Learning from HIV: Exploring migration and health in South Africa

Abstract

Southern Africa is associated with high HIV prevalence and diverse population movements, including temporary, circular movements between rural and urban areas within countries (internal migration), and movements across borders (international migration). Whilst most migration in southern Africa is associated with the search for improved livelihood opportunities in urban areas a small – but significant – number of people are forced to migrate to escape persecution or civil war. This paper utilises recent empirical studies conducted in South Africa to explore linkages between migration into urban areas and health, focusing on HIV. It is shown that the relationship between migration and HIV is complex; that both internal and international migrants move to urban areas for reasons other than healthcare seeking; and that most migratory movements into urban areas involve the positive selection of healthy individuals. Whilst healthy migration has economic benefits for rural sending households, the data uncovers an important process of return migration (internally or across borders) in times of sickness, with the burden of care placed on the rural, sending household. There is an urgent need for a comprehensive response that maintains the health of migrants in urban areas, and provides support to rural areas in times of sickness.

Keywords:

• migration
• health
• HIV
• South Africa
• urban–rural linkages

Acknowledgements

The author is grateful to Ingrid Palmary, Liz Thomas and Lorena Nunez for useful comments on earlier versions of this paper. The University of the Witwatersrand and Carnegie Corporation of New York are thanked for the AIDS Research Initiative (ARI) PhD bursary provided to the author. Two anonymous reviewers are thanked for their useful input into the development of this paper.

Notes

1. During apartheid, cities were ‘off-limits’ to most black South Africans, who required special permission and permits to enter the city.

2. Formerly the Forced Migration Studies Programme (FMSP).