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Presented at the Regional RENEWAL 3 Workshop at the Glenburn Lodge, South Africa
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Theme 1:
AIDS, Agriculture and Livelihood Security
Projects under Theme 1
1. 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); and
5. Changing Livelihoods in the Face of AIDS (CLIVIA) (beginning with HEARD).
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)
PLANET OF SLUMS?
6% of urban pop in developed countries live in slums 78% of urban pop in the least developed
countries live in slumsThe Challenge of Slums –
UN-HABITAT Report!
Kibera, Nairobi
Swilling, M. 2007
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
Migration, HIV and food security
A focus on Johannesburg through a livelihoods lens
University of the WitwatersrandForced Migration Studies ProgrammeHealth and Migration Initiative
Jo Vearey and Lorena Nunez
African cities are characterised by rapid urbanisation – including
high rates of in-migration:
Internal (from within South Africa)
Circular migration
Cross-border
Urban informal settlements have double the HIV prevalence of urban
formal areas.
African urban environments
1. 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.
Objectives
To 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.
Johannesburg study sites
5
Berea, Jeppestown and Hillbrow
Sol Plaatjies informal settlement
n = 300n = 200
Workshop venue
Methodology
Cross-sectional household survey (2008)– Johannesburg: a complex urban context– Purposively selected areas across urban informal and
formal• 3 inner-city suburbs• 1 informal settlement
• Administered questionnaire;
• Cluster-based random sampling.
487 households:
• 60% (n = 293): South African internal migrants
• 31% (n = 150): Cross-border migrants
• 9% (n = 44): Always resided in Johannesburg
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
lack of access to food
sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in Johannesburg
HIV
pressure to remit
FOOD SECURITY: (access to food, dietary diversity score & food shortage)
SOCIAL PROTECTION FAMILY BACK
HOME
SOCIAL CAPITAL HOUSING
INCOMEREGULAR
HIV TESTING
INFORMATION: HIV testing and
ART
EDUCATION
HEALTH STATUS
natural
loss of incomedeath of a family member
Unreliable income
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
Lack of access to food
Sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in JohannesburgHIV
pressure to remit
FOOD SECURITY HEALTH STATUS
natural
Who are the migrants?
0
10
20
30
40
50
60
70
80
South Africaninternal migrant
Cross-bordermigrant
Always lived inJohannesburg
Migration status
Rel
ativ
e fre
quen
cy (%
)
InformalFormal
n = 293 n = 150 n = 44
n = 487
Chi-square = 62.4; p = <0.001
♀ ♂
0
20
40
60
80
100
120
140
160
10 20 30 40 50 60 70 80
Age (yrs)
Abs
olut
e fre
quen
cy
Distribution of age among the respondents
N = 487
• 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).
Who are the migrants?
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
Lack of access to food
Sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in JohannesburgHIV
pressure to remit
FOOD SECURITY HEALTH STATUS
natural
What are their assets?– Income– Social protection– Social capital– Housing– Regular HIV testing and knowledge of ART
Distribution of number of incomes in the household within each
migration status group
010203040506070
0 inc
ome
1 inc
ome
2 inc
omes
3 inc
omes
Perc
enta
ge (%
) internal migrants
cross-bordermigrantsalways lived in JHB
Social protectionGrants
05
101520253035404550
Informal Formal
Residential area
Rela
tive
frequ
ency
(%)
n = 83
n = 27
Housing
0
10
20
30
40
50
60
70
80
90
Own Self-constructed Rent RDP
Tenure
Rel
ativ
e fr
eque
ncy
(%)
InformalFormal
Chi-square = 364.696; p = <0.0001
n = 479
Repeated HIV testing and knowledge of ART
0
10
20
30
40
50
60
70
Yes No
Have you ever tested for HIV?
Rel
ativ
e fr
eque
ncy
(%)
InformalFormal
Chi-square = 18.420; p = <0.0001
n = 485
National HIV prevalence in urban informal settlements is double that of urban formal areas: 18% compared to 9% (HSRC, 2005)
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
Lack of access to food
Sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in JohannesburgHIV
pressure to remit
FOOD SECURITY HEALTH STATUS
natural
What stressors do urban migrants face?– An interlinked livelihood
• Perception of risk of HIV• Pressure to remit
Perception of risk of HIV
0
10
20
30
40
50
60
70
No Risk Risk
Perception of risk of HIV
Rela
tive
frequ
ency
(%)
InformalFormal
Chi-square = 14.221; p = 0.0002
Linkages and pressure to remit
0
10
20
30
40
50
60
70
Send money Send food Send goods
Remittance
Rel
ativ
e fre
quen
cy (%
)
Internal South African migrantCross-border migrantAlways lived in JHB
An interlinked livelihood system
Johannesburg Another
place
Provision of remittances
Receiving remittances
Stressors ASSETS(strengths)
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
Lack of access to food
Sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in JohannesburgHIV
pressure to remit
FOOD SECURITY HEALTH STATUS
natural
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
Shocks causing food shortage
0
10
20
30
40
50
60
Loss of job Death in thefamily
Just arrived inJHB
Unreliableincome
Food securityis always poor
Reason for food shortage
Rela
tive
frequ
ency
(%)
InformalFormal
Chi-square 52.788; p = <0.0001
Food shortage:respondents residing informally are more likely to have
experienced a food shortage in the last 12 months
0
10
20
30
40
50
60
70
80
Yes No
Have you experienced a food shortage in the last 12 months?
Perc
enta
ge (%
)
Informal
Formal
Sickness and HIV
Shocks
– 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
Sickness and HIV:if the individual in the city becomes too sick to work,
the majority will return back home
Support
54%
67%
Importance of
food Burden on the household back
home.
Urban livelihood that supports
another household ‘back home’ would
be affected. 65% informal48% formal
An interlinked livelihood system
SICKNESS
Johannesburg
Family back home
Provision of care, including food
ASSETS(strengths)
Stressor
Shocks
Remittances stop
StressorShocks
Sickness
Another place
Sickness and HIV:if someone ‘back home’ becomes sick with HIV/AIDS
Send money home
Return home to provide
care
33% 19%
Nothing
34%
Bring to JHB
14%
63% 11% 6% 21%
Informal
Formal
n = 457Chi-square = 40.796; p = <0.001
An interlinked livelihood system
Johannesburg SICKNESS
Another place
Family in JHB
ASSETS(strengths)
Stresses
ShocksStresses
Shocks
Sickness
Send money
Travel home
Bring them to the city
Remittances
ASSETS(strengths)
Outcome
StressorsShocks
financial physicalhuman social
hunger
Lack of access to food
Sickness: themselves and those back home
Urban migrants• Internal South African migrants
• Cross-border migrants
• Always lived in JohannesburgHIV
pressure to remit
FOOD SECURITY HEALTH STATUS
natural
Outcomes of the livelihoods system: – Health status– Urban food security (DDS)
Health status
perc eiv ed health s tatus
1%5%
15%
65%
10%
very poor poor average good very good
0
10
20
30
40
50
60
70
Yes: it is better now Yes: it is worse now No: no change
Has your food access changed since moving to Johannesburg?
Perc
ent
Informal
Formal
Food access:respondents residing informally are more likely to report
that their food access has worsened since moving to Johannesburg
Chi-square 32.170; p = <0.0001
24 hours Dietary Diversity Score:respondents residing informally are more likely to
have a deficient dietary score
0
10
20
30
40
50
60
70
Deficient Sufficient Diverse
Rela
tive
frequ
ency
InformalFormal
Chi-square 89.880;
p = <0.0001
Score 0 - 3 Score 4 - 6 Score 7 - 9
24 hour Dietary Diversity Score
24 hour Dietary Diversity Score migration status
Chi-square 19.252; p = 0.0007
0
10
20
30
40
50
60
Cross-border migrant South African internalmigrant
Always lived inJohannesburg
Migration status
Rel
ativ
e fre
quen
cy (%
)
Deficient (0 - 3)Sufficient (4 - 6)Diverse (7 - 9)
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.
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
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
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