Health is not a privilege, but a human right
How can you create offers for specific target groups in health communication? Omer Idrissa Ouedraogo is a migration specialist at Deutsche Aidshilfe and talks to Inga Dryer about the role of participation in HIV prevention.
What are the tasks of the migration department at Deutsche Aidshilfe?
The Migration Department has existed since 2017. It was important to Deutsche Aidshilfe to initiate its own department so that target group-specific services can be developed for different groups of migrants. To this end, we work with cooperation partners in various federal states and migrant communities. At the same time, we are also active at a political level. We talk to politicians to communicate the needs and requirements of the various target groups.
Why is it important to create target group-specific services for migrants?
Statistically speaking, around one in three new HIV diagnoses in Germany is made by a migrant. This shows that services and measures are needed. It is primarily about reducing inequalities and creating access to information, prevention, advice and care. The group of migrants is very heterogeneous. There are queer people, refugees, people who speak Arabic, English or French, for example. One of our target groups is men who have sex with men. Another target group is people who use drugs.
A previously neglected group in HIV prevention in Germany are people without valid residence papers and health insurance. This group is de facto excluded from the healthcare system. Many are afraid to get tested because they have no residence status. They fear being deported, for example. This is because antiretroviral therapy is not possible without health insurance or valid residence papers. For these people, ways to get tested and campaigns, as well as information material and key points for treatment and care must be found.
We believe that the time is ripe for people without a valid residence permit to no longer be afraid of using healthcare services. We are politically committed to ensuring that there is healthcare that is not dependent on residence status or place of birth. Health is not a privilege, but a human right.
What obstacles do your target groups face in accessing information?
The hurdles are very different. If you don't know the language, that can be an obstacle. But difficulties can also be cultural or religious. We have to act sensitively and look closely at which target group has which needs. Over time, Deutsche Aidshilfe has learned that it makes sense to address African migrants by working together with key people from religious communities and churches. We have therefore initiated participatory programs with African pastors. in 2015, the project "Your health, your faith - HIV prevention in African church communities" was launched. Language is an issue, but there is more to it. It is important to get to know the people and develop participatory offers from the outset.
How do you develop target group-specific offers?
The methods are very different. As an umbrella organization, we try to develop concepts in different languages in the migration department that the local AIDS service organizations can implement in their prevention work. It should always be part of HIV prevention that staff visit local people to offer prevention services. We have achieved positive results by working with people from the various communities, who then carry out peer-to-peer work as health ambassadors or mediators.
We also work in a participatory way with people living with HIV. For example, there is the "Naturally positive" campaign by people with HIV for people with HIV. "Naturally positive" is a podcast for an active, open and self-confident life with HIV. The podcast guests tell personal stories about successes, but also setbacks and how they overcame them. The podcast, which is primarily aimed at people with HIV, aims to provide advice, support and encouragement on the path to self-confidence.
We also support self-organizations in the communities that create their own services, for example the AfroLebenPlus network. This is an association of HIV-positive migrants. AfroLeben Plus was founded in 2001 and is a nationwide association of HIV-positive migrants that is structurally supported by Deutsche Aidhilfe. Most members come from different countries around the world. AfrolebenPlus pursues the following goals, among others: low-threshold HIV prevention in migrant communities, promoting solidarity with HIV-positive people and promoting the inclusion of refugees and migrants in Germany. They are active as multipliers in their communities, carry out prevention work, are politically active and try to improve the living situation of HIV-positive migrants.
Why do you think participatory involvement is important?
I am a fan of participation. For example, we developed the PaKoMi project, short for "Participation and Cooperation in HIV Prevention with Migrants" and carried out participatory case studies in various cities
case studies in various cities. I was involved in Hamburg, where the question was: How can we better reach French-speaking Africans? Right from the start, we engaged with key people from the communities and developed questions and methods together. In doing so, we identified: Who has what expertise? Because everyone is an expert in something. We then conducted the survey within the community and evaluated it together. The results of the accompanying studies showed that If people are involved right from the start and contribute their own ideas and wishes, you can find out what they really need. Through the participation and active involvement of people with a migration biography, primary prevention can find a place in the lives of the target group throughout Germany. The focus must also be on people without valid residence papers and/or without health insurance.
What role do prejudice and discrimination play in prevention work with migrants?
It is a sad reality that migrants in Germany experience discrimination and racism. If you are also HIV-positive, you can also be ostracized within your own community. This means that you face multiple forms of discrimination. People who experience exclusion and rejection need empowerment. That's why we do anti-racist work and support groups and initiatives so that they can take countermeasures. People with HIV are part of society. You can live well with the virus, it is an easily treatable infection. However, rejection and a lack of knowledge can be dangerous if it leads to people not getting tested, passing on the virus and not receiving treatment.
Migrants experience everyday racism, but also structural racism. Many of us have no chance of getting better jobs and working at the same level in the hierarchy as people without a migration background. One problem is that school qualifications are often not recognized. Some people are constantly checked by the police because of their origin, ethnicity or skin color. BPoC (Black and People of Color) also experience racism and discrimination in the healthcare sector. This is particularly intolerable in the healthcare sector, where we encounter people in particularly vulnerable life situations.
What does this mean for participatory research projects and the institutions behind them?
Project-based work for six months or a year is not enough. Long-term employment is needed for people with a migration background. Many have families and children and they also need to be able to make a living from their work. In the beginning, we at PaKoMi criticized this as a problem. Deutsche Aidshilfe then motivated the member organization to give people with a history of migration the chance to be employed. In general, job advertisements should emphasize the possibility that people with a migration background can apply. This is because they bring many skills with them, speak different languages and can reach different target groups. It's about giving up power and opening up structures. Many AIDS service organizations now employ migrants. This is something we welcome. Participatory projects and research are implemented together with the migrant target group.
How is HIV prevention work going in times of corona?
The past two years have shown us that nothing can be predicted or taken for granted. The health crisis has directly affected the progress and recent victories in the fight against HIV.
We feel that there are fewer financial resources available for our work. The Covid pandemic has meant that HIV prevention has been forgotten. That's a problem, because HIV is still here. In France, the campaign "l'épidémie n'est pas finie", "the epidemic is not over yet", is currently underway. As activists in the HIV field, we say that we must not neglect education. We fear, for example, that the use of PrEP, the "pre-exposure prophylaxis", in which people take a drug to protect themselves from a possible infection, is declining. We are also concerned that people are getting tested less. This means that something has to be done in parallel to combat coronavirus and HIV.
The AIDS service organizations have a lot of experience in health communication. Is there anything you can take away from this for dealing with the coronavirus pandemic?
Of course. The AIDS service organizations emerged from a civil and human rights movement and have established professional prevention work. We can also learn from this for Covid-19 prevention. Thanks to their experience, the AIDS service organizations are in a position to undertake parallel prevention work. There are offers on the topic of HIV prevention and also on Covid-19. Information materials have been developed to reach different target groups.
Our migration work in 2021 continued to focus, for example, on switching training courses to digital formats, which meant we were able to offer seven training courses online from January to April. Topics such as hepatitis B and Covid-19 were included in prevention events in African church communities. Prevention services for queer refugees were also developed further. In addition, the training courses on diversity were expanded to include the modules Intersectionality & Practical Reflection and Social Work Critical of Racism. The content of the training courses on "Migration, flight and trauma" was updated and offered with different focal points.
Health communication can be implemented in various forms if all participants are involved. Participatory and integrative dialog remains essential to the success of prevention work in the health sector.
Omer Idrissa Ouedraogo is a migration specialist at Deutsche Aidshilfe. The social worker and psychologist worked as a social pedagogue at the Aids-Hilfe in Hamburg and accompanied the PaKoMi case study (participation and cooperation in HIV primary prevention) in Hamburg as coordinator. Originally from Burkina Faso, he has lived in Germany since 2007. He is chairman of the board of Abed e.V., an aid organization for children and young people, and co-founder of the African Health and HIV Network in Germany (AGHNiD).
The interview first appeared on Wissenschaftskommunikation.de