Migrant men and HIV care engagement in Johannesburg, South Africa

Abstract

Background: South Africa (SA) has one of the highest rates of migration on the continent, largely comprised of men seeking labor opportunities in urban centers. Migrant men are at risk for challenges engaging in HIV care. However, rates of HIV and patterns of healthcare engagement among migrant men in urban Johannesburg are poorly understood. Methods: We analyzed data from 150 adult men (>=18 years) recruited in 10/2020-11/2020 at one of five sites in Johannesburg, Gauteng Province, SA where migrants typically gather for work, shelter, transit, or leisure: a factory, building materials store, homeless shelter, taxi rank, and public park. Participants were surveyed to assess migration factors (e.g., birth location, residency status), self-reported HIV status, and use and knowledge of HIV and general health services. Proportions were calculated with descriptive statistics. Associations between migration factors and health outcomes were examined with Fisher exact tests and logistic regression models. Internal migrants, who travel within the country, were defined as South African men born outside Gauteng Province. International migrants were defined as men born outside SA. Results: Two fifths (60/150, 40%) of participants were internal migrants and one fifth (33/150, 22%) were international migrants. More internal migrants reported living with HIV than men born in Gauteng (20% vs 6%, p=0.042), though in a multi-variate analysis controlling for age, being an internal migrant was not a significant predictor of self-reported HIV positive status. Over 90% all participants had undergone an HIV test in their lifetime. Less than 20% of all participants had heard of pre-exposure prophylaxis (PrEP), with only 12% international migrants having familiarity with PrEP. Over twice as many individuals without permanent residency or citizenship reported never visiting a health facility, as compared to citizens/permanent residents (28.6% vs. 10.6%, p=0.076). Conclusions: Our study revealed a high proportion of migrants within our community-based sample of men and demonstrated a need for bringing PrEP awareness and services to migrants in Johannesburg. Future research is warranted to further disaggregate this heterogenous population by different dimensions of mobility and to understand how to design HIV programs in ways that will address migrants' challenges.

“Emotional stress is more detrimental than the virus itself”: A qualitative study to understand HIV testing and pre‐exposure prophylaxis (PrEP) use among internal migrant men in South Africa

“…South African men who move within the country, called internal migrants [27, 28], bear two to three times the burden of HIV as compared to non‐migrant men in South Africa [29, 30], and they also have a higher burden of HIV than international migrants [30]. Migrant men are at higher risk for HIV acquisition during the disruptive process of relocation [31] and engage in higher sexual risk behaviours [32].…”

“…Compared to non‐migrants, internal migrants are less likely to use health services, more likely to use private services or traditional healers and less likely to test for HIV [33, 34]. Migrants are identified as a “key population” for HIV prevention [35], but only 15% of internal migrant men surveyed in community sites in Johannesburg were aware of PrEP [30]. HIV interventions that engage men in testing and prevention, such as workplace programmes and partner notification strategies [36], may exclude men who are unemployed or unpartnered, as is common for migrant men [30].…”

“…Migrants are identified as a “key population” for HIV prevention [35], but only 15% of internal migrant men surveyed in community sites in Johannesburg were aware of PrEP [30]. HIV interventions that engage men in testing and prevention, such as workplace programmes and partner notification strategies [36], may exclude men who are unemployed or unpartnered, as is common for migrant men [30]. Moreover, large trials to improve HIV testing among men in South Africa have found substantial challenges reaching communities with high mobility and in‐migration [37].…”