Global Health
The Impact of Circular Migration on the HIV Care Continuum: A Qualitative Analysis in Northeastern South Africa Maryam Alkhamees* Maryam Alkhamees Rachel Yorlets Linda Ndlovu Maryam Alkhamees Nomi Nkalanga Philasande Accordance Carren Ginsburg Abigail Harrison Mark N Lurie F Xavier Goméz-Olivé
Background
Within-country migration is a well-documented driver of the HIV epidemic in South Africa, as living away from home complicates health care uptake. However, minimal literature gives voice to migrants’ first-hand perspectives on how living away from home facilitates or complicates engagement in each step of HIV care.
Methods
Using the frameworks of the HIV care cascade and the three delays model, we conducted semi-structured interviews with migrants living with HIV. In August 2022, a trained fieldworker interviewed 30 participants from The Migration and Health Follow-Up Study, focusing on adults aged 18-40 from Agincourt, Mpumalanga. We used stratified purposive sampling to select participants with a confirmed HIV diagnosis who spent four to five nights away from home per week before the study. After translation and de-identification, one analyst undertook immersion, coding, and thematic synthesis.
Results
Migrants described seeking HIV care in the absence of social support: several explained that making a clinic appointment results in lost revenue, as they have no one to run their business, and numerous participants had never disclosed their HIV status outside their immediate family; one had never disclosed to anyone other than a clinical provider. In reaching care, migrants face the financial barrier of taxi fare, which they must borrow. At the clinic, participants overall said that they were satisfied with the confidentiality and privacy at clinics, although some noted long wait times. Motivation for adherence was unrelated to migration; most cited their own survival, often for children.
Conclusions
Migrants living with HIV faced financial and logistical obstacles in seeking and reaching care, but migration had no negative effect on treatment adherence. We suspect interventions like mobile clinics and medication delivery systems would alleviate the costs associated with HIV care.