Eastern and Southern Africa

This article reviews the literature on migration and the spread of HIV/AIDS in Eastern and Southern Africa. It includes Angola, Botswana, Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The literature focuses separately on AIDS or migration. HIV/AIDS is widespread and prevalent in these regions. The major concern is that migrants are at risk due to their migration and HIV infection is spread after a return to their home countries. Populations at risk include rural-to-urban migrants, displaced persons in the Sudan and in the Horn of Africa, refugees crossing borders, and pastoralists moving within rural areas. In 1997, there were an estimated 1.3 million refugees in east African countries and 5 million internally displaced due to conflicts in Angola, Mozambique, and South Africa. Risk factors among migrant groups include high rates of partner change, unprotected sexual intercourse, nonuse of condoms, prior sexually transmitted diseases, IV drug use, and residence in a high HIV-prevalence community. Confounding factors may be age, gender, occupation, and mobility. Health services for migrants vary between countries. There are successful models for prevention of HIV. 13 targeted interventions are identified.     

Temporary Migration and The Spread of STDs/HIV in China: Is There A Link?1

Using data from the literature and a specially designed community‐level survey, this article examines the link between temporary migration and the spread of HIV/STDs in China. The results suggest that temporary migrants not only are overrepresented among people with STD/HIV risk‐taking behaviors, but also account for disproportionately more STD patients and persons infected with HIV. It is imperative that STD and AIDS prevention intervention and education programs in China target temporary migrants. More research is needed that focuses on the underlying mechanisms by which the process of temporary migration renders migrants vulnerable to STD/HIV risk‐taking behaviors.     

Mexico and Central America

This article reviews the literature on migration and HIV/AIDS in Mexico and Central America, including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Most migrants travel to the US through Mexico. US-Mexico trade agreements created opportunities for increased risk of HIV transmission. The research literature focuses on Mexico. Most countries, with the exception of Belize and Costa Rica, are sending countries. Human rights of migrants are violated in transit and at destination. Migration policies determine migration processes. The Mexican-born population in the US is about 3% of US population and 8% of Mexico's population. About 22% arrived during 1992-97, and about 500,000 are naturalized US citizens. An additional 11 million have a Mexican ethnic background. Mexican migrants are usually economically active men who had jobs before leaving and were urban people who settled in California, Texas, Illinois, and Arizona. Most Mexican migrants enter illegally. Many return to Mexico. The main paths of HIV transmission are homosexual, heterosexual, and IV-drug-injecting persons. Latino migrants frequently use prostitutes, adopt new sexual practices including anal penetration among men, greater diversity of sexual partners, and use of injectable drugs.     

AIDS,travel and migration: legal and human rights aspects

This article discusses the legal and human rights aspects of AIDS, travel, and migration in Africa. Restrictions upon migration and travel in the context of HIV/AIDS have directed attention on the jeopardy of free international movement and the need to uphold it. International travel and migration have been blamed for introducing HIV and restrictions imposed to prevent the import of such disease. Contemporary legal and administrative barriers to free movement of people across national borders are similar to the physical barriers imposed to prevent the spread of diseases in past centuries. However, physical barriers failed to prevent the international spread of diseases and legal and administrative barriers have been proven ineffective. Meanwhile, responses to HIV/AIDS set patterns for other health-related issues and to affect the entire legal framework of international travel and migration. Based on previous studies, data on migratory flows and numbers of travelers and migrants are scarce in Africa. Migrants represent more or less 10% of the population of sub-Saharan Africa or 35 million persons, including some 60 million refugees.     

Rural/Urban Residence,Migration, HIV/AIDS,and Safe Sex Practices among Men in Zimbabwe*

Abstract The AIDS epidemic was initially thought to be primarily an urban phenomenon. However, migration between rural and urban areas has resulted in the spread of the virus to all segments of the population. Prevention efforts continue to focus on the ABCs of AIDS, namely, abstinence among young adults, being faithful within a monogamous relationship, and/or using condoms at each sexual encounter. We examine the effects of residence, migration status, and selected social and demographic variables on the use of these three practices among men in Zimbabwe, a nation experiencing one of the highest HIV/AIDS prevalence rates in the world. Both residence and migration status were found to be significantly related to safe sex practices. Knowledge of a source with easy access to condoms was the strongest predictor of this behavior. Knowledge of prevention methods and experience with persons with AIDS also exerted significant effects, although not always in the manner hypothesized. Possible reasons for the findings and implications for policy are discussed.     

South-East Asia

This article reviews the literature on migration and HIV infections in the Mekong Region countries of Cambodia, China, Laos, Myanmar, Thailand, and Viet Nam. The HIV/AIDS situation is profiled in each country. The populations at risk include legal and undocumented cross-border migrants, internal migrants, sex workers, and mobile occupational persons, such as truck drivers, fishermen, seafarers, and cross-border traders. Currently, there is little regional cooperation on the issue of HIV among migrants. Prevalence is high in most of the region. Programs range from being very developed in Thailand to minimal in China. Recently, nongovernmental organizations have created innovative models. AIDSCAP studies have focused on river trade routes along the Thai-Lao border and fishing ports in Thailand and Cambodia. The Asian Research Center for Migration has researched fishermen in 6 countries; Burmese women in Thailand; migrants along the Thai-Myanmar borders; and the impact of transportation routes on the spread of HIV/AIDS along six main inter-country routes. Coordination of Action Research has engaged in research and action projects in 8 southeast Asian countries. The region would benefit from information exchanges about lessons learned and best practices. Field researchers could use better technical support. Regional strategies are useful for providing support from origin to destination.     

Migration,Poverty, and Risk of HIV Infection: An Application of Social Capital Theory

A majority of current HIV/AIDS interventions are designed primarily after individual-based public health models and pay little attention to the socioeconomic environment in which HIV transmission occurs. This article focuses on outlining how migration acts as a conduit for disease transmission in South Africa and then proposes a macro-level prevention model based on social capital theory, thus then supplementing current prevention literature. It is based on the argument that social disruption and stresses from migration lead to sexual interactions during the migration periods that amplify the risk of HIV transmission among migrants.     

Migration and AIDS

This article presents the perspectives of UNAIDS and the International Organization for Migration (IOM) on migration and HIV/AIDS. It identifies research and action priorities and policy issues, and describes the current situation in major regions of the world. Migration is a process. Movement is enhanced by air transport, rising international trade, deregulation of trade practices, and opening of borders. Movements are restricted by laws and statutes. Denial to freely circulate and obtain asylum is associated with vulnerability to HIV infections. A UNAIDS policy paper in 1997 and IOM policy guidelines in 1988 affirm that refugees and asylum seekers should not be targeted for special measures due to HIV/AIDS. There is an urgent need to provide primary health services for migrants, voluntary counseling and testing, and more favorable conditions. Research is needed on the role of migration in the spread of HIV, the extent of migration, availability of health services, and options for HIV prevention. Research must be action-oriented and focused on vulnerability to HIV and risk taking behavior. There is substantial mobility in West and Central Africa, economic migration in South Africa, and nonvoluntary migration in Angola. Sex workers in southeast Asia contribute to the spread. The breakup of the USSR led to population shifts. Migrants in Central America and Mexico move north to the US where HIV prevalence is higher.     

West and Central Africa

This article reviews scientific and other literature during the 1990s that links migration and mobility with the spread of sexually transmitted diseases (STDs), including HIV/AIDS. The focus is on key population groups linked to the spread of HIV and STDs in West and Central Africa: migrant laborers, truck drivers, itinerant traders, commercial sex workers (CSWs), and refugees. Countries with high emigration and immigration tend to have high levels of HIV infection, with the exception of Senegal. The main destination of immigrants are Senegal, Nigeria, and Cote d'Ivoire in West Africa and Cameroon, Congo, Gabon, and Congo in Central Africa. The risk of infection and the spread of HIV is variable among migrants. There is little in the literature that substantiates hypotheses about the strong association between migration and HIV-positive status. Information is needed on the duration, frequency of return visits, living conditions, sexual activities with multiple partners, and information before departure, along the routes, at final destination, and at the time of returns. Action-based research in five West African countries (Burkina Faso, Cote d'Ivoire, Mali, Niger, and Senegal) should produce results in late 1998. Comparable studies in Central Africa are unknown. Regional studies should be complemented by local studies. Prevention would benefit from studies on the relative size of these five population groups by geographic location.     

ECONOMIC AND OTHER SOCIETAL DETERMINANTS OF THE PREVALENCE OF HIV: A Test of Competing Hypotheses

The spread of human immunodeficiency virus (HIV) is believed to result from HIV-infected individuals who are unaware of their infection and, thus, the possible consequences of their sexual behavior for others. However, differential rates of HIV infection between countries may reflect a different set of circumstances. We obtained data from the World Bank and several other sources to test eight alternative explanations for the global differences in prevalence of HIV infection: (1) economic underdevelopment, (2) inadequate public health care, (3) insufficient media, (4) political instability, (5) overurbanization, (6) social inequity, (7) religion, and (8) region. Our regression findings showed that income inequality and political instability had statistically significant positive effects on HIV/AIDS prevalence and that gender equality had a negative effect on HIV/AIDS prevalence. Religion and region were also important predictors, as countries that were predominately Muslim and Christian Orthodox generally had lower prevalence of HIV/AIDS, whereas West Africa, Central Africa, and Southern Africa had a higher prevalence of HIV/AIDS. None of the public health and media indicators were statistically relevant.     

The assessment of sexual practices relevant to the transmission of AIDS: A global perspective

Despite global similarities between the immunologic and pathogenic properties of HIV infection, there are substantial cultural and geographical variations in the transmission dynamics of HIV infection/AIDS. In the United States and Europe, for example, HIV infection/AIDS is predominantly evident among homosexual men and intravenous drug abusers. However, in Central Africa, the data indicate that HIV infections/AIDS is heterosexually acquired. Thus, the purpose of the present paper is to suggest some basic strategies and raise some critical issues for collecting data on sexual practices relevant to the transmission of HIV infection/AIDS throughout the world. Topics include assessment strategies, language and meta‐language, cross‐cultural and intra‐cultural comparability, general methodological issues, and constraints for the assessment of anal intercourse.     

Illegality of international population movements in Poland

Until the beginning of the 1990s Poland did not receive foreign migrants. Thereafter, the situation changed dramatically. A large part of the inflow proved to be illegal migrants, many of whom were in transit to Western Europe. Although these movements gradually declined in the second half of the decade, some became increasingly identified with relatively sophisticated smuggling of people. Foreigners smuggled from the South to the West, together with the international criminal networks assisting them, became typical of the migratory movements of people in Central and Eastern Europe during the 1990s. This article seeks to describe illegal migration from the perspective of Poland, a country often perceived as a major transit area in the smuggling of persons to Western Europe. The conclusions draw on the findings of several surveys recently carried out in Poland. Basic concepts related to illegal migration are defined and juxtaposed, and various myths and stereotypes concerning it that most often stem from the paucity of empirical evidence are examined. Finally, the trends observed in Poland are interpreted within the larger context of contemporary European migration.     

Recession and Migration: A New Era for Labor Migration?

The current recession, the worst in a half century, is likely to affect international migration differently than past recessions. In 1973–1974 and 1981–1982, rising oil prices led to recessions in oil‐importing countries and economic booms in oil‐exporting countries, enabling some migrants to shift from bust to boom areas, as from Europe to the Middle East. The 1997–1998 Asian financial crisis did not spread globally, and was followed by a relatively quick resumption of economic and job growth that attracted migrant workers. The 2008–2009 recession is most severe in countries that had the most severe debt excesses, including the U.S., Spain, and Eastern Europe, and in countries most dependent on trade, including many Asian countries. New deployments of migrants are likely to slow, but what is not yet clear is how many migrants who lose jobs will remain abroad.     

Marital Aspirations,Sexual Behaviors,and HIV/AIDS in Rural Malawi

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in‐depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long‐overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.     

Empowering,invasive or a little bit of both? A reflection on the use of visual and narrative methods in research with migrant sex workers in South Africa

Although migration plays a critical role in the economic landscape of the world, government officials and researchers do not sufficiently include migration and/or migrants in research studies and development policies. In South Africa, many migrants – both internal and cross-border – engage in informal livelihood strategies, including sex work (see Richter et al. 2012). Currently, the bulk of research that is being conducted in South Africa in the areas of migration and sex work rely heavily on the use of traditional research approaches and focus mainly on concerns surrounding issues of public health, with increased attention to HIV (for example, see SANAC 2013; Scheibe, Drame and Shannon 2012; Scorgie et al. 2011). While this work is invaluable, there is a need for research that can counter the stigma that sex workers overwhelmingly face in light of HIV/AIDS. Participatory visual and narrative research approaches – as part of mixed method study designs – that examine the lived experiences of migrant sex workers can provide important insights that ‘move beyond the polarized and simplistic arguments that have circulated in South African about migrant sex workers’ (Nyangairi and Palmary, 2014, 132). This methodological approach makes important and necessary contributions to national and international discourses on migration and sex work (see Oliveira and Vearey 2015). In addition, these methods provide a unique platform where the normative discourses that portray migrants as a homogenous vulnerable and apolitical group of people can be contested (Palmary 2006). In this article, I present and discuss three participatory visual and narrative research projects that have been conducted with migrant men, women and transgender persons who sell sex in two Provinces of South Africa and examine the suitability of these approaches.     

An Approach to Community Outreach Practice in the 21st Century

ABSTRACT

This article presents the findings of a study about knowledge, attitudes and beliefs about AIDS held by older Hispanic adults. Members of the convenience sample provided responses that identify concerns about effective practice in outeach and information provision to older adults with regard to risky sexual practices. Intervention to prevent the spread of HIV/AIDS among older adults needs to be culturally competent and to be attuned to social practices, traditions, community concerns, and generational perspectives with regard to serious health problems related to sexual behavior. The sample composition was primarily Hispanic (97.4%); Catholic, (92.1%) and female (84.2%) with a mean age of 73.7 years. Approximately 28.2% of those surveyed stated that they felt that AIDS was an important problem for older adults. The majority, (76.3%) were aware of locations where health information and services were available if AIDS were a problem. Even though the majority indicated knowledge that AIDS is spread through sexual intercourse, more than one third, (36.8%) thought that sexually active adults 55 and over never use condoms. A discussion of the implications for disease prevention programs and community practice is presented emphasizing the importance of empowerment strategies in health promotion programs and the strengthening of multidisciplinary collaborative efforts to effect positive community health changes.     

Consanguineous Marriage in Turkish Families in Turkey and in Western Europe

The paper compares the prevalence and development of consanguineous marriages between Turkish migrants in Western Europe and stayers from the same regions of origin in Turkey. Analyses draw from three‐generational family data of the 2000 Families study. Findings suggest a decline of kin marriage over generations and time in both groups, but a higher prevalence of kin marriage among migrants. Parental impact was influential, but effects of transmission were lower among migrants. Kin marriage was strongly linked with cross‐border partner choice. The results support previous findings and indicate the specific effect of migration on seemingly traditional patterns of marriage.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Evaluation of HIV/AIDS peer education projects in Zambia

This 1998 evaluation assessed the peer education programmes of HIV/AIDS projects run by four non-governmental organisations. A mini-case study approach was used and analysis was based on cross-case itemistic variables. The projects were assessed only in terms of immediate developmental outcomes to target groups rather than on long-term impact. The study concluded the following: (1) The projects had raised community awareness of HIV/AIDS; (2) Basic knowledge of HIV/AIDS was for the most part accurate; (3) There was anecdotal evidence of behavioural changes in terms of partner-reduction as reported by the projects, though the evidence was sometimes conflicting; and (4) There was evidence that certain traditional practices, which contributed to the spread of the virus (e.g. sexual cleansing and scarification), were becoming modified over time. The programmes were also instrumental in protecting human rights and enabling people living with HIV/AIDS to maintain human dignity.     

An impact evaluation of student teacher training in HIV/AIDS education in Zimbabwe

Zimbabwe introduced a nation-wide program to teach AIDS education in 1994. This paper evaluates changes in student teachers' level of knowledge about transmission, symptoms and prevention of STDs and HIV/AIDS; their attitude towards persons living with AIDS; and their sensitivity to the impact of the epidemic and to discussing and teaching about these issues. There was an increase in knowledge of HIV prevention and in teachers' ability to discuss reproductive health and sexual issues. However, as students were exposed to other HIV material outside the programme, not all of this change is due to the programme. Course attendance needed to be enforced and the curriculum needed to be updated with student participation. Peer educators and participatory techniques are needed to get students to internalise positive attitudes and behaviour. The education materials need to address the lack of female empowerment in making decisions and negotiating for safer sex.