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Executive summary
The purpose of this study was to identify and study the links between mobility and HIV/AIDS in Southern Africa. The study took place in five provinces in three countries in Southern Africa: Limpopo Province, South Africa; Matabeleland South Province and Chiredzi South Province, Zimbabwe; and Niassa Province and Nampula Province, Mozambique. The study focused on highly mobile communities including male and female informal traders, sex workers, other vulnerable women such as domestic workers, migrant labourers, farming communities, mine workers, construction workers, truckers, uniformed government employees such as customs and immigration officials, in- and out-of-school youth, and truck drivers.
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KEY RESULTS AND RECOMMENDATIONS
South Africa
Five vulnerable groups were identified in the border town of Messina, Limpopo Province: truck drivers, sex workers, informal traders, domestic workers, farm workers. The groups face differing levels of vulnerability to infection by HIV/AIDS. Sex workers and truck drivers are the most obvious and visible vulnerable groups. However, high rates of sexual harassment and rape of female informal traders and lack of any specific programmes targeting these incidents make female informal traders particularly at risk. Therefore, there is a need to establish programmes dealing with the prevention of gender violence and abuse. There is also a need to develop and strengthen HIV/AIDS prevention programmes targeting farm workers. Farm workers are predominantly illegal migrant labourers from Zimbabwe and Mozambique. They reportedly have multiple sexual partners both in South Africa and in their home countries with irregular condom use. Local peer educator programmes and clinics, though active, need to be supported to allow for expansion of programmes and increased quality of services. Also, condoms need to be more accessible to all these vulnerable groups.
Five high-risk groups were identified in the rural, mainly farming community of Tzaneen: farm workers, informal traders, truck drivers, sex workers, and youth. Unlike in Messina, the majority of farm workers in Tzaneen are female. The farm workers' knowledge of HIV prevention and STI recognition and treatment is very low. Female informal traders are also vulnerable as they are sometimes forced to exchange sex for transport to and from the informal markets by the taxi drivers. There is very little overt commercial sex work but sex workers can be found in the town of Tzaneen. Sex workers are often of school-going age and rarely insist on condom use. Their main clients are truck drivers. Poverty, crime, increasing school dropout rates and high levels of sexual abuse make young people particularly vulnerable. Young people should therefore be the focus of HIV prevention activities in Tzaneen. Law enforcement officers and health service providers also need training in dealing with sexual abuse and becoming more youth friendly. Finally, as in Messina, peer mediated HIV prevention programmes need to be introduced and strengthened.
Zimbabwe
Beitbridge is the very busy town on the border between Zimbabwe and South Africa. The study identified five vulnerable groups in Beitbridge as being at elevated risk of HIV: sex workers, truck drivers, migrant labourers, informal traders, and youth. Sex workers can be as young as 13 years old. Their major clients are truck drivers, male informal traders and uniformed government officials. Female informal traders are a highly vulnerable group in Beitbridge who are often forced to exchange sex for transport from taxi and truck drivers and face daily harassment and physical and verbal abuse. As in the opposite border town of Messina, there are no programmes advocating for reduction of these incidents or providing counselling and support to victims. Therefore, there is an immediate need for programmes that target the perpetrators, mostly customs and immigration officials, police and soldiers, as well as educate women on the legal recourses available in case of harassment and abuse. Also, it is important to develop and strengthen prevention and care programmes in Beitbridge through increased funding and technical assistance.
The study in the rural farming community of Malipati, which is the main gateway into Mozambique, focused on five vulnerable groups: sex workers, migrant labourers, youth, spouses of migrant labourers and informal traders. There is a lot of overlap between these vulnerable groups, with spouses of migrant labourers sometimes being sex workers or informal traders at the same time. Most women in Malipati are the spouses of migrant labourers. Extreme poverty and hunger has forced many of them to engage in commercial sex work and there were reports of women exchanging sex for food aid with distribution officials. Informal traders are routinely harassed and verbal and physical abuse by uniformed government officials has been reported. Migrant labourers have disposable income which could lead to multiple partners once they are in South Africa or, less likely, in Mozambique. The men also irregularly use condoms, especially with their wives in Zimbabwe. A key recommendation therefore is to work with food distribution agencies in providing food aid to all needy community members, including the spouses of migrant labourers. In addition, there is a need to introduce peer mediated HIV prevention interventions targeting vulnerable women and condoms need to be more accessible.
Mozambique
Mandimba lies on the border between Mozambique and Malawi. Nacala is a big port town and Nampula is the capital city of Nampula Province. The increasing economic developments along the Nacala Corridor that stretches from the coast to the Malawi border has further underscored the need for programmes that target commercial sex workers, youth, and sex worker clients (including road construction workers and itinerant traders).
In Mandimba, knowledge on HIV/AIDS is low, there is limited access to condoms and there are high numbers of sex workers. Poverty levels are high and young girls turn to sex work, crossing the border into Malawi to solicit for clients.
Similar to Mandimba, the most vulnerable group in Nacala is sex workers, who have high rates of partner change, irregularly use condoms and displaying myths and misconceptions about HIV/AIDS. The recent construction in the area (re-built roads, repaired railway line and conversion of an old army base into a commercial airport) has impacted on HIV vulnerability as the number of construction workers in the area has increased.
Nampula has three highly visible vulnerable groups: youth, migrant labourers and sex workers. The sex workers' major clients are the many migrant labourers, typically informal traders who are usually not linked to local services and/or sources of information, and are attracted to the area because of the busy development corridor. Young people reportedly have multiple partners and girls often have older partners who supply them with gifts and money. There is a need for programmes that target commercial sex workers, students, other young people and clients of sex workers. Local health service providers need technical assistance to counsel youths with STIs and HIV and also to act as focal points for HIV information dissemination.
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