Who cares?     The impact of HIV-related sickness on migration patterns in Southern Africa Lorena Nunez Jo Vearey Scott Dr...
Overview <ul><li>Background to the study </li></ul><ul><ul><li>Study rationale; prevailing assumptions linking health seek...
Drivers of HIV
Background A region of high HIV prevalence and population mobility <ul><li>SADC Meeting 2006 in Maseru: Key drivers </li><...
Background Renewal study  exploring linkages between migration, HIV and food security <ul><li>A livelihood lens to explore...
Study methodology   <ul><ul><ul><li>Cross sectional household survey undertaken in 2008 in Johannesburg  </li></ul></ul></...
Analysis <ul><li>A Livelihoods Framework  </li></ul><ul><ul><li>Includes migration as a livelihood strategy </li></ul></ul...
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...
Sickness and HIV ‘Back Home’: if someone ‘back home’ becomes sick with HIV/AIDS Send money home Return home to provide car...
Key findings <ul><li>Need for remittances </li></ul><ul><ul><li>Unidirectional (city to “back home”) </li></ul></ul><ul><u...
Care, health seeking behavior and mobility  <ul><li>1.  Care   </li></ul><ul><li>Connects households, is reciprocal, is pr...
Conclusions  <ul><li>Migration patterns  </li></ul><ul><li>Returning home as health seeking behaviour. This highlights the...
<ul><ul><ul><ul><ul><li>Thank you!  </li></ul></ul></ul></ul></ul>
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Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa

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

  1. 1. 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
  2. 2. Overview <ul><li>Background to the study </li></ul><ul><ul><li>Study rationale; prevailing assumptions linking health seeking, HIV and migration </li></ul></ul><ul><li>Study methodology </li></ul><ul><ul><li>Cross-sectional household survey </li></ul></ul><ul><li>Analysis </li></ul><ul><ul><li>Exploring the impact of HIV-related sickness on migration </li></ul></ul><ul><li>Key findings </li></ul><ul><ul><li>Linkages between HIV, provision of care and migration </li></ul></ul><ul><li>Conclusions </li></ul><ul><ul><li>Recommendations for policy and programming </li></ul></ul>
  3. 3. Drivers of HIV
  4. 4. Background A region of high HIV prevalence and population mobility <ul><li>SADC Meeting 2006 in Maseru: Key drivers </li></ul><ul><ul><li>High population mobility was recognised as a key social and </li></ul></ul><ul><ul><li>structural driver of high HIV prevalence in Southern Africa </li></ul></ul><ul><li>However, the relationship between HIV and population mobility remains poorly understood </li></ul><ul><li>Existing studies challenge some prevailing assumptions, </li></ul><ul><ul><ul><li>MIGRANTS BRING HIV </li></ul></ul></ul><ul><ul><ul><li>MALE MIGRANTS BRING BACK HIV FROM THE CITY TO RURAL WIFE </li></ul></ul></ul><ul><ul><ul><li>MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTS A BURDEN ON SERVICES </li></ul></ul></ul>
  5. 5. Background Renewal study exploring linkages between migration, HIV and food security <ul><li>A livelihood lens to explore linkages </li></ul><ul><ul><li>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 </li></ul></ul><ul><li>Focus on linkages between urban and “back home” </li></ul><ul><ul><li>Predominantly rural; recognition of importance of intra- and inter- urban movement </li></ul></ul><ul><li>Three countries </li></ul><ul><ul><li>Comparative study between South Africa, Namibia and Ethiopia </li></ul></ul>
  6. 6. Study methodology <ul><ul><ul><li>Cross sectional household survey undertaken in 2008 in Johannesburg </li></ul></ul></ul><ul><ul><ul><li>Purposively selected areas across urban informal and formal </li></ul></ul></ul><ul><ul><ul><ul><li>3 inner-city suburbs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1 informal settlement </li></ul></ul></ul></ul><ul><ul><ul><li>Administer questionnaire 487 households= 1533 individuals </li></ul></ul></ul><ul><ul><ul><li>Cross border migrants, internal migrants and non-migrants (always lived in Johannesburg) </li></ul></ul></ul><ul><ul><ul><li>60% (n = 293): South African internal migrants </li></ul></ul></ul><ul><ul><ul><ul><ul><li>31% (n = 150): Cross-border migrants </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>9% (n = 44) : Always resided in Johannesburg </li></ul></ul></ul></ul></ul>
  7. 7. Analysis <ul><li>A Livelihoods Framework </li></ul><ul><ul><li>Includes migration as a livelihood strategy </li></ul></ul><ul><ul><ul><li>The importance of remittances </li></ul></ul></ul><ul><ul><li>A tool to explore the impact of HIV and sickness on livelihood strategies (including migration) </li></ul></ul>
  8. 8. An interlinked livelihood system: Johannesburg Provision of care Remittances Back home
  9. 9. 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
  10. 10. 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
  11. 11. Key findings <ul><li>Need for remittances </li></ul><ul><ul><li>Unidirectional (city to “back home”) </li></ul></ul><ul><ul><li>Productive role of those who are earning cash (mostly male migrants) </li></ul></ul><ul><ul><li>Affects migration (to the city) </li></ul></ul><ul><li>Impact of sickness </li></ul><ul><ul><li>Uncovered importance of provision of care </li></ul></ul><ul><ul><li>Bidirectional </li></ul></ul><ul><ul><li>Highlights reciprocal nature of interlinked livelihood systems that connect urban with “back home” </li></ul></ul><ul><ul><li>Reproductive role of female migrants </li></ul></ul><ul><ul><li>Affects migration (“back home”): either to provide or receive care </li></ul></ul><ul><ul><li>“ Care as a commodity” for those who are not earning cash (mostly women) </li></ul></ul>
  12. 12. Care, health seeking behavior and mobility <ul><li>1. Care </li></ul><ul><li>Connects households, is reciprocal, is provided through remittances, food, shelter, and the physical presence (mobility) to provide supervision and emotional support </li></ul><ul><li>2. Provision of care is gendered </li></ul><ul><ul><li>Men send cash </li></ul></ul><ul><ul><li>Women provide physical and emotional care </li></ul></ul><ul><ul><li>(either they travel to the place, or are already there) </li></ul></ul>
  13. 13. Conclusions <ul><li>Migration patterns </li></ul><ul><li>Returning home as health seeking behaviour. This highlights the centrality of the networks care in explaining migration patterns. </li></ul><ul><li>This challenges presumptions that migration to urban centres is motivated by a better access to services and to health care </li></ul><ul><li>A public health approach to the urban is not a discrete space but the urban and rural are a continuum. </li></ul><ul><li>Gender and care </li></ul><ul><li>Women are the main responsible for providing care, care provided by women becomes a commodity, in the absence of cash. Men would provide cash </li></ul>
  14. 14. <ul><ul><ul><ul><ul><li>Thank you! </li></ul></ul></ul></ul></ul>

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