AIDS, Agriculture and Livelihood Security

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Presented at the Regional RENEWAL 3 Workshop at the Glenburn Lodge, South Africa

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AIDS, Agriculture and Livelihood Security

  1. 1. Theme 1:AIDS, Agriculture and Livelihood Security
  2. 2. Projects under Theme 11. Risks and Vulnerabilities to HIV and AIDS within the Plantation Systems of the Lake Victoria Basin (ongoing with AMREF);2. Quantifying the Impact of HIV/AIDS on Government Agricultural Extension Service Delivery in Zambia and Malawi (ongoing);3. Urban-Rural Linkages in Three African Cities (winding up);4. Longitudinal Tracking in Kenya-Nairobi Urban Slums (winding up); and5. Changing Livelihoods in the Face of AIDS (CLIVIA) (beginning with HEARD).
  3. 3. Urbanisation & Urban-Rural Links• Emphasis on “livelihoods” as opposed to “rural livelihoods”• Acknowledging changing systems and increased urbanisation (Durban, Mbekweni, Nairobi, Jo’burg, Windhoek, Addis Ababa)• Focusing on urban-rural linkages incl migration• Considers HIV and AIDS and food insecurity as key dimensions of these areas – eg. informal urban areas (SA)
  4. 4. PLANET OF SLUMS? 6% of urban pop in developed countries live in slums 78% of urban pop in the least developed countries live in slums The Challenge of Slums – UN-HABITAT Report ! Kibera, Nairobi Swilling, M. 2007
  5. 5. Recognising the complexity of African cities: the importance of diversity• UR Links study engages complexity : – Adopts an “ecohealth” approach – Focus on different types of migrants: Internal & external – Complex linkages; people, food, money, goods (reciprocity) – Diverse settlement types• Mixed methodology: – Quantitative surveys in Addis Ababa, Johannesburg & Windhoek – Qualitative research with different groups including children – Engaged decision makers throughout
  6. 6. Migration, HIV and food security A focus on Johannesburg through a livelihoods lens Jo Vearey and Lorena Nunez University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative
  7. 7. African cities are characterised byrapid urbanisation – including high rates of in-migration:Internal (from within South Africa) Circular migration Cross-border
  8. 8. Urban informal settlements have double the HIV prevalence of urban formal areas.
  9. 9. African urban environments1. High rates of migration;2. Increasing pressure on appropriate housing;3. High urban HIV prevalence rates – highest in urban informal areas;4. Dependency on survivalist livelihoods located within the informal sector;5. Increasing urban inequalities that impact ‘urban poor’ groups.
  10. 10. ObjectivesTo explore the linkages between HIV, migration and urban food security through a livelihoods lens.To better understand differences in urban livelihood systems between: • Those residing informally and those residing formally; • Internal and cross-border migrants.
  11. 11. Johannesburg study sites Workshop venueSol Plaatjiesinformalsettlement Berea, Jeppestown and Hillbrown = 200 n = 300 5
  12. 12. MethodologyCross-sectional household survey (2008) 487 households: – Johannesburg: a complex urban context –• Purposively selected areas across urbanmigrants and 60% (n = 293): South African internal informal formal • 3 (n = 150): Cross-border migrants • 31%inner-city suburbs • 1 informal settlement • 9% (n = 44): Always resided in Johannesburg• Administered questionnaire;• Cluster-based random sampling.
  13. 13. Shocks Stressorslack of access to pressure to remitfood Urban migrants sickness: • Internal South African migrants HIV themselves and • Cross-border migrants those back home • Always lived in Johannesburg Unreliable incomeloss of income hungerdeath of a family ASSETSmember (strengths) natural INFORMATION: SOCIAL CAPITAL HIV testing and HOUSING human social ART SOCIAL INCOME financial physical REGULAR PROTECTION FAMILY BACK HIVEDUCATION HOME TESTING Outcome FOOD SECURITY: HEALTH STATUS (access to food, dietary diversity score & food shortage)
  14. 14. Shocks StressorsLack of access to pressure to remitfood Urban migrants • Internal South African migrants Sickness: • Cross-border migrants themselves and HIV • Always lived in Johannesburg those back home hunger ASSETS (strengths) natural human social financial physical Outcome FOOD SECURITY HEALTH STATUS
  15. 15. Who are the migrants? 80 70Relative frequency (%) 60 50 Informal 40 ♀ Formal 30 20 ♂ 10 n = 293 n = 150 n = 44 0 South African Cross-border Always lived in internal migrant migrant Johannesburg Migration status n = 487 Chi-square = 62.4; p = <0.001
  16. 16. Who are the migrants? Distribution of age among the respondents 160 140 Absolute frequency 120 100 80 60 40 20 N = 487 0 10 20 30 40 50 60 70 80 Age (yrs)• The average of respondents is 33 yrs old and half of them have less than 30 yrs old• Female cross-border migrants are the youngest group (median, 25 years)• Men who have always lived in Johannesburg are the oldest (median 36 years).
  17. 17. Shocks StressorsLack of access to pressure to remitfood Urban migrants • Internal South African migrants Sickness: • Cross-border migrants themselves and HIV • Always lived in Johannesburg those back home hunger ASSETS (strengths) natural human social financial physical Outcome FOOD SECURITY HEALTH STATUS
  18. 18. What are their assets? – Income – Social protection – Social capital – Housing – Regular HIV testing and knowledge of ART
  19. 19. Distribution of number of incomes in the household within each migration status group 70 60 internal migrantsPercentage (%) 50 40 cross-border 30 migrants 20 always lived in JHB 10 0 e e es es m m m m co co co co in in in in 0 1 2 3
  20. 20. Social protection Grants 50 45 40Relative frequency (%) 35 30 25 20 15 n = 83 10 5 n = 27 0 Informal Formal Residential area
  21. 21. Housing 90 80 70Relative frequency (%) 60 50 Informal 40 Formal 30 20 10 0 Own Self-constructed Rent RDP Tenure n = 479 Chi-square = 364.696; p = <0.0001
  22. 22. Repeated HIV testing and knowledge of ART 70 60 50Relative frequency (%) National HIV prevalence in urban informal 40 settlements is double that of urban formal Informal areas: 18% compared to 9% (HSRC, 2005) Formal 30 20 10 0 Yes No Have you ever tested for HIV? n = 485 Chi-square = 18.420; p = <0.0001
  23. 23. Shocks StressorsLack of access to pressure to remitfood Urban migrants • Internal South African migrants Sickness: • Cross-border migrants themselves and HIV • Always lived in Johannesburg those back home hunger ASSETS (strengths) natural human social financial physical Outcome FOOD SECURITY HEALTH STATUS
  24. 24. What stressors do urban migrants face? – An interlinked livelihood • Perception of risk of HIV • Pressure to remit
  25. 25. Perception of risk of HIV 70Relative frequency (%) 60 50 40 Informal 30 Formal 20 10 0 No Risk Risk Perception of risk of HIV Chi-square = 14.221; p = 0.0002
  26. 26. Linkages and pressure to remit 70 60 50Relative frequency (%) 40 Internal South African migrant Cross-border migrant 30 Always lived in JHB 20 10 0 Send money Send food Send goods Remittance
  27. 27. An interlinked livelihood system Stressors ASSETSProvision of (strengths)remittances Johannesburg Another Receiving place remittances
  28. 28. Shocks StressorsLack of access to pressure to remitfood Urban migrants • Internal South African migrants Sickness: • Cross-border migrants themselves and HIV • Always lived in Johannesburg those back home hunger ASSETS (strengths) natural human social financial physical Outcome FOOD SECURITY HEALTH STATUS
  29. 29. What are the shocks that urban migrants face? – Loss of income; death of a family member; arriving in Johannesburg • Poor food access – Specific sickness episode, HIV and Aids
  30. 30. Shocks causing food shortage 60 50Relative frequency (%) 40 Informal 30 Formal 20 10 0 Loss of job Death in the Just arrived in Unreliable Food security family JHB income is always poor Reason for food shortage Chi-square 52.788; p = <0.0001
  31. 31. Food shortage: respondents residing informally are more likely to have experienced a food shortage in the last 12 months 80 70 60Percentage (%) 50 Informal 40 Formal 30 20 10 0 Yes No Have you experienced a food shortage in the last 12 months?
  32. 32. Sickness and HIVShocks – A specific sickness episode which may be related to HIV or Aids – This sickness can affect the respondent, a household member in the city, or a household member back home
  33. 33. Sickness and HIV:if the individual in the city becomes too sick to work, the majority will return back home 54% 67% Urban livelihood Support Importance of that supportsanother household food Burden on the household back‘back home’ would be affected. 65% informal home. 48% formal
  34. 34. An interlinked livelihood system Shocks StressorSickness Shocks Remittances stop SICKNESS Another place Provision of care, including Johannesburg food Stressor ASSETS Family (strengths) back home
  35. 35. Sickness and HIV: if someone ‘back home’ becomes sick with HIV/AIDS Return Send home to money provide Bring to home care JHB Nothing Informal 33% 19% 14% 34% Formal 63% 11% 6% 21%Chi-square = 40.796; p = <0.001 n = 457
  36. 36. An interlinked livelihood system Shocks Stresses Shocks Sickness Johannesburg SICKNESS Another placeSend money Travel home Stresses Bring them to the city ASSETS Family in (strengths) JHB Remittances
  37. 37. Shocks StressorsLack of access to pressure to remitfood Urban migrants • Internal South African migrants Sickness: • Cross-border migrants themselves and HIV • Always lived in Johannesburg those back home hunger ASSETS (strengths) natural human social financial physical Outcome FOOD SECURITY HEALTH STATUS
  38. 38. Outcomes of the livelihoods system: – Health status – Urban food security (DDS)
  39. 39. Health status 65% 15% 10% 5% 1%very poor poor averag e g ood very g ood perc eiv ed health s tatus
  40. 40. Food access:respondents residing informally are more likely to report that their food access has worsened since moving to Johannesburg 70 60 50 Percent 40 Informal 30 Formal 20 10 0 Yes: it is better now Yes: it is worse now No: no change Has your food access changed since moving to Johannesburg? Chi-square 32.170; p = <0.0001
  41. 41. 24 hours Dietary Diversity Score:respondents residing informally are more likely to have a deficient dietary score 70 60 50 Relative frequency 40 Informal Formal 30 20 10 0 Deficient Sufficient Diverse Score 0 - 3 Score 4 - 6 Score 7 - 9 Chi-square 89.880; 24 hour Dietary Diversity Score p = <0.0001
  42. 42. 24 hour Dietary Diversity Score migration status 60 50Relative frequency (%) 40 Deficient (0 - 3) 30 Sufficient (4 - 6) Diverse (7 - 9) 20 10 0 Cross-border migrant South African internal Always lived in migrant Johannesburg Migration status Chi-square 19.252; p = 0.0007
  43. 43. Linkages to the National Strategic Plan • South African NSP (2007 – 2011) – Recognition of migrants (internal and cross-border, refugees, asylum seekers and undocumented); – Emphasis on informal settlements and recognition of highest HIV prevalence. • However: – Lack of guidance for how to implement action at the local level; – This research contributes to generating such a framework – through dialogue with policy makers and practitioners, including local government.
  44. 44. Policy engagement• Local - City of Johannesburg – Ongoing engagement through FMSP and MRC linkages – Forthcoming dissemination workshop• Regional - SADC – SADC Parliamentarian Meeting on migration – Regional guidelines on migration and HIV• Multi-disciplinary national technical advisory group • Medical Research Council • University of the Witwatersrand • Population Council • IFPRI - RENEWAL – Research planning, analysis, discussion, engagement, use of data
  45. 45. Policy recommendations• The importance of an interlinked livelihood system – Rural-urban linkages – The meaning of ‘home’ – Rural development must engage with the urban, and urban development must engage with rural
  46. 46. Ongoing and future research• Ongoing research: – Student projects – Wits – MRC/Centre for Health Policy• Research needs: – Rural sending communities – The role of social networks within the livelihoods system – Intra-household dynamics • Migration decisions • Resource use – Intervention Research: process evaluations

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