who cares sahara

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Who cares? Who cares? The impact of HIV The impact of HIV - - related sickness on related sickness on migration patterns in Southern Africa migration patterns in Southern Africa Lorena Nunez Lorena Nunez Jo Vearey Jo Vearey Scott Drimie Scott Drimie http://migration.org.za University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative RENEWAL

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Page 1: Who Cares Sahara

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

Page 2: Who Cares Sahara

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

Page 3: Who Cares Sahara

Drivers of HIVDrivers of HIV

Page 4: Who Cares Sahara

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

Page 5: Who Cares Sahara

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

Page 6: Who Cares Sahara

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

Page 7: Who Cares Sahara

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)

Page 8: Who Cares Sahara

An interlinked livelihood system:An interlinked livelihood system:

Johannesburg

Provision

of care

Remittances

Back home

Page 9: Who Cares Sahara

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

Page 10: Who Cares Sahara

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

Page 11: Who Cares Sahara

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)

Page 12: Who Cares Sahara

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)

Page 13: Who Cares Sahara

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

Page 14: Who Cares Sahara

►►Thank you! Thank you!