HIV, mobility and migration
The relationship between population mobility, migration and HIV is one that is both complex and contested. This has particular relevance for the sub-Saharan African (SSA) region, a setting associated with a generalised HIV epidemic (GHE) and a high prevalence of diverse population movements. In this research project, the role of contemporary population mobility in mediating the HIV epidemic in SSA is explored and recommendations for action to assist in strengthening responses to HIV – including the call for migration-aware programming – in the region will be made.
In 2016, the SSA region remains home to the largest number of people living with HIV and – whilst some successes have been reported, such as increased numbers of people on treatment, fewer deaths, and a reduction in new cases of HIV per year – challenges remain to the development and implementation of effective combination prevention interventions.
Population mobility is often assumed to act as a key driver of GHEs but the most recent evidence suggests that whilst this may be true from a historical perspective – with migration fuelling the early spread of epidemics within the region, individual-level associations between (often poorly defined) migration status and HIV are not borne out at a population level; national migration levels are not associated with national HIV prevalence. In 2016, the movement of people is not a determinant of population HIV prevalence within GHE settings such as SSA, including within conflict and post-conflict contexts.
In spite of this, decisions related to the control of HIV are often fuelled by wider political debates linked to anti-(im)migration sentiments (and associated poor understandings of the heterogeneity of population movements), rather than being informed by evidence. These debates involve a range of unfounded assumptions that continue to negatively associate the movement of people with the spread of HIV and other infectious diseases, and fail to consider the complex ways in which other aspects of GHE settings – such as continued access to antiretroviral treatment and combination prevention programming – may be mediated by migration and mobility.
In order to support the call for renewed responses to address the structural drivers of HIV, as part of a combination prevention approach, there is an urgent need to better understand contemporary relationships between diverse population movements and HIV – including any implications for expanding treatment-as-prevention and pre-exposure prophylaxis (PreP) programmes.
In line with renewed calls for a focus on the structural drivers of HIV, this is a critical time – a strategic opportunity – for (re)focusing on structural drivers of HIV; population mobility is one such prevalent structural reality associated with the SSA region that affects HIV policy and programming in multiple ways.