Migration plays a critical role in the spread of HIV, as Edna's story makes clear. Several factors link mobility and HIV, including the conditions under which people migrate; poverty; gender inequality; separation from families and partners, and the absence of the socio-cultural norms that guide people's behaviour in stable communities.(2)
In Zambia, like in the rest of Southern Africa, HIV/AIDS is devastating. Internal and cross-border migration exacerbates the spread of the disease. Hundreds of thousands of men from the region make a living by working in the mines in South Africa, where they spend years away from their families. While away from home, many men engage in unsafe sexual behaviour. They have other partners, go to sex workers, and seldom use condoms.
Gender inequalities and lack of respect for women's and girls' rights adds to their risk of contracting the virus. Of the 6.2 million young people living with HIV/AIDS in sub-Saharan Africa, three out of four are female.(3)
Mobile populations, like labour migrants; commercial sex workers; truck-drivers; salesmen; railway workers, and members of the military are among the groups particularly at risk. Truck drivers and traders, for example, crossing what is called the "Great Corridor from the Cape to Cairo", are known to be at particular risk of contracting HIV. Maps show how towns and cities on that route are hotspots for HIV. Along the corridor, in truck-stops and squatter camps, border communities and near army bases, poor women may turn to commercial sex work to find a living. Men often share sex partners, increasing everyone's vulnerability to HIV.(4)
Not only has migration helped to spread HIV/AIDS, but research shows that the epidemic itself has brought with it a new form of migration, of HIV/AIDS-affected children and young people forced to leave by the illness or death of one or both parents. In Southern Africa, the region most affected by HIV/AIDS, roughly one in ten children have lost their parents.(5)
As household income dwindles due to the illness and loss of adult family members, children and young people move to live with relatives. When there are already too many mouths to feed in relatives' homes, they may have to drop out of school to earn their keep. They may be pushed out to live on the streets. Girls may be married off early. Some young people move to take care of an ailing parent or relative. Quite a number of them are left to survive on their own, as heads of household. For young people migrating abroad, not only are they leaving behind familiar surroundings and friends, but they may not know the language and culture, posing additional challenges to their sense of belonging.
Both international and domestic migrants need access to a complete spectrum of HIV prevention options, including counselling, testing and treatment for sexually transmitted infections; affordable condoms, and information on assessing, reducing and eliminating the risk of infection.
For example, in Asia, another region where poverty pushes young people to migrate, UNFPA and the European Union have launched the Reproductive Health Initiative for Youth in Asia to respond to these needs. Under this initiative and in collaboration with the International Planned Parenthood Federation, young migrant factory and sex workers in communities in the "Golden Triangle" on the borders of Thailand, Lao People's Democratic Republic, Myanmar, and Southern China are beginning to enjoy expanded access to sexual and reproductive health services, including HIV prevention.(6)