“Migrants are human beings and they don’t sleep with animals” healthcare workers and migrants’ experiences of the impact of inadequate antiretroviral therapy provision in Botswana

Migrant populations in Botswana face considerable barriers to accessing HIV prevention and treatment services, particularly antiretroviral therapy (ART). These gaps undermine both individual health outcomes and broader public health goals. This study explores the perceptions of healthcare workers and cross-border migrants on the impact of inadequate ART provision to migrants and the consequences for the local population. A qualitative study was conducted in Gaborone and Francistown, Botswana. In-depth interviews were carried out with 12 healthcare providers and 20 cross-border migrants. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Ethical approval was granted by the Health Research Development Committee of Ministry of Heath, Botswana. Participants highlighted that excluding migrant from ART programs exacerbates health inequalities and contribute to avoidance of HIV transmission. Migrants, particularly those involved in sex work were perceived as both vulnerable to HIV and as potential vectors of transmission to the broader population. Denying treatment in critical contexts such as during childbirth, was regarded by both groups as a major public health and ethical failure. Healthcare workers expressed moral distress in being unable to provide care due to institutional restrictions, and emphasized that access to essential health services should not be contingent on migration status. The findings underscore an urgent need for inclusive health policies that extend ART and related HIV services to all individuals in Botswana, regardless of migration status. Failing to do so not only endangers the health of migrant populations but also places the broader public at risk and raises fundamental ethical concerns about health equity and human rights.