Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa

Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa Lorena Nunez Jo Vearey Scott Drimie http://migration.org.za University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative RENEWAL

Overview
Background to the study
Study rationale; prevailing assumptions linking health seeking, HIV and migration
Study methodology
Cross-sectional household survey
Analysis
Exploring the impact of HIV-related sickness on migration
Key findings
Linkages between HIV, provision of care and migration
Conclusions
Recommendations for policy and programming

Drivers of HIV

Background A region of high HIV prevalence and population mobility
SADC Meeting 2006 in Maseru: Key drivers
High population mobility was recognised as a key social and
structural driver of high HIV prevalence in Southern Africa
However, the relationship between HIV and population mobility remains poorly understood
Existing studies challenge some prevailing assumptions,
MIGRANTS BRING HIV
MALE MIGRANTS BRING BACK HIV FROM THE CITY TO RURAL WIFE
MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTS A BURDEN ON SERVICES

Background Renewal study exploring linkages between migration, HIV and food security
A livelihood lens to explore linkages
Initial hypothesis: remittances are reciprocal with the household “back home” supporting urban household through provision of food/cash/goods in a time of crisis/need
Focus on linkages between urban and “back home”
Predominantly rural; recognition of importance of intra- and inter- urban movement
Three countries
Comparative study between South Africa, Namibia and Ethiopia

Study methodology
Cross sectional household survey undertaken in 2008 in Johannesburg
Purposively selected areas across urban informal and formal
3 inner-city suburbs
1 informal settlement
Administer questionnaire 487 households= 1533 individuals
Cross border migrants, internal migrants and non-migrants (always lived in Johannesburg)
60% (n = 293): South African internal migrants
31% (n = 150): Cross-border migrants
9% (n = 44) : Always resided in Johannesburg

Analysis
A Livelihoods Framework
Includes migration as a livelihood strategy
The importance of remittances
A tool to explore the impact of HIV and sickness on livelihood strategies (including migration)

An interlinked livelihood system: Johannesburg Provision of care Remittances Back home

Sickness and HIV in Johannesburg : if the individual in the city becomes too sick to work, the majority will return back home Support 68% 58% Importance of food Burden on the household back home. Urban livelihood that supports another household ‘back home’ would be affected. MEN WOMEN

Sickness and HIV ‘Back Home’: if someone ‘back home’ becomes sick with HIV/AIDS Send money home Return home to provide care 66% 8% Nothing 19% Bring to JHB 6% 38% 18% 12% 32% MEN WOMEN n = 457

Key findings
Need for remittances
Unidirectional (city to “back home”)
Productive role of those who are earning cash (mostly male migrants)
Affects migration (to the city)
Impact of sickness
Uncovered importance of provision of care
Bidirectional
Highlights reciprocal nature of interlinked livelihood systems that connect urban with “back home”
Reproductive role of female migrants
Affects migration (“back home”): either to provide or receive care
“ Care as a commodity” for those who are not earning cash (mostly women)

Care, health seeking behavior and mobility
1. Care
Connects households, is reciprocal, is provided through remittances, food, shelter, and the physical presence (mobility) to provide supervision and emotional support
2. Provision of care is gendered
Men send cash
Women provide physical and emotional care
(either they travel to the place, or are already there)

Conclusions
Migration patterns
Returning home as health seeking behaviour. This highlights the centrality of the networks care in explaining migration patterns.
This challenges presumptions that migration to urban centres is motivated by a better access to services and to health care
A public health approach to the urban is not a discrete space but the urban and rural are a continuum.
Gender and care
Women are the main responsible for providing care, care provided by women becomes a commodity, in the absence of cash. Men would provide cash

Thank you!

Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa

by African Centre for Migration & Society, University of the Witwatersrand on Jan 06, 2010

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Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa — Presentation Transcript