Migration, pastoralists, HIV infection and access to care: the nomadic Fulani of northern Nigeria.

The burden of HIV infection among the nomadic Fulani of northern Nigeria is unknown. Migration - a way of life for this population - is known to increase the rate of HIV transmission and may limit individuals' access to treatment and care. Many of Africa's other traditional, pastoral societies are similarly affected. This paper explores cultural practices and factors among the Fulani that may influence HIV transmission, vulnerability to infection, sustainability and challenges to treatment access, and avenues and models for outreach services; lastly, we proffer some solutions and recommendations. An extensive literature search with cross-referencing was done, and relevant publications on similar themes were reviewed. Three cases of Fulani nomads with HIV are presented to illustrate the challenge of providing a care continuum as well as to demonstrate successes when appropriate HIV interventions are employed. Patient interviews provide valuable insight and information on living and coping with HIV. Community mobility limits opportunities for counselling, testing and diagnosis, as well as HIV-related care access and maintenance. Consanguinity and certain cultural practices among the Fulani have clear amplification potential for HIV transmission. Treatment support through the use of coaches and life partners improves adherence to antiretroviral therapy (ART). Existing programmes for nomads afford opportunities for absorption and integration of HIV services. Nomadic communities should be provided with basic HIV-related services, including risk-reduction education and methods, counselling and testing, ART, medication adherence counselling, access to laboratory tests and health monitoring. These services should be taken to nomadic communities using novel approaches such as mobile units, extension services, case management, directly observed care, and treatment supporters linked to neighbouring health facilities in a hub-and-spoke model. Stronger collaborations are recommended between programmes for nomads and HIV services, and also between veterinary and public health services. Community participation and leadership should be encouraged to ensure the sustainability of HIV-related care delivery. More research is needed on the epidemiology and sociology of HIV infection and the best ways to provide services to hard-to-reach nomadic populations.