1. MOBILITY AND VULNERABILITY TO HIV : A STRATEGY TO SEEK AND IMPROVE ACCESS TO HEALTH CARE SYMPOSIUM : BARRIERS TO MIGRANTS AND MOBILE POPULATIONS IN ACCESSING COMPREHENSIVE HIV SERVICES AND TREATMENT 20.07.2010 Fatou Maria DRAME, PhD Assistant Professor Gaston Berger University (SENEGAL)

2. OUTLINE INTRODUCTION I. WEST AFRICAN MOBILITY II. CROSS BORDER MOBILITY AND ACCESS TO HIV CARE III KEY CHALLENGES AND A REGIONAL RESPONSE CONCLUSION

3. INTRODUCTION UNDERSTANDING LINKAGES BETWEEN MOBILITY AND HIV -Flow of population: factor of diffusion of the epidemic ( generalied/ concentrated or low epidemic factor related to the growth of urban areas where high population density contribute to the expansion of the epidemics -Mobile persons : vulnerable groups UNDERSTANDING MOBILITY IN THE PERSPECTIVE OF A STRAGETY TO ACCESS CARE AND PREVENTION SERVICES Does mobility facilitate ou hinder access to care and prevention services ? Example focus on Senegal and its bordering countries

4. I.WEST AFRICAN MOBILITY West Africa mobility is Histotical and permanent : trans-saharian exchange, colonial structure, political et economic regional organisation (ECOWAS, UEMOA) Selective : young persons, men but more and more women, and fragile populations (context of political instability) Mobility facilitated by -Same cultural and social context: same language, cultural similarities and strong religious and family relationships across the border -Significant development of infrastructure: roads, bridges, communication, airport, etc.

5. 30 millions of Africans have change their residence between 1960 and 1990 In 1990’s 3% of the west african region population is a migrant. (2% for all Africa and 0,5% for European Union)

6. Cross border exchanges

7. II. CROSS BORDER MOBILITY AND ACCES TO HIV CARE * 6% of patient on ART in Bignona are from the Gambia (mars 2010) *10,5% of patient on ART treated at PTA of Ziguinchor come from Guinée Bissau (mai 2010) S elective attraction Bignona Gambia Ziguinchor G Bissau

8. Men Women Ziguinchor de 481 m à 3,5km 100 km Estimated Distance from patient community to ART service ( PTA in Ziguinchor) Preliminary results : More (+ )distance to health center increases, less (-) women are involved

9. Determinants : Unbalanced quality and accessility of ART services across the border Attraction of best services( Bignona for Gambia et Ziguinchor for Bissau) Communication facilities Family relationship Seeking for confidentialy

10. Insuffisant development of multi- actors partnership across the borders Lack of knowledge transfer and information sharing among health professional Not effective cross border platform for mutual experience sharing and learning between community and medical professional * Lack of formal and systemic collaboration or structured cross border programme on HIV III. KEY CHALLENGES AND A REGIONAL RESPONSE:

11. Initiating a regional and multi-focus response : The FEVE (Frontières et Vulnérabilités au VIH) project Intra country response CAP VERT GUINEE BISSAU GUINEE SENEGAL Target groups: PLWAS, marginalized populations, mobile population Main focus areas: cross borders regions, urban city Activities: Prevention activities Care and psycho social support Capacity building of medical and community services providers Impact mitigation( IGA) Operation

12. Some Results of FEVE projet 2008-2010: FSW: 500 in Cap Vert, 257 in G. Bissau, 1850 in Guinée Conakry, 2990 in Senegal : VCT, STI/ARV treatment and support PLHIV: Medical care to 329 HIV+ in G. Conakry / support for 851 HIV+ in G Bissau / Support and Care for 390 HIV+ in Senegal 32 Public health services are directly supported by the project …

13. Inter-country response: *Sharing of technical information and skills between services providers *Develop innovative strategies accross border to facilitate acces to care and support for marginalized and infected people *Cross border joint team to provide services *Intercountry training programme

14. CONCLUSION Mobility can be an expression of social network density, an expression of care opportunities How to define health ressource allocation? theoretical attraction / effective attraction Country programming ( programmatic and ressources) must integrate mobility dynamics and specificity of bordering regions Interventions in cross border areas need re- invention and adaptation of our strategies

15. THANK YOU FOR YOUR ATTENTION