1. Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa Lorena Nunez Jo VeareyScott Drimie University of the Witwatersrand Forced Migration Studies ProgrammeHealth and Migration InitiativeRENEWAL http://migration.org.za
2. Overview Background to the studyStudy rationale; prevailing assumptions linking health seeking, HIV andmigration Study methodologyCross-sectional household survey AnalysisExploring the impact of HIV-related sickness on migration Key findingsLinkages between HIV, provision of care and migration ConclusionsRecommendations for policy and programming 3. Drivers of HIV 4. BackgroundA region of high HIV prevalence and population mobility SADC Meeting 2006 in Maseru: Key drivers High population mobility was recognised as a key social andstructural 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 RURALWIFE MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTSA BURDEN ON SERVICES 5. Background Renewal study exploring linkages between migration, HIVand food security A livelihood lens to explore linkagesInitial hypothesis: remittances are reciprocal with the householdback home supporting urban household through provision offood/cash/goods in a time of crisis/need Focus on linkages between urban and back homePredominantly rural; recognition of importance of intra- and inter-urban movement Three countriesComparative study between South Africa, Namibia and Ethiopia 6. Study methodology Cross sectional household survey undertaken in 2008 inJohannesburg Purposivelyselected areas across urban informal and formal3 inner-city suburbs1 informal settlement Administer questionnaire 487 households= 1533 individuals Crossborder migrants, internal migrants and non-migrants(always lived in Johannesburg)60% (n = 293): South African internal migrants 31% (n = 150): Cross-border migrants9% (n = 44) : Always resided in Johannesburg 7. Analysis A Livelihoods FrameworkIncludes migration as a livelihood strategy The importance of remittancesA tool to explore the impact of HIV and sicknesson livelihood strategies (including migration) 8. An interlinked livelihood system: RemittancesJohannesburg Back homeProvision of care 9. Sickness and HIV in Johannesburg: if the individual in the city becomes too sick to work, the majority will return back homeMEN68%WOMEN58% Urban livelihood SupportImportance ofthat supports Burden on the another householdfoodhousehold back back home would be affected. home. 10. Sickness and HIV Back Home: if someone back home becomes sick with HIV/AIDSReturnSendhome tomoney provide Bring tohomecareJHBNothingMEN66% 8% 6%19% WOMEN 38% 18% 12%32% n = 457 11. 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) 12. Care, health seeking behavior andmobility 1. CareConnects households, is reciprocal, is providedthrough remittances, food, shelter, and thephysical presence (mobility) to provide supervisionand 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) 13. Conclusions Migration patterns Returning home as health seeking behaviour. This highlights thecentrality of the networks care in explaining migration patterns. This challenges presumptions that migration to urban centres ismotivated by a better access to services and to health care A public health approach to the urban is not a discrete space but theurban 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 14. Thank you!