Integrative asylum policy within South Africa:   investigating access to ART services for refugees and asylum seekers with...
Overview of presentation <ul><li>Background; </li></ul><ul><li>Aims; </li></ul><ul><li>Methods; </li></ul><ul><li>Key find...
An integrative asylum policy <ul><li>South Africa has an  integrative asylum policy : </li></ul><ul><ul><li>Refugees and a...
Current context: Johannesburg <ul><li>Violence against international migrants  (May 2008); </li></ul><ul><li>As a result, ...
Johannesburg – a complex urban environment <ul><li>Estimated population of nearly 3.9 million; </li></ul><ul><li>In certai...
Study aims <ul><li>To understand the extent to which  different categories of migrants  are able to  access ART  in Johann...
Methods <ul><li>4 ART sites in Johannesburg inner-city  were purposively selected from migrant dense areas:  2 government ...
<ul><li>Key findings </li></ul>
Health migrants? <ul><li>These individuals are  not health migrants : </li></ul><ul><ul><li>Discovered their status in Sou...
Continuity of treatment <ul><li>In this study,  20% of international migrants reported initiating ART in another country …...
Like South Africans, international migrants are most likely to test only when sick (Chi-squared;  P = 0.122)
International migrant clients are no more likely than South Africans to not collect or not take their ART (Chi-squared;  p...
<ul><li>Only 22% of all non-citizens interviewed were accessing ART at government sites; </li></ul><ul><li>The difference ...
A dual healthcare system <ul><li>Non-citizens are  referred out of the public sector and into the NGO sector : </li></ul><...
Summary <ul><li>Whilst the numbers of international migrants in need of ART are small, they are  significant ; </li></ul><...
Key recommendations <ul><li>The  right to health  for all migrants, regardless of status, must be upheld. </li></ul><ul><l...
Acknowledgements <ul><li>All study participants, both healthcare providers and ART clients </li></ul><ul><li>Study sites <...
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Integrative asylum policy within South Africa: investigating access to ART services for refugees and asylum seekers within a complex urban environment

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Integrative asylum policy within South Africa: investigating access to ART services for refugees and asylum seekers within a complex urban environment

  1. 1. Integrative asylum policy within South Africa: investigating access to ART services for refugees and asylum seekers within a complex urban environment Jo Vearey PhD Student, School of Public Health Doctoral Research Fellow, Forced Migration Studies Programme University of the Witwatersrand [email_address] http://migration.org.za Reproductive Health in Emergencies Conference 2008, Kampala 20 th June 2008
  2. 2. Overview of presentation <ul><li>Background; </li></ul><ul><li>Aims; </li></ul><ul><li>Methods; </li></ul><ul><li>Key findings; and </li></ul><ul><li>Key recommendations. </li></ul>
  3. 3. An integrative asylum policy <ul><li>South Africa has an integrative asylum policy : </li></ul><ul><ul><li>Refugees and asylum seekers are encouraged to self-settle and integrate ; </li></ul></ul><ul><li>A range of rights are afforded: </li></ul><ul><ul><li>Policies exist that assure the right to health – including ART – for refugees , asylum seekers and other international migrants ; </li></ul></ul><ul><li>Key challenges to the effective implementation of these policies: </li></ul><ul><ul><li>Backlog at Department of Home Affairs; and </li></ul></ul><ul><ul><li>Lack of awareness of rights: service providers. </li></ul></ul>
  4. 4. Current context: Johannesburg <ul><li>Violence against international migrants (May 2008); </li></ul><ul><li>As a result, estimates of: </li></ul><ul><ul><li>200,000 displaced; </li></ul></ul><ul><ul><li>25,000 – 35,000 Mozambicans and Zimbabweans fled South Africa </li></ul></ul><ul><li>Establishment of temporary shelters and camps ……. </li></ul><ul><li>The majority of international migrants remain self-settled . </li></ul>
  5. 5. Johannesburg – a complex urban environment <ul><li>Estimated population of nearly 3.9 million; </li></ul><ul><li>In certain inner-city neighbourhoods, one quarter to half of residents are estimated to be international migrants (Landau, 2006; Leggett, 2003): </li></ul><ul><ul><li>Asylum seekers; </li></ul></ul><ul><ul><li>Refugees; </li></ul></ul><ul><ul><li>Work/study/visitor permits; </li></ul></ul><ul><ul><li>Undocumented migrants. </li></ul></ul><ul><li>The context of HIV in urban environments provides an additional challenge: prevention, testing, treatment, support. </li></ul>
  6. 6. Study aims <ul><li>To understand the extent to which different categories of migrants are able to access ART in Johannesburg and the barriers that may hinder their access. </li></ul><ul><li>To provide recommendations to institutions and Provincial Department of Health (DoH) . </li></ul><ul><li>To test common assumptions that relate to the presence of international migrants in South Africa: </li></ul><ul><ul><li>Health migrants? </li></ul></ul><ul><ul><li>Adherence? </li></ul></ul>
  7. 7. Methods <ul><li>4 ART sites in Johannesburg inner-city were purposively selected from migrant dense areas: 2 government sites; 2 non-governmental </li></ul><ul><li>Desk-based literature and policy review ; </li></ul><ul><li>Semi-structured interviews with health care providers (n = 34); </li></ul><ul><li>1 focus group discussion with 8 refugee HIV counsellors; and </li></ul><ul><li>Cross-sectional survey questionnaire conducted with a random sample of citizen and migrant ART clients (n = 449). </li></ul>
  8. 8. <ul><li>Key findings </li></ul>
  9. 9. Health migrants? <ul><li>These individuals are not health migrants : </li></ul><ul><ul><li>Discovered their status in South Africa (80%); </li></ul></ul><ul><ul><li>Mostly first tested for HIV in South Africa (76%); </li></ul></ul><ul><ul><li>Came to South Africa for other reasons </li></ul></ul><ul><ul><ul><li>Qualitative follow up study; </li></ul></ul></ul><ul><ul><li>Have been here for a period of time before discovering their status. </li></ul></ul>
  10. 10. Continuity of treatment <ul><li>In this study, 20% of international migrants reported initiating ART in another country ….. </li></ul><ul><ul><li>Appears that other reasons (economic) are the reason for movement; </li></ul></ul><ul><ul><li>Further research needed – is access to ART (becoming) a determinant of migration? </li></ul></ul><ul><ul><ul><li>Qualitative follow up study; </li></ul></ul></ul><ul><ul><li>Continuity of treatment . </li></ul></ul>
  11. 11. Like South Africans, international migrants are most likely to test only when sick (Chi-squared; P = 0.122)
  12. 12. International migrant clients are no more likely than South Africans to not collect or not take their ART (Chi-squared; p = 0.404)
  13. 13. <ul><li>Only 22% of all non-citizens interviewed were accessing ART at government sites; </li></ul><ul><li>The difference between the two government sites can be explained by the differences in institutional policy . </li></ul>International migrants are accessing ART in the non-governmental sector Government sites Non-governmental
  14. 14. A dual healthcare system <ul><li>Non-citizens are referred out of the public sector and into the NGO sector : </li></ul><ul><ul><li>Reasons for this include not having a South African identity booklet and ‘ being foreign ’; </li></ul></ul><ul><ul><li>This goes against existing legislation. </li></ul></ul><ul><li>A dual healthcare system exists for the delivery of ART: public and NGO, presenting a range of challenges: </li></ul><ul><ul><li>Logistical issues : cross-referral, loss to follow up, workload pressure; </li></ul></ul><ul><ul><li>Falsification of documents … impact on adherence </li></ul></ul><ul><ul><li>The responsibility of the public sector is being met by NGO providers. </li></ul></ul>
  15. 15. Summary <ul><li>Whilst the numbers of international migrants in need of ART are small, they are significant ; </li></ul><ul><li>Existing protective legislation is not applied uniformly across public institutions; </li></ul><ul><li>The resultant dual healthcare system presents challenges ; and </li></ul><ul><li>HIV is a public health challenge : ensuring access to ART is upheld for all who need it within South Africa will have a population-level benefit. </li></ul>
  16. 16. Key recommendations <ul><li>The right to health for all migrants, regardless of status, must be upheld. </li></ul><ul><li>As is the case for South African citizens, campaigns must be implemented to encourage early HIV testing for non-citizens. </li></ul><ul><li>NDoH must work to ensure, through training, that protective frameworks and policies are applied uniformly across all public institutions. </li></ul><ul><li>There is a need for assessment and monitoring of ART access (continuity of treatment) given recent displacement and establishment of temporary camps and shelters. </li></ul>
  17. 17. Acknowledgements <ul><li>All study participants, both healthcare providers and ART clients </li></ul><ul><li>Study sites </li></ul><ul><ul><li>Support to the research and dissemination </li></ul></ul><ul><li>Forced Migration Studies Programme </li></ul><ul><ul><li>Fieldworkers (survey) </li></ul></ul><ul><ul><li>Dr. Ingrid Palmary </li></ul></ul><ul><li>Lawyers for Human Rights </li></ul><ul><li>Ford Foundation </li></ul>

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