Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority.

introductionGlobal migration policy discussions are increasingly driven by moral panics - public anxiety about issues thought to threaten the moral standards of society. This includes the development of two Global Compacts - agreed principles to guide an international response - for (1) "Refugees" and (2) "Safe, Regular and Orderly Migration." While the need to address migration and health is increasingly recognized at the global level, concerns are raised about if this will be reflected in the final Compacts. The Compacts focus on securitization, an approach that aims to restrict the movement of people, presenting potentially negative health consequences for people who move. Globally, concern is raised that migration-aware public health programming initiatives could be co-opted through a global health security agenda to further restrict movement across borders. This is particularly worrying in the Southern African Development Community (SADC) - a regional economic community associated with high levels of migration and the largest population of people living with HIV globally; this case is used to explore concerns about the health implications of the Global Compacts. DISCUSSION: Current HIV responses in SADC do not adequately engage with the movement of healthcare users within and between countries. This negatively affects existing HIV interventions and has implications for the development of universal HIV testing and treatment (UTT) programmes. Drawing on literature and policy review, and ongoing participant observation in policy processes, I outline how Global Compact processes may undermine HIV prevention efforts in SADC.

conclusionsThe global health imperative of developing migration-aware and mobility-competent health responses must not be undermined by moral panics; the resultant international policy processes run the risk of jeopardizing effective action at the local level. Globally, migration is increasingly recognized as a central public health concern, providing strategic opportunities to strengthen public health responses for all. Without mainstreaming migration, however, health responses will struggle. This is particularly concerning in SADC where HIV programmes - including UTT initiatives - will struggle, and key health targets will not be met. Globally, contextually appropriate migration-aware responses to health are needed, including and a specific focus on HIV programming in SADC.