\u2018Leaving no one behind\u2019: reflections on the design of community-based HIV prevention for migrants in Johannesburg\u2019s inner-city hostels and informal settlements

Fiona Scorgie,Monique Oliff,Jo Vearey,Jonathan Stadler,Sinead Delany-Moretlwe,Emilie Venables,Matthew F Chersich

doi:10.1186/s12889-017-4351-3

Fiona Scorgie, Monique Oliff + Show 5 more

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https://doi.org/10.1186/s12889-017-4351-3

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Abstract

BackgroundUnmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors’ experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project.MethodsFormative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey (n = 1458) and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components.ResultsThe project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women (56%) than men (24%). Overwhelmingly, hostel residents were internal migrants from another province, and most felt ‘alienated’ from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women (70%) regarded their community as unsafe (cf. 47% of men). In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. ‘Community health clubs’ were established to build residents’ capacity to promote health and longer term well-being, and to initiate and sustain change within their communities.ConclusionsTo improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival.

Highlights

Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas
In sub-Saharan Africa – and in southern Africa in particular – rapid urbanisation is intersecting with generalised HIV epidemics, resulting in remarkably high prevalence and incidence in urban areas [2, 3], and even more so in areas of urban informal housing [4, 5]
In the city of Johannesburg, almost one quarter of the population reside in informal housing, which takes the form of unmanaged municipal hostels; informal shack settlements; illegally occupied, abandoned warehouses and factories; and subdivided flats controlled by slum landlords [9]

Summary

Introduction

Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors’ experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. In 2012, while 18.8% of the country’s reproductive population (15–49 years) was living with HIV, a prevalence of 29.9% was recorded in urban informal areas [7] This was higher than any other locality type, and double that of urban formal areas (14.7%) – a reminder that cities should not be thought of as homogenous spaces. Many are newcomers to the city, migrants in search of work These “hidden spaces” are characterised by high unemployment, poverty and overcrowding, alongside very high rates of HIV and TB co-infection [10]. Owing to a process of oscillating, or circular, migration, cities such as Johannesburg experience the continuous movement of populations between cities, smaller towns and rural areas [11]

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