Sexual and Reproductive Health in Southern Africa: Expanding Services and Rights to Migrants and Migration Affected Communities

“I am HIV-positive, and I have used anti-retroviral treatment before, but I have stopped taking the medication for a while now”, admitted a young herdboy  from Lesotho *.

During a door-to-door activity with adolescents and young people, an IOM change agent came across Katleho on pastures near Linotsing Clinic-Leribe, in Lesotho. A comprehensive sexuality education session with him was conducted and topics such as Gender based Violence, HIV/AIDS and Sexually Transmitted Infections were discussed.

The young man eventually disclosed his HIV status to the change agent and admitted that he had used anti-retroviral treatment but defaulted since he forgot to use them as prescribed. Through further candid exchanges with Katleho, the change agent was able to highlight the importance of adhering to medication, and the consequences that may be brought about by the improper use of the medication, including potential drug resistance, which may worsen his existing health condition. Katleho’s responsiveness to the change agent’s counselling resulted in an accompanied visit to the nearest clinic, and a return to his ARV treatment.

Sub-Saharan Africa has some of the greatest sexual and reproductive health  challenges, including high rates of unplanned pregnancies, maternal mortality and morbidity; unmet family planning needs; high prevalence of STIs, HIV,reproductive tract infections, cervical cancer, and; significant numbers ofclandestine/unsafe abortions.

In 2016, The International Organization for Migration (IOM), Save the Children Netherlands (SC) and the University of the Witwatersrand School of Public Health (WSPH), formed a consortium called the SRHR-HIV Knows No Borders”, thus collaborating to implement a holistic, regional project to improve sexual and reproductive health and HIV (SRH-HIV) amongst migrants.

This collective effort, which is implemented in six countries in southern Africa region (Lesotho, Malawi, Mozambique, South Africa, Eswatini and Zambia), includes migrants, adolescent and young people, sex workers, as well as people living in migration-affected communities.

The goal of the project is to improve sexual and reproductive health and HIV related outcomes amongst target populations in selected migration affected communitieswith a primary focus on border regions with high levels of mobility. To date, the project has reached 229,575 beneficiaries (including migrants, adolescents, young people and sex workers) with comprehensive SRHR-HIV information and through the community based referral system,. 8,092 people have received services ranging from HIV testing, family planning, initiation on HIV treatment (ART) as well as  services for survivors of sexual and gender based violence.

The project has engaged 1,470 community change agents , whose impeccable work is evident through stories of change among those who have been reached through the program, the increase in persons reached with comprehensive SRH-HIV services and a referral follow through rate of above 60% among clients referred from communities to local health facilities. Some of the activities undertaken by the change agents to reach beneficiaries include home visits, with consistent follow-up; community dialogues, awareness campaigns, mobile clinic outreaches and training of health care providers and gate keepers, mainly community, traditional & religious leaders, to ensure that barriers to access and use of SRHR-HIV services by the vulnerable groups are removed.

The project recognises that sustainable improvement in health outcomes involves working at multiple levels, i.e. community, local, national and regional. As such, IOM and implementing partners in the six countries of implementation engage in multiple forums to advocate for the maintenance of health rights for migrants, and the improvement of cross-border health systems.

The SRHR-HIV project is funded by the Kingdom of the Netherlands, and is ending in December 2020 but high potential for continuity.


*Note: Names are not real for confidentiality purpose. A consent form was completed but *Katleho denied to be taken a photo because of his vulnerability to his relatives.

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