Accessing ART in Malawi while living in South Africa – a thematic analysis of qualitative data from undocumented Malawian migrants

ABSTRACT

The majority of international migrants from Malawi to South Africa are undocumented, and some of them are on ART. This study explored how these migrants manage to access ART. Qualitative data were collected using open-ended questions in semi-structured interviews. 23 returned undocumented Malawian migrants from South Africa participated in the study. Also, key informant discussions were held with three health workers. Data collection took place in April and May 2015 at a rural village of Namwera in Mangochi district in southern Malawi. Interviews were audio-recorded, transcribed and translated into English for thematic analysis. The guardians collected ART from health facilities in Malawi on behalf of the migrants. The guardians sent ART through truck and bus drivers to the migrants in South Africa. The migrants shared their ART. Others bought ART from the ‘street pharmacies’. Others accessed ART from South African health facilities through the help of their South African friends. There are risks to dispensing ART to the migrants who do not themselves present at health facilities. There is value to more regular contacts between clients and health service system that is compromised by alternative strategies. It is better to deliver ART services in South Africa to the undocumented migrants.

KEYWORDS:

• Malawi
• migration
• South Africa
• HIV
• antiretroviral therapy

Acknowledgements

I am indebted to 23 study participants and three health workers – the key informants. I thank the Health Economics and HIV and AIDS Research Division within the University of KwaZulu-Natal for Ph.D. scholarship that enabled me conduct the study. I am grateful to Dr. Mvuselelo Ngcoya who supervised the Ph.D. research project and Dr. Kaymarlin Govender who hosted me during the time of writing this paper. I thank two anonymous reviewers for their useful input into the development of this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Key: Study participants

In-depth interviews

1. Male, Cape Town, did not visit health facility while in South Africa, HIV-

2. Male, Cape Town, did not visit health facility while in South Africa, HIV+

3. Female, Cape Town, did not visit health facility while in South Africa, HIV+

4. Female, Cape Town, visited health facility while in South Africa, HIV-

5. Male, Durban, did not visit health facility while in South Africa, HIV-

6. Male, Durban, did not visit health facility while in South Africa, HIV+

7. Male, Durban, did not visit health facility while in South Africa, HIV+

8. Male, Durban, visited health facility while in South Africa, HIV+

9. Male, Johannesburg, visited health facility while in South Africa HIV-

10. Male, Johannesburg, did not visit health facility while in South Africa, HIV-

11. Male, Johannesburg, did not visit health facility while in South Africa, HIV-

12. Male, Johannesburg, did not visit health facility while in South Africa, HIV+

13. Male, Johannesburg, did not visit health facility while in South Africa, HIV+

14. Female, Johannesburg, did not visit health facility while in South Africa, HIV+

Group discussion participants and where they had returned from

1. Five male participants: 2 Johannesburg, 2 Cape Town, 1 Durban

2. Four female participants: 2 Johannesburg, 1 Cape Town, 1 Durban

Key informants

1. Facility in-charge and ART provider

2. Clinician and ART provider

3. Medical assistant and ART provider