The drug smugglers keeping HIV patients alive in South Africa
Antiretroviral drugs are free in South Africa – but thousands of undocumented HIV-positive migrants dare not seek them out
The decision to leave Malawi was an easy one for McLean Nyirenda. He could either languish in poverty at home, as he had done for his whole life, or depart in search of work that would support both himself and his family.
He settled upon South Africa, the continent’s most advanced country, one full of opportunity and adventure – yet in leaving for the Rainbow nation, the 27-year-old’s life has since been placed in grave danger.
Nyirenda is one of thousands of HIV-positive Malawians living in South Africa as an undocumented migrant. Because of his illegal status, he dares not visit a hospital to access – for free – the antiretroviral drugs which are needed to keep him alive.
Across the country, non-South African citizens are frequently denied antiretroviral therapy at public health care institutions, and Nyirenda fears he would not only meet the same fate, but be reported to law enforcement and deported back home.
In desperation, the young man, who works as a watchman at the house of a wealthy South African businessman, has turned to a syndicate of drug smugglers who supply the precious antiviral medication to irregular Malawians at an exorbitant price.
“I depend on smuggled antiretrovirals for my health, and this is the only way for most of us here to live longer and achieve what we came here for,” says Nyirenda.
It’s estimated there were at least 2.9 million immigrants residing in South Africa in 2020, but rising unemployment challenges and the impacts of natural disasters across the continent have likely further increased this number.
The Malawi High Commission in South Africa estimates there are more than 140,000 undocumented Malawians living in the country, of whom 30 per cent are believed to be HIV positive.
Despite antiretroviral services being free of charge for anyone in South Africa, most irregular migrants do not access the medicine via local hospitals because of their illegal status.
This creates opportunity for Malawi drug smugglers, who typically masquerade as drivers or businessmen, but it can also lead to patients skipping their antiretroviral therapy.
These drugs are needed to suppress the HIV virus within an infected individual; without them, the pathogen has the opportunity to replicate within the body and, over time, Aids can develop.
A Malawi High Commission official, who spoke on the condition of anonymity for fear of reprisals, said the situation in South Africa is culminating in a rise in Aids-related deaths among Malawian patients.
“At the moment we don’t have statistics to share with you but I can confirm that a number of deaths and dead bodies being repatriated to Malawi are HIV related and mostly caused by drug defaulting,” the official said.
Nyirenda has yet to meet the same fate, thanks to his mother Grace who has managed to source his medication through drug smugglers and a local hospital in Malawi.
“I was worried to hear that he was not able to go to hospital and access the antiretrovirals because he doesn’t have legal documents for his stay there,” she tells the Telegraph. “I felt my son will die due to lack of treatment.
“Then, I approached one of the health workers at Nyungwe rural hospital [in northern Malawi] who managed to sell me each bottle of antiretroviral drugs at MWK 5,000 [the equivalent of $5] and I sent him them through the drug smugglers.”
When she is unable to buy the antivirals from the local hospital, Grace turns to the Malawian drug syndicate, which charges $50 for three months’ worth of supplies. She says the smugglers always have the medication in stock.
“They charge MWK 15,000 [$15] for transportation if I source it myself and MWK 50,000 [$50] when they are supplying it themselves.”
One of the smugglers, a Malawian bus driver called James who travels back and forth to South Africa, said there is high demand for HIV patients living in the country, adding that, like Grace, he buys the medication from health workers in government hospitals at $5 a bottle.
However, James said, the reason the smugglers charge “exorbitant prices” to patients is because they need to bribe security forces at border crossings and road blocks.
“We know it’s illegal, but we can’t do otherwise because we have to save the lives of our colleagues,” he adds.
Mathews Ngware, a medical doctor and chairperson of the Malawi Parliament committee on health, says the problem in accessing antiretrovirals via public hospitals is common to irregular immigrants across the continent.
“This is a big issue across Africa because it involves undocumented migrants who fear to be identified if they go to public health facilities to access the drugs,” he says. “We have similar cases of Malawians travelling back home from Botswana, Zimbabwe and other countries to get their antiretrovirals.”
He added that the phenomenon of drug defaulting among patients – “which may give chances of new infections if they engage in unsafe sex with others” – threatens to undermine the global target of ending HIV as a public health threat by 2030.
The strategy, adopted by UNAIDS in 2021, seeks to eliminate new HIV infections and Aids-related deaths by 2030.
To combat the issue of drug defaulting, Malawi National Aids Commission has launched a new programme which provides HIV-positive Malawians living outside of the country with six months’ worth of medication at a time.
It’s hoped such an approach will ensure treatment consistency and stop people like Nyirenda from missing out on their drugs.
“We are informing all those living outside the country to come and identify themselves as irregular immigrants so that they can collect drugs in large volumes,” says Karen Msiska, a spokesperson for the Commission. “Through this initiative we hope we can end issues of defaulting due to the unavailability of the drugs.”
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