A Review of Migrant and Mobile Populations within Border Areas of SADC: Implications for HIV Prevention Programming

This 58-page report outlines research exploring sexual and reproductive health (SRH) and HIV needs in migrant, mobile, and border populations in the Southern Africa Development Community (SADC), highlighting implications for HIV prevention programming in border areas. Conducted by the African Centre for Migration and Society at Wits University for the Soul City Institute for Health and Development Communication, the findings were intended to inform the regional HIV prevention programming activities of Soul City. According to the report, the "border space" is an interactive space that involves both one-off and repeated encounters between different groups. For some, the "border space" is transitory. For others, it is home. It is essential to consider different kinds of populations when planning interventions, as migrant and non-migrant groups interact in various ways, including through sexual networks.

The study involved three main components. Firstly, a review of literature relating to SRH (with a focus on HIV) and migration in SADC was undertaken. Secondly, two case studies on migration and HIV in border areas were generated. These case studies involved a team of two researchers visiting two border areas and conducting primary research including interviews, focus group discussions, and observations. Finally, a set of targeted interviews were undertaken with key informants involved in migration and HIV programming in the SADC region. Based on the research, the report outlines the following key findings, among others:

• A range of "othering" discourse is prevalent in border spaces. "The other" is blamed for bringing HIV across borders, for being sex workers, or for violence. Different nationalities are positioned very differently with clear assumptions associated with them. There is a need for interventions to reduce this “othering” in order to improve relations between the multiple nationalities present in any given border area.
• There is a need for simple messaging and communication to present clear and correct basic information about HIV, particularly relating to the transmission of HIV and how it affects a person living with HIV. Communication media must engage with the languages spoken in the border area.
• There is a need to improve awareness within border spaces relating to access to antiretroviral theradpy (ART) and adherence. This includes ensuring that practitioners and clients are aware of how to ensure continuity of treatment, including how to switch regimens if an individual arrives from a different country.
• Improving access to documentation and the immigration system will improve access for cross-border migrants to healthcare and reduce labour exploitation.
• There is an urgent need to make sex work safe. This will involve engaging with both clients and police, and advocating for the decriminalisation of sex work.
• As in other areas of the SADC region, sexual concurrency is a concern in border spaces. There is a need to develop appropriate interventions to assist people to make concurrency safe.
• Improving living and working conditions in border farms would address the vulnerabilities faced by single female workers. Additionally, there is a need to address the "no work, no pay” philosophy surrounding time off to access healthcare; outreach services to farms are urgently needed.
• As in other areas of SADC, there is a need to reduce stigma associated with HIV in order to assist individuals to test for HIV and access treatment if required.
• There is currently a lack of solidarity between religious leaders around HIV; religious leaders are in need of guidance to ensure that they deliver appropriate sermons that contain relevant messages.
• There is a need to develop an improved understanding of sexual dynamics relating to child abuse and child prostitution.

The review includes a set of key messages and considerations for future programming.

• Mainstream migration into HIV prevention responses: Border areas are home to a diverse population that is made up of both migrant and non-migrant groups. It is essential that migrants and migration are not exceptionalised when thinking about HIV programming; migrants and non-migrants form overlapping sexual networks and require linked responses. There are some particular needs associated with being a migrant that require specific responses; these should not be to the detriment of the non-migrant population.
• Conduct situational analyses at each border area: No two border areas are the same; they can be land, sea, or air. Researchers suggest involving representatives of border populations as researchers - during case studies, researchers engaged with representatives of various border population groups who facilitated access and provided critical insight.
• Involve border populations in the design of behaviour change communication (BCC) campaigns: This involves engaging with representatives of the different border groups (migrant and non-migrant) identified to develop messages and materials. It is clear that there is a demand for more "interactive" and localised materials, including DVDs and CDs. Researchers suggest that participatory approaches should be applied to develop locally-relevant, locally-produced materials with border populations themselves.
• Involve border populations as peer educators: The purpose would be to assist in improving knowledge within the different border groups on issues relating to health, HIV, and migration. Success has been demonstrated in working with sex workers as peer educators. It is suggested in expanding this to also consider truck drivers, taxi drivers, cross-border traders, seafarers, fishermen, and other groups, including immigration officials and security personnel.
• Make use of existing networks and interventions: This is particularly relevant when working with truck drivers (Trucking Wellness, North Star) and sex workers (Sisonke Sex Worker Movement, African Sex Worker Alliance). It is important to draw on existing knowledge and lessons learned about working with these groups.
• Develop strong cross-border and regional networks and alliances: Current regional HIV prevention interventions are weak, and effective campaigns will require cross-border cooperation. This will also involve working with SADC to advocate for the implementation of the (draft) Protocol on Population Mobility and Communicable Diseases.
• Make sex work safe: This involves working with sex workers to develop peer-led initiatives and to support the decriminalisation of sex work. Sex workers are at risk of both acquiring and transmitting HIV and interact with multiple border populations. From a public health and human rights perspective, it is critical to address the HIV prevention concerns associated with sex work. Making sex work safe involves working to support decriminalisation and engagement with the police and with clients.

The report concludes that it is clear that there are some general recommendations relating to HIV messaging within border areas. These are likely to be the same messages that are applied in other parts of the SADC region, and are not necessarily specific or unique to border areas; it is essential to remember that many who reside within border areas are not mobile and that they require the same information/messaging as provided to communities elsewhere. However, there are also particularities associated with border areas that must be considered. The report suggests two key ways of engaging with border areas: (1) spatially and (2) through focusing on specific population groups. The report provides suggestions for interventions that engage truck drivers, taxi drivers, cross-border traders, farm workers, and sex workers.