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

2. Overview
► Background to the study
Study rationale; prevailing assumptions linking health seeking, HIV and
migration
► Study methodology
Cross-sectional household survey
► Analysis
Exploring the impact of HIV-related sickness on migration
► Key findings
Linkages between HIV, provision of care and migration
► Conclusions
Recommendations for policy and programming

3. Drivers of HIV

4. Background
A region of high HIV prevalence and population mobility
► SADC Meeting 2006 in Maseru: Key drivers
High population mobility was recognised as a key social and
structural driver of high HIV prevalence in Southern Africa
► However, the relationship between HIV and population mobility
remains poorly understood
► Existing studies challenge some prevailing assumptions,
► MIGRANTS BRING HIV
► MALE MIGRANTS BRING BACK HIV FROM THE CITY TO RURAL
WIFE
► MIGRATION IS LINKED TO HEALTHCARE SEEKING AND PRESENTS
A BURDEN ON SERVICES

5. Background
Renewal study exploring linkages between migration, HIV
and food security
► A livelihood lens to explore linkages
Initial hypothesis: remittances are reciprocal with the household
“back home” supporting urban household through provision of
food/cash/goods in a time of crisis/need
► Focus on linkages between urban and “back home”
Predominantly rural; recognition of importance of intra- and inter-
urban movement
► Three countries
Comparative study between South Africa, Namibia and Ethiopia

6. Study methodology
► Cross
sectional household survey undertaken in 2008 in
Johannesburg
► Purposivelyselected areas across urban informal and formal
3 inner-city suburbs
1 informal settlement
► Administer questionnaire 487 households= 1533 individuals
► Crossborder migrants, internal migrants and non-migrants
(always lived in Johannesburg)
60% (n = 293): South African internal migrants
31% (n = 150): Cross-border migrants
9% (n = 44) : Always resided in Johannesburg

7. Analysis
►A Livelihoods Framework
Includes migration as a livelihood strategy
►The importance of remittances
A tool to explore the impact of HIV and sickness
on livelihood strategies (including migration)

8. An interlinked livelihood system:
Remittances
Johannesburg Back home
Provision
of care

9. Sickness and HIV in Johannesburg:
if the individual in the city becomes too sick to work,
the majority will return back home
MEN 68%
WOMEN 58%
Urban livelihood Support
Importance of
that supports
Burden on the
another household food household back
‘back home’ would
be affected. home.

10. Sickness and HIV ‘Back Home’:
if someone ‘back home’ becomes sick with HIV/AIDS
Return
Send home to
money provide Bring to
home care JHB Nothing
MEN 66% 8% 6% 19%
WOMEN 38% 18% 12% 32%
n = 457

11. Key findings
► Need for remittances
Unidirectional (city to “back home”)
Productive role of those who are earning cash (mostly male migrants)
Affects migration (to the city)
► Impact of sickness
Uncovered importance of provision of care
Bidirectional
Highlights reciprocal nature of interlinked livelihood systems that
connect urban with “back home”
Reproductive role of female migrants
Affects migration (“back home”): either to provide or receive care
“Care as a commodity” for those who are not earning cash (mostly
women)

12. Care, health seeking behavior and
mobility
► 1. Care
Connects households, is reciprocal, is provided
through remittances, food, shelter, and the
physical presence (mobility) to provide supervision
and emotional support
► 2. Provision of care is gendered
Men send cash
Women provide physical and emotional care
(either they travel to the place, or are already
there)

13. Conclusions
Migration patterns
► Returning home as health seeking behaviour. This highlights the
centrality of the networks care in explaining migration patterns.
► This challenges presumptions that migration to urban centres is
motivated by a better access to services and to health care
► A public health approach to the urban is not a discrete space but the
urban and rural are a continuum.
Gender and care
► Women are the main responsible for providing care, care provided by
women becomes a commodity, in the absence of cash. Men would
provide cash

14. ►Thank you!