HIV Prevention for Mobile and Displaced Populations in Africa

Extracted from HIV prevention for mobile and displaced populations in Africa, Anthony Bennett, Family Health International, Arlington, USA, in Magazine AIDS INFOTHEK, 2/2000, www.aidsnet.ch

It is generally accepted that extended or repeated overnight travel away from home and community is associated with a higher risk of HIV infection. Slowing down the movement of populations might slow down the spread of HIV but no prevention programme is proposing any strategy to impede mobility (with the possible exception of anti-human trafficking programmes). Instead, most programmes try one or a combination of three strategies to reach the more vulnerable of mobile populations, and to extend HIV/AIDS prevention services:

· At the point of origin
· At the point of destination
· At the cross - roads en route.

Mobility related to work often creates an imbalance in the ratio of men and women, which means that the sharing of sex partners is normal practice. Extreme examples of this are truck stops where female sex workers, vendors and drink shop owners outnumber the men who are passing through at any given time. The reverse is true in mining camps where men greatly outnumber the women. In both cases, HIV and other sexually transmitted diseases (STDs) tend to flourish because of the greater likelihood of sharing sex partners.

There are some impressive examples of effective programmes to address these imbalances in various parts of Africa but they primarily deal with mobile populations on an individual basis, as opposed to a contextual approach. For example, qualitative assessments of extremely high-risk communities along the Durban-Lusaka highway indicate that men and women change their behaviour when in cross border communities and engage in risk behaviour that they would not do at home. This phenomenon strongly argues for a contextual and community response to risk-reduction , rather than one which focuses on the client.

Also, while most mobility is domestic, funding agencies and prevention programmes need to focus much more on international mobility because:

· HIV epidemics tend to erupt at the periphery of a country first before spreading to the larger cities and rural communities

· Busy, international border crossings often have a relatively higher risk environment than other trade towns

· National prevention programmes are relatively weaker at border towns and international ports compared with services in the capital and central part of the country

· Mobile populations can be reached more efficiently at international border ' funnels' than at other points along a travel route.

Cross-border prevention programmes range from minimal, one-way information-based services, such as leaflets, to comprehensive community-wide intervention programmes including STD control, peer education and condom social marketing. Data on these programmes' effectiveness is still limited because cross-border prevention is a relatively recent phenomenon. Nevertheless, enough experience has accumulated to permit the following recommendations:

· Prevention services need to be linked on both sides of a border, through cross-referral or an easily recognisable symbol or project logo signalling user friendly services for mobile populations

· Cross-border communities need to be considered as a single, extended town due to the heavy interaction between the populations on both sides

· Mobile populations need to be forewarned that the border crossing area presents an environment of unusually high risk for HIV/STDs, and that they need to anticipate the need for protection when passing through the area

· Communications materials need to be produced in all of the major languages spoken at a border area.

Mobile populations need access to the full range of prevention options including quality STD diagnosis and treatment, affordable and accessible condoms, and information on assessing self-risk and opportunities to reduce/eliminate risk. There are also special intervention strategies especially suited to mobile populations such as:

· pre-packaged STD treatment kits containing a complete dose of an effective antibiotic plus basic information on prevention

· employer programmes for populations in camps, working on large-scale projects such as dams and roads

· accelerating the processing of trucks through border customs to reduce overnight stays

· changes in trucking company policies to discourage overnight stays and provide intensive education on prevention, free STD screening and treatment, and ample condom supplies.