The Feminization of Migration and the Fight Against HIV

[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 migrantsare 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.

Labor Migration

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.

Forced Migration

A 2007 United Nations High Commissioner for Refugees (UNHCRreport 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.

Article: The Overlap Between Human Trafficking and HIV AIDS in Africa

[Cross-linked at Future Challenges Organization]

There has not been very much discussion on the overlap of human trafficking and HIV/AIDS on the continent of Africa.  Both human trafficking and HIV/AIDS are recognized as impediments to economic development on the continent of Africa.  HIV/AIDS is acknowledged as one of the push factors for human trafficking in southern Africa, in addition to poverty and undereducation. The  HIV/AIDS epidemic has disproportionately affected marginalized groups- particularly women and children.  Subsequently, the prevalence of HIV/AIDS among victims of human trafficking is higher than that of the general population, and because of their status, these victims often do not have access to the medical care that they require.

The fact is that Africa is a very young continent.  Some 60% of its population is under the age of 24. Additionally, the continent of Africa has over 14 million AIDS orphans. These children live with particular vulnerabilities. As children, they are already susceptible to exploitation (human trafficking, in particular), as one or more of their parents is deceased. Children who have lost at least one parent to HIV/AIDS are more susceptible to traffickers’ manipulations. For example, older children trying to feed their siblings are most likely to be lured by a trafficker’s fraudulent job offer. Continue reading

Article: How Trade Agreements Affect Access to Affordable AIDS Treatments in Africa

Crosslinked at Future Challenges Organization

(Macrotrends: Pandemics + Globalization)

„Because TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights)allowed countries to issue compulsory licences only for domestic use, however, countries without local drug-manufacturing industries, including 37 in Africa, were unable to use compulsory licences to keep medicines affordable.“ („A ‘crisis in waiting’ for AIDS patients:Trade rules will make it harder to get cheap generic medicines)

In the year 2009, an estimated 1.3 million adults and children died as a result of AIDS in sub-Saharan Africa. African women and girls are particularly vulnerable to HIV. As about 76% of all HIV-positive women in the world live in Africa south of the Sahara. Since the beginning of the epidemic, more than 15 million Africans have died from AIDS.

While access to antiretroviral treatment is beginning to mitigate the toll of AIDS, fewer than half of African AIDS patients are receiving the treatment.  In 2009, only 37% of AIDS patients have access to antiretroviral treatments, compared to just 2% in 2002. According to the UNAIDS factsheet, between 2004 and 2009, AIDS-related deaths decreased by 20% in sub-Saharan Africa.

HIV infections and AIDS-related deaths are on the decline among children on the African continent. In southern Africa, between 2004 and 2009, the number of children under 15 who became newly infected with HIV was reduced by 32% (fell from 190 000 in 2004 to 130 000 in 2009). Between 2005 and 2009, the percentage of pregnant women living with HIV in sub-Saharan Africa who received antiretroviral drugs to prevent transmission of HIV to their children increased from 15% to 54%. Continue reading

Article: Maternal Mortality and Africa’s Internally Displaced Persons

Crosslinked at Future Challenges Organization’s blog:

Internally displaced people (IDP) face a very specific set of dangers. In addition to susceptibility to famine in conflict zones, IDPs also deal with lessened (or near-non-existent) access to basic amenities like clean water sources, food sources and medical care. Lessened access to medical care is a major factor in maternal mortality rates among internally displaced populations.

There are an estimated 11.8 million internally displaced people on the continent of Africa according to the United Nations (“Internal Displacement: Global Overview of Trends and Developments in 2006”). Internal Displacement Monitoring Centre (IDMC). April 2007)  The creation of internally displaced populations in areas like Chad, Democratic Republic of the Congo, Côte D‘Ivoire‘s western regions, Kenya (250,000 – 400,000, post 2007-elections), Sudan (5-6 million) and Somalia (about a 1 million due to civil war) is usually attributed to weak governments and armed conflicts. Continue reading

World AIDS Day & Celebrity Narcissism

I have not even watched this video, but I’ve seen enough of the advertising to see that HIV and AIDS-related deaths are trivalized.  Not to mention the fact that the severity of HIV/AIDS is undermined by the comparison between death and logging off of the internet for a day.  Y’all know this whole “movement” got a side-eye from me.  They would be more effective in helping if they allowed the voices of those living with HIV and AIDS to be heard, rather than the deafening sound of their egos inflating.

Now, let’s get down to raising awareness about AIDS. Last year I wrote “Putting the AIDS Discourse in Context:

…I’ll talk some more about the economic and human toll of AIDS in Africa.  There are 22.4 MILLION AIDS cases in sub-Saharan Africa.  Africa has 14 million AIDS orphans.  The rate of transmission from mother to child is alarming.  A study in Ivory Coast revealed that families of AIDS victims spend far more on medicine and medical care than they did on food.   In developing and transitional countries, 9.5 million people are in immediate need of life-saving AIDS drugs; of these, only 4 million (42%) are receiving the drugs.

Disease, mortality and limited access to healthcare are part of a cyclical process whereby economic growth is stunted or declines. Continue reading


(originally published 1 December, 2009)

worldaidsday400_558.jpgToday is World AIDS Day.  Since 1981, 25 million have died from AIDS. There were 33.4 million people living with AIDS in 2008.  At the end of 2008, 50% of AIDS cases were women.  There are over 1.4 million AIDS cases in North America.

I didn’t wear red today (I go to Cal… I don’t own a single red article of clothing!), but I did tweet about HIV/AIDS and did some reading about AIDS today.  I’ll admit, my last tweet was flippant.  I simply said “get tested and don’t do anything stupid.”  Of course, that’s not sufficient.

There is the issue of considering the well-being of others [particularly sexual partners and children.]  While I advocate abstinence, I can only suggest using condoms for any and all sexual activity with a partner.  Maybe I am being uncharacteristically frank today, but I have to do more than wring my hands and quote statistics.  I won’t turn this into an essay extolling the virtues of chastity and abstinence.

But I will point to the truth.  The truth is about the most offensive thing I can say.  AIDS is not merely “the gay disease.”  That meme inhibited any progress that could have been made to prevent the spread in the 1980s in the US.  The politically conservative climate would not allow for the progression of the overlapping discourses of human sexuality and epidemics- especially if HIV/AIDS was understood in terms of gayness.  The misconception that HIV could be spread through casual contact made the stigmas surrounding homosexuality even worse. Continue reading