HIV patients: rejected by both family and healthcare providers [Archives:2008/1176/Health]
Khaled Al-Hilaly
An HIV-positive refugee from the Horn of Africa languished for three days outside the fence of Al-Jumhury Hospital in Sana'a. Sleeping on the ground and covered with a piece of cardboard, the man eventually attracted the attention of a homeless wanderer who brought food and juice to nourish him. The African man eventually was admitted to the hospital, where he died shortly afterward. His body still hasn't been identified.
“He looked extremely sick and couldn't move or talk,” recalled Mustafa Al-Shaubi, who works at a pharmacy near the hospital. “When we told the hospital's criminal investigations office that there was a patient near its fence, they replied, 'This patient has HIV, but had no companion or even an identification card, so we ejected him,'” Al-Shaubi continued.
According to Abdulqader Al-Mutawakil, head of Al-Jumhury's criminal investigations office, the man was in an extremely poor state and defecating on himself. “While it's true that there was no one to look after him, no one from the hospital threw him out – we never do that. He somehow got out by himself,” Al-Mutawakil maintained, adding, “Refugees receive better treatment than Yemenis themselves.”
Dr. Ahmed Al-Garati, coordinator of Al-Jumhury's National AIDS Control Program, alleges that the Ethiopian Embassy usually doesn't cooperate with the hospital. “They refuse to send someone to look after those Ethiopian HIV patients without companions, whereas the Somali Embassy does do this.”
Al-Garati notes that Al-Jumhury currently is keeping the bodies of four African refugees who died of AIDS-related causes in the hospital's mortuary refrigerator because it has no information on them.
He adds, “However, we have 14 HIV-positive refugees with identification cards issued by the United Nations High Commissioner for Refugees, all of whom have documents to receive treatment at the hospital.”
However, Ahmed Kalla, an Ethiopian Embassy employee who coordinates with Yemeni hospitals, says, “No one from Al-Jumhury Hospital called us regarding that patient and, in fact, the last time I was there, I looked after two female Ethiopian patients, whom we sent back to Ethiopia.
“In order to determine whether a patient is Ethiopian, I ask for their identification cards. I then speak to him or her in Amharic to determine the exact area from which he or she comes,” Kalla explained.
“The Ethiopians here in Yemen are from different tribes, each with its own committee to help those in need. The Ethiopian community gives Ethiopian patients medicine, money or a companion to help them if the patient needs to stay in the hospital,” he added.
Al-Jumhury Hospital requires all patients, including refugees, to have identification cards or to bring an accompanying companion to identify them.
Thousands of refugees from the Horn of Africa arrive in Yemen every year. HIV-positive refugees usually have no families to look after them and rarely have UNHCR-registered ID cards. Although those with advanced HIV or AIDS require intensive medical attention, Yemeni hospitals won't treat them without identification.
“Our hospital isn't responsible for those on the streets. Only if the patient is inside the hospital are we responsible,” Al-Jumhury's assistant general manager Mohammed Al-Qudaimi remarked.
“While I have paid hospital staff to wash this African refugee's body [the one who was on the street for three days], I want to remind the public that Al-Jumhury Hospital isn't a refuge for AIDS patients – it's a treatment center,” Al-Garati noted, adding, “A patient can come to us to receive medicine or a consultation and then return home.”
According to Dr. Abdulhameed Al-Suhaibi, manager of the National AIDS Control Program, Al-Jumhury Hospital hasn't rejected any patients. The particular HIV-positive refugee in question remained in front of the hospital and when people saw him, they informed the hospital and he was brought inside, Al-Suhaibi says.
He added, “We are arranging to meet with UNHCR to discuss the problem of HIV-positive refugees entering Yemen without ID cards.”
Al-Suhaibi says the National AIDS Control Program attempts to help HIV-positive refugees by paying HIV-positive companions to look after them, sometimes providing these HIV-positive refugees free medicine as well.
However, Al-Suhaibi says it's not the program's responsibility to gather up sick people off the streets. “Most unidentified AIDS patients arrive during the latter stages of the disease, which means they require much more care and medicine,” he explains, adding, “HIV-positive patients' families should bring them to the hospital to receive medication, not dump them alone in front of the hospital.”
“It's not only refugees who face discrimination regarding HIV, as Yemenis also are subjected to it everywhere they go,” says Abu Muhanad, an HIV-positive Yemeni who asked to remain anonymous to protect his privacy.
“When I took my then-pregnant wife, who also is HIV-positive, to deliver our baby in Sana'a, three large hospitals refused to take her after I informed them that she was HIV-positive,” he recounts. “I finally was forced to hide the fact that she's HIV-positive, as I had been advised by the National AIDS Control Program.
Abu Muhanad also recalled the plight of an Ethiopian woman whose family left her alone at the hospital and how health workers there mistreated her. “She was left for two days on the floor of the hospital corridor with no food or water. When I asked for food for her, a health worker put some food inside a plastic bag and threw it at her. I called the National AIDS Control Program manager and he came and asked for another person living with HIV to look after her.”
Most, if not all, AIDS patients come to Al-Jumhury Hospital, the only AIDS treatment center in Sana'a, their conditions usually requiring intensive hospital care because they're often near death in the late stages of the disease.
HIV-positive Yemenis suggest establishing a special center for HIV/AIDS patients – separate from hospitals – for those requiring long-term care.
Despite all efforts to educate public health providers in Yemen, HIV-positive patients maintain that they still suffer discrimination at hospitals everywhere.
“We are concerned about the community, but they don't care about us,” laments Abu Rashid, another HIV-positive Yemeni requesting anonymity in an effort to avoid further discrimination.
“When I told my dentist that I'm HIV positive, he accused me of adultery and asked me to leave,” Abu Rashid recounted. “We need specially trained doctors to take care of AIDS patients, while those who already have such training should pay more attention to AIDS patients.”
“There are HIV-positive people who have been forced out of mosques and their neighborhoods, however, I don't blame ordinary citizens,” Abu Muhanad says, “Instead, I blame those doctors who discriminate against us.”
Yemenis with HIV still live in fear – more afraid of societal rejection than of the disease itself. Because of this, Yemenis living with HIV or AIDS often hide their disease.
However, Abu Muhanad advises all of those in Yemen who are hiding their HIV infection to live normally.
“They can visit the National AIDS Control Program to receive free medicine and treatment. Because their information is kept confidential, they can live their lives like other people and not worry,” he concluded.
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