# Mobility in Africa: human rights and the HIV care cascade

Joseph Larmarange

► To cite this version:

Joseph Larmarange. Mobility in Africa: human rights and the HIV care cascade. 22nd International AIDS Conference, International AIDS Society, Jul 2018, Amsterdam, Netherlands. ird-04109543

HAL Id: ird-04109543

https://ird.hal.science/ird-04109543

Submitted on 13 Jun 2023

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# Mobility in Africa: human rights and the HIV care cascade

Joseph Larmarange

Institut de Recherche pour le Développement (IRD)
# Preliminary comment

* Increasing concern about restricting the movement of population

* Current policy processes have the potential to undermine efforts to improve the global responses to migration and HIV

(Vearey JIAS 2018)

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Presentation overview

> Context: mobility and migration in Africa

> Mobility and HIV acquisition

> Mobility and the HIV care cascade

> African migrants living in Europe

> Key populations and mobility

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# Mobility in sub-Saharan Africa

* Low transcontinental migration

* Intra-sub-Saharan African migration is the largest south-to-south movement

* High level of internal mobility

* Rural to urban, between rural, rural to semi-urban...

* "Household fluidity" (PopART HPTN 071) (Hoddinot et al. JIAS 2018)

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# The HIV care cascade

> Population-based and cross-sectional concept

> Proportion of HIV+ being

> diagnosed,

> in care,

> on ART,

> virally suppressed

> Computed

> among resident PLWHIV

> within a geographical area

> at a specific time point

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# Mobility and HIV acquisition

* Increased sexual risk behaviour and HIV prevalence among migrants

* in Kenya and Uganda (SEARCH) (Camlin et al. *JIAS* 2018)

* in rural KwaZulu Natal (South Africa) (McGrath et al. *Lancet HIV* 2015)

* Relation between distance of migration and HIV acquisition (Dobra et al. *AIDS* 2017)

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# Population dynamics & the HIV care cascade

> Data from ANRS 12249 TasP trial

> rural KwaZulu Natal

> 2012-2016

> Individual longitudinal trajectories

> residency

> HIV status

> engagement with HIV care

(Larmarange et al. JIAS 2018)

<figure><img src="image_9.png" /></figure>
# Population dynamics & the HIV care cascade

> Data from ANRS 12249 TasP trial

> rural KwaZulu Natal

> 2012-2016

> Individual longitudinal trajectories

> residency

> HIV status

> engagement with HIV care

(Larmarange et al. JIAS 2018)

<figure><img src="image_10.png" /></figure>
Cascade status at entry/exit

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ANRS 1229 TasP
(Larmarange et al.
JIAS 2018)
Relative position in the HIV care cascade

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Difference between cascade score at entry/exit and the cluster average score

<figure><img src="image_16.png" /></figure>

ANRS 1229 TasP
(Larmarange et al.
JIAS 2018)
# Mobility, access to and retention into care

* Optimal lifelong engagement with HIV care could be threatened by mobility

* Will be detailed in the following presentations, in particular with results from PopART HPTN 071 and MaxART

* Migrants face specific vulnerabilities that limit their retention at each step of the cascade

<figure><img src="image_17.png" /></figure>
# African migrants in Europe

> Overrepresented in European epidemic

> ANRS Parcours study

> ~ half of African migrants acquired HIV after migration (Desgrées du Lou et al. *Eurosurveillance* 2015)

> Increased exposure to HIV acquisition due to social hardships, including **lack of a residence permit** (Pannetier et al. *Lancet Public Health* 2017)

> Timing and determinants: tomorrow at 11:00 in Elicium 1 (Gosselin #WEAC0104)

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# Migrants in Europe (2)

* aMASE study (Fakoya et al. JIAS 2018)

* 9 European countries / 57 HIV clinics

* Median time to diagnosis

* 5 years (women)

* 8 years (heterosexual men)

* 7 years (gay and bisexual men)

* Late diagnosis

* Despite utilization of health services

* Missed opportunities for testing

* Migration-specific barriers, including
  **difficulties understanding the legal rights**
  to accessing health care

<figure><img src="image_19.png" /></figure>
# Key Populations and mobility

* Missed opportunities in terms of prevention among gay and bisexual migrants in Europe (Fakoya et al. JIAS 2018)

* Sex workers and men who have sex with men very mobile in southern Africa (Vearey JIAS 2018)

* Mobility of female sex workers in Côte d'Ivoire: a challenge for continuity of prevention and care (Becquet et al. ICASA 2017)

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(re)Setting the policy
agenda on migration

> It is crucial to integrate the dimension of mobility and migrations into our responses to the HIV epidemics

> Access to prevention and care is also a fundamental right for mobile populations

> "There is an urgent need to develop migration-aware and mobility-competent responses to health globally."
(Vearey JIAS 2018)

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Thank you
for your attention

Photos from Nubia Navarro (nubikini):
https://www.pexels.com/