Migration-Induced HIV and AIDS in rural Mozambique and Swaziland

Series Editor: Jonathan Crush
Authors: Jonathan Crush, Ines Raimundo, Hamilton Simelane, Boaventura Cau and David Dorey

Migration Policy Series No. 53

Executive Summary

South Africa's gold mining workforce has the highest prevalence rates of tuberculosis and HIV infection of any industrial sector in the country. The contact migrant labour system, which has long outlived apartheid, is responsible for this unacceptable situation. The spread of HIV to rural communities in Southern Africa is not well understood. The accepted wisdom is that migrants leave for the mines, engage in high-risk behaviour, contract the virus and return to infect their rural partners. This model fails to deal with the phenomenon of rural-rural transmission and cases of HIV discordance (when the female migrant is infected and the male migrant not). Nor does it reveal whether all rural partners are equally at risk of infection.

This study examines the vulnerability of rural partners in southern Mozambique and southern Swaziland, which are two major source areas for migrant miners. It presents the results of surveys with miners and partners in these two sending-areas and affords the opportunity to compare two different mine-sending areas. The two areas are not only geographically and culturally different, they have had contrasting experiences with the mine labour system over the last two decades. The spread of HIV in Southern Africa in the 1990s coincided with major downsizing and retrenchment in the gold mining industry which impacted differently on Mozambique and Swaziland. Swaziland has been in decline as a source of mine migrants while Mozambique remained a relatively stable source of mine migrants. The study therefore aims not only to shed light on vulnerability in mine sending areas, but also to draw out any contrasts that might exist between two mine-sending areas that were inserted into the mine migrant labour system in different ways during the expansion of the HIV epidemic.

The surveys collected data on (a) the age and socio-economic profiles
of miners and partners; (b) migration behaviour (particularly how often
migrants returned home and for how long; (c) the knowledge of and attitudes
towards HIV and AIDS among both groups; (d) sexual behaviour
and protection measures against infection and (e) perceptions of vulnerability
and risk. Knowledge of HIV and AIDS is reasonably good amongst
residents of both areas. Many of the common myths about HIV are held
by only a tiny minority. Most seem to know what puts them at risk, know
that the disease is fatal, know that ART is not a remedy and do not
appear to have a great deal of faith in traditional healers. One exception
is the rather large proportion of Mozambican miners who believe the disease
is curable. If anything, rural partners are better informed than miners.
In both Mozambique and Swaziland, the main source of knowledge
is not workplace programmes on the mines or in the community nor peer
education nor the medical community, but radio.

Perception of personal vulnerability is also high. Yet, both miners and
female rural partners of migrants are at risk through their behaviour.
The reasons, though, are quite different. In the case of miners, high risk
behaviour is a consequence of the migrant labour system which sees them
spend the greater part of the working year away from home in an all-male
environment of macho masculinity with easy access to transactional sex.
These miners are aware that condom use would reduce their risk of contracting HIV but actual use is sporadic to non-existent. Condom use is
rejected on grounds of personal preference or attributed to forgetfulness.

Miners at home are even less likely to use condoms than when they
are on the mine. The risks of contracting HIV are certainly lower (since
commercial sex workers on the mines exhibit much higher HIV prevalence
than rural partners). But their unwillingness to use protection puts
their rural partners at greatly increased risk. Rural partners perceive
themselves to be at high risk precisely because their partners do not
wish to use protection. Miners clearly expect their partners to be faithful
and do not see themselves at risk when they go home. Any woman who
insists on condom use is seen to be implicitly questioning her partner's
fidelity. Women's lack of use of condoms has virtually nothing to do with
personal preference. Partners of migrant miners wish to use condoms to
protect themselves. Their inability to do so with the frequency and consistency
that they would like is related to the demands of men for unprotected
sex. Ultimately, therefore, it is the gendered relations of inequality
that make it very difficult for women to protect themselves against the
high-risk environment of the mines.

One of the basic hypotheses of this study was that different migration
patterns affect the risk profile of miners and rural partners. Mozambican
miners return home only once a year for annual leave. Swazi miners, in
contrast, visit home at least once a month or every month or two. Yet,
both engage in equally risky behaviour while they are away at work. This
places Swazi women at greater personal risk than their Mozambican
counterparts.

On the other hand, the comparison between Mozambican and Swazi
women suggests that the Mozambican partners may be more prone to
forming other relationships outside their primary relationship with their
usually absent partner for a host of different reasons including emotional
and financial support. In some cases, increased poverty from a reduced
flow of remittances may force some rural women to seek support through
other relationships.

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