Introduction
The severity of the HIV epidemic in Southern Africa cannot be overstated. Globally, there are an estimated 43 million people
infected with HIV. Some 25 million people infected with HIV, 66 per cent of the global burden, live in sub-Saharan Africa.1 Within sub-Saharan Africa, the countries of Southern Africa are the worst affected. The reason why the epidemic is particularly virulent in Southern Africa is still unclear. A number of different factors have been advanced to explain the general picture of HIV and AIDS in Southern Africa including its rapid spread, high HIV prevalence and uneven distribution.2 They include poverty and economic marginalization; differing strains of HIV; high rates of sexually transmitted infections (STIs) and other opportunistic infections; sexual networking and patterns of sexual contact, including high levels of concurrent sexual partners; the absence of male circumcision; and the role of core-groups such as commercial sex workers. But perhaps the key neglected factor in explaining the rapid spread of HIV over the last decade is population mobility. The social economy of mobility comprises a set of complex and interconnected factors that help to explain the high burden of HIV and AIDS faced by Southern African countries.3
Although both mobility and HIV have been exhaustively and separately examined in Southern Africa, we are still far from
understanding just how mobility and HIV interact. Part of the reason is that studies of migration and disease tend to concentrate on the urban or “receiving” areas with much less attention being paid to people living in the rural or “sending” areas, or people “on the move” between the two. Furthermore, there have been few well-designed epidemiological studies documenting the relationship between migration and infectious diseases. Even more important, at this late stage in the Southern African HIV epidemic, there have been few intervention programmes, even on a small scale, which specifically attempt to reduce transmission among migrants and their rural or urban partners.4
From a research perspective, the connections between population mobility and HIV are more difficult to unravel because the disease arrived in the region at a time when population mobility and systems of migration were undergoing rapid transformation.5 Population mobility is, by its very nature, highly dynamic and has changed dramatically in scope, scale and diversity over the last two decades. Recent migration trends in Southern Africa will be discussed in Section 1.
Today it is certainly much more difficult to map the connections between disease and mobility than it was in the past. The
vulnerability to HIV infection of people (migrant and non-migrant, mobile and relatively immobile) associated with Southern Africa's changing regime of mobility is poorly understood. The evidence seems to suggest that migrants and migrant households are
particularly at risk.6 So too are the residents of non-migrant communities with whom migrants interact on a daily basis.7 The linkages between HIV and population mobility and a review of research done on this link will be discussed in Section 2.
The links between HIV and mobility have their roots in social and economic structures to thoroughly understand these connections, we must explore the unique structural forces at play in Southern Africa's major migrant-employing industries and the movement regimes of non employment-related migration. Population movement in the Southern African region now takes many and
increasingly complex forms. Indeed there are many different “types” of migration and each may carry different levels of risk for HIV and other STIs. Section 3 presents an overview of the different groups of migrants and how each group is at increased risk of HIV infection. Some of these groups, like mine workers and transport workers, have been researched extensively in the region, while other groups like agricultural workers, construction workers, domestic workers, informal traders, commercial sex workers, members of military, and refugees have not been the subject of much HIV related research.
Section 4 describes the, often, missing link between research and policy development. Research findings should ideally feed into the development of new policies and programmes. This section looks at the different types of policies in the region and at what levels policy development takes place.
During the workshop “Research priority setting on HIV/AIDS, population mobility and migration in Southern Africa” that was held on 22 and 23 November 2004 a number of research gaps and recommendations for future research on the link between HIV and
Migration were identified. These include recommendations on research methodologies and how to close the gap between the
research community and the policymakers.
Footnotes:
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UNAIDS, 2004 Report on the global AIDS epidemic.
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4 Macdonald, D.S., 'Notes on the Socio-economic and Cultural Factors Influencing the Transmission of HIV in Botswana', Social Science and Medicine, 42(9) (1996): 1325-33; Williams, B. and C. Campbell, 'Understanding the Epidemic of HIV in South Africa: Analysis of the Antenatal Clinic Survey Data', South African Medical Journal, 88(3) (1998): 247-51; Barnett, T. and A. Whiteside, AIDS in the Twenty- First Century (New York: Palgrave, 2002); Kalipeni, E., et al., (eds.), HIV and AIDS in Africa (Oxford: Blackwell, 2004).
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Crush, J., et al., 'Spaces of Vulnerability: Migration and HIV/AIDS in South Africa', Development Southern Africa (in press).
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Campbell, C. and B. Williams, 'Riding the Tiger: Contextualising HIV Prevention in South Africa', African Affairs, 100 (2001): 135-40; Campbell, C. and Y. Mzaidume, 'How can HIV be Prevented in South Africa? A Social Perspective', British Medical Journal, 324 (2002): 229-32.
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McDonald, D. (ed.), On Borders: Perspectives on the International Migration in Southern Africa (New York and Cape Town: St Martin's Press and SAMP, 2000).
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Lurie, M., Migration and the Spread of HIV in South Africa, (Baltimore, MD: Ph.D thesis, Johns Hopkins University School of Hygiene and Public Health, 2001).
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Auvert, B., et al., 'HIV Infection Among Youth in a South African Mining Town is Associated with Herpes Simplex Virus-2 Sero-positivity and Sexual Behaviour', AIDS, 15 (2000):885-96; Williams, B., et al., The Natural History of AIDS in South Africa: A Biomedical and Social Survey in Carletonville (Johannesburg: CSIR, 2000); Campbell, C. and C. MacPhail, 'Peer Education, Gender and the Development of Critical Consciousness: Participatory HIV Prevention by South African Youth', Social Science and Medicine, 55(2) (2002):331-45; Eaton, L., et al., 'Unsafe Sexual Behaviour in South African Youth', Social Science and Medicine, 56(1) (2003):149-65.
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