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Who Cares Sahara
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Who cares?Who cares?
The impact of HIVThe impact of HIV--related sickness on related sickness on
migration patterns in Southern Africamigration patterns in Southern Africa
Lorena NunezLorena Nunez
Jo VeareyJo Vearey
Scott DrimieScott Drimie
http://migration.org.za
University of the WitwatersrandForced Migration Studies Programme
Health and Migration InitiativeRENEWAL
OverviewOverview
►► Background to the studyBackground to the study�� Study rationale; prevailing assumptions linking health seeking, Study rationale; prevailing assumptions linking health seeking, HIV and HIV and
migrationmigration
►► Study methodologyStudy methodology�� CrossCross--sectional household surveysectional household survey
►► AnalysisAnalysis�� Exploring the impact of HIVExploring the impact of HIV--related sickness on migrationrelated sickness on migration
►► Key findingsKey findings�� Linkages between HIV, provision of care and migrationLinkages between HIV, provision of care and migration
►► ConclusionsConclusions�� Recommendations for policy and programmingRecommendations for policy and programming
Drivers of HIVDrivers of HIV
BackgroundBackground
A region of high HIV prevalence and population mobilityA region of high HIV prevalence and population mobility
►► SADC Meeting 2006 in Maseru: Key driversSADC Meeting 2006 in Maseru: Key drivers
High population mobility was High population mobility was recognisedrecognised as a key social andas a key social and
structural driver of high HIV prevalence in Southern Africastructural driver of high HIV prevalence in Southern Africa
►► However, the relationship between HIV and population mobility However, the relationship between HIV and population mobility remains poorly understoodremains poorly understood
►► Existing studies challenge some prevailing assumptions, Existing studies challenge some prevailing assumptions,
►► MIGRANTS BRING HIVMIGRANTS BRING HIV►► MALE MIGRANTS BRING BACK HIV FROM THE CITY TO RURAL MALE MIGRANTS BRING BACK HIV FROM THE CITY TO RURAL
WIFEWIFE►► MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTS MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTS
A BURDEN ON SERVICESA BURDEN ON SERVICES
BackgroundBackgroundRenewal study Renewal study exploring linkages between migration, HIV exploring linkages between migration, HIV
and food securityand food security
►► A livelihood lens to explore linkages A livelihood lens to explore linkages �� Initial hypothesis: remittances are reciprocal with the househoInitial hypothesis: remittances are reciprocal with the household ld
““back homeback home”” supporting urban household through provision of supporting urban household through provision of food/cash/goods in a time of crisis/needfood/cash/goods in a time of crisis/need
►► Focus on linkages between urban and Focus on linkages between urban and ““back homeback home””�� Predominantly rural; recognition of importance of intraPredominantly rural; recognition of importance of intra-- and interand inter--
urban movementurban movement
►► Three countriesThree countries�� Comparative study between South Africa, Namibia and Ethiopia Comparative study between South Africa, Namibia and Ethiopia
Study methodologyStudy methodology
►►Cross sectional household survey undertaken in 2008 in Cross sectional household survey undertaken in 2008 in Johannesburg Johannesburg
►►Purposively selected areas across urban informal and formalPurposively selected areas across urban informal and formal
�� 3 inner3 inner--city suburbscity suburbs
�� 1 informal settlement1 informal settlement
►►Administer questionnaire 487 households= 1533 individuals Administer questionnaire 487 households= 1533 individuals
►►Cross border migrants, internal migrants and nonCross border migrants, internal migrants and non--migrants migrants (always lived in Johannesburg) (always lived in Johannesburg)
60% (n = 293): South African internal migrants60% (n = 293): South African internal migrants
31% (n = 150): Cross31% (n = 150): Cross--border migrantsborder migrants
9% (n = 44) : Always resided in Johannesburg9% (n = 44) : Always resided in Johannesburg
AnalysisAnalysis
►►A Livelihoods Framework A Livelihoods Framework
�� Includes migration as a livelihood strategyIncludes migration as a livelihood strategy
►►The importance of remittancesThe importance of remittances
�� A tool to explore the impact of HIV and sickness A tool to explore the impact of HIV and sickness
on livelihood strategies (including migration)on livelihood strategies (including migration)
An interlinked livelihood system:An interlinked livelihood system:
Johannesburg
Provision
of care
Remittances
Back home
Sickness and HIV in Sickness and HIV in JohannesburgJohannesburg::if the individual in the city becomes too sick to work, if the individual in the city becomes too sick to work,
the majority will the majority will return back homereturn 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
Sickness and HIV Sickness and HIV ‘‘Back HomeBack Home’’::if someone if someone ‘‘back homeback home’’ becomes sick with HIV/AIDSbecomes sick with HIV/AIDS
Send money home
Return home to provide
care
66% 8%
Nothing
19%
Bring to JHB
6%
38% 18% 12% 32%
MENMEN
WOMENWOMEN
n = 457
Key findingsKey findings
►► Need for remittancesNeed for remittances�� Unidirectional (city to Unidirectional (city to ““back homeback home””))
�� Productive role Productive role of those who are earning cash (mostly male migrants)of those who are earning cash (mostly male migrants)
�� Affects migration (to the city)Affects migration (to the city)
►► Impact of sicknessImpact of sickness�� Uncovered importance of provision of careUncovered importance of provision of care
�� BidirectionalBidirectional
�� Highlights reciprocal nature of interlinked livelihood systems tHighlights reciprocal nature of interlinked livelihood systems that hat connect urban with connect urban with ““back homeback home””
�� Reproductive roleReproductive role of female migrantsof female migrants
�� Affects migration (Affects migration (““back homeback home””): either to provide or receive care): either to provide or receive care
�� ““Care as a commodityCare as a commodity”” for those who are not earning cash (mostly for those who are not earning cash (mostly women)women)
Care, health seeking behavior and Care, health seeking behavior and
mobility mobility
►►1. 1. CareCare
Connects households, is reciprocal, is provided Connects households, is reciprocal, is provided
through remittances, food, shelter, and the through remittances, food, shelter, and the
physical presence (mobility) to provide supervision physical presence (mobility) to provide supervision
and emotional supportand emotional support
►►2. Provision of care is gendered2. Provision of care is gendered
Men send cashMen send cash
Women provide physical and emotional careWomen provide physical and emotional care
(either they travel to the place, or are already (either they travel to the place, or are already
there)there)
Conclusions Conclusions
Migration patterns Migration patterns
►► Returning home as health seeking Returning home as health seeking behaviourbehaviour. This highlights the . This highlights the
centrality of the networks care in explaining migration patterncentrality of the networks care in explaining migration patterns. s.
►► This challenges presumptions that migration to urban This challenges presumptions that migration to urban centrescentres is is
motivated by a better access to services and to health care motivated by a better access to services and to health care
►► A public health approach to the urban is not a discrete space buA public health approach to the urban is not a discrete space but the t the
urban and rural are a continuum.urban and rural are a continuum.
Gender and careGender and care
►► Women are the main responsible for providing care, care provideWomen are the main responsible for providing care, care provided by d by
women becomes a commodity, in the absence of cash. Men would women becomes a commodity, in the absence of cash. Men would
provide cash provide cash
►►Thank you! Thank you!