Migration and HIV & AIDS are crucial social issues facing today’s changing world.⁽²⁾ Migration is recognised as a risk factor for the spread of HIV & AIDS,⁽³⁾ and this is especially relevant to sub-Saharan Africa where migration is a fundamental part of the way in which communities are structured.⁽⁴⁾ A migrant population can be defined as a group of people who tends to relocate for different reasons, including employment, retirement and/or family responsibilities. This paper will discuss the challenges of rendering HIV & AIDS related health care and treatment among migrant populations.

Migration patterns and associated factors

The southern African region has high levels of migration.⁽⁵⁾ The most common kind of migration found in the region is circular or “oscillating”, in which men leave their rural homes and seek employment in the cities or urban areas, while visiting their original homes periodically.^(6,7) Other patterns may be seen within rural farm areas where villagers seek employment in farms and factories from neighbouring towns. The majority of migrant workers are employed in mines, factories and, periodically, in farms. Some governmental institutions have also been a source of employment for migrant workers, such as army and police forces, who are major employers of migrant labourers.

Most often male migrant workers do not forge permanent residences in places they work.⁽⁸⁾ Although they may stay in one area for a long period of time, they are most likely to go back home from time to time, and return home permanently after they have retired. In some instances their female partners also periodically come to visit or stay with them. This group of women are often highly nomadic as they would go back home from time to time to take care of other family responsibilities including post natal care, look after children or sick family members.⁽⁹⁾

Migration and factors associated to the spread of HIV & AIDS

Throughout the world, migrants are at a greater risk than the overall population for poor health in general⁽¹⁰⁾ and HIV infection in particular.⁽¹¹⁾ Literature has shown that people who are more mobile or who have recently changed residence tend to be at higher risk for HIV and other sexually transmitted diseases than people in more stable living arrangements.^{(12,13,14,15)} Migration has been one of the major social factors responsible for the spread of HIV, and has been linked to an increase in prevalence of HIV in some areas.⁽¹⁶⁾ Lurie et al. conducted a comparative study on HIV prevalence among migrant and non migrant workers.⁽¹⁷⁾ The study found that the prevalence of HIV among male migrant workers were significantly higher than their non migrant counterparts.⁽¹⁸⁾ One of the major risk factors for male HIV infection was identified as migrating on numerous occasions in a lifetime. The study also identified predictive factors to HIV infection, which included being a migrant, having lived in four or more places during a lifetime, and not using condoms.⁽¹⁹⁾

A complex relationship exists between migration and the spread of HIV.⁽²⁰⁾ HIV is mainly transmitted first to adult men as a result of sexual contacts met during their seasonal migration, and second to their wives when they return.⁽²¹⁾ Furthermore, there is evidence that suggests that migrant populations may expose their host areas to HIV risk, but may also be vulnerable to HIV infections from their host areas.⁽²²⁾

Migration and challenges in rendering of HIV and AIDS health care services

There are challenges faced in rendering services to migrant workers and for migrant workers to access services of the health systems of the host region or country.⁽²³⁾ Migrants face challenges in accessing health care services, such as encountering negative attitudes from health workers and struggling to overcome language barriers.⁽²⁴⁾ On the other hand, host regions may also experience challenges in providing services to migrant populations which include counterproductive health beliefs⁽²⁵⁾ and attitudes regarding HIV health care services,⁽²⁶⁾ low awareness of personal risk of HIV infection,⁽²⁷⁾ and reduced willingness to seek medical attention.⁽²⁸⁾

Rehab et al. conducted a comparative study among ART patients in community health centre and workplace programme located within a tertiary mining company hospital. In the study, they found that level of education and health beliefs were determining factors of attrition among ART patients in the workplace programme.⁽²⁹⁾ The study specified health beliefs as beliefs related to existence of HIV, efficacy of ART treatment and confidence in traditional healing.⁽³⁰⁾ Conclusions made by the study indicated that poor health seeking behaviours was a barrier to ART adherence among ART patients in the workplace. The study also suggested that a “healthy worker” effect may also have contributed to the poor level of ART adherence among patients in the work programme. For example, patients who felt physically well, were more likely to be sceptical regarding the necessity of ART.⁽³¹⁾ Findings of another study indicated that stigma and fear of being isolated as a major factor that inhibited migrant workers to access voluntary counselling and testing (VCT) at the workplace.⁽³²⁾

Concluding remarks

HIV remains a major challenge in sub-Saharan Africa. The epidemic affects various sectors of sub-Saharan African countries, which is why it is important to understand all factors related to the affected populations. There is a need for further research on the effect of HIV & AIDS prevention, care and treatment on migration workers. Furthermore, studies are needed that would focus on other employment sectors and industries that make use of services from migrant populations. In addition, more empirical information is required to gain a thorough understanding of different migration trends and their effects on the health outcomes of the society.

There also appears to be a need for interventions targeting migrant populations. These interventions should improve access to HIV knowledge that is aimed at reducing stigma and misconceptions about HIV & AIDS, while promoting health beliefs that encourage use of HIV prevention, treatment and care.

NOTES:

(1) Contact Tshadinyana Phetoe through Consultancy Africa Intelligence's HIV & AIDS Unit (hiv.aids@consultanyafrica.com).
(2) UNESCO/UNAIDS, 2000. Migrant populations and HIV/AIDS: The development and implementations of programs: Theory, methodology and practice. Geneva: UNAIDS.
(3) Lurie, M.N. et al., 2003. The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30(2), pp.149-156.
(4) Lurie, M., 2000. Migration and AIDS in Southern Africa: A review. South African Journal of Science, 96, pp.343-347.
(5) McDonald, D. ed., 2000. On borders: Perspectives on international migration in Southern Africa. New York: St Martin’s Press.
(6) Lurie, M.N. et al., 2003. The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30(2), pp149-156.
(7) Ibid.
(8) Ibid.
(9) Lurie, M., 2000. Migration and AIDS in Southern Africa: A review. South African Journal of Science, 96, pp.343-347.
(10) Zwi, A. and Cabral, A.J., 1991. Identifying “high risk situations” for preventing AIDS. British Medical Journal, 303, pp.1527–1529.
(11) Lurie, M.N. et al., 2003. The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30(2), pp149-156.
(12) Pison, G. et al., 1993. Seasonal migration: A risk factor for HIV in rural Senegal. Journal of Acquired Immune Deficiency Syndromes, 6, pp.196–200.
(13) Legarde, E., Pison, G. and Enel, C., 1996. A study of sexual behaviour change in rural Senegal. Journal of Acquired Immune Deficiency Syndromes, 11, pp.282–287.
(14) Mbizvo, M.T. et al., 1996. HIV seroincidence and correlates of seroconversion in a cohort of male factory workers in Harare, Zimbabwe. Journal of Acquired Immune Deficiency Syndromes, 10, pp.895–901.
(15) Brewer, T.H. et al., 1998. Migration, ethnicity and environment: HIV risk factors for women on the sugar cane plantations of the Dominican Republic. AIDS, 12, pp.1879–1887.
(16) Lurie, M.N. et al., 2003. The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30(2), pp.149-156.
(17) Ibid.
(18) Ibid.
(19) Ibid.
(20) Ibid.
(21) Pison, G. et al., 1993. Seasonal migration: A risk factor for HIV in rural Senegal. Journal of Acquired Immune Deficiency Syndromes, 6, pp.196–200.
(22) Zwi, A. and Cabral, A.J., 1991. Identifying “high risk situations” for preventing AIDS. British Medical Journal, 303, pp.1527–1529.
(23) Moroka, T. M. and Tshimunga, M., 2009. Barriers to and use of health care services among cross border migrants. International Journal of Migration, Health and Social Care, 5(4), pp.33-42.
(24) Ibid.
(25) Ibid.
(26) Day, J.H. et al., 2003. Attitudes to HIV voluntary counselling and testing among mineworkers in South Africa: Will availability of antiretroviral therapy encourage testing? AIDS Care, 15(5), pp.665-672.
(27) Ibid.
(28) Lurie, M.N. et al., 2003. The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30(2), pp.149-156.
(29) Dahab, M. et al., 2010. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: A cohort study. BioMed Central Public Health, 10, http://www.biomedcentral.com.
(30) Ibid.
(31) Ibid.
(32) Day, J.H. et al., 2003. Attitudes to HIV voluntary counselling and testing among mineworkers in South Africa: will availability of antiretroviral therapy encourage testing? AIDS Care, 15(5), pp.665-672.

Written by Tshadinyana Phetoe ⁽¹⁾