Human Mobility and HIV Workshop - Full Summary
Human mobility is broadly defined as human movement of individuals or groups in space and time, and includes livelihood mobility, displacement, household fluidity, rural to urban migrations, and involuntary mobility such as trafficking for sexual exploitation or forced labor. The world’s displaced populations are at record highs, human trafficking is increasingly a global problem, and migration pressures are increasing for many, particularly those living in low-resource settings. Mobility can disrupt health care, endanger the health of individuals living with illness, and thwart efforts to contain and treat infectious diseases, including HIV.
Population mobility has been long recognized as an important factor in managing the prevention and treatment of HIV. Providing resources to accommodate mobility is critically important to advance knowledge and develop interventions to prevent HIV acquisition and sustain treatment efforts. As population mobility continues to accelerate worldwide, the National Institute of Mental Health (NIMH) recognizes the significant implications of these movement patterns on individual and population-level health wellbeing, and care provision. Among the most affected by human migration are people living with HIV (PWH), whose movement may facilitate disease transmission within and across populations and can hinder access and adherence to high-quality preventives and treatments.
To accelerate the fight against HIV, this workshop convened prominent researchers to share their perspectives on human mobility. The intent of the workshop was to advance evidence-based research and stimulate innovative solutions to alleviate physical and psychological symptoms among HIV positive and high incidence people among mobile populations. The presentations and discussions addressed mobility as it relates to the intersection of HIV acquisition, sex, and the type of mobility. Understanding higher-level mobility among individuals living with HIV is important for strategic HIV response and targeted care. Going forward, these populations may benefit from new therapeutic technologies such as longer-acting formulations of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) which reduce the need for mobile individuals to make repeated clinic visits.
The meeting was organized around four major themes:
- Human Mobility Across the Globe
- New Methodologies and Approaches to Understanding Mobility
- Personal Perspectives on Mobility
- Implications for Interventions
The first session included presentations on the influence of mobility on the HIV care continuum, including disrupting access to treatment and services, interrupting medication supply, lack of privacy to take ART, loss of social support, and unfamiliar settings and care systems. The importance of social and structural context for understanding human mobility and HIV was also discussed, highlighting the importance of the effect of isolation, stigma, discrimination, gender issues, and access to health care. Key takeaway messages included the need for tailored interventions for mobile PWH, the need for data sharing across intra- and inter-national borders, and the importance of collaborating with stakeholders.
The second session focused on new methodologies to study migration and its impact, including modeling strategies, and combining epidemiology and phylogenetics to elucidate the link between migration and HIV. Understanding migration patterns and behaviors provides opportunities to tailor interventions and successfully reach populations most at risk. Also included were discussions about technical aspects of measuring mobility, such as using available data from global positioning systems (GPS) to determine the geometry, size, and structure of human activity and the use of phylogeography to understand the spatial and temporal features of mobility. However, most current modeling methods lack spatial detail fine enough to support development of interventions for mobile people.
The third session addressed issues of mobility from the personal perspectives of Mr. Bernal Cruz of Rain International and Ms. Pari Mazhar of Cascadia Behavioral Healthcare and STIRY. This session included discussions about the many social and legal challenges faced by migrants. They presented their experiences in being labelled with an alien number and how they were able to demonstrate resilience in the face of the asylum process. Programs that support migrants’ integration into communities were discussed, and strategies for implementing effective and socio-culturally appropriate programs. effective.
The opening session on day two highlighted challenges and lessons learned from research on displaced persons in humanitarian settings. Important considerations include effective cultural adaptation, attention to translation/dialect, reaching priority populations, and ensuring continuity of care, which is challenging among migrants. Going forward, program developers and policy makers must consider scalability, sustainability, capacity, and cost effectiveness of interventions. This session also included lessons learned from the HIV and COVID-19 pandemics and the importance of addressing stigma, discrimination, and restrictive laws, policies, and practices against displaced populations. The presenters discussed marginally improved changes in the response to the COVID-19 pandemic for displaced persons compared to that of HIV.
The final session focused on implications for interventions. This included how climate-induced migration impacts food insecurity and leads to poor HIV health, and how structural interventions can improve food security and consumption, ART adherence, decrease depression and HIV stigma, and increase the odds of viral suppression. The session also included discussion of utilizing social networks to improve HIV prevention and care cascade outcomes in mobile men -- an example of how social and sexual network-based approaches can help to fill these gaps among hard-to-reach individuals such as highly mobile men. An intervention to improve retention in care for mobile women was presented, which was developed to improve poor engagement in and attrition from HIV care during the peripartum period. One presenter discussed how to optimize refugee-specific interventions to improve care, such as using a task-shifting approach to enhance access to HIV services and foster connection with social supports to enhance ART pick-up, clinic attendance, and viral loads.
The closing session included a very rich reflection on the many presentations and discussions throughout the meeting.