The Beitbridge border post has been left out of a proposed cross-border initiative to improve the regional response to HIV/Aids.
If funding is approved, the Southern African Development Community (SADC) will set up HIV programmes at 32 cross-border sites. Four of these are to be located in South Africa, but the country’s two most high-profile border crossings have not been included.
Mickael Le Paih, Médecins sans Frontières (MSF) head of mission in South Africa and Lesotho, questioned why these critical sites have not been considered. ‘It’s estimated that 350 people try to get asylum documents at the refugee office in Musina every day,” said Le Paih.
Musina is the closest town to Beitbridge, one of the busiest borders in Southern Africa, where thousands of truckers and informal traders cross between South Africa and Zimbabwe each day. This emerged in a report on HIV prevention and treatment among mobile populations released last week by the International Organisation of Migration (IOM).
The report suggests that regional policies could be implemented to make migrant workers less vulnerable to the disease. It recommends that SADC countries coordinate to provide accessible health facilities and HIV-prevention programmes in all countries in the region and suggests that HIV treatment systems be ‘harmonised”, as protocols differ from country to country.
It’s estimated that there are between one and three million crossborder migrants in South Africa, or 3% of the total population, a figure that correlates with global migration estimates. If the initiative gets off the ground it could go a long way towards preventing the spread of HIV among people crossing borders and the communities that spring up at border posts.
Southern Africa is known to be a high mobility region and the IOM has identified border-crossings as ‘spaces of vulnerability”. IOM consultant Andrew Hartnack, who helped compile the report, said it’s important that intervention strategies address all the populations interacting in spaces of vulnerability.
‘If you focus on one population, for example truck drivers, who are known to engage in high-risk activities and be away from home for long periods, and give them education and VCT [voluntary testing and counselling], you could be ignoring all the other populations they come into contact with.”
He said that in many spaces of vulnerability, like ports, mines or border posts, work is very male oriented, which often leaves local women with very little choice but to engage in transactional sex. The IOM has called for further research to better understand the sexual networks and behaviour patterns in these hot spots.
Another challenge to preventing the spread of HIV in mobile populations is ensuring a ‘continuum of care” as people move from one place to another. Le Paih said that while it’s easy to provide patients with the treatment they need, ‘the question [for migrants] is will you be accepted into healthcare facilities?”
‘On paper, it’s easy to access treatment in South Africa — The directives are clear enough: foreigners should have access to healthcare and treatment for free. In reality, it’s not so clear,” he said.
Denial of access is a problem in Johannesburg, Le Paih said, whereas in Musina, where the MSF also operates, the challenge of continuing care is more related to a lack of resources.
The report suggested that the SADC should consider ‘introducing a card system that can be used within the region to access ART”, what some researchers call a ‘health passport”.
In addition, the authors suggested that governments enforce stiffer regulations to ensure that smaller companies also provide workplace policies and regular access to HIV prevention services for all workers. Casual and migrant workers in spaces of vulnerability often lose out when it comes to health benefits.
Hartnack said that while many large, established companies have workplace programmes in place that provide voluntary testing and counselling and antiretroviral medication, smaller companies, labour brokers and informal workplaces often do not provide the same services because ‘they’re not being pressured or given incentives to do so”. He pointed to the Durban ports as an example.
‘The dock in Durban has good workplace policies but their casual staff don’t benefit from them — There are about 30 000 workers associated with the Durban port but only about 10 000 of these have access to workplace interventions. The rest have to access healthcare through government clinics or NGOs,” he said.
Aids researchers welcomed the report, which highlights the HIV risk of often ignored mobile populations. Mobile populations — including farmhands, miners, construction workers, informal traders, dock workers or truckers — have been identified as a group that is particularly vulnerable to HIV.
‘Health isn’t something that stays within a country. It crosses borders,” said Jo Vearey, a researcher in migration and health with the Forced Migration Studies Programme (FMSP) at Wits University.
‘People are moving towards the recognition that we need to look at migration and health in a regional context … This is an important ideological shift to make as Southern Africa is a region with high mobility.” Vearey pointed out that not all migrants cross borders.
In Gauteng, the destination of most migrant workers, the FSMP estimates that 7% of the population is made up of cross-border migrants while 35% are internal migrants.
She said that because HIV is more prevalent in urban contexts, it’s important to understand the links between health and migration. ‘We know that migration is part of development so we need to look at both those issues together,” she said.