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Migrant men and HIV care engagement in Johannesburg, South Africa

BMC Public Health volume 24, Article number: 435 (2024) Cite this article

Abstract

Background

South Africa (SA) has one of the highest rates of migration on the continent, largely comprised of men seeking labor opportunities in urban centers. Migrant men are at risk for challenges engaging in HIV care. However, rates of HIV and patterns of healthcare engagement among migrant men in urban Johannesburg are poorly understood.

Methods

We analyzed data from 150 adult men (≥ 18 years) recruited in 10/2020–11/2020 at one of five sites in Johannesburg, Gauteng Province, SA where migrants typically gather for work, shelter, transit, or leisure: a factory, building materials store, homeless shelter, taxi rank, and public park. Participants were surveyed to assess migration factors (e.g., birth location, residency status), self-reported HIV status, and use and knowledge of HIV and general health services. Proportions were calculated with descriptive statistics. Associations between migration factors and health outcomes were examined with Fisher exact tests and logistic regression models. Internal migrants, who travel within the country, were defined as South African men born outside Gauteng Province. International migrants were defined as men born outside SA.

Results

Two fifths (60/150, 40%) of participants were internal migrants and one fifth (33/150, 22%) were international migrants. More internal migrants reported living with HIV than non-migrants (20% vs 6%, p = 0.042), though in a multi-variate analysis controlling for age, being an internal migrant was not a significant predictor of self-reported HIV positive status. Over 90% all participants had undergone an HIV test in their lifetime. Less than 20% of all participants had heard of pre-exposure prophylaxis (PrEP), with only 12% international migrants having familiarity with PrEP. Over twice as many individuals without permanent residency or citizenship reported “never visiting a health facility,” as compared to citizens/permanent residents (28.6% vs. 10.6%, p = 0.073).

Conclusions

Our study revealed a high proportion of migrants within our community-based sample of men and demonstrated a need for HIV and other healthcare services that effectively reach migrants in Johannesburg. Future research is warranted to further disaggregate this heterogenous population by different dimensions of mobility and to understand how to design HIV programs in ways that will address migrants’ challenges.

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Introduction

South Africa has one of the highest rates of migration on the continent [1]. In urban Gauteng Province alone, an estimated 29% of the population is “internal” migrants who have changed residences within the country and 6% is international migrants who have crossed country borders [2]. Migration and mobility, both within and into South Africa, have been key drivers of the country’s HIV epidemic [3, 4]. While there are growing numbers of migrant women [5], the majority of migrants are men seeking work in urban centers [6, 7]. These men are often driven by a lack of employment opportunities [8] and shifts in climate affecting agricultural practices in rural areas [9,10,11], and they often retain strong ties to their homes of origin [8]. Migrant men in South Africa have borne twice the burden of HIV compared to non-migrant men with an HIV prevalence of ~ 25.9% [12]. Migrant men have been shown to be less likely to engage in HIV services, including HIV testing [13,14,15,16], pre-exposure prophylaxis (PrEP) [17, 18], and antiretroviral therapy (ART) [19, 20].

The associations between migration and HIV acquisition, care engagement, and HIV-related outcomes are complex and incompletely understood [5, 21]. Some research has shown that people already living with HIV are more likely to migrate [22, 23]. Other evidence shows that some migrants may be healthier when they leave their homes of origin, often called the “healthy migrant” hypothesis [24]. Migrants often have worse mental and physical health outcomes in their new destinations [21, 25]. Individuals who travel more frequently away from home have been shown to be at higher risk for acquiring HIV than those who travel less [26]. In addition, migration and mobility pose significant challenges to health systems which assume a stable catchment area. South Africa’s decentralized health system is ill-suited for facilitating people changing clinics because it is difficult to easily transfer patient data across facilities [27]. Migrants also face other intersecting psychosocial and structural challenges which affect HIV and healthcare engagement, such as the disruption of relocation [22], lifestyle changes [5], unstable or lack of employment [21], isolation and difficult living conditions [25], lack of residency or citizenship documentation [28], and fear and language issues [29]. While some migrants nonetheless seek care in South Africa’s public healthcare system [30], research suggests that international migrants may also access healthcare at sites that are community-based or religiously-affiliated, especially where there are no fees or requirements for identity documentation or residence status [31]. For male migrants, challenges in seeking and accessing care are compounded by internal and social constructs of masculinity, which impede care engagement in healthcare settings felt to be oriented towards women’s needs [32].

The heterogenous nature of population mobility and varying definitions of migration further complicate efforts to understand migration and healthcare engagement, especially across different settings and populations [33, 34]. For example, some studies focus on the temporal nature of mobility (e.g., seasonal migration [35]), while others focus on specific social reasons for mobility (e.g., market traders [36] or miners [37]), or spatial aspects of mobility, such as how distance traveled affects HIV acquisition risk [38, 39]. In addition, there are challenges accessing migrant men in research. For example, large trials to improve HIV testing uptake among men in South Africa have found substantial barriers to reaching men in communities with high mobility patterns [40]. A demographic surveillance study from rural South Africa showed that 69% of the adult population cohort migrated out of the study area at least once during a 13 year follow-up period [22]. Most of these men seek employment opportunities in cities in Gauteng Province, where Johannesburg is located, and yet research describing migrants within these urban destination sites remains limited and often comes from ethnographic rather than HIV studies [41, 42].

Movement into and within South Africa, particularly from rural to urban centers, continues to rise along with the country’s rapid socio-economic growth [22] and accelerating urbanization throughout the region [43]. There is a growing recognition of the need to make HIV care more accessible to migrants in order to achieve UNAIDS 95–95-95 goals [32]. Yet despite migrants’ vulnerability to HIV acquisition [39, 44] and susceptibility to poor health engagement [20, 45, 46], there are few recent studies that seek to describe urban South African migrants, document their rates of HIV, or understand their health seeking behaviors [47, 48]. In this study, we sought to understand these gaps by characterizing migrant men within a broader sample of men recruited at community venues in Johannesburg, Gauteng Province, for a study to understand men’s patterns of care engagement. Gauteng Province has the largest concentration of people living with HIV in South Africa, including an average HIV prevalence of 14.7% for men [49]. In this study, we aimed to analyze participants’ burden of HIV, rates of HIV testing, awareness and knowledge of PrEP, and overall healthcare utilization. We hypothesized that both internal and international migrants, compared to non-migrants, would be at a greater risk for acquiring HIV, and be less likely to engage in treatment and prevention services. Lastly, we hypothesized that migrants would be less likely than non-migrants to have ever visited a health facility, and that migrants without citizenship or permanent residency would be less likely to have ever visited a health facility, as compared to citizens or permanent residents.

Methods

This cross-sectional, migration-specific study was embedded within our team’s broader “Men’s Choice” study, which included a prospective cohort of 150 adult men recruited at community-based, non-healthcare sites in Johannesburg in October and November 2020. The goal of the “Men’s Choice” study was to understand men’s preferences for accessing HIV and other healthcare services in Johannesburg through a discrete choice experiment (DCE) survey [50]. The results of the DCE have been presented elsewhere [50, 51]. For this study, we administered a survey that preceded the DCE survey and included questions on men’s migration patterns, HIV care utilization, and socio-demographic measures.

Participants, study setting, and procedures

Five Johannesburg recruitment sites in the Hillbrow, Midrand, Woodmead and Roodeport areas were chosen following a period of observation and discussion with community stakeholders. These sites (factory, building materials store, taxi rank, homeless shelter, and public park) were selected to represent a range of locations where men go for work, transit, shelter, and leisure. We chose to focus on sites outside of healthcare facilities in order to reach men who may not seek care at traditional healthcare settings. Recruitment occurred during the Covid-19 pandemic-related restrictions. Therefore, we used a convenience sampling method in which team members recruited available and interested participants by directly distributing study flyers at some sites (taxi rank, public park) or by asking leadership at some sites (homeless shelter, factory site, building materials store) to distribute flyers on the team’s behalf. These flyers gave information about the study and invited men to contact the study team if they were interested in participating. Those men who made contact were then given further information and taken through the consent process over the phone. The team checked telephone numbers, names, and identifiers to ensure that the same participant did not enroll twice. The study was conducted in English, isiZulu, Setswana, isiXhosa, and Sesotho. Several of the first survey interviews were completed over the phone, but as restrictions lifted in later 2020, survey interviews were then completed face-to-face. After completing the survey, participants were reimbursed for their time with a ZAR150 (~ USD10) electronic shopping voucher, sent directly to the participant’s cell phone number.

Eligibility

We included men who were 18 years or older, willing to participate in a 2-h survey (including the DCE), and able to provide informed consent. Given Covid-19 pandemic restrictions, participants were also required to have access to a cell phone number so that informed consent and, if necessary, survey interviews could be conducted telephonically. Men were excluded from the study if they were believed to be intoxicated at the time of consent (in which case, they were invited to return the following day), unable to understand the study information, or had previously enrolled in the study.

Measures and study design

For the “Men’s Choice” study, we used the Theory of Triadic Influence to inform the full selection of measures for the socio-demographic survey in order to understand correlates of HIV-related behavior, focusing on individual, interpersonal, and structural factors relevant for behavior change [52]. For this migration-specific study to understand the role of migration and mobility in this population, questions in the socio-demographic survey included location of birth (South African province or country outside South Africa), duration of time in Gauteng, if and where participants moved in the past two years (between districts, provinces, or countries), reason for moving in the past two years, if applicable, and current residency status in South Africa (permanent resident or citizen, temporary or long-term visa holder, asylum-seeker with or without documentation). We also assessed educational status, relationship status, and employment status. The list of socio-demographic survey measures which we report in this manuscript is shown in Additional file 1: Appendix Table 1. These measures included the frequency of health facility visits; ever testing for HIV and frequency of testing for HIV; self-reported HIV status; and awareness and knowledge of PrEP.

Statistical methods

We defined internal migrant as South African men born outside of Gauteng Province, and international migrants as men born outside South Africa. We chose to define migrants based on their location of birth to broadly capture men who traveled to Gauteng Province at some point in their lifetime. The International Organization for Migration similarly defines the term “migrant” broadly to encompass “the common lay understanding of a person who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons” [53]. We distinguished between men born within and outside of South Africa because these groups may have different HIV and other healthcare experiences in South Africa based on factors such as xenophobia [54], language [19], identification documentation, and citizenship status [28]. We also recognized that internal migrants and international migrants are both heterogenous groups. Therefore, we sought to measure other aspects of migration and mobility, including length of time in Johannesburg, reasons for moving, travel in the past two years, and residency status.

We estimated the prevalence of internal migrants and international migrants by calculating the proportion of each of these categories among all participants. We used Fisher’s exact tests to assess associations between migration factors and HIV and health utilization outcomes. Specifically, we compared self-reported HIV status, HIV testing in the past year, and PrEP knowledge between internal migrants and non-migrants and between international migrants and non-migrants. We used Kruskal–Wallis tests to compare age across different migrant groups and to assess for associations between HIV positivity and age. We used Fisher’s exact tests to compare the proportion of men ever visiting a health facility between South African citizens or permanent residents and men without permanent residency or citizenship. In addition, we used logistic regression to predict HIV status by migration history. For all statistical tests, we assessed significance at the 0.05 level.

Ethics

The ethics committees at the University of the Witwatersrand (M191068), Mass General Brigham (Harvard University) (2020P002251), and Boston University (H-40529) approved the study. All participants provided written informed consent. Study data were collected and managed using Research Electronic Data Capture (REDCap), a secure, web-based tool.

Results

Socio-demographic characteristics of migrants

In our sample of 150 men, nearly two thirds (62%) were migrants. As shown in Table 1, two fifths (60) of these migrants were internal migrants and one fifth (33) were international migrants. Internal migrants had a median age of 38 years (IQR 32–46 years), and international migrants had a median age of 40 years (IQR 30–42 years). Non-migrants were younger than both internal migrants (Kruskal–Wallis test, p = 0.0001) and international migrants (Kruskal–Wallis test, p = 0.0012), with a median age of 30 (IQR 25–35). Internal migrants represented all South African provinces outside of Gauteng, with the highest proportion born in Limpopo, followed by KwaZulu-Natal. All international migrants reported being from other countries on the African continent, with three fourths (25/33) from Zimbabwe. Most participants had at least a secondary level of education, although international migrants were more likely to have vocational training (21.2%) as compared to non-migrants (3.5%, p = 0.020). Most migrants were in a relationship, but the majority did not live with their primary partner. The majority (85%) of all migrants reported living in Gauteng Province for more than one year, and just under half of all migrants had lived in Gauteng for more than ten years. Only two of the 33 international migrants (6.3%) reported being a permanent resident or citizen of South Africa. Approximately 16% (5/33) international migrants reported holding a visa for South Africa, whereas the remainder of international migrants (78%) reported seeking asylum.

Table 1 Recruitment site and socio-demographic characteristics of participants by migrant status (Total N = 150)
Full size table

Of the migrants who reported on their reason for moving to Gauteng in the past two years (N = 18), over half cited seeking or finding employment, followed by family reasons or an educational opportunity. Within this subset of 18 participants, as shown in Fig. 1, 70% migrants who moved to seek employment reported being currently unemployed, and all migrants reporting moving to Gauteng for family or educational reasons reported unemployment as well.

Fig. 1
figure 1

Employment among migrants reporting a reason for moving to Gauteng in the past two years. The vertical axis represents the number of participants for a total of N = 18 who responded when asked for their reason for moving to Gauteng in the past two years

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HIV status

Out of the 137 participants who chose to report their HIV status, 17 reported living with HIV. As shown in Fig. 2, of the 54 internal migrants who reported on their HIV status (90.0% all internal migrants), 11 internal migrants reported living with HIV, representing 20.4% (11/54) internal migrants who reported on their status. In contrast, of the 52 men from Gauteng who reported on their HIV status (91.2% all men from Gauteng), 3 reported living with HIV (5.8%) (p = 0.042). A logistic regression predicting HIV status among internal migrants as compared to men from Gauteng resulted in an odds ratio of 4.2 (95%CI = [1.1,16.0], p = 0.037). A logistic regression predicting HIV status among internal migrants as compared to men from Gauteng, controlling for age, resulted in an odds ratio of 3.0 (95%CI = [0.7,12.0], p = 0.125). Among the 31 (93.9%) international migrants reporting on their HIV status (93.9% of international migrants), 3 (9.7%) reported living with HIV. There was no difference in self-reported HIV status between international migrants and non-migrants. Among the 137 participants reporting on their HIV status, those reporting living with HIV were more likely to be older (median age 42 years) than those reporting not living with HIV (median age 34 years) (Kruskal–Wallis test, p = 0.0038).

Fig. 2
figure 2

Self-reported HIV status among participants reporting on their HIV status (total N = 137). Using a Fisher's exact test to compare HIV status between internal migrants and non-migrants, 20.4% internal migrants who reported on their HIV status (N = 54) reported living with HIV, whereas 5.8% non-migrant men who reported on their HIV status (N = 52) reported living with HIV (p = 0.042). In a logistic regression model controlling for age, this difference in self-reported HIV status between internal migrants and non-migrants was no longer significant

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HIV care cascade engagement and PrEP knowledge

Almost all participants reported ever testing for HIV (94.6%), with no statistically significant difference in ever testing between non-migrants as compared to either migrant group. (See Table 2) Nearly two thirds of all men tested in the past year, again with no difference between non-migrants as compared to either migrant group. Most men reported “No” or “Unsure” when asked if they had heard of PrEP (84.7%), with similar proportions of internal migrants and international migrants reporting this. When asked what PrEP does, nearly a third of non-migrants answered correctly that it prevents HIV, versus 20.4% internal migrants and 12.0% of international migrants who answered this correctly.

Table 2 HIV testing and PrEP knowledge, comparing migrants to non-migrants
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Residency status and overall healthcare utilization

As shown in Table 3, among all men who reported on their migration status as well as their healthcare utilization (N = 112), the proportions of internal migrants, international migrants, and non-migrants reporting ever visiting a health facility were similar. Among participants who reported on their residency status as well as their healthcare utilization (N = 110), 28.6% men without permanent residency reported never visiting a health facility as compared to 10.6% citizens/permanent residents (p = 0.073).

Table 3 Healthcare utilization among all participants by migrant status (total N = 112) and residency status (total N = 110). We used Fisher's exact tests to compare ever having visited a health facility by migrant status and by residency status
Full size table

Discussion

In this study of men in Johannesburg, we found that migrants comprised approximately two thirds of our sample, with nearly twice as many internal migrants as compared to international migrants. These proportions are higher than estimates for the proportion of migrants in the province overall, likely reflecting that these recruitment sites, which provide shelter, work, and transit opportunities, attract a disproportionately high number of migrants. Of the participants reporting on their HIV status, a fifth of internal migrants reported living with HIV, while 10% of international migrants and 6% of non-migrants reported living with HIV. Rates of ever testing for HIV were high for all participants, though all participants had low awareness and knowledge of PrEP. Most men reported visiting a health facility, although almost a third of migrants without South African permanent residency or citizenship reported never visiting a health facility at any point in their lifetime.

While our study was not designed to representatively sample migrants within Johannesburg, our finding of a high proportion of internal migrants from Limpopo may support evidence that economic opportunity remains a major driver of migration and mobility within South Africa [38, 55, 56]. Limpopo is South Africa’s fifth most populous province [57], but it has one of the highest rates of poverty in the country [58]. Our high representation of international migrants from Zimbabwe is unsurprising given that there are an estimated one million Zimbabweans in South Africa who migrate for factors including economic opportunities and political unrest in their home country [56]. Within our small sample of men who reported on their reason for moving to Gauteng in the past two years, most moved to Gauteng for employment opportunities. Yet over 80% internal migrants and over half of the international migrants in our sample reported having no current formal or informal (e.g., temporary “piece work” arrangements with payment by unit produced) employment. Despite Johannesburg’s reputation as the “City of Gold,” the economic landscape for migrants remains challenging, with problems including persistent electricity cuts and job losses in the construction, manufacturing, and mining industries [59, 60]. International migrants may face additional hurdles due to new South African laws restricting employment of foreign workers [61]. In addition, Covid-related restrictions during the time of this study further tightened job opportunities and exacerbated vulnerabilities for those working in South Africa’s informal labor sector [62, 63].

It is notable that a small proportion (5/57 or 8.8%) of non-migrants reported living outside of Gauteng in the past two years and that 7/57 (12.3%) of non-migrants reported living in Gauteng for less than ten years. This suggests that although these men are not migrants in terms of their birthplace, they are nonetheless mobile in terms of where they have lived throughout their lifetime. Mobility is associated with heightened HIV risk and poor HIV treatment outcomes due to factors such as interruptions in HIV services and challenges transferring clinics [64]. It will be important for future research to further understand the ways in which mobility and migration overlap in affecting HIV risk and HIV care engagement for men, as well as tease apart the factors that may be uniquely associated with migration or mobility alone.

Our unadjusted analysis found that internal migrant men were more likely to be living with HIV than men from Gauteng. However, this difference in self-reported HIV status was not found to be significant in our logistic regression model when controlling for age. We found that internal migrant men were older than non-migrants, and older men were more likely to be living with HIV. Prior research has also shown an association between older men and internal migration [46] and between older men and HIV infection [65,66,67]. In addition, prior research has demonstrated an association between migration and higher HIV risk and prevalence [5, 26, 39]. Data show that older men may be less likely to test [68,69,70] and less likely to know their HIV status as compared to younger men [71]. Given that we relied upon self-report for determining HIV status in this study, our data may have under-estimated the proportion of all participants living with HIV, and particularly for older migrant men. Also, the confidence intervals in our logistic regression models were large, and it is possible that our relatively small sample size limited our ability to detect a significant difference in HIV status between internal migrants and non-migrants. Nonetheless, our findings that 20% of internal migrants and 10% of international migrants reported living with HIV highlight the need for HIV services that are inclusive of migrants’ needs. For example, ensuring sufficient interpreter services to account for the range of languages spoken throughout and outside South Africa may address potential language barriers for migrants in clinical settings [46].

Our finding of high rates of ever testing for HIV among all participants may reflect South Africa’s overall gains in HIV testing [72]. Yet this national progress has been uneven among different populations [73]. Approximately a third of participants had not tested for HIV in the past year, despite the fact that testing at least annually has been shown to reduce the burden of undiagnosed HIV [13], and testing remains an important entry point for engagement in HIV care [74,75,76]. However, it may be difficult to interpret these data in the setting of Covid-related restrictions, which likely had an impact on HIV testing and other healthcare engagement for all participants during the year preceding this study [62].

Despite overall high rates of ever HIV testing, all participants in our cohort had low awareness of and low knowledge of PrEP. This may be suggestive of general gaps in PrEP awareness [77, 78] and knowledge [79] in South Africa, despite South Africa’s efforts to promote PrEP use through existing services and differentiated service delivery models [80]. In addition, although migrant men are considered a key population in need of targeted HIV services [81, 82], there are few PrEP programs reaching men more broadly [83, 84], and none to our knowledge targeting migrant men specifically. In addition, more than a quarter of men without permanent residency or citizenship reported never visiting a health facility. While it is South African policy that healthcare should be provided in the public sector to all who need it, barriers to healthcare for non-nationals may include fear of exposing one’s undocumented status, stigma for being a non-citizen, or the potential for healthcare fees [28]. These barriers not only impact migrants themselves but may also impede South Africa’s ability to curb its HIV epidemic. For example, neighboring Botswana provides free ART for all citizens, but despite having one of the highest levels of viral suppression globally, HIV incidence remains > 1% per year in adults 15 to 49 [85]. In Botswana, the need to close gaps in persistent HIV incidence has led to calls to expand free ART for all immigrants as well as citizens [85, 86].

Taken together, our findings have important implications for the design of health and HIV programs in South Africa, as well as for other countries with growing rates of migration. In order to close the remaining gaps in reaching UNAIDS targets [87], it is imperative to engage migrant men in HIV services. There is also a need to better understand and address migrants’ knowledge of and attitudes toward PrEP [47, 48] in order to design PrEP programs that include them [81, 88]. Existing research on HIV care for migrants in Johannesburg has focused on international migrants [28, 31], who receive justified national and international attention for challenges that may include xenophobia [89], language barriers, and lack of permanent residency or citizenship status [90, 91]. However, our study highlights that internal migrants also have high rates of HIV and may warrant targeted attention to ensure that they are reached by HIV services.

Our study is cross-sectional and thus limited in that it represents a population of migrant men at one point in time. In addition, our study recruited from community locations in Johannesburg to find men who may not commonly access healthcare services, so our findings may not be generalizable to migrants in other parts of the province or country. We defined “migrant” as born in a province or country outside of Gauteng. This approach, focusing on the spatial dimension of migration, is similar to what has been used in several other studies involving migrants [12, 19, 92]. However, we acknowledge inherent limitations to this approach, as temporal dimensions of mobility (e.g., the amount of time spent in a particular location or seasonal travel) and social dimensions of mobility (e.g., the reason for travel) may contribute to a more nuanced understanding of migrant and mobile populations [7, 34, 39]. We conducted our study in English, isiZulu, Setswana, and isiXhosa, and Sesotho, but we were unable to use all potential first languages for migrants. Response rates were variable for some survey items, such as healthcare utilization, residency status, and reason for migration, which limits our ability to interpret these data. In particular, data on ART use were not obtained due to a data collection error, so we were unable to assess this aspect of care engagement for participants living with HIV. This study focused on HIV and overall healthcare engagement, but future research may consider more deeply the impact of trauma and mental health care as an important need within this population [93]. Lastly, our sample size of 150 participants may not have been sufficient to detect meaningful differences in HIV status and healthcare utilization among migrant and non-migrant populations; future larger studies may detect these differences, if present.

Conclusions

Our study revealed a high proportion of migrants within our community-based sample of men and demonstrates a need for HIV and other healthcare services that effectively engage migrant men in Johannesburg. Future research is warranted to further explore potential differences in HIV prevalence and healthcare usage among migrant and non-migrant populations, as well as to further disaggregate migrant populations by different dimensions of mobility. We anticipate that our findings, as well as further research among different migrant populations, will have relevance not only for South African’s health system and policies, but also for other African countries experiencing quickly growing rates of migration and urbanization [94].

Availability of data and materials

All study data and materials are available upon request by emailing the corresponding author.

References

  1. Bell M, Charles-Edwards E, Ueffing P, Stillwell J, Kupiszewski M, Kupiszewska D. Internal Migration and Development: Comparing Migration Intensities Around the World. Popul Dev Rev. 2015;41(1):33–58.

    Article  Google Scholar 

  2. 2016 Community Survey [Internet]. Gauteng City-Region Observatory. 2016. Available from: https://africacheck.org/fact-checks/factsheets/factsheet-domestic-migration-south-africa. Cited 2021 Apr 8.

  3. Jochelson K, Mothibeli M, Leger JP. Human Immunodeficiency Virus and Migrant Labor in South Africa. Int J Health Serv. 1991;21(1):157–73.

    Article  CAS  PubMed  Google Scholar 

  4. Lurie MN, Williams BG, Zuma K, Mkaya-Mwamburi D, Garnett GP, Sweat MD, et al. Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. AIDS. 2003;17(15):2245–52.

    Article  PubMed  Google Scholar 

  5. Camlin CS, Charlebois ED. Mobility and its Effects on HIV Acquisition and Treatment Engagement: Recent Theoretical and Empirical Advances. Curr HIV/AIDS Rep. 2019;16(4):314–23.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Camlin CS, Hosegood V, Newell ML, McGrath N, Bärnighausen T, Snow RC. Gender, Migration and HIV in Rural KwaZulu-Natal, South Africa. Myer L, editor. PLoS ONE. 2010;5(7):e11539.

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  7. Collinson M, Wolff B, Tollman S, Kahn K. Trends in internal labour migration from the rural Limpopo Province, male risk behaviour, and implications for spread of HIV/AIDS in rural South Africa. 2010;20.

  8. Collinson MA, Tollman SM, Kahn K. Migration, settlement change and health in post-apartheid South Africa: Triangulating health and demographic surveillance with national census data1. Scand J Public Health. 2007;35(69_suppl):77–84.

    Article  Google Scholar 

  9. Mastrorillo M. Climate Change and Migration South Africa [Internet]. Climate and Migration Coalition. 2019. Available from: http://climatemigration.org.uk/climate-change-and-migration-in-south-africa. Accessed 6 Feb 2024.

  10. Lottering SJ, Mafongoya P, Lottering R. The Impacts of Drought and the Adaptive Strategies of Small-Scale Farmers in uMsinga, KwaZulu-Natal. South Africa J Asian Afr Stud. 2021;56(2):267–89.

    Article  Google Scholar 

  11. Migration Data in the Southern African Development Community (SADC) [Internet]. Migration Data Portal. 2021. Available from: https://migrationdataportal.org/regional-data-overview/southern-africa. Cited 2021 Apr 9.

  12. Lurie MN, Williams BG, Zuma K, Mkaya-Mwamburi D, Garnett GP, Sturm AW, et al. The Impact of Migration on HIV-1 Transmission in South Africa: A Study of Migrant and Nonmigrant Men and Their Partners. Sex Transm Dis. 2003;30(2):149–56.

    Article  PubMed  Google Scholar 

  13. Kranzer K, van Schaik N, Karmue U, Middelkoop K, Sebastian E, Lawn SD, et al. High Prevalence of Self-Reported Undiagnosed HIV despite High Coverage of HIV Testing: A Cross-Sectional Population Based Sero-Survey in South Africa Landay. A, editor. PLoS ONE. 2011;6(9):e25244.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  14. Camlin CS, Ssemmondo E, Chamie G, El Ayadi AM, Kwarisiima D, Sang N, et al. Men “missing” from population-based HIV testing: insights from qualitative research. AIDS Care. 2016;28(sup3):67–73.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Larmarange J, Diallo MH, McGrath N, Iwuji C, Plazy M, Thiébaut R, et al. The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu-Natal (South Africa). J Int AIDS Soc. 2018;21(Suppl 4):e25128.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tanser F, Bärnighausen T, Vandormael A, Dobra A. HIV treatment cascade in migrants and mobile populations. Curr Opin HIV AIDS. 2015;10(6):430–8.

    Article  PubMed  Google Scholar 

  17. Bärnighausen K, Geldsetzer P, Matse S, Hettema A, Hughey AB, Dlamini P, et al. Qualitative accounts of PrEP discontinuation from the general population in Eswatini. Cult Health Sex. 2021;23(9):1198–214.

    Article  PubMed  Google Scholar 

  18. Koss CA, Ayieko J, Mwangwa F, Owaraganise A, Kwarisiima D, Balzer LB, et al. Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda. Clin Infect Dis. 2018;67(12):1853–60.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Faturiyele I, Karletsos D, Ntene-Sealiete K, Musekiwa A, Khabo M, Mariti M, et al. Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study. BMC Public Health. 2018;18(1):668.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to Antiretroviral Adherence for Patients Living with HIV Infection and AIDS in Botswana. JAIDS J Acquir Immune Defic Syndr. 2003;34(3):281–8.

    Article  PubMed  Google Scholar 

  21. Ginsburg C, Bocquier P, Béguy D, Afolabi S, Kahn K, Obor D, et al. Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data. BMC Public Health. 2018;18(1):918.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dzomba A, Kim HY, Tomita A, Vandormael A, Govender K, Tanser F. Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017). BMC Public Health. 2022;22(1):1141.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Anglewicz P, VanLandingham M, Manda-Taylor L, Kohler HP. Migration and HIV infection in Malawi. AIDS. 2016;30(13):2099–105.

    Article  PubMed  Google Scholar 

  24. Anglewicz P, VanLandingham M, Manda-Taylor L, Kohler HP. Health Selection, Migration, and HIV Infection in Malawi. Demography. 2018;55(3):979–1007.

    Article  PubMed  Google Scholar 

  25. Capazario B, Kollamparambil U. Mental and Physical Health Effect of Rural-Urban Migration in South Africa: A Quasi-Experimental Impact Evaluation Study. J Dev Stud. 2022;58(9):1732–49.

    Article  Google Scholar 

  26. McGrath N, Eaton JW, Newell ML, Hosegood V. Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa. Lancet HIV. 2015;2(6):e252–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Clouse K, Vermund SH, Maskew M, Lurie MN, MacLeod W, Malete G, et al. Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa. JAIDS J Acquir Immune Defic Syndr. 2017;74(4):383–9.

    Article  PubMed  Google Scholar 

  28. Shearer K, Clouse K, Meyer-Rath G, MacLeod W, Maskew M, Sanne I, et al. Citizenship status and engagement in HIV care: an observational cohort study to assess the association between reporting a national ID number and retention in public-sector HIV care in Johannesburg, South Africa. BMJ Open. 2017;7(1):e013908.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KKV, Rodriguez-Cruz A, et al. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDs. 2021;35(8):288–307.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Manji K, Perera S, Hanefeld J, Vearey J, Olivier J, Gilson L, et al. An analysis of migration and implications for health in government policy of South Africa. Int J Equity Health. 2023;22(1):82.

    Article  PubMed  PubMed Central  Google Scholar 

  31. McCarthy K, Chersich MF, Vearey J, Meyer-Rath G, Jaffer A, Simpwalo S, et al. Good treatment outcomes among foreigners receiving antiretroviral therapy in Johannesburg South Africa. Int J STD AIDS. 2009;20(12):858–62.

    Article  CAS  PubMed  Google Scholar 

  32. Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, et al. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc. 2022;25(3):e25889.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Thorp M, Bellos M, Temelkovska T, Mphande M, Cornell M, Hubbard J, et al. Mobility and ART retention among men in Malawi: a mixed-methods study. 2023.

    Google Scholar 

  34. Camlin CS, Charlebois ED. Mobility and its Effects on HIV Acquisition and Treatment Engagement: Recent Theoretical and Empirical Advances. Curr HIV/AIDS Rep. 2019;16(4):314–23.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Weine SM, Kashuba AB. Labor Migration and HIV Risk: A Systematic Review of the Literature. AIDS Behav. 2012;16(6):1605–21.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Camlin CS, El Ayadi AM, Kwena ZA, McFarland W, Johnson MO, Neilands TB, et al. High Mobility and HIV Prevalence Among Female Market Traders in East Africa in 2014. J Acquir Immune Defic Syndr 1999. 2017;74(5):e121-8.

    Article  Google Scholar 

  37. Semá Baltazar C, DeLima YV, Ricardo H, Botão C, Chitsondzo Langa D, da Costa P, et al. HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: The need for increasing awareness and knowledge. Caylà JA, editor. PLOS ONE. 2020;15(4):e0231303.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Oosthuizen M, Pranushka N. University of Cape Town, School of Economics, Development Policy Research Unit. Internal migration to the Gauteng province. Cape Town: Development Policy Research Unit, University of Cape Town; 2004.

    Google Scholar 

  39. Dobra A, Bärnighausen T, Vandormael A, Tanser F. Space-time migration patterns and risk of HIV acquisition in rural South Africa. AIDS. 2017;31(1):137–45.

    Article  PubMed  Google Scholar 

  40. Floyd S, Shanaube K, Yang B, Schaap A, Griffith S, Phiri M, et al. HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial. Geng EH, editor. PLOS Med. 2020;17(4):e1003067.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Musariri L, Moyer E. A black man is a cornered man: migration, precarity and masculinities in Johannesburg. Gend Place Cult. 2021;28(6):888–905.

    Article  Google Scholar 

  42. Gordon D. Migrant Women of Johannesburg: life in an in-between city by Caroline Wanjiku Kihato. Transform Crit Perspect South Afr. 2015;89(1):123–6.

    Google Scholar 

  43. United Nations. World urbanization prospects: the 2018 revision. Department of Economic and Social Affairs, Population Division. 2019.

    Google Scholar 

  44. Olawore O, Tobian AAR, Kagaayi J, Bazaale JM, Nantume B, Kigozi G, et al. Migration and risk of HIV acquisition in Rakai, Uganda: a population-based cohort study. Lancet HIV. 2018;5(4):e181–9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Taylor BS, Garduño LS, Reyes EV, Valiño R, Rojas R, Donastorg Y, et al. HIV Care for Geographically Mobile Populations: HIV C ARE FOR G EOGRAPHICALLY M OBILE P OPULATIONS. Mt Sinai J Med J Transl Pers Med. 2011;78(3):342–51.

    Article  Google Scholar 

  46. Ginsburg C, Collinson MA, Gómez-Olivé FX, Gross M, Harawa S, Lurie MN, et al. Internal migration and health in South Africa: determinants of healthcare utilisation in a young adult cohort. BMC Public Health. 2021;21(1):554.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Scorgie F, Vearey J, Oliff M, Stadler J, Venables E, Chersich MF, et al. ‘Leaving no one behind’: reflections on the design of community-based HIV prevention for migrants in Johannesburg’s inner-city hostels and informal settlements. BMC Public Health. 2017;17(S3):482.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health. 2021;tmi:13560.

    Google Scholar 

  49. Kim H, Tanser F, Tomita A, Vandormael A, Cuadros DF. Beyond HIV prevalence: identifying people living with HIV within underserved areas in South Africa. BMJ Glob Health. 2021;6(4):e004089.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Pascoe S, Govathson C, Mngadi Ncube S, Ngcobo N, Nardell MF, Katz IT, et al. Fast and friendly is key to keeping men on HIV treatment! - Results from a discrete choice experiment to understand men’s preferences in Johannesburg, South Africa for HIV treatment services. Oral Presentation presented at: International AIDS Society; 2021.

    Google Scholar 

  51. Pascoe S, Mngadi-Ncube S, Ngcobo N, Govathson C, Letswalo D, Nardell M, et al. Understanding HIV and health care utilisation among men in Gauteng, South Africa. 2021.

    Google Scholar 

  52. Flay B, Snyder F, Petraitis J. The Theory of Triadic Influence. In: DiClemente RJ, Crosby RA, Kegler MC, editors. Emerging theories in health promotion practice and research. 2nd ed. New York: Jossey-Bass; 2009.

    Google Scholar 

  53. IOM Definition of “Migrant”. IOM UN Migration. 2019. Available from: https://www.iom.int/who-migrant-0. Cited 2022 Nov 16.

  54. Mukumbang FC, Ambe AN, Adebiyi BO. Unspoken inequality: how COVID-19 has exacerbated existing vulnerabilities of asylum-seekers, refugees, and undocumented migrants in South Africa. Int J Equity Health. 2020;19(1):141.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Six Charts Explain South Africa’s Inequality. International Monetary Fund. 2020. Available from: https://www.imf.org/en/News/Articles/2020/01/29/na012820six-charts-on-south-africas-persistent-and-multi-faceted-inequality. Cited 2023 Jan 20.

  56. Mathekga R. Migration crisis in Southern Africa. GIS; 2022 Apr. Available from: https://www.gisreportsonline.com/r/zimbabwe-immigration/. Cited 2023 Jan 20.

  57. Galal S. Total population of South Africa in 2021, by province. Statista. 2022. Available from: https://www-statista-com.ezp-prod1.hul.harvard.edu/statistics/1112169/total-population-of-south-africa-by-province/. Cited 2024 Feb 6.

  58. Statistics South Africa Community Survey 2016. Mapping poverty in South Africa. South Africa Gateway. 2016. Available from: https://southafrica-info.com/people/mapping-poverty-in-south-africa/. Cited 2023 Mar 24.

  59. Mbazima N. VIEWPOINTS: Reviving a declining mining industry. Centre for Development and Enterprise. 2020. Available from: https://www.cde.org.za/viewpoints-reviving-a-declining-mining-industry/. Cited 2023 Mar 24.

  60. South Africa’s unemployment rate hits new record high in Q4 2021. Reuters. 2022. Available from: https://www.reuters.com/world/africa/south-africas-unemployment-rate-hits-new-record-high-q4-2021-2022-03-29/. Cited 2023 Mar 24.

  61. New regulations make it tougher to hire foreign workers in South Africa - what you need to know. Business Tech. 2022. Available from: https://businesstech.co.za/news/trending/610554/new-regulations-make-it-tougher-to-hire-foreign-workers-in-south-africa-what-you-need-to-know/. Cited 2023 Mar 24.

  62. Ginsburg C, Collinson MA, Gómez-Olivé FX, Harawa S, Pheiffer CF, White MJ. The impact of COVID-19 on a cohort of origin residents and internal migrants from South Africa’s rural northeast. SSM - Popul Health. 2022;17:101049.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Guven M, Karlen R. Supporting Africa’s urban informal sector: Coordinated policies with social protection at the core. World Bank Blogs. 2020. Available from: https://blogs.worldbank.org/africacan/supporting-africas-urban-informal-sector-coordinated-policies-social-protection-core. Cited 2023 Apr 14.

  64. Thorp M, Ayieko J, Hoffman RM, Balakasi K, Camlin CS, Dovel K. Mobility and HIV care engagement: a research agenda. J Int AIDS Soc. 2023;26(3):e26058.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Makusha T, Mabaso M, Moyo S, Zungu N, Zuma K, Simbayi L. HIV Prevalence and Associated Factors Among Men in South Africa 30 Years into the Epidemic: The Fifth Nationwide Cross-Sectional Survey. AIDS Behav. 2022;26(3):986–95.

    Article  PubMed  Google Scholar 

  66. Govender K, Beckett SE, George G, Lewis L, Cawood C, Khanyile D, et al. Factors associated with HIV in younger and older adult men in South Africa: findings from a cross-sectional survey. BMJ Open. 2019;9(12):e031667.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Newman J, Iriondo-Perez J, Hemingway-Foday J, Freeman A, Akam W, Balimba A, et al. Older Adults Accessing HIV Care and Treatment and Adherence in the IeDEA Central Africa Cohort. AIDS Res Treat. 2012;2012:725713.

    PubMed  PubMed Central  Google Scholar 

  68. Shanaube K, Schaap A, Floyd S, Phiri M, Griffith S, Chaila J, et al. What works – reaching universal HIV testing: lessons from HPTN 071 (PopART) trial in Zambia. AIDS. 2017;31(11):1555–64.

    Article  PubMed  Google Scholar 

  69. Schatz E, Knight L. “I was referred from the other side”: Gender and HIV testing among older South Africans living with HIV. Anglewicz P, Editor. PLOS ONE. 2018;13(4):e0196158.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Mohlabane N, Tutshana B, Peltzer K, Mwisongo A. Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing. Health SA Gesondheid. 2016;21:86–95.

    Article  Google Scholar 

  71. West CA, Chang GC, W Currie D, Bray R, Kinchen S, Behel S, et al. Unawareness of HIV Infection Among Men Aged 15–59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015–2019. JAIDS J Acquir Immune Defic Syndr. 2021;87(1):S97-106.

    Article  PubMed  Google Scholar 

  72. AVERT. HIV and AIDS in South Africa. Available from: https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/south-africa#:~:text=Compared%20to%20women%2C%20an%20analysis,were%20also%20first%2Dtime%20testers. Cited 6 Feb 2024.

  73. Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson C, Long L, et al. Men’s Engagement in the HIV Care Continuum in Sub-Saharan Africa: a Meta-Analysis and Meta-Synthesis. 2021.

    Google Scholar 

  74. Nardell MF, Hedt-Gauthier B, Earnshaw V, Bogart LM, Dietrich JJ, Courtney I, et al. Understanding Repeat Positive Testing in South Africa Under Changing Treatment Guidelines. International Association of Providers of AIDS Care (IAPAC) Adherence Conference. Invited Oral Presentation.; 2020.

  75. Jacob N, Rice B, Kalk E, Heekes A, Morgan J, Hargreaves J, et al. Utility of digitising point of care HIV test results to accurately measure, and improve performance towards, the UNAIDS 90–90–90 targets. Lessells RJ, editor. PLOS ONE. 2020;15(6):e0235471.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Giguère K, Eaton JW, Marsh K, Johnson LF, Johnson CC, Ehui E, et al. Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000–20: a modelling study using survey and HIV testing programme data. Lancet HIV. 2021;8(5):S2352301820303155.

  77. Eakle R, Bourne A, Mbogua J, Mutanha N, Rees H. Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa. J Int AIDS Soc. 2018;21(2):e25081. https://doi.org/10.1002/jia2.25081.

  78. Ajayi AI, Mudefi E, Yusuf MS, Adeniyi OV, Rala N, Goon DT. Low awareness and use of pre-exposure prophylaxis among adolescents and young adults in high HIV and sexual violence prevalence settings. Medicine (Baltimore). 2019;98(43):e17716.

    Article  PubMed  Google Scholar 

  79. Shamu S, Shamu P, Khupakonke S, Farirai T, Chidarikire T, Guloba G, et al. Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts. Glob Health Action. 2021;14(1):1886455.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Duncombe C, Rosenblum S, Hellmann N, Holmes C, Wilkinson L, Biot M, et al. Reframing HIV care: putting people at the centre of antiretroviral delivery. Trop Med Int Health TM IH. 2015;20(4):430–47.

    Article  PubMed  Google Scholar 

  81. Joint United Nations Programme on HIV/AIDS (UNAIDS). Blind spot: Reaching out to men and boys. Geneva, Switzerland; 2017. Available from: https://www.unaids.org/sites/default/files/media_asset/blind_spot_en.pdf. Cited 6 Feb 2024.

  82. Barr D, P Garnett G, Mayer KH, Morrison M. Key populations are the future of the African HIV/AIDS pandemic. J Int AIDS Soc. 2021;24(S3). Available from: https://onlinelibrary.wiley.com/doi/10.1002/jia2.25750. Cited 2022 Oct 13.

  83. Smith PJ, Daniels J, Bekker LG, Medina-Marino A. What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo city municipality, South Africa. BMC Public Health. 2023;23(1):418.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Population Services International (PSI). Uptake and Use of Oral PrEP among Heterosexual Men: Results and lessons from a pilot study in Johannesburg, South Africa. PrEP Watch. November 22. Available from: https://www.prepwatch.org/events/uptake-and-use-of-oral-prep-among-heterosexual-men-results-and-lessons-from-a-pilot-study-in-johannesburg-south-africa/. Cited 2023 Apr 14.

  85. Escudero DJ, Marukutira T, McCormick A, Makhema J, Seage GR. Botswana should consider expansion of free antiretroviral therapy to immigrants. J Int AIDS Soc. 2019;22(6):e25328.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Marukutira T, Scott N, Kelly SL, Birungi C, Makhema JM, Crowe S, et al. Modelling the impact of migrants on the success of the HIV care and treatment program in Botswana. Kowalska JD, editor. PLOS ONE. 2020;15(1):e0226422.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. UNAIDS. Fast Track: Ending the AIDS Epidemic by 2030. Available from: https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf. Cited 6 Feb 2024.

  88. Hannaford A, Lim J, Moll AP, Khoza B, Shenoi SV. ‘PrEP should be for men only’: Young heterosexual men’s views on PrEP in rural South Africa. Glob Public Health. 2020;15(9):1337–48.

    Article  PubMed  Google Scholar 

  89. South Africa ‘on the precipice of explosive xenophobic violence’, UN experts warn. UN News: Global perspective Human stories. 2022. Available from: https://news.un.org/en/story/2022/07/1122612. Cited 2023 Jan 19.

  90. White JA, Levin J, Rispel LC. Migrants’ perceptions of health system responsiveness and satisfaction with health workers in a South African Province. Glob Health Action. 2020;13(1):1850058.

    Article  PubMed  PubMed Central  Google Scholar 

  91. White JA, Blaauw D, Rispel LC. Social exclusion and the perspectives of health care providers on migrants in Gauteng public health facilities, South Africa. Cuthill F, editor. PLOS ONE. 2020;15(12):e0244080.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Camlin CS, Kwena ZA, Dworkin SL, Cohen CR, Bukusi EA. “She mixes her business”: HIV transmission and acquisition risks among female migrants in western Kenya. Soc Sci Med. 2014;102:146–56.

    Article  PubMed  Google Scholar 

  93. Migration History Tool: Limpopo Region Preliminary Report. Medecins Sans Frontieres; 2021. Available from: https://www.msf.org.za/sites/default/files/2021-03/Migration_history_tool_Limpopo_Mobility_Survey.pdf. Cited 2023 Jan 20.

  94. Saghir J, Santoro J. Urbanization in Sub-Saharan Africa. Center for Strategic and International Studies. 2018. Available from: https://www.csis.org/analysis/urbanization-sub-saharan-africa. Cited 2023 Mar 16.

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Acknowledgements

The authors gratefully acknowledge Jenny Jyoung Lee for her statistical contributions toward this manuscript.

Funding

This work has been made possible by the generous support of the American People and the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement 72067419CA00004 to HE2RO. The contents are the responsibility of the authors and do not necessarily reflect the views of PEPFAR, USAID or the United States Government. https://www.state.gov/pepfar/ MFN was supported by grant number T32 AI007433 from the National Institute of Allergy and Infectious Diseases (NIAID) and the Harvard University Center for AIDS Research (CFAR) NIH/NIAID fund under grant number 5P30AI060354-18. LL was supported by the National Institute of Mental Health of the National Institutes of Health under grant number K01MH119923. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was supported by the Harvard Global Health Institute Burke Fellowship.

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Author notes

  1. Maria Francesca Nardell and Caroline Govathson contributed equally to this work.

  2. Ingrid Theresa Katz and Sophie Pascoe contributed equally to this work.

Authors and Affiliations

  1. Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Maria Francesca Nardell

  2. Harvard Medical School, Boston, MA, USA

    Maria Francesca Nardell & Ingrid Theresa Katz

  3. Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa

    Caroline Govathson, Sithabile Mngadi-Ncube, Nkosinathi Ngcobo, Daniel Letswalo, Jacqui Miot, Lawrence Long & Sophie Pascoe

  4. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Caroline Govathson, Sithabile Mngadi-Ncube, Nkosinathi Ngcobo, Daniel Letswalo, Jacqui Miot & Sophie Pascoe

  5. Brown University School of Public Health, Brown University, Providence, Rhode Island, USA

    Mark Lurie

  6. Department of Global Health, Boston University School of Public Health, Boston, MA, USA

    Lawrence Long

  7. Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA

    Ingrid Theresa Katz

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Contributions

MFN conceptualized the focus on migration within this study and added survey questions on migration to the parent study, with input from CG, LL, ITK and SP. JM is the PI of the parent study from which these analyses are based. NN led the recruitment and data collection team, with oversight by DL and CG. MFN completed all analyses, with assistance in data preparation by SMN. MFN interpreted the results and completed the first draft of the manuscript. All authors made intellectual contributions to the interpretation of the results and edited the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Maria Francesca Nardell.

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Ethics approval and consent to participate

The ethics committees at the University of the Witwatersrand (M191068), Mass General Brigham (Harvard University) (2020P002251), and Boston University (H-40529) approved the study. All participants provided written informed consent. Study data were collected and managed using Research Electronic Data Capture (REDCap), a secure, web-based tool.

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The authors declare no competing interests.

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Supplementary Information

Additional file 1: Appendix Table 1.

Key Domains, Variables, and Measures.

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Nardell, M.F., Govathson, C., Mngadi-Ncube, S. et al. Migrant men and HIV care engagement in Johannesburg, South Africa. BMC Public Health 24, 435 (2024). https://doi.org/10.1186/s12889-024-17833-2

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