Who Cares Sahara

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<p> 1. Who cares? The impact of HIV-related sickness on migration patterns in Southern Africa Lorena Nunez Jo Vearey Scott Drimie University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative RENEWAL http://migration.org.za 2. 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 3. Drivers of HIV 4. 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 5. 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 6. Study methodology Cross sectional household survey undertaken in 2008 in Johannesburg Purposivelyselected areas across urban informal and formal 3 inner-city suburbs 1 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 migrants 9% (n = 44) : Always resided in Johannesburg 7. 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) 8. An interlinked livelihood system: Remittances Johannesburg Back home Provision of care 9. Sickness and HIV in Johannesburg: if the individual in the city becomes too sick to work, the majority will return back home MEN 68% WOMEN 58% Urban livelihood Support Importance of that supports Burden on the another household food household back back home would be affected. home. 10. Sickness and HIV Back Home: if someone back home becomes sick with HIV/AIDS Return Send home to money provide Bring to home care JHB Nothing MEN 66% 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 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) 13. 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 14. Thank you! </p>