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1.
Article in English | MEDLINE | ID: mdl-36011606

ABSTRACT

Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as "essential workers", including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.


Subject(s)
COVID-19 , Transients and Migrants , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Communicable Disease Control , Health Services Accessibility , Humans , Pandemics/prevention & control , SARS-CoV-2 , Vaccination
2.
Glob Public Health ; 7(1): 58-70, 2012.
Article in English | MEDLINE | ID: mdl-21360380

ABSTRACT

Southern Africa is associated with high HIV prevalence and diverse population movements, including temporary, circular movements between rural and urban areas within countries (internal migration), and movements across borders (international migration). Whilst most migration in southern Africa is associated with the search for improved livelihood opportunities in urban areas a small--but significant--number of people are forced to migrate to escape persecution or civil war. This paper utilises recent empirical studies conducted in South Africa to explore linkages between migration into urban areas and health, focusing on HIV. It is shown that the relationship between migration and HIV is complex; that both internal and international migrants move to urban areas for reasons other than healthcare seeking; and that most migratory movements into urban areas involve the positive selection of healthy individuals. Whilst healthy migration has economic benefits for rural sending households, the data uncovers an important process of return migration (internally or across borders) in times of sickness, with the burden of care placed on the rural, sending household. There is an urgent need for a comprehensive response that maintains the health of migrants in urban areas, and provides support to rural areas in times of sickness.


Subject(s)
Anti-HIV Agents/administration & dosage , Emigration and Immigration/statistics & numerical data , HIV Infections/epidemiology , Health Planning/organization & administration , Population Dynamics/statistics & numerical data , Africa, Southern/epidemiology , Anti-HIV Agents/standards , Anti-HIV Agents/supply & distribution , Emigration and Immigration/trends , HIV Infections/drug therapy , HIV Infections/prevention & control , Health Planning/standards , Health Policy , Humans , National Health Programs , Population Dynamics/trends , Prevalence , Rural Population/statistics & numerical data , Rural Population/trends , South Africa/epidemiology , Urban Population/statistics & numerical data , Urban Population/trends
3.
Article in English | MEDLINE | ID: mdl-21686331

ABSTRACT

This article is a review of the PhD thesis undertaken by Joanna Vearey that explores local government responses to the urban health challenges of migration, informal settlements, and HIV in Johannesburg, South Africa. Urbanisation in South Africa is a result of natural urban growth and (to a lesser extent) in-migration from within the country and across borders. This has led to the development of informal settlements within and on the periphery of urban areas. The highest HIV prevalence nationally is found within urban informal settlements. South African local government has a 'developmental mandate' that calls for government to work with citizens to develop sustainable interventions to address their social, economic, and material needs. Through a mixed-methods approach, four studies were undertaken within inner-city Johannesburg and a peripheral urban informal settlement. Two cross-sectional surveys - one at a household level and one with migrant antiretroviral clients - were supplemented with semi-structured interviews with multiple stakeholders involved with urban health and HIV in Johannesburg, and participatory photography and film projects undertaken with urban migrant communities. The findings show that local government requires support in developing and implementing appropriate intersectoral responses to address urban health. Existing urban health frameworks do not deal adequately with the complex health and development challenges identified; it is essential that urban public health practitioners and other development professionals in South Africa engage with the complexities of the urban environment. A revised, participatory approach to urban health - 'concept mapping' - is suggested which requires a recommitment to intersectoral action, 'healthy urban governance' and public health advocacy.


Subject(s)
Emigration and Immigration , Residence Characteristics , Social Environment , Urban Population , Academic Dissertations as Topic , Cross-Sectional Studies , HIV Infections/epidemiology , Humans , Socioeconomic Factors , South Africa/epidemiology , Urban Health , Urbanization
4.
Health Place ; 16(4): 694-702, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20400354

ABSTRACT

Developing country urban contexts present multiple challenges to those responsible for ensuring the good health of urban populations. These include urban growth, migration, informal settlements, intra-urban inequalities and - in some cases - high HIV prevalence. Using Johannesburg as a case study, this paper explores the complexities of the urban context by comparing the social determinants of urban health between migrant groups residing in the inner-city and a peripheral urban informal settlement. It is argued that any attempt to improve the health of urban populations in the context of migration and HIV requires understanding that 'place matters'.


Subject(s)
HIV Infections/epidemiology , Health Status Disparities , Poverty/statistics & numerical data , Transients and Migrants/statistics & numerical data , Urban Health/statistics & numerical data , Adult , Analysis of Variance , Chi-Square Distribution , Cross-Sectional Studies , Developing Countries/statistics & numerical data , Family Characteristics , Female , Health Services Needs and Demand , Health Surveys , Humans , Income/statistics & numerical data , Male , Residence Characteristics/statistics & numerical data , Social Environment , Socioeconomic Factors , South Africa/epidemiology , Statistics, Nonparametric , Urbanization
5.
Afr J AIDS Res ; 7(3): 361-74, 2008 Nov.
Article in English | MEDLINE | ID: mdl-25875464

ABSTRACT

Since the end of apartheid, patterns of migration into South Africa have shifted, and South Africa has become a destination for people from across the African continent and beyond - a small but important number of whom are refugees and asylum seekers. While South Africa has a protective, integrative, urban refugee policy, many of these individuals struggle to access the rights to which they are entitled, including healthcare. In addition, many lower-skilled international migrants are unable to legalise their stay in South Africa. As a result, international migrants often become part of the group of 'urban poor,' falling within the periphery of health and social welfare provision and relying on a survivalist livelihood within the informal economy. The health and wellbeing of an individual impact greatly on their ability to maintain a secure livelihood, and this becomes more difficult in the context of an HIV epidemic. This paper presents findings from a case study situated in the City of Johannesburg. The research made use of 1) 2006 survey data on migrant livelihood strategies in Johannesburg, 2) a study investigating non-citizens' access to antiretroviral treatment (ART) in the inner city, which included 3) a set of interviews conducted with migrant ART clients who were working in the city's informal economy. The findings indicate (a) the importance of the informal economy for migrants to Johannesburg; (b) the challenges that non-citizens face in accessing ART in the public sector in South Africa; and (c) the linkages between urban migrants' access to ART and their ability to maintain a survivalist livelihood. The paper argues that upholding people's right to ART for all who need it within South Africa will enable international migrants (including refugees and asylum seekers) to maintain an otherwise fragile survivalist livelihood, and this in turn will assist their self-reliance and integration into urban life. Recommendations are made to ensure that the right to healthcare is upheld for all in South Africa.

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