Executive summary
In much of the literature on HIV/AIDS and mobility, mobile populations and/or
migrants are described and treated as one, homogenous group. This report examines
the different sub-groups of mobile populations, and looks at their commonalities and
differences.
Mobile groups are vulnerable to HIV/AIDS in different respects, which complicates
prevention and mitigation strategies. Vulnerability to HIV/AIDS is often related
to a particular stage of the mobility process. IOM has defined a process framework
for HIV/AIDS based on four stages of mobility:
- Source: where people come from, why they leave, and the relationships they
maintain at home while away;
- Transit: the places people pass through, how they travel and their behaviour while
they travel;
- Destination: where people go, the attitudes they encounter and their new living
and working conditions;
- Return: the changes that have occurred in people’s lives and the conditions they
find upon their return.
Some migrants are most vulnerable at their destination – for example, men who
work far from home, such as mine workers, farm workers and military personnel
who live in men-only camps or barracks. For others, the greatest risk occurs in transit,
when female informal traders or farm workers might have to trade sex in order to
survive or complete their journeys.2
This report highlights the ways in which the different mobile populations are vulnerable
to HIV/AIDS, and draws together some of the policies and programmes that
governments, employers, unions and NGOs have put in place. Since different mobile
populations are vulnerable to HIV infection at different stages of mobility, the report
formulates recommendations for each stage of the mobility process. Although Commercial
Sex Workers (CSWs) constitute a mobile group in their own right, we have
decided not to highlight them in a separate section but rather integrate them in the
other sections. A separate section on Commercial Sex Workers can be found in the
bibliography in Annex C.
Findings
It has long been clear that the AIDS epidemic thrives in an environment of social
exclusion. Most mobile populations work and live in such an environment. Separated
from their familiar social structures and from shared norms and values, language and
social support, they are more likely to engage in risky behaviour. Their new environment
often lacks strong community cohesiveness, thus increasing the risk of HIV
infection.3
The optimal context for HIV transmission is one where men have money, have
few recreational options, are away from families, and are amid low-income communities
where women’s limited access to education, employment, credit or income can
force resort to commercial or transactional sex. Thus, migrant workers – including
(seasonal) plantation workers, truckers, military personnel and mine workers – are
especially vulnerable to HIV,4 and infection rates tend to be highest in peri-urban
areas beside major highways, military bases, mines, plantations, timber estates and
other migrant centres.
Mobile populations experience a multitude of risks. Preoccupied by more immediate
challenges of physical survival and financial need, many people on the move
regard HIV as a distant risk.5
The transient nature of migrants’ lives puts them at risk. The longer they spend
away from home, the more likely it is that some will indulge in casual, high-risk sex.
Other factors boost the odds of infection even more. Lengthy delays at border crossings
can turn those areas hotspots for high-risk sexual activities. The overcrowded
shacks of farm workers, the isolation of migrant worker hostels or the anonymity of
refugee camps beckons companionship and the possibility of risky sexual conduct.
Gender relations are an important dimension of migration. In Southern Africa most
migrants are men who move to urban areas, leaving their partners in rural areas.
Areas from which migrants originate often are underdeveloped and impoverished –
and women, in the absence of their partners, might have to sell or trade sex in order
to survive. Rural women face an even higher risk of HIV infection when their migrant
partners return home regularly from areas of high HIV prevalence.
Many migrating women move to urban areas in order to achieve economic and
social independence. Lack of education, however, restricts many of them to the informal
trading sector, domestic work or sex work. CSWs are often migrant workers
themselves, moving from city to city in pursuit of better earning opportunities and
safer working conditions. For example, a study found that 40 per cent of the CSWs in
Hillbrow, Johannesburg, were originally from South Africa’s Eastern Cape province.6
At the same time, migrating female farm workers in rural areas (who often outnumber
men as seasonal labourers on some border farms in South Africa) have been
known to exchange sex for food.7
The social constructions of gender and sexuality underpin HIV vulnerability.
Working environments, such as that of truckers,soldiers, mineworkers, plantation
workers and fishermen, contribute significantly to male notions of masculinity and
sexuality. Next to the boredom and loneliness of these jobs, the men endure dangerous
and unpleasant working conditions, poor accommodation and estranging environments,
to which they may respond with exaggerated “masculinity” and sexual bravado.8
Male migrants often subscribe to gender norms that prize multiple sexual partnerships.
Another significant source of HIV transmission is sex between men, especially
those working and living in predominantly male environments.9
In summary, the main factors increasing the vulnerability of mobile populations to
HIV include:10
- work involving mobility, in particular the obligation to travel regularly and live away
from spouses;
- separation from socio-cultural norms that regulate behaviour in stable communities;
- work in isolated environments with limited recreation and easy access to CSWs,
drugs and alcohol;
- limited access to health facilities, including treatment for sexually transmitted infections
(STIs) and HIV/AIDS prevention and care programmes;
- types of accommodation such as single-sex, overcrowded living quarters or having
to sleep in trucks;
- difficult and dangerous working conditions, with high risk of physical injury;
- workplaces dominated by men;
- transactional sex, sexual abuse and sexual violence;
- a sense of anonymity which allows for more sexual freedom;
- xenophobia and discrimination;
- lack of legal rights and legal protection.
There are many policies and programmes in place to address the vulnerability of
various mobile populations to HIV/AIDS. Many are related to the workplace and
address issues such as discrimination, confidentiality, recruitment and employment,
testing and treatment. Some government departments have established strategic plans
on HIV/AIDS for specific sectors, though their implementation has been slow.
Most workplace programmes cover peer education, condom distribution, dissemination
of Information, Education and Communication (IEC) materials, HIV/AIDS
awareness programmes and support to Voluntary Counselling and Testing (VCT).
Some trade unions have been active in addressing some of the socio-economic factors
driving the epidemic like housing and working conditions of migrant workers.
Some successful programmes, mostly funded by international donors, have specifically
addressed HIV vulnerability of certain mobile workers such as truck drivers,
CSWs, traders and miners in mining towns, border areas and other risk-areas along
transport routes.
Overall, however, few policies and programmes address the specific socioeconomic
conditions that increase HIV risk for mobile workers. Conditions that devalue
people’s dignity signal to individuals that their lives are considered to be of little worth.
In such circumstances the fight against HIV/AIDS is unlikely to encounter much
success.
Dangerous work environments – the heat and noise of a cramped mine stope, the
ferocity of a battlefront, the rush to meet tight transport deadlines – imperil life. Why
worry about HIV/AIDS when one may die in a rock fall, a landmine explosion or an
accident? And poverty imposes its own imperatives. As one Botswana sex worker
once explained, “I can ask clients to use condoms but they pay more for sex without
condoms, by the time I die of AIDS I will have been able to educate my children and
build a house.”11
SADC governments, companies and NGOs need to take such factors into consideration
when they develop policies and programmes on HIV/AIDS and mobile
populations.
The way forward
To reduce the HIV vulnerability of mobile populations in the long term, the socioeconomic
and political factors that drive mobility should be addressed, including the
uneven distribution of resources, unemployment, socio-economic insecurity, economic
instability and political unrest.
Similarly the characteristics and underlying conditions of migration should be addressed.
Programmes that train peer educators in the workplace and that distribute
IEC materials and condoms are extremely important. But they do not address the
root causes of vulnerability. Therefore such programmes need to be implemented in tandem with efforts that protect basic human rights and improve the living and working
conditions of mobile workers. If these workers feel valued and have their basic
human rights protected, they would be more likely to value their own lives enough to
practice safe sex.
The next section, Agenda for Advocacy, offers recommendations for action on
policy, research, programme implementation and advocacy. Heeding and implementing
them can address some of the structural causes of HIV vulnerability among mobile
populations.
Footnotes:
- The bibliography on mobile populations and HIV/AIDS is attached to this report in
Annex C.
- UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, UNAIDS, Geneva: 115,
http://www.unaids.org/barcelona/presskit/barcelona%20report/contents.html.
- Barnett, T., L. Decosas and A. Whiteside, “The Jaipur paradigm: a conceptual; framework
for understanding social susceptibility and vulnerability to HIVо , Journal of the
SA Medical Association, Vol. 90, November 2000.
- John Snow International, HIV/AIDS Interventions for Sex Workers and Mobile
Populations in Zimbabwe, November 2001.
- Kambou, S.B. (Care International), Proximate Cause: Addressing Financial Vulnerability
among Mobile Populations of West Africa, Abstract [F11976], XIV International
AIDS Conference in Barcelona.
- Leggett, T., Rainbow Vice: The Drugs and Sex Industries in the New South Africa,
David Philip, Cape Town, 2001.
- Crush, J., et al., Borderline Farming: Foreign Migrants in South African Commercial
Agriculture, South African Migration Project, Migration Policy Series No.16: 77,
http://www.queensu.ca/samp/publications/policyseries/policy16.htm.
- Ibid.
- Global HIV/AIDS Epidemic 2002: 114.
- International Labour Organization (ILO), An ILO code of Practice on HIV/AIDS and the
World of Work, ILO, Geneva, 2001.
- Smith, C., “HIV and the Media” in D. Martin (Ed.), Looking the Beast in the Eye, HIV/
AIDS in South Africa, Jonathan Ball publishers, 2002.
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