Abstract
ObjectivesResearch on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. We aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women's migration contributes to their high infection risk.DesignData on socio-demographic characteristics, patterns of migration, sexual behavior and HIV infection status were obtained for a population of 11,677 women aged 15–49 and men aged 15–54, resident members of households within a demographic surveillance area participating in HIV surveillance in 2003–04.MethodsLogistic regression was conducted to examine whether sex and migration were independently associated with HIV infection in three additive effects models, using measures of recent migration, household presence and migration frequency. Multiplicative effects models were fitted to explore whether the risk of HIV associated with migration differed for males and females. Further modeling and simulations explored whether composition or behavioral differences accounted for observed associations.ResultsRelative to non-migrant males, non-migrant females had higher odds of being HIV-positive (adjusted odds ratio [aOR] = 1.72; 95% confidence interval [1.49–1.99]), but odds were higher for female migrants (aOR = 2.55 [2.07–3.13]). Female migrants also had higher odds of infection relative to female non-migrants (aOR = 1.48 [1.23–1.77]). The association between number of sexual partners over the lifetime and HIV infection was modified by both sex and migrant status: For male non-migrants, each additional partner was associated with 3% higher odds of HIV infection (aOR = 1.03 [1.02–1.05]); for male migrants the association between number of partners and HIV infection was non-significant. Each additional partner increased odds of HIV infection by 22% for female non-migrants (aOR = 1.22 [1.12–1.32]) and 46% for female migrants (aOR = 1.46 [1.25–1.69]).ConclusionsHigher risk sexual behavior in the context of migration increased women's likelihood of HIV infection.
Highlights
A growing literature confirms that migration confers economic benefit to migrants and their households [1,2,3,4,5,6,7,8,9,10], and this is no less true in South Africa, where in the 1990s some 16% of the rural population moved annually to urban areas [11] to escape poverty and provide financial support to families left behind [5,12,13]
If the typical corridors of migration differ for males and females in a given region, male and female migrants may be exposed to sexual networks and geographic areas with different levels of HIV prevalence and different probabilities of infection with a given sexual act [32,33]
The population was highly mobile: 35.8% of men and 38.0% of women migrated at least once in the two years prior to HIV surveillance. (Of note, persons who out-migrated before 1 June 2003 and did not retain household membership are not included; men were more likely to out-migrate and not return.) In non-migrants, HIV prevalence was higher in women (29.5%; 95% CI, 28.3–30.7%) than in men (18.9%; 95% CI, 17.6–20.1%); the sex disparity was wider in those who had migrated: among migrants, 42.8% of women vs. 24.4% of men were HIV antibody-positive
Summary
A growing literature confirms that migration confers economic benefit to migrants and their households [1,2,3,4,5,6,7,8,9,10], and this is no less true in South Africa, where in the 1990s some 16% of the rural population moved annually to urban areas [11] to escape poverty and provide financial support to families left behind [5,12,13]. While statistical comparisons of migrants and non-migrants have been undertaken in male and female populations, to our knowledge no studies have tested the hypothesis of potential sex differences in HIV risks associated with migration. In South Africa, women tend to migrate shorter distances to informal settlement areas and regional towns, and retain ties to rural homes, while men tend to migrate longer distances to urban areas, and are less likely to return to households of origin [12,27,28,29,30,31]. In the context of South Africa, population-based studies have found HIV prevalence to be up to twice as high in informal settlements and peri-urban areas compared to urban and rural areas [17,26,34,35,36,37,38]. Having multiple households may foster having multiple ‘‘main’’ lovers - men with whom condom use is least likely [20,39,40]
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