Botswana’s ARV policy hands foreign prisoners a slow death sentence

In Botswana, persons who are eligible for anti-retroviral (ARV) drug treatment are defined in the health policy as citizens of Botswana who meet the criteria established by the government.

On the basis of this, Botswana has refused to give ARVs to foreign convicts who are living with HIV/Aids, insisting that provision of treatment to “outsiders” is too costly. Is this, for the helpless prisoners, a death sentence?

The plight of foreign inmates was brought to light by two Zimbabwean men, Dickson Tapela and Mbuso Piyee, both serving 10-year prison sentences for armed robbery. 

The Botswana High Court last year ruled that foreign convicts be supplied with ARVs free of charge, but government is appealing that ruling. Fortunately for Mr Tapela and Mr Piye, who have been living with HIV for several years, a well wisher pledged to sponsor them to purchase ARVs until the case is over.

But what about the nearly 1,000 foreign prisoners, mostly Zimbabweans, languishing in the 23 state prisons dotted around the Southern African country?

Mr Tapela and Mr Piye’s case has provoked much discussion about prisoners’ rights, with the dominant line of thought being that this is a violation of their right to life, as well as the right of freedom from discrimination. Octavia Sibanda, a health expert, argues that Botswana’s stance is as good as a death sentence.

“The two men are in for 10 years and if the well wishers were not supplying them with ARVs they would probably be dead. This is tantamount to a death sentence,” Mr Sibanda saids.

READ: People on ARVs unlikely to infect partners, says report

What makes the plight of most of these foreigners even more pitiful is that many of them have no relatives in Botswana to give them the medication. Home is too far away for relatives to travel with medication on a regular basis.

In fact, a correctional services officer at the Village Prison in Gaborone reveals that some prisoners serve out their full time without getting a single visit from a relative.

Mr Tapela has said that after being sentenced to a decade behind bars, his partner informed him that she had been diagnosed with HIV and advised him to go for a test, which turned out to be positive.

Research around the Southern African region shows Botswana is the only country that does not provide ARVs to prisoners. South Africa has the highest population of foreign inmates in the region and does provide ARVs. Namibia, Angola and Swaziland are also home to thousands of expatriates and supply all prisoners with HIV treatment.

George Vingaso, an inmate extradited from South Africa’s North West Province and convicted of car theft in the Botswana, was taken aback when denied ARV treatment.

Correctional services officials in South Africa confirm he was receiving ARVs in South Africa. On the other hand, Botswana government only provides non-citizen prisoners with treatment for opportunistic infections, such as tuberculosis. 

READ: Aids now the number one killer of adolescents in Africa

Fletcher Ndlovu, a human- rights activist, concurs with Mr Sibanda, saying President Ian Khama’s government has denied prisoners “the right to life”.

“To say the least, this is inhuman, degrading treatment, discrimination and inequality,” said Mr Ndlovu.

He adds: “The availability of ARVs help reduce the chances of one dying quickly but the Botswana government is denying the prisoners a chance to live longer. What they are doing is killing the prisoners slowly.”

The Botswana Network on Ethics, Law and HIV/Aids (Bonela), the organisation listed as litigant in Mr Tapela and Mr Piye’s fight against the government’s policy, have repeatedly said foreign prisoners are a vulnerable group who usually have no means to access life-saving medication if the government does not supply it.

Bonela executive director, Cindy Kelemi, said: “These prisoners face great suffering and even death if the government continues to deny them ARVs.”Bonela has also received backing from the Southern Africa Litigation Centre (SALC) in the matter. SALC has described government’s decision to deny foreign prisoners ARVs as irrational.

Mr Ndlovu, who has followed the case from day one, believes this also puts Botswana’s citizens who are in prison at risk.  

“I think the sooner the Botswana government realises that this not only puts foreign prisoners’ health at severe risk, but also places other prisoners at risk of illnesses, including tuberculosis and HIV, the better. We all know what happens in prisons,” he added.

While the diamond-rich nation claims it would be costly to provide foreign prisoners with ARVs, whose monthly supply would cost in the region of $19, the government pays fees for all university students. The students also get a monthly allowance of $150.

“It’s a surprise for a country this stable economically and that pays fees for university students and then pays them an allowance to study, to claim they cannot supply free ARVs to foreigners,” argued Mr Ndlovu.

Most of these prisoners, according to officials, have lived in Botswana for many years and will likely stay in the country after their release.

“Whom do they live with afterwards? Botswana citizens. They will come out of prison and spread the virus.”

Botswana’s National Aids Coordinating Agency recently said the country’s HIV prevalence rate has been stabilising over the past few years. The agency said Botswana has recorded an estimated 73 per cent decline in HIV incidence between 2001 and 2011. 

In 2001, Botswana was losing close to 21,000 people annually due to AIDS but the figure has since dropped to 5,700 in 2012,
representing a 73 per cent decline. Mr Ndlovu said that the government’s policy could cause a major disaster in the long run.

“Botswana is home to thousands of foreigners who have sexual relations with locals and they do not have access to ARVs like locals do. I am sure a number of these are people who do menial jobs and cannot afford ARVs. I think the government must rethink this policy.”

In 2004, Zimbabwe’s hospitals started providing free ARV drugs in partnership with UNAids, WHO and the health ministry. The programme was part of WHO’s “Three by Five” vision of providing three million people globally with access to ARVs by 2005.

To date, Zimbabwe’s government hospitals still supply the drug. However, the Botswana government’s representative in the case, principal state counsel David Moloise, has reiterated their stance was purely on the grounds of “public interest.”

In August last year, Tshiamo Rantao, a lawyer representing Mr Tapela and Mr Piye, told The EastAfrican that the government was failing to give plausible facts to back the reasoning behind the refusal to provide ARV treatments to foreign inmates.

The government could not explain the basis on which it was refusing access to ARV treatment to foreign inmates; neither could it satisfy the court that it lacked the resources to provide treatment to HIV-positive foreign prisoners. Mr Moloise said. “When the cost of ARV goes down, the state may reconsider.”

Mr Ndlovu accuses the government of being intolerant of foreigners. “They say this is purely in the public interest, but I say this is purely xenophobic. There’s no other way to explain this,” he said.

Botswana has a small population of just over 2.2 million people and has had an influx of foreign nationals mainly from Zimbabwe, Zambia, China, India and Nigeria in recent years.