2003_2_the impact of family housing on HIV transmission among mining communities in South Africa

Sexual Health Exchange 2003-2

The impact of family housing on HIV transmission among mining communities in South Africa

Hirut Gebrekristos & Mark Lurie

Early in the history of the AIDS epidemic, there was great interest in migration and HIV/AIDS. In particular, the public health community was interested in mapping the routes of HIV infection in hopes of containing the epidemic. Similarly, governments have been and to some degree continue to be interested in migration and AIDS. The consequence of government interest has had implications for immigration in the form of travel restrictions and mandatory HIV testing. Over the years, the AIDS and migration issue has moved away from viewing the immigrant/migrant as a carrier of HIV to trying to understand how the conditions of migration facilitate HIV infection.

Several studies have shown that the migrant labour system – marked by the disruption of families and stable sexual relationships – increases the risk of HIV transmission. This issue is especially significant in South Africa where there are both high levels of movement and migration as well as high prevalence of HIV/AIDS. The mining communities in South Africa are some of the worst affected areas in the world.

Labour migration, the backbone of the South African mining industry, has a long historical presence in the most remote communities in southern Africa. South Africa has both cross-border and internal contract migration. Cross-border migrants have traditionally come from neighbouring southern African nations. Migrants coming from Lesotho, Mozambique, Malawi, Botswana, and Swaziland represent the majority of international mine workers in South Africa. The migrant labour system in South Africa is a type of migration marked by circular patterns of movement from rural homes to work areas. This process of circular migration started as early as 1889 when the diamond mines, providing contracts of limited duration, began to house their labour force in single-sex hostels. The labour force returned home once their contract ended. Other mining sectors adopted this same strategy soon after. Although restrictive laws have been eliminated in post-apartheid South Africa, labour migration continues to be of circular nature.

Visiting home and HIV transmission

The literature highlights two distinct, but related reasons for why the migrant labour system in South Africa encourages risky sexual behaviour. The first is the separation of familial and stable sexual relationships. The second is the presence of commercial sex in mining towns. The circular nature of the migrant labour system in South Africa is not only circular with regards to labour, but it has also developed circular forms of sexual networks between rural areas and labour centres. Miners have sexual partners at the labour centres while continuing a long-distance relationship with their regular partners back in the rural areas. Although less is known about the miners' partners, there is some evidence that they also have other sexual partners while their husbands are at the mines.

The two most common migration arrangements for South African miners are those where the men are able to return home two to four times a year and those where the men are able to return every month. In a study comparing the prevalence of HIV among men in the two migration arrangements and their respective partners against non-migrating men and their partners, Lurie et al found that the prevalence of HIV infection is lower when men spend more time at home with their partners.1 The study also illustrates that the partners of the migrants who come home more (once a month) have the highest HIV prevalence when compared to the other partner categories. This suggests that increased visits within the context of migration could have a negative impact on partners. This may be because migrants continue to engage in casual sex while also returning home more frequently thereby putting their partners at greater risk. At the same time, the data indicates that the lowest HIV rates are found among couples that remain together year round, which suggests that establishing family-style housing may dramatically decrease the incidence of HIV among migrants and their partners.

Probability of HIV infection under single-sex hostels and family housing

Figure - The single-sex hostel bar represents the probability of becoming infected with HIV under the existing conditions and the family housing bar represents the probability of becoming HIV-infected given family housing. Family housing consistently yields lower values of HIV transmission than single-sex hostels.^{2
An appeal for family housing

Based on this data, we examined how changing single-sex hostels into family-style housing would impact the HIV/AIDS epidemic. Using a mathematical model, we were able to estimate the impact of establishing family housing on HIV transmission. This type of modelling has been used widely to understand the effectiveness of risk reduction interventions, condom use, and vaccines. Although there are many challenges to modelling the complex sexual relationships in the migrant labour environment, the model indicates that family housing has the possibility of reducing the impact of HIV/AIDS among mining communities in South Africa. Because family housing would provide the structural support to change migrants' risky sexual behaviour, we estimate that the family housing intervention can bring about a 41% reduction in HIV transmission.
Efforts to stabilize the workforce by providing migrants with permanent residence near the mines have historically been minimal. Most efforts discriminated against unskilled labourers and also international migrants. Although living arrangements and options are more diverse for miners than they have been in the past, family housing continues to be limited for miners. The high cost associated with family-style housing is often cited as a reason for continuing with single-sex hostels; however, the potential positive impact that family housing has on decreasing HIV transmission among migrants may outweigh any cost that is incurred by the industry and the state.}

Hirut Gebrekristos, National Institutes of Health Research Fellow, Brown University School of Medicine and The Miriam Hospital; e-mail: hirut_gebrekristos@yahoo.com and Mark Lurie, Assistant Professor of Medicine and Community Health (Research), Brown University School of Medicine and The Miriam Hospital; e-mail: mark_lurie@brown.edu

For editorial reasons, most references are left out of the article. A full bibliography is available from the authors.

Notes

1. Lurie, M, Williams, B, Mkaya-Mwamburi, D, Garnett, G, Sturm, AW, Sweat, MD, Gittelsohn, J, and Karim, SA. The Impact of Migration on HIV-1 Transmission in South Africa. Sexually Transmitted Diseases 2003, 30(2):149-155.

2. Gebrekristos, H. Implications of Family Housing on HIV/AIDS Among Migrants in South Africa. Yale University, Department of Epidemiology and Public Health, Master's Thesis, 2001.