Between Borders and Barriers: What Mozambican Migrants Face in Accessing HIV Treatment in South Africa

Opening: When Borders Block Lifesaving Care

In a cramped hostel on the edge of Johannesburg, a 34-year-old Mozambican miner — Pedro — skipped his monthly clinic appointment. His employer refused him time off, and his identity document lacked updated work details. At the public clinic, staff insisted on verification before issuing his antiretroviral therapy (ART). Consequently, Pedro went home untreated, fearing job loss or deportation.

Stories like Pedro’s are far from isolated. For instance, a 2024 study of migrant men in Johannesburg found that 28.6% of non-citizens had never visited a health facility, compared with 10.6% of South African citizens (BMC Public Health, 2024).

Meanwhile, across the border in Mozambique’s Gaza Province — a key sending region — HIV prevalence among mine-worker communities reached 24.2%, yet only 22% of respondents demonstrated comprehensive HIV knowledge (PMC, 2021).

These statistics reveal a crisis of mobility, stigma, and policy ambiguity. Therefore, Mozambican migrants face multiple barriers to HIV treatment — ranging from documentation and language gaps to workplace restrictions and xenophobia.

This blog unpacks these barriers, examines South African policy gaps, and proposes practical, evidence-based solutions for policymakers, health practitioners, NGOs, and researchers.

The Policy Landscape: Rights on Paper, Barriers in Reality

Legal Entitlements

South Africa’s Constitution (1996) guarantees that “Everyone has the right to have access to health care services.” This clause explicitly includes migrants, regardless of nationality. In addition, the National Health Act (2003) and a Department of Health circular (2007) affirm that refugees and asylum-seekers can access free primary health care and HIV treatment (Gender Justice SA, 2025).

However, the National Health Insurance (NHI) Act (2023) introduces ambiguity. It limits undocumented migrants and asylum-seekers to “emergency medical services” and “services for communicable diseases.” Therefore, HIV treatment remains in a grey zone (HHR Journal, 2024).

Policy in Practice

Despite progressive laws, implementation is inconsistent. Healthcare workers often interpret policies differently, and some clinic managers deny services without documentation. As a result, many migrants stop seeking care altogether.

A 2025 Business Day report confirmed that the Department of Health does not track migrant service use, making planning for high-mobility populations difficult (Business Day, 2025).

Furthermore, xenophobic attitudes — including vigilante “community patrols” outside clinics — prevent many from accessing treatment. Médecins Sans Frontières (MSF) found that over half of 15 surveyed clinics in Gauteng had incidents where foreign nationals were blocked from entry (HIV Justice, 2025).

Intersectional Realities: Gender, Age, and Status

Barriers are not uniform. They intersect with social identity, migration status, and occupation.

Gender: Male miners often live in hostels with poor privacy, discouraging ART adherence. Conversely, women in domestic work rely on employers for time off, limiting clinic access.
Age: Young migrants often have limited HIV knowledge, whereas older workers face co-morbidities like TB or silicosis.
Documentation: Expired work permits or asylum papers prevent treatment access.
Language and culture: Portuguese-speaking Mozambicans struggle in clinics dominated by Zulu or English speakers.

On the Ground: Johannesburg and Tshwane

In Gauteng Province, international migrants access HIV services less frequently than local populations. For example, a 2024 Johannesburg study revealed that only 12% of migrants had heard of pre-exposure prophylaxis (PrEP). Many had never visited a clinic.

Similarly, in Tshwane, long queues, ID checks, and occasional harassment discourage attendance. Staff shortages and overworked nurses amplify these challenges. Consequently, migrants are deprioritized, and treatment continuity suffers.

Eight Key Barriers to HIV Treatment

1. Rigid Clinic Hours and Work Schedules

Mining and farm work demand long, inflexible hours. Consequently, standard clinic schedules force migrants to choose between income and medication.

2. Documentation and Residency Requirements

Many clinics require a South African ID, proof of residence, or work permit. Therefore, migrants without these documents are frequently turned away.

3. Xenophobia and Discrimination

Even when entitled to care, migrants face bias. Nurses may prioritise citizens, impose extra fees, or make degrading remarks.

4. Language and Cultural Gaps

Portuguese-speaking Mozambicans often struggle to understand consent forms, dosage instructions, or appointment schedules. Few clinics provide interpreters.

5. Interrupted Treatment Across Borders

Circular migrants travel home frequently. Without coordinated ART continuity, treatment lapses occur, increasing resistance risk.

6. Occupational and Health Burdens

Many miners suffer from TB or silicosis alongside HIV. These co-morbidities require integrated care that most clinics lack.

7. Fear of Arrest or Deportation

Undocumented migrants avoid public facilities, fearing that healthcare data could be shared with immigration officials.

8. Health System Overload

Overcrowded facilities and staff shortages mean that migrant patients are often deprioritised, especially in urban districts.

Lived Realities: Three Anonymised Stories

Maria, 28, works as a domestic helper in Tshwane. After an HIV diagnosis during workplace testing, her employer denied time off for clinic visits. Two missed refills led to viral rebound before an NGO helped her join a mobile ART service.

João, 45, a Mozambican mineworker, defaulted for six months after returning home for a funeral. When he returned, his work permit had expired. A church-based outreach programme helped him reconnect to care.

Ntombi, a Gauteng nurse, described mobs stationed outside her clinic. “They shout at foreigners, calling them thieves of healthcare,” she said. Many migrants now send neighbours to collect medicine for them.

These snapshots illustrate the interplay of labour exploitation, bureaucratic barriers, and public hostility.

Emerging Innovations and Promising Practices

Despite challenges, several models show progress:

Cross-Border Collaboration: The IOM operates occupational health centres in Ressano Garcia and Xai-Xai, screening over 18,000 Mozambican miners and providing cross-border referrals (IOM Mozambique, 2022).
Community Health Workers (CHWs): In southern Mozambique, 37 CHWs track and support HIV-positive migrants, linking them to South African clinics.
Mobile Clinics in Gauteng: Outreach teams now visit taxi ranks, hostels, and factories. Flexible schedules improve ART adherence.
Peer Navigation and Multilingual Education: Migrant peer educators and Portuguese-language materials improve understanding and trust.

These approaches help South Africa move closer to the UNAIDS 95-95-95 targets by reaching mobile populations.

Actionable Recommendations

National Level (Department of Health)

Clarify Migrant Entitlements: Within 6 months, issue guidance defining HIV service access under the NHI Act.
Track Migrant Data: Within 12 months, include nationality and documentation in HIV/TB monitoring systems.
Enable Cross-Border ART: In 12-18 months, establish joint ART referral protocols with Mozambique.
Train Health Workers: Within 9 months, launch anti-xenophobia training modules for public health staff.

Provincial and District Level

Flexible Clinic Hours: Pilot extended or weekend ART clinics in high-migrant areas within 6 months.
Multilingual Communication: Produce Portuguese and Changana HIV education materials within 3 months.
Migrant Peer Navigators: Deploy community health workers from migrant communities within 12 months.

Employers and Industry Partners

Workplace Health Access: Offer paid time off for ART visits and integrate adherence support into occupational health programmes.
Expand Mine-Clinic Linkages: Collaborate with IOM and Right to Care to align workplace screenings with ART referrals.

NGOs and Research Institutions

Community Monitoring: Within 3 months, create a migrant-health coalition to document discrimination and advocate for care.
Operational Research: Over 24 months, fund studies on ART retention among Mozambican migrants.

Knowledge Gaps and Research Priorities

Limited longitudinal data on ART adherence and viral suppression among Mozambican migrants.
Gender-specific research beyond male mineworkers is sparse.
Few evaluations exist of cross-border ART models or peer-support interventions.
Migration variables remain weakly integrated in national HIV datasets.

Future research should examine mobility patterns, stigma, and transnational care pathways.

Conclusion: No Health Without Inclusion

Legal guarantees mean little if they stop at clinic doors. Mozambican migrants remain excluded due to bureaucracy, discrimination, and unclear policy.

Policymakers must align constitutional rights with NHI implementation. Clinicians should adopt compassionate, multilingual practices. Employers must support ART adherence and safe working conditions. Finally, researchers need to document what works and share lessons regionally.

A “Leave No Migrant Behind” approach is critical. Every missed appointment weakens national HIV control. Ensuring continuous ART access for Mozambican migrants is not charity — it is public health justice.

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