"It takes a willingness to work at eye level"

Participation is key: HIV affects everyone, but not everyone has the same access to information and care. The "Migration" department of Deutsche AIDS-Hilfe, which was founded 10 years ago, not only wants to address migrants, but also actively involve them.

When migrants go to the AIDS service organization in Düsseldorf for advice, Rufin Kenfack is their first point of contact. "They see me as an employee who has a migration background himself, who thinks the topic of HIV/AIDS is important and, above all, doesn't make it a taboo," says the health scientist, who also co-coordinates a prevention project for people from sub-Saharan Africa in North Rhine-Westphalia.

His own migration background makes it easier for him to make initial contact with migrants, he says. "They don't feel like I'm pointing the finger at them." For many of his clients, being able to talk openly about HIV and Aids is something special. "It's a great joy for most of them, a wow effect. In their home countries, HIV/Aids is often a taboo and a stigma."

Foundation of a separate department

"Migration" has been an issue for the AIDS service organization since the mid-1990s. At the time, more and more migrants were seeking support and advice from local AIDS service organizations, which in turn reported their urgent need for information material and training courses to Deutsche AIDS-Hilfe (DAH). "AIDS and migration" was finally established as a cross-sectional task for all DAH departments; a first handbook was published and the first surveys and assessments were carried out.

In 2000, the DAH "Women" department was commissioned to coordinate the "HIV and Migration" field of work. One year later, the first "Nationwide meeting for positive African migrants" took place, from which the self-help network "Afro-Leben+" soon began to form - still one of DAH's most important cooperation partners in this field today.

Ten years ago, a separate "Migration" department was founded, after some local AIDS service organizations had already been pioneers in this field. This anchored the topic even more firmly institutionally and created a sustainable basis for the coordination and further development of HIV/AIDS prevention with migrants as well as for the political representation of interests in this area.

And that's a good thing, because: "The need has continued to grow over the years," says Tanja Gangarova, who comes from Bulgaria herself and has been head of the department since 2010. In the last five years in particular, the work has become even more important - especially due to the influx of refugees and new EU citizens, she says.

"The need has continued to grow"

Figures from the Robert Koch Institute also show how important the work is: After men who have sex with men, migrants are the second largest epidemiologically relevant group in terms of HIV. Every third new HIV infection affects a person who has immigrated. Around 40 percent of affected migrants first became infected in Germany. In addition, the proportion of migrants who are diagnosed with the infection at a late stage is very high. "This is a clear signal that there are information gaps," says Gangarova.

She sees structural exclusion as one of the causes. People without papers or health insurance and refugees in particular have limited access to the healthcare system. One of the DAH department's tasks is therefore political lobbying. By founding the federal initiative "HIV and Migration" and actively participating in nationwide committees on the topic, the aim is to generate more publicity and political pressure.

Participation as the key to success

Another goal is to promote diversity and participation in the prevention work itself. "The participation of migrants is the key to success," says Gangarova. This can also be seen with other target groups: "Gay prevention is so successful because it follows a participatory approach."

"It is important to develop needs-based approaches," emphasizes Idrissa Omer Ouedraogo. The psychologist and social worker with roots in Burkina Faso works as a freelance consultant for the DAH and is a volunteer for Aidshilfe Hamburg.

He was also involved as a coordinator in the PaKoMi (Participation and Cooperation in HIV Prevention with Migrants) pilot project, which the DAH carried out from 2008 to 2011 together with the Social Science Research Center Berlin and representatives of various migrant communities. One of the aims at the time was to develop HIV prevention services that are better tailored to the needs of migrants and enable them to participate.

PaKoMi brought the specific expertise of migrants to light, says Quedraogo. "Many of us bring experience from our home countries to HIV prevention." Their diverse language skills alone are helpful in establishing contact with the communities.

"I can say where the AIDS service organization should look"

Adama Thorlie, Migration and Social Law Officer at the Berlin AIDS service organization, mentions another area of expertise: people with a migration background can help AIDS service organizations to understand the needs of their communities. "I can say where the AIDS service organization should look. I can be an eye for the institution and support it strategically."

Thorlie herself grew up in Sierra Leone and completed her A-levels in Germany. Thanks to her own experiences, she can put herself in the shoes of people who have to find their way in a new country, explains the sociologist, who also has a master's degree in public health. "I think it's very important that migrants find themselves in AIDS service organizations, because that's a piece of empowerment," she emphasizes.

For needs-based and appropriate HIV prevention

"PaKoMi" is by no means the only project of the DAH department to focus on participation: "MuMM " was about training people with a migration background as multipliers and developing needs-based and appropriate HIV prevention together for and with the communities. the aim of "AfroLebenVoice" was to record experiences of discrimination and racism among HIV-positive migrants and to develop an anti-discrimination campaign. "Your Health, Your Faith" is dedicated to HIV prevention in African church communities. Projects from the department have already been awarded the HIV Community Prize twice as part of the German-Austrian AIDS Congress.

Migrants can help to gain access to certain target groups. However, Rufin Kenfack emphasizes that we should not stop here. Sustainable work is only possible if migrants are involved in the planning, implementation and evaluation of projects.

In the meantime, other local AIDS service organizations have set up their own specialist departments for "migration". However, some AIDS service organizations are too small or have too little money, says Kenfack. Nevertheless, he appeals to them to focus more on migration, pool their expertise and ask for support from other colleagues who are already experienced in this area. Involving migrants also requires them to give up or share power. "It requires a willingness to work on an equal footing," says Kenfack.

Something is happening

At the same time, the willingness to get involved must also come from the communities. However, many migrants are not familiar with the concept of volunteering from their home countries - or they simply cannot afford to volunteer for free. In addition, many migrants have no access to the job market or are involved in many different projects.

This is why it is important to create opportunities to remunerate work and at the same time encourage migrants not to completely rule out volunteering, says Kenfack. However, the former is not easy in some cases for structural reasons alone, explains Tanja Gangarova. People in the asylum process have the problem that their benefits are cut if they receive fees above a certain amount.

Nevertheless, something is happening. "It's great that there are now also people of color in Aidshilfe," says Adama Thorlie. It is now also known in the migrant communities that they can find contact persons at Aidshilfe. "It's good that there are projects that make migrants more visible." But Thorlie also says: "Ten years is still young, there is still a lot to learn."

"Ten years is still young, there is still a lot to learn"

Her dream would be to consolidate the department's projects into long-term programs - so that she doesn't have to keep applying for new funding. There is a lot to do, especially in primary prevention, i.e. the prevention of infections. "MiSSA", a study by the Robert Koch Institute on sexual health among migrants from sub-Saharan Africa, has shown how important health education is. According to Thorlie, these results now need to be implemented. The Ministry of Health also has a duty to do so.

There is also potential for networking. The people with a migration background who come to her at the AIDS service organization have other problems in addition to HIV infection: for example, no housing or lack of access to the job market. As a counselor, she quickly reaches her limits. "We can't provide housing and training, but we can network. We have to put out our antennae," she says. It's never just about infection, but also about integration into society.

"We need to network even more"

Tanja Gangarova also tries to look at the big picture. For example, a current project in the "Migration" department is dedicated to queer refugees. "They are exposed to multiple forms of discrimination and need special safe spaces," she says.

Another very diverse group are migrants who use drugs. Addiction in the context of migration raises very specific problems, especially legal ones. "Questions arise that we haven't had to deal with yet. But we are also working on this."

By Inga Dreyer