MOBILITY AND VULNERABILITY TO HIV : A STRATEGY TO SEEK

AND IMPROVE ACCESS TO HEALTH CARE

SYMPOSIUM : BARRIERS TO MIGRANTS AND MOBILE POPULATIONS IN ACCESSING COMPREHENSIVE HIV SERVICES AND

TREATMENT20.07.2010

Fatou Maria DRAME, PhD

Assistant Professor Gaston Berger University (SENEGAL)

OUTLINEINTRODUCTION

I. WEST AFRICAN MOBILITY

II. CROSS BORDER MOBILITY AND ACCESS TO HIV CARE

III KEY CHALLENGES AND A REGIONAL RESPONSE

CONCLUSION

INTRODUCTION• UNDERSTANDING LINKAGES BETWEEN MOBILITY

AND HIV- Flow of population: factor of diffusion of the epidemic ( generalied/ concentrated or low epidemicfactor related to the growth of urban areas where high population density contribute to the expansion of the epidemics- Mobile persons : vulnerable groups

• UNDERSTANDING MOBILITY IN THE PERSPECTIVE OF A STRAGETY TO ACCESS CARE AND PREVENTION SERVICES

Does mobility facilitate ou hinder access to care and prevention services ?Example focus on Senegal and its bordering countries

I.WEST AFRICAN MOBILITY West Africa mobility is

Histotical and permanent : trans-saharian exchange,

colonial structure, political et economic regional organisation

(ECOWAS, UEMOA)

Selective : young persons, men but more and more women,

and fragile populations (context of political instability)

• Mobility facilitated by- Same cultural and social context: same language, cultural

similarities and strong religious and family relationships across the border

- Significant development of infrastructure: roads, bridges, communication, airport , etc.

30 millions of Africans have change their residence between 1960 and 1990

In 1990’s 3% of the west african region population

is a migrant.(2% for all Africa and

0,5% for European Union)

Cross border exchanges

II. CROSS BORDER MOBILITY AND ACCES TO HIV CARE

* 6% of patient on ART in Bignona are from the Gambia (mars 2010)

*10,5% of patient on ARTtreated at PTA of Ziguinchor come fromGuinée Bissau (mai 2010)

Selective attractionBignona GambiaZiguinchor G Bissau

BOUCO

TTE

SANTHIABA

BELFORT

COLO

BANE

TILENE

KANDE

NEMA

GD D

AKAR

KANDIALANG

LYNDIANE

G B

ISSAU

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

f(x) = 0.172424086587016 exp( 0.160468249347046 x )R² = 0.973566770597786

Men

BOUCO

TTE

SANTHIABA

BELFORT

COLO

BANE

TILENE

KANDE

NEMA

GD D

AKAR

KANDIALANG

LYNDIANE

G B

ISSAU

0%

20%

40%

60%

80%

100%f(x) = 0.0785911058638331 x + 0.126643053915782R² = 0.986100904500744

Women

Ziguinchor de 481 m à 3,5km 100 km

Estimated Distance from patient community to ART service ( PTA in Ziguinchor)

Preliminary results :

More (+ )distance to health center increases, less (-) women are involved

Determinants :

• Unbalanced quality and accessility of ART

services across the border

• Attraction of best services( Bignona for

Gambia et Ziguinchor for Bissau)

• Communication facilities

• Family relationship

• Seeking for confidentialy

•Insuffisant development of multi- actors partnership across the borders

•Lack of knowledge transfer and information sharing among health professional

•Not effective cross border platform for mutual experience sharing and learning between community and medical professional

* Lack of formal and systemic collaboration or structured cross border programme on HIV

III. KEY CHALLENGES AND A REGIONAL RESPONSE:

Initiating a regional and multi-focus response : The FEVE (Frontières et Vulnérabilités au VIH) project

Intra country response

CAP VERT

GUINEE BISSAU

GUINEE

SENEGAL

Target groups: PLWAS, marginalized populations,

mobile populationMain focus areas: cross

borders regions, urban city

Activities: Prevention activities

Care and psycho social supportCapacity building of medical and

community services providersImpact mitigation( IGA)

Operation

Some Results of FEVE projet 2008-2010:

FSW: 500 in Cap Vert , 257 in G. Bissau, 1850 in Guinée

Conakry,2990 in Senegal : VCT, STI/ARVtreatment and support PLHIV: Medical care to 329 HIV+ in

G. Conakry / support for 851 HIV+ in

G Bissau / Support and Care for 390

HIV+ in Senegal

32 Public health services are directly supported by the project

…

Inter-country response: *Sharing of technical information and skills

between services providers*Develop innovative

strategies accross border to facilitate acces to care and

support for marginalized and infected people

*Cross border joint team to provide services

*Intercountry training programme

CONCLUSION• Mobility can be

an expression of social network density,

an expression of care opportunities

• How to define health ressource allocation? theoretical attraction / effective attraction

Country programming ( programmatic and ressources) must integrate mobility dynamics and specificity of bordering regions

• Interventions in cross border areas need re-invention and adaptation of our strategies

THANK YOU FOR YOUR ATTENTION