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1. Introduction Migration is a fundamental part of the architecture of modern day South Africa, shaping many social and cultural practices. Unfortunately, the history and geography of migration in South Africa have been characterised by intractably complex problems, compounded by poverty, inequality and HIV/AIDS. The vulnerabilities of migrant living are exacerbated by poverty and transience, and key decisions on sexual health practices are rooted in complex social– environmental contexts. The impact of migration on the HIV/AIDS epidemic in sub-Saharan Africa, and indeed worldwide, remains woefully underevaluated. Migration is a poorly understood phenomenon, evading characterisation and meaningful measurement. Efforts to capture migrant behaviour through survey methodology do not effectively reflect its dynamism. Population-based surveys typically exclude those living in hostels, and where they attempt to ascertain the impact of migration on the household, fall short of adequate definitions. Additionally, sub-standard measurement techniques have thwarted attempts to capture health risks in migrant communities and limited the scope of quantitative analyses. Assessing the impact of migration as a contributor to ill-health is problematic, in part because there are many confounders related to both mobility and health status, including a variety of economic variables such as poverty and income distribution, and in part because of differences in the behavioural characteristics of migrant communities. As a result, it is prudent to remember that a multitude of confounding factors can influence such links. Global links between migration and HIV/AIDS are, however, clear. In areas of the world where populations are mobile, there are clear trends towards the spread of disease. RISK AMPLIFICATION: HIV IN MIGRANT COMMUNITIES PRERNA BANATI 13 Chapter|215| Ecological analyses also provide insight into associations and suggest possible proximal determinants of HIV risk. A comparative study (Boerma et al., 2002; undated) of relatively high and low level prevalence areas in Kisesa, Tanzania, and Manicaland, Zimbabwe, identifies mobility as a potential risk factor for the uneven spread of HIV in rural areas. In Kisesa, prevalence among men aged 17 to 44 and women 15 to 44 was 5,3 per cent and 8 per cent respectively, while in Manicaland these values were more than three times higher: 15,4 per cent and 21,1 per cent respectively. In the low-mobility area of Kisesa, 0,8 per cent of husbands and 1,6 per cent of wives were not cohabiting with their spouses, while in the high-mobility areas of Manicaland, the corresponding values were 10,8 per cent and 52,9 per cent. Recent in-migration was a significant risk factor for HIV at both sites, and in Kisesa, those who had moved into the ward had a higher HIV prevalence than those who had been resident in the ward all their lives. Additionally, HIV prevalence was twice as high in the trading centres as in the surrounding areas. The authors suggest that higher levels of mobility and spousal separation in Manicaland may have led to greater contact with high-risk groups. Another recent study (Lagarde, 2003), conducted in West Africa where the epidemic is more attenuated than in southern Africa, shows the impact of mobility on epidemic spread. A comparison of rural communities in Senegal and Guinea-Bissau showed that mobility was a key factor for HIV spread in rural areas, in part because population movement allowed the spread of HIV, but also because of the particularly risky behaviours of mobile communities. Short-term mobility was found to be a risk factor for HIV, with male migrants being twice as likely to be infected as non-migrants. This chapter explores the relationship between HIV risk and migration in South Africa by identifying urban informal settlements as key magnifiers of risk, increasing the vulnerability of migrants to HIV. It makes a concerted attempt to look beyond the oft-cited unidimensional relationship between HIV and migration and begins to contextualise the problem into the unique environments in which migrants live, exploring the urban informal settlement as a focal determinant of HIV risk (Banati, 2005). This approach allows a reconfiguration of the migration–HIV dialectic by ensuring a contextualisation of the HIV/AIDS problem within a broader discussion and provides a better understanding of the determinants of HIV infection in migrant communities. HIV programmatic interventions can be vastly improved when a holistic picture can be presented. To date, however, these have been typically vertical in nature. In identifying the multidimensionality of HIV risk, this study presents solutions that may fall outside of traditional programmatic interventions and have not...


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