Poverty, mobility and HIV

Mobility is often a sign of poverty, with people travelling out of their home areas looking for fresh opportunities. But in the struggle to make ends meet, mobility can also increase vulnerability to HIV/AIDS. A study by the International Organisation for Migration (IOM) and CARE International has tried to identify the links between mobility and HIV/AIDS in Southern Africa by focusing on highly mobile communities in towns along transport corridors in South Africa, Zimbabwe and Mozambique. Truck drivers and commercial sex workers are the most obvious of the vulnerable groups. But the CARE/IOM study also included female informal traders, domestic workers, migrant labourers, farming communities, mine and construction workers, uniformed government officials like customs officers, and school-age children. "The HIV epidemic is so integrated with the [regional] food crisis," project manager Barbara Rijks told PlusNews. "We wanted to get an idea of the informal groups that are moving that are never documented, but are quite significant in the Southern Africa context." Truck drivers and commercial sex workers were all identified as high risk groups in the four towns studied in South Africa and Zimbabwe. Condom use by sex workers was found to be "highly sporadic". Even though most of those interviewed knew how HIV is transmitted, the most frequently cited reasons for not using condoms was: the fear the client would go elsewhere or become abusive, and the additional money charged for sex without a condom. "As long as you have poverty you won't have any consistent condom use," Rijks said, adding that at times a fatalism undermined the idea of real choice. She added that the failure to negotiate the use of condoms also often extended to wives, even when they knew their men to be unfaithful. "In the epidemic we have now, [many] infections are taking place within a relationship." Female informal traders are another group seen as particularly vulnerable. In the Zimbabwean border town of Beitbridge, they face high rates of harassment and even rape, particularly by customs and immigration officials, the police and soldiers. The study recommended intervention programmes dealing with gender violence and abuse, providing women with information on legal resources. In South Africa's northern Limpopo province town of Messina, farm workers are predominantly illegal male migrant labourers from Zimbabwe and Mozambique. "They have multiple partners in South Africa and their home countries, and condom use is irregular." A lot of stigma is associated with condoms, with women who use them regarded as "prostitutes" and men as not "real men", the study found. Out of eight farms visited, three did not have any HIV/AIDS programmes for their workers. In neighbouring Tzaneen, where the majority of farm workers are women, their knowledge of HIV prevention was also low, and although often monogamous, their partners have multiple sex partners. The study also focused on the youth of sex workers in the town. Frequently of school-going age, they rarely insist on condoms with their clients, who are mainly truck drivers, whose attraction is that they are relatively well off. The study called for youth-orientated prevention activities and the strengthening of peer mediated programmes for farm workers. Malipati is Zimbabwe's gateway to Mozambique, and an area severely hit by drought. Among the high risk groups identified in the study were the spouses of migrant labourers working in South Africa. They hardly ever see their husbands, and when remitances do not arrive, are "forced to exchange money for food". All the wives interviewed said they had never used a condom. Mandimba is a poor Mozambican town on the border with Malawi. It has high commercial sex work activity, limited access to condoms and HIV/AIDS knowledge is low. Similarly, in the port town of Nacala the most vulnerable group are sex workers "who display myths and misconceptions about HIV/AIDS." Construction workers and itinerant traders along the expanding transport corridor to Malawi are among their clients. The study called for technical support to the local health services for HIV counselling and information dissemination. Rijks pointed out that the "socio-economic conditions that lead to vulnerability" are often overlooked. "You have a [migrant] mine worker who does a nasty job and has bad accommodation with no privacy. His only recreation is to visit a sex worker ... He's not interested in safe sex because he doesn't believe he is cared for. [Employers] give little thought to anything beyond the immediate output of his work."