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
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