Abstract
Home to one fifth of all people living with HIV, South Africa carries the world’s heaviest burden of this disease. While a significant proportion of those infected are immigrants from other African high-prevalence countries, little is known about how these migrants engage with healthcare systems in shifting cultural and clinical settings. This article draws on fieldwork from migrant communities and twenty-one ethnographic life histories told by HIV-positive Mozambicans in a major South African HIV clinic. From their collective narratives, a range of structural vulnerabilities are found that limit immigrants’ access to, and proper integration within, healthcare services. These include perilous migration, xenophobia and deportation, exclusion and exploitation, language barriers, medical pluralism, cultural estrangement, social isolation, and the stigmas of being HIV-positive. In conjunction, these structural factors may delay treatment-seeking and inhibit drug adherence, which could increase rates of morbidity and mortality as well as contribute to viral mutation and antiretroviral drug resistance.
Highlights
Almost 37 million people currently live with HIV
While much research has been conducted on obstacles to healthcare integration and antiretroviral therapy (ART) – such as barriers to patient counselling and adherence to drug regimens – migrant populations are not well integrated into healthcare services and little is known about how migrant groups behave in regards to HIV within changing clinical and cultural landscapes
The ethnographic life histories described the circumstances of patients, in regards to living with HIV, and as African migrants living in South Africa
Summary
Almost 37 million people currently live with HIV. Around one fifth of them (7.2 million people) reside in South Africa, which has responded with one of the world’s most comprehensive public treatment programmes, providing antiretroviral drugs (ARVs) for 4.4 million people. This article locates stigma and identifies vulnerabilities to HIV among Mozambican immigrants in South Africa not merely in interpersonal behaviour, but in the (dys)functions of markets and institutions It does this by exploring structural avenues through which migrants are rendered vulnerable to HIV: perilous journeys, deportation and xenophobic violence, exclusion from public services, destitution and labour exploitation, low levels of education and language barriers, medical pluralism (co-consulting with traditional healers), social isolation in urban African immigrant enclaves, and the stigmas of living with HIV. These structural circumstances, I argue, compound to form both visible and invisible barriers to ART and the wider integration of African migrants into South African healthcare services. It was in this ambiance that I investigated the structural vulnerabilities of migrants
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