Gruchy Thea de, Vearey Jo
The African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa.
Afr J AIDS Res. 2020 Mar;19(1):57-68. doi: 10.2989/16085906.2019.1698624. Epub 2020 Mar 10.
Like many other countries, South Africa (SA) has committed to the Sustainable Development Goals that aim to "leave no-one behind", in efforts towards universal health coverage, and meeting the UNAIDS 90-90-90 targets through the implementation of universal test and treat (UTT) interventions. SA is associated with high levels of international and internal migration that, in certain contexts, are known to (1) increase the risk of acquiring HIV and (2) present challenges to HIV treatment access and continuity. Despite this, migration and mobility are not adequately considered in responses to HIV. As SA rolls out UTT programmes and antiretroviral treatment as prevention (TasP) interventions, including pre-exposure prophylaxis (PreP), there is an urgent need to ensure that these are migration-aware and mobility-competent. In SA, a key population that experiences a disproportionate HIV burden is international migrant farm workers living and working on commercial farms along the border with Zimbabwe. In this article, a social determinants of health approach is applied to explore the context within which this population struggles to access positive determinants of health, including the public health care system, and the implications of this for HIV programming. It is argued that, unless policies and programming become migration-aware and mobility-competent, UTT and TasP interventions will struggle to address the high burden of HIV among this population and, as a result, progress towards global health targets will be limited.
与许多其他国家一样，南非致力于实现可持续发展目标，这些目标旨在“不让任何人掉队”，努力实现全民健康覆盖，并通过实施普遍检测和治疗（UTT）干预措施来实现联合国艾滋病规划署的90-90-90目标。南非存在大量的国际和国内移民，在某些情况下，这些移民（1）感染艾滋病毒的风险增加，（2）在获得艾滋病毒治疗和保持治疗连续性方面面临挑战。尽管如此，在应对艾滋病毒的过程中，移民和流动问题并未得到充分考虑。随着南非推出UTT计划以及抗逆转录病毒治疗作为预防（TasP）干预措施，包括暴露前预防（PreP），迫切需要确保这些措施考虑到移民因素并具备应对流动情况的能力。在南非，艾滋病毒负担过重的一个关键人群是在与津巴布韦接壤边境的商业农场生活和工作的国际移民农场工人。在本文中，采用健康的社会决定因素方法来探讨这一人群在获取包括公共医疗保健系统在内的健康积极决定因素方面所面临的背景情况，以及这对艾滋病毒规划的影响。有人认为，除非政策和规划考虑到移民因素并具备应对流动情况的能力，否则UTT和TasP干预措施将难以解决这一人群中沉重的艾滋病毒负担，结果是在实现全球健康目标方面的进展将受到限制。
