1. MIGRATION THE IMPACT ON HIV/AIDS

2. Push factorsPull factors THE MOVEMENT OF PEOPLE FROM ONE PLACE TO ANOTHER

3. Unemployment Socio-economic instability Unequal distribution of resources Quality of life War Violence Human rights Ethnic tension Famine Poverty Construction – 10m a year for dam projects alone REASONS FOR MIGRATION

4. HIV AND MIGRANTS UN has characterised AIDS and international migration patterns in resource poor countries as the 2 most crucial issues facing todays’ world. Being a migrant is not a risk factor BUT activities and conditions for migrants are. In 2003 175m lived and worked outside their own country (est. 15m illegally)

5. 1. Workers – truck drivers, miners, construction workers separated from partners 2. Abuse – vulnerable groups mainly women and children not in control of own lives, raped abused 3. Health care – limited access to health care, knowledge and protection affects cause and effect MIGRANTS ARE VULNERABLE TO HIV

6. SOUTH AFRICAN SURVEY 196 migrant men and 130 of their rural partners 64 non migrant men and 98 of their partners 26% migrant men have HIV 12.7% non-migrant men have HIV Being a partner of a migrant man appears not to be significant

7. MOBILE POPULATIONS ARE OFTEN MARGINALISED Discrimination Xenophobia Exploitation Harassment Little access to legal/social protection Illegal migrants may lack access to education/health care and social services for fear of detention

8. MIGRATION AND RISK Regions with higher rates of seasonal or long term mobility have higher rates of infection Transport routes and borders Uganda, rate of 11.5% twice the rate of non migrants 50% migrants report having sex at their destination, 10% use condoms Host country unwilling to invest in health and sanitation for migrants, discriminate by excluding migrants

9. Civil war more often that conflict between countries 72 countries with regional conflicts 1974 – 2.4m refugees 2003 – 27.4m 13 of the top 17 with highest HIV rates have conflict Sierra Leone, 10 year conflict – HIV in sex workers increased from 27% to 71% 11% Nigerian peace keepers returned with HIV 1994 war and genocide in Rwanda lead to spread into rural areas FACTORS INFLUENCING AIDS AND MIGRATION

10. WAR AND HIV Mass population movement disrupts community and support mechanisms Women/girls coerced into sex for money, food or protection Rape as a weapon of war (Bosnia, Congo, Liberia, Rwanda)

11. Economic globalisation, trade liberalisation, opening borders Looking for better life in other countries Rapid urbanisation with imbalance in social and community development Migrant workers required quickly at short notice, just viewed as workforce by host hence no education welfare or medical provision and rapid expulsion if economy declines GLOBALISATION AND MIGRATION

12. MIGRANT WORKERS S. Africa mines, 95% migrant workers, 18% infection rate Senegal, 82% of men aged 20-40 migrate for work. Labour mobility the only significant factor in HIV rates

13. Droughts, famine, flood displace millions 2004 Bangladesh floods affected 25m people, Dhaka alone had 1.5m to re-home. Sewage systems destroyed worsening pre-existing conditions of poverty and health service putting more at risk of HIV 1990’s 100m displaced for construction. 3 Gorges dam displaced 3m along Yangtze and knock on effect for further 20m. Active nightlife/sex for workers ENVIRONMENTAL DEGRADATION

14. Aid is often linked with restrictive financial policies imposed by the World bank that has reduced expenditure in the health sector Most African countries have a health budget of less that $10 per person and in some of Sub Saharan Africa they are paying $1.30 on debt servicing for every $1 received in aid Freer trade has reduced the ability to regulate and invest in public services Increased trend for private for profit hospitals (neglect the needs of the poor)Mexican workers in California, 30% never seen doctor, 75% no health insurance Doctors for highly developed countries recruited from poor countries PUBLIC HEALTH EXPENDITURE

15. BRAIN DRAIN Ghana vacancies for doctors 72% Malawi 52.9% vacancy for nurses Saskatchewan 54% doctors trained outside Canada 1998 Canada had 1,338 graduates from South African medical schools

16. 1994 Rwanda 1% rural infection 1997 11% due to mixing rural and urban groups in refugee camps 2m fled to other countries In Tanzania displaced refugees increased adolescent sex, prostitution, low condom access and lack of family planning services in refugee camps. Rape as weapon of war. Rwanda, 17% of women who were raped tested positive. In Uganda, 10% military tested positive REGIONAL SNAP SHOTS

17. Rapid increase in China, Vietnam, Indonesia 7.4m with HIV Sex trade increases risk, in some areas of Thailand, Cambodia and Myanmar the prevalence rate is 40-60% International tourism and the sex industry, large numbers of single young men and women. Young women often join or are forced into prostitution to send money home. SOUTH EAST ASIA