Eastern and Southern Africa.

Abstract

The countries included in this review are Angola, Botswana, Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Very little research has specifically addressed the important issue of the relationship between migration and HIV/AIDS in these regions of Africa. However there is a great deal of information about migration, and also about HIV/AIDS, in isolation from each other.HIV/AIDS is widespread and prevalent throughout the two regions. Since HIV prevalence rates are now high in almost all African countries, the concern that migrants may bring the virus with them is no longer appropriate. Instead, the concern is that migrants may be vulnerable to acquiring the infection during migration, and that they may spread the infection when they return to their homes at the end of migration. In the eastern African region there has been rapid growth of urban populations during the last ten years, mainly as a result of rural to urban migration. In addition, the conflict in Sudan and disputes in the Horn of Africa have created large numbers of internally displaced persons. Most recently, conflict in the Great Lakes region has also resulted in very large numbers of refugees crossing international borders. The UNHCR estimates that there were approximately 1.3 million refugees from and in eastern African countries in 1997, and an estimated 5 million internally displaced persons (4 million in Sudan alone).In the southern Africa region there has been a rapid increase in rural‐urban migration. In post‐apartheid South Africa, many workers come to the cities for contract periods only, during which they are often housed in hostel accommodation, separated from their families. There are large internally displaced populations in Angola (up to 1.2 million persons) as a result of civil war in that country and large refugee populations in various countries as a result of conflict in Mozambique, South Africa and Angola.Although it is often stated that migrants are at increased risk of HIV infection, direct data from eastern Africa are difficult to find. A study from the Horn of Africa region has shown HIV prevalence rates among Ethiopian sailors to be 9.6 per cent, and rates may be particularly high among long distance truck drivers. In southern Africa there is some direct prevalence data available for mineworkers, but an extensive search did not find any data for undocumented migrants. The most widely accepted risk factors for many migrant groups include high rate of partner change, unprotected sexual intercourse, non‐use of condoms, prior STDs, injections, and a high prevalence of HIV in the community. There are also a number of recognized associations, such as age, gender, occupation, and mobility, which may be associated with confounding factors, or may play some causal role in their own right. Rural to urban migration in particular appears to result in a redefining of traditional “family” units. Women migrants are twice as likely to enter into “alliance” households (in which friends, family and lodgers make up the family unit) or be heads of households.The state of medical services available to migrants varies from country to country, and between different migrant groups. In particular, the state of services for family planning, women’s health, and the early detection and treatment of STDs may not always have been recognized as a priority in large camps for refugees and internally displaced persons. In South Africa, there are indications that the large undocumented migrant population may avoid the use of the public sector health services for fear of being reported to the authorities, and may not benefit from health promotional and preventive interventions offered there. This may be the case in a number of other countries in these two regions.