year
in Angola and Mozambique that will complement the projects we already
have underway," explained Francisco Porto Ribeiro, a member of
Abraço's board of directors.

Meanwhile, immigrants continue to arrive in Portugal and to knock on
Margarida Martins' door, hoping to obtain the treatment they couldn't
get in their own countries.

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Theme(s): (IRIN) HIV/AIDS (PlusNews)
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