why there is no doctor: high-risk migration patterns (4)

(photo: traffic in Johannesburg)

Apartheid worked on a model of strict population control for increased economic gains. Removing millions to overcrowded townships and Bantustans far from city centers developed a system of forced migrant labor. Both men and women had to leave these areas to find any economic stability for their families.

It has been estimated that one third of the adult male population in the Bantustans is absent at any one time, contributing to the low level of farming. Many women are also forced to seek work elsewhere to support their families. In general they are excluded from seeking work on the industrial areas of South Africa and the majority work as domestics or in agriculture (32).

The migration of Black populations to find work had adverse effects on the health of individuals, families, as well as communities. The movements of people from rural to urban areas became entrenched in the economic system where state interventions actively controlled and mobilized labor migrations (33). In 1990, a study in KwaZulu-Natal province found that men who were migrant workers in the mines had twice the HIV rates as non-migrant workers, while women who attended prenatal clinics in the province had twice the national level of HIV infection (34).

During the period of 1993-1999, there was a significant increase in migrant labor. This can be explained by the ending of apartheid laws creating an increased mobility of populations of workers. In 1993, 32.6% of rural Black Africans were migrant laborers (35). In 1999, almost 40% of rural Black Africans were migrant laborer and 34% of all these migrant workers were women (36). This period also marked the ending of apartheid laws, the first democratic elections in South Africa as well as the doubling of HIV prevalence rates (37). Recent studies have shown that labor migration patterns did not change with the ending of apartheid, but rather increased. A 2003 study concluded that,

Migration continues to play an important role in the spread of HIV-1 in South Africa. The direction of spread of the epidemic is not only from returning migrant men to their rural partners, but also from women to their migrant partners. Prevention efforts will need to target both migrant men and women who remain at home (38).

Professor Lurie and researchers from Brown University, Harvard Medical School and Imperial College London used data collected from nearly 500 men and women living in bustling towns and rural villages to create a mathematical model that shows that migration of South African workers played a major role in the spread of HIV mainly by increasing high-risk sexual behaviors. Very often young men would leave the rural Bantustans in order to earn a living in the urban areas and mines only returning home once a year. With the lifting of travel restrictions on Black South Africans after apartheid this “circular movement” increased (40). Professor Lurie said,

Our model showed that migration primarily influences HIV spread by increasing high-risk sexual behavior. Migrant men were four times as likely to have a casual sexual partner than non-migrant men. So, when coupled with an increase in unprotected sex, we found the frequent return of migrant workers to be an important risk factor for HIV (41).

32. Seedat, Aziza. Crippling a Nation: Health in Apartheid South Africa, 18.
33. Posel, Dorrit. “Have migration patterns in post-apartheid South Africa changed?” 4-7 June 2003.
34. “HIV and other STDs. Chapter 3, Part 1” Population Reports. November 1996, 20.
35. Posel, Dorrit. “Have migration patterns in post-apartheid South Africa changed?” 4-7 June 2003, 3.
36. Ibid.
37. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
38. Lurie, Mark N; Williams, Brian G; Zuma, Khangelani; Mkaya-Mwamburi, David; Garnett, Geoff P; Sweat, Michael D; Gittelsohn, Joel; Karim, Salim SAbdool. AIDS:17 October 2003 – Volume 17 – Issue 15 – pp 2245-2252.
39. Ibid.
40. Ibid.
41. Ibid.

Coming next: Scapegoating “tropical workers”

changing human behaviors: sexual and social

Review of AIDS in Africa: a perspective on the epidemic
by: Michael C. Latham

Africa is a continent wrought with many pressing issues, these issues are often not natural or specific to the continent, but they have been forced and applied to the people and so become a burden of near epic proportions. One of these pressing issues is the epidemic of HIV/AIDS. Responses to HIV/AIDS are based in human behaviors, both sexual and social.

Michael Latham noted that many accounts, “may suggest that the virus originated in Africa, and therefore it is Africans who are blamed for this human scourge.” (39) However, as many know, HIV/AIDS is not solely an African problem, uncontrolled and spreading like wildfire. These accounts springboard off of old myths of a ‘dark continent’ into new myths of dirt, death, and disease. This new myth is of a continent ravaged by disease inside and out, you can’t run from all the disease in Africa. It is also important to note that there is still no solid proof or knowledge of the origin of HIV/AIDS.

If the world is to blame Africa for HIV/AIDS, then Latham writes,

[…] but does it matter that syphilis was probably spread to the rest of the world from cases brought back to Europe from the Americas, to that cholera originated in the Ganga Delta of India and eventually reached East Africa from the middle east only in the mid twentieth century. Should Africans flagellate North Americans and Asians for spreading highly infectious diseases to Africa? (39)

Here we are at the historical spread of diseases and also, more notably, the social implications of associating one area or group of people with a disease. The social implications of chalking AIDS up to African causes becomes especially problematic in the medical community. Latham writes about when one potentially useful drug in the treatment of AIDS [HIV] waa described by the Kenya Medical Research Institute in 1990, it was largely ignored by the world press and […] the west.” (40) This proves a strong disdain and indifferent to Africa as well as a lack of respect for African doctors.

A key feature of HIV/AIDS is that it places all segments of society at risk: mother and father, child and grandparent, youth and elderly. Latham decries the lack of adequately funded research on HIV/AIDS in Africa, or anywhere (42).

We should have African anthropologists and sociologists in the bars and on the truck routes, in the urban slums and rural villages, gathering data on human behaviours, including sexual behavior, that may influence the spread of the disease. We need local epidemiological sleuths conducting the kinds of studies which led us to understand how cholera was spread and how pellagra could be controlled. (42)

Comprehensive understandings of HIV/AIDS and sexual behaviors in Africa will only be more helpful, but the social behaviors of the West and its institutions create a serious roadblock. The Kenyan discovery of Kemron was shown to reduce the effects of full-blown AIDS, but the announcement by the Kenyan president didn’t even make headlines. If a Western doctor had made the discovery the coverage would have been entirely different (46).

Another well-known fact about HIV/AIDS is that it is highly preventable. The only thing that needs to be changed or taught is human behavior: both sexual and social. There needs to be adequate health education for female members of a community. Female members also need more control in those communities, socially and sexually. Very often there is a strong gendered focus on women, but men also need serious engagement and education if their mindsets are going to change about women.

HIV/AIDS is an illness that requires changes in human behaviors: socially and sexually. There needs to be more comprehensive education on sexual prevention as well as a shift in the minds of Western organizations and institutions. There cannot only be a call for changed sexual behaviors in Africa, there must also be a concurrent change in the social behaviors of the West.