[crossposted at Future Challenges Organization's blog]
Is there a direct relationship between the feminization of migration and HIV prevalence on the African continent? The answer is more complicated than it appears. While the HIV/AIDS epidemic and the aftershocks of regional conflict have had disproportionate impacts on African women, the assumption that HIV/AIDS and conflict/displacement are somehow related is spurious. Yes, migration in its myriad forms- primarily labor migration and forced migration- does add risk factors that contribute to the HIV/AIDS epidemic, but we cannot say that it is a direct relationship. Women who migrate for work face vulnerabilities (risk factors including separation from partners, family, loss of support base) that increase their chances of being infected with HIV.
Areas where there are disruptions in the social order tend to have higher HIV rates. This includes war zones, impoverished and disenfranchised outer-city slums. There are various forms of migration: examples include forced migration due to regional conflict or land grabs or labor migration in response to high regional unemployment. It is important to note that in the last fifteen years, we have seen the feminization of migration on a global scale. A majority of refugees and internally displaced people are women and their children, and an increasing percentage of migrant laborers are women. A growing number of rural-to-urban migrants are women in both Asia and Africa. Globally, women represent about 50 percent of the migrants.
Areas with low levels of education, high unemployment tend to have high rates of circular labor migration. In South Africa, gendered migration patterns were largely due to the several factors. First, a decline in patriarchal control, plus the end of Apartheid afforded women greater mobility. Prior to the fall of the Apartheid government, Influx Control Acts specifically granted economically-productive (Black) African men the right to migrate for work, while limiting their female counterparts‘ mobility.
In 1995, 38% of South African women ages 15-65 were actively looking for work. In 1999, that figure was 95%. This trend South African women entering the migrant labor force occured in the context of decreasing marital rates and income insecurity. Taking all of these factors into account, there is a trend of women increasingly constituting temporary, migrant labor populations. Migration is essential to economic well-being- especially for women.
In West Africa, migration patterns have been a mainstay of the regional economic bloc, dating back to the trans-Saharan trade of the 8th century. This includes North-South migration within Ghana, Togo, Benin, and Nigeria and the longer distance migration between the northern Sahelian countries (Mali, Burkina Faso, Niger and Chad) and the coastal countries to the south. Historically, migrant populations have been mostly male, but recently, women have comprised significant number.
High HIV Prevalence Among Migrant Women:
There is a circular relationship between HIV and population mobility. Migrants face separation from their partners and families, also separation from the social mores that might govern their behavior- particularly when they face loneliness and isolation in communities that are not theirs. Additionally, migrants‘ vulnerability to exploitation is exacerbated by a loss of localized social support systems, linguistic differences and power imbalances between job seeker and employer. For migrant women, especially refugees and internally displaced persons, sexual violence is a risk factor. For all migrants, lack of access to healthcare is a major factor in heightened prevalences of HIV among migrant populations.
In South Africa and Northern Tanzania, migrant women have higher prevalences of HIV than their non-migrant counterparts. This is due, in part, to the fact that the sex trade serves as a complementary work sector to local mining industries. In the mining sector, workers often live away from their spouses, living in company-owned housing. For this reason, among others, there is a demand for a localized sex industry. Within the sex trade, young girls often recruit their peers, citing opportunity and income. However, for the less-fortunate, sex trafficking is their entry into sex work. I discuss the overlap between human trafficking and HIV/AIDS in Africa in this article.
A 2007 United Nations High Commissioner for Refugees (UNHCR) report questions the commonly-held belief that there is direct relationship between conflict, forced migration and wartime rape and increased HIV prevalence among internally-displaced persons and refugees. The data, culled from seven countries/regions affected by conflict [Democratic Republic of the Congo, Southern Sudan, Rwanda, Uganda, Somalia, Burundi, and Sierra Leone] revealed that there was no increase in prevalence of HIV infection during periods of conflict. However, it is important to note that the sample population was primarily refugee and IDP women and children who sought and received antenatal care.
There is no substantive evidence that refugees exacerbate the HIV epidemic in their host communities. With the exception of the Eastern part of the Democratic Republic of the Congo, HIV prevalence is higher in urban areas than in rural areas. Most refugees on the African continent are fleeing rural areas- which typically have lower HIV prevalence- affected by conflict. This may explain why refugees generally have a lower HIV prevalence than that of their host communities. In Burundi, Rwanda and Uganda, HIV prevalence in urban areas affected by conflict had similar rates to urban areas unaffected by conflict. In the rural areas of these countries, the prevalence of HIV infections remained relatively low and stable. Furthermore, there is no evidence that refugees exacerbate the HIV epidemic in their host communities.
One of the challenges here is to broaden the sample population beyond the minority of refugees who had access to medical care. While the regions of origin for most refugees and IDPs are rural areas are typically characterized by low HIV prevalence, we cannot assume the same for future conflicts. Unchallenged assumptions about trends in migration, pandemics and regional conflict will only endanger the most vulnerable among us.