Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
UN Integrated Regional Information Networks - November 5, 2007
Martins is the president of the non-governmental organisation (NGO) Abra o, 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 Ant<=nio Rodrigues, a social worker and counsellor at Abra o.
Today, some 50 Angolans, besides patients from other Portuguese-speaking African countries, are receiving treatment through Abra o. "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 Am lia 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 Abra o comes in," said Sara Carvalho, a social worker at Abra o'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 Abra o 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 Abra o'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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