Migration-Induced Hiv and Aids in Rural Mozambique and Swaziland
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THE SOUTHERN AFRICAN MIGRATION PROGRAMME MIGRATION-INDUCED HIV AND AIDS IN RURAL MOZAMBIQUE AND SWAZILAND MIGRATION POLICY SERIES NO. 53 MIGRATION-INDUCED HIV AND AIDS IN RURAL MOZAMBIQUE AND SWAZILAND JONATHAN CRUSH, INES RAIMUNDO, HAMILTON SIMELANE, BOAVENTURA CAU AND DAVID DOREY SERIES EDITOR: PROF. JONATHAN CRUSH SOUTHERN AFRICAN MIGRATION PROGRAMME (SAMP) INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM) 2010 ACKNOWLEDGEMENTS We wish to thank the PHAMSA Program of the IOM (Pretoria) for funding the research on which this report is based. The survey was designed by a working group which included Mark Lurie, Krista House, David Dorey and Hamilton Simelane. Brian Williams alerted us to some important work in this area. We would like to thank all these colleagues for their input and assistance. Ashley Hill assisted with data analysis and report writing. Cassandra Eberhardt, Barbara Rijks, Maria Salamone, Katy Barwise and Searle Schonewille assisted with editing. We would also like to thank the IDRC for its support of SAMP and the DFID for funding the publication of this report. Published by Idasa, 6 Spin Street, Church Square, Cape Town, 8001, and Southern African Research Centre, Queen's University, Canada. ISBN 978-1-920409-49-4 First published 2010 Design by Bronwen Müller All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without prior permission from the publishers. Bound and printed by Logo Print, Cape Town CONTENTS PAGE EXECUTIVE SUMMARY 1 INTRODUCTION 3 MINE LABOUR FROM MOZAMBIQUE AND SWAZILAND 5 HIV AND AIDS IN RURAL SWAZILAND AND MOZAMBIQUE 9 STUDY METHODOLOGY 12 PROFILE OF RESPONDENTS 15 SWAZILAND SURVEY FINDINGS 17 MOZAMBIQUE SURVEY FINDINGS 21 CONCLUSION 27 ENDNOTES 30 MIGRATION POLICY SERIES 34 TABLES PAGE TABLE 1: MINE MIGRATION TO SOUTH AFRICA, 1920-2005 6 TABLE 2: AGE OF MIGRANT MINERS FROM MOZAMBIQUE AND SWAZILAND 8 TABLE 3: FREQUENCY OF RETURN HOME BY MIGRANT MINERS 8 TABLE 4: HIV INFECTION TRENDS AMONG ANC RESPONDENTS 11 BY DISTRICT, 1994-2002 TABLE 5: ESTIMATED ADULT HIV PREVALENCE RATES, MOZAMBIQUE, 2002 11 TABLE 6: AVERAGE MONTHLY INCOME FOR MINERS AND PARTNERS 16 TABLE 7: REASONS FOR NOT USING CONDOMS 25 FIGURES PAGE FIGURE 1: MIGRANT LABOUR ON SOUTH AFRICAN MINES, 1990-2007 7 FIGURE 2: HIV PREVALENCE (ANC RESPONDENTS), 1992-2004 9 FIGURE 3: GAZA PROVINCE AND CHOKWE DISTRICT, MOZAMBIQUE 13 FIGURE 4: SHISELWENI DISTRICT, SWAZILAND 14 FIGURE 5: MAIN MEANS OF PROTECTION AGAINST HIV 18 FIGURE 6: SELF-ASSESSMENT OF RISK OF INFECTION 18 FIGURE 7: NUMBER OF LIFETIME SEXUAL PARTNERS 20 FIGURE 8: REASON FOR NOT USING CONDOM DURING LAST SEXUAL ACT 20 FIGURE 9: PERCEIVED METHODS OF CONTRACTING HIV/AIDS 22 FIGURE 10: MEANS OF PROTECTION FROM HIV 22 FIGURE 11: MAIN CAUSES OF DEATH IN HOME COMMUNITIES (PARTNERS) 23 FIGURE 12: WOMEN’S REASONS FOR HAVING OTHER PARTNERS 26 MMIGRATIONIGRATION PPOLICYOLICY SERIESERIES NO. 4553 EXECUTIXECUTIVEVE SSUUMMARYMMARY outhealth Africa’s workers gold aremining one ofworkforce the categories has the of highest skilled prevalenceprofession- ratesals of most tuberculosis affected andby globalization. HIV infection Over of any the industrial past decade, sector in the therecountry. has The emerged contract a substantial migrant labour body ofsystem, research which that has tracks long outlivedpatterns apartheid, of international is responsible migration for this of unacceptable health personnel, situation. SHThe spread of HIV to rural communities in Southern Africa is not well assesses causes and consequences, and debates policy responses at global understood.and national The scales. accepted Within wisdom this literature, is that migrants the case leave of South for the Africa mines, is engageattracting in high-riskgrowing interest.behaviour, For contract almost 15the years virus Southand return Africa to has infect been theirthe target rural ofpartners. a ‘global This raiding’ model of fails skilled to deal professionals with the phenomenonby several devel- of rural-ruraloped countries. transmission How to anddeal cases with ofthe HIV consequences discordance of (when the resultant the female out- migrantflow of healthis infected professionals and the male is a core migrant policy not). issue Nor for does the itnational reveal whethgov- - erernment. all rural partners are equally at risk of infection. ThisThis studypaper examinesaims to to the examine vulnerability policy ofdebates rural partnersand issues in concerningsouth- ernthe Mozambiquemigration of skilledand southern health Swaziland,professionals which from are the two country major and source to areasfurnish for new migrant insights miners. on the It presents recruitment the resultspatterns of ofsurveys skilled with health miners per- andsonnel. partners The objectivesin these two of sending-areasthe paper are andtwofold: affords the opportunity to compare• To two provide different an auditmine-sending of the organization areas. The twoand areaspatterns are ofnot recruit- only geographicallyment of and skilled culturally professionals different, from they South have Africahad contrasting in the health experi- ences withsector. the Themine paper labour draws system upon over a detailedthe last twoanalysis decades. of recruitment The spread of HIV inadvertising Southern appearing Africa in thein the 1990s South coincided African with Medical major Journal downsizing for and retrenchmentthe period in2000-2004 the gold miningand a series industry of interviews which impacted conducted differ with- ently onprivate Mozambique recruiting and enterprises.Swaziland. Swaziland has been in decline as a source• of Based mine upon migrants the abovewhile Mozambiqueanalysis and additionalremained ainterviews relatively withstable source ofkey mine stakeholders migrants. inThe the study South therefore African aims health not sector,only to the shed paper light on vulnerabilityoffers a seriesin mine of recommendationssending areas, but foralso addressing to draw out the any problem contrasts of that mightskilled exist health between migration. two mine-sending These recommendations areas that were are inserted grounded into the minein migrant both South labour African system experience in different and ways an during interrogation the expansion of inter- of the HIVnational epidemic. debates and ‘good policy’ practice for regulating recruit- The ment.surveys collected data on (a) the age and socio-economic profiles of minersThe paper and partners;is organized (b) into migration five sections. behaviour Section (particularly Two positions how often migrantsdebates about returned the homemigration and offor skilled how long; health (c) professionalsthe knowledge within of and a atti- tudeswider towardsliterature HIV that and discusses AIDS amongthe international both groups; mobility (d) sexual of talent. behaviour andSection protection Three reviewsmeasures research against oninfection the global and circulation(e) perceptions of health of vulner pro-- abilityfessionals, and focusingrisk. Knowledge in particular of HIV upon and debates AIDS isrelating reasonably to the good experience amongst residentsof countries of both in the areas. developing Many of world. the common Section myths Four moves about theHIV focus are held from byinternational only a tiny tominority. South AfricanMost seem issues to knowand provides what puts new them empirical at risk, mate- know thatrial drawnthe disease from isthe fatal, survey know of recruitmentthat ART is patternsnot a remedy and key and interviews do not appearundertaken to have with a greathealth deal sector of faith recruiters in traditional operating healers. in South One Africa. exception isSection the rather Five large addresses proportion the questions of Mozambican of changing miners policy who interventions believe the dis in- easeSouth is Africacurable. towards If anything, the outflow rural partners of skilled are health better professionalsinformed than and min the- ers.recruitment In both Mozambiqueof foreign health and Swaziland,professionals the to main work source in South of knowledge Africa. The is not workplace programmes on the mines or in the community nor peer education nor the medical community, but radio. 1 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 MIGRATION-INDUCED HIV AND AIDS IN RURAL MOZAMBIQUE AND SWAZILAND EXECUTIVE SUMMARY Perception of personal vulnerability is also high. Yet, both miners and female rural partners of migrants are at risk through their behaviour. ealth workers are one of the categories of skilled profession- The reasons, though, are quite different. In the case of miners, high risk als most affected by globalization. Over the past decade, behaviour is a consequence of the migrant labour system which sees them there has emerged a substantial body of research that tracks spend the greater part of the working year away from home in an all-male patterns of international migration of health personnel, environment of macho masculinity with easy access to transactional sex. H These miners are aware that condom use would reduce their risk of con- assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is tracting HIV but actual use is sporadic to non-existent. Condom use is attracting growing interest. For almost 15 years South Africa has been rejected on grounds of personal preference or attributed to forgetfulness. the target of a ‘global raiding’ of skilled professionals by several devel-