AIDS, Agriculture and Livelihood Security

Theme 1:

AIDS, Agriculture and Livelihood Security

Projects under Theme 1

1. Risks and Vulnerabilities to HIV and AIDS within the Plantation Systems of the Lake Victoria Basin (ongoing with AMREF);

2. Quantifying the Impact of HIV/AIDS on Government Agricultural Extension Service Delivery in Zambia and Malawi (ongoing);

3. Urban-Rural Linkages in Three African Cities (winding up);

4. Longitudinal Tracking in Kenya-Nairobi Urban Slums (winding up); and

5. Changing Livelihoods in the Face of AIDS (CLIVIA) (beginning with HEARD).

Urbanisation & Urban-Rural Links• Emphasis on “livelihoods” as opposed to “rural

livelihoods”

• Acknowledging changing systems and increased urbanisation (Durban, Mbekweni, Nairobi, Jo’burg, Windhoek, Addis Ababa)

• Focusing on urban-rural linkages incl migration

• Considers HIV and AIDS and food insecurity as key dimensions of these areas – eg. informal urban areas (SA)

PLANET OF SLUMS?

6% of urban pop in developed countries live in slums 78% of urban pop in the least developed

countries live in slumsThe Challenge of Slums –

UN-HABITAT Report!

Kibera, Nairobi

Swilling, M. 2007

Recognising the complexity of African cities:the importance of diversity

• UR Links study engages complexity :

– Adopts an “ecohealth” approach– Focus on different types of migrants: Internal & external– Complex linkages; people, food, money, goods (reciprocity)– Diverse settlement types

• Mixed methodology:– Quantitative surveys in Addis Ababa, Johannesburg &

Windhoek– Qualitative research with different groups including children– Engaged decision makers throughout

Migration, HIV and food security

A focus on Johannesburg through a livelihoods lens

University of the WitwatersrandForced Migration Studies ProgrammeHealth and Migration Initiative

Jo Vearey and Lorena Nunez

African cities are characterised by rapid urbanisation – including

high rates of in-migration:

Internal (from within South Africa)

Circular migration

Cross-border

Urban informal settlements have double the HIV prevalence of urban

formal areas.

African urban environments

1. High rates of migration;

2. Increasing pressure on appropriate housing;

3. High urban HIV prevalence rates – highest in urban informal areas;

4. Dependency on survivalist livelihoods located within the informal sector;

5. Increasing urban inequalities that impact ‘urban poor’ groups.

Objectives

To explore the linkages between HIV, migration and urban food security through a livelihoods lens.

To better understand differences in urban livelihood systems between:• Those residing informally and those residing

formally;• Internal and cross-border migrants.

Johannesburg study sites

5

Berea, Jeppestown and Hillbrow

Sol Plaatjies informal settlement

n = 300n = 200

Workshop venue

Methodology

Cross-sectional household survey (2008)– Johannesburg: a complex urban context– Purposively selected areas across urban informal and

formal• 3 inner-city suburbs• 1 informal settlement

• Administered questionnaire;

• Cluster-based random sampling.

487 households:

• 60% (n = 293): South African internal migrants

• 31% (n = 150): Cross-border migrants

• 9% (n = 44): Always resided in Johannesburg

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

lack of access to food

sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in Johannesburg

HIV

pressure to remit

FOOD SECURITY: (access to food, dietary diversity score & food shortage)

SOCIAL PROTECTION FAMILY BACK

HOME

SOCIAL CAPITAL HOUSING

INCOMEREGULAR

HIV TESTING

INFORMATION: HIV testing and

ART

EDUCATION

HEALTH STATUS

natural

loss of incomedeath of a family member

Unreliable income

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

Lack of access to food

Sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in JohannesburgHIV

pressure to remit

FOOD SECURITY HEALTH STATUS

natural

Who are the migrants?

0

10

20

30

40

50

60

70

80

South Africaninternal migrant

Cross-bordermigrant

Always lived inJohannesburg

Migration status

Rel

ativ

e fre

quen

cy (%

)

InformalFormal

n = 293 n = 150 n = 44

n = 487

Chi-square = 62.4; p = <0.001

♀ ♂

0

20

40

60

80

100

120

140

160

10 20 30 40 50 60 70 80

Age (yrs)

Abs

olut

e fre

quen

cy

Distribution of age among the respondents

N = 487

• The average of respondents is 33 yrs old and half of them have less than 30 yrs old• Female cross-border migrants are the youngest group (median, 25 years) • Men who have always lived in Johannesburg are the oldest (median 36 years).

Who are the migrants?

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

Lack of access to food

Sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in JohannesburgHIV

pressure to remit

FOOD SECURITY HEALTH STATUS

natural

What are their assets?– Income– Social protection– Social capital– Housing– Regular HIV testing and knowledge of ART

Distribution of number of incomes in the household within each

migration status group

010203040506070

0 inc

ome

1 inc

ome

2 inc

omes

3 inc

omes

Perc

enta

ge (%

) internal migrants

cross-bordermigrantsalways lived in JHB

Social protectionGrants

05

101520253035404550

Informal Formal

Residential area

Rela

tive

frequ

ency

(%)

n = 83

n = 27

Housing

0

10

20

30

40

50

60

70

80

90

Own Self-constructed Rent RDP

Tenure

Rel

ativ

e fr

eque

ncy

(%)

InformalFormal

Chi-square = 364.696; p = <0.0001

n = 479

Repeated HIV testing and knowledge of ART

0

10

20

30

40

50

60

70

Yes No

Have you ever tested for HIV?

Rel

ativ

e fr

eque

ncy

(%)

InformalFormal

Chi-square = 18.420; p = <0.0001

n = 485

National HIV prevalence in urban informal settlements is double that of urban formal areas: 18% compared to 9% (HSRC, 2005)

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

Lack of access to food

Sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in JohannesburgHIV

pressure to remit

FOOD SECURITY HEALTH STATUS

natural

What stressors do urban migrants face?– An interlinked livelihood

• Perception of risk of HIV• Pressure to remit

Perception of risk of HIV

0

10

20

30

40

50

60

70

No Risk Risk

Perception of risk of HIV

Rela

tive

frequ

ency

(%)

InformalFormal

Chi-square = 14.221; p = 0.0002

Linkages and pressure to remit

0

10

20

30

40

50

60

70

Send money Send food Send goods

Remittance

Rel

ativ

e fre

quen

cy (%

)

Internal South African migrantCross-border migrantAlways lived in JHB

An interlinked livelihood system

Johannesburg Another

place

Provision of remittances

Receiving remittances

Stressors ASSETS(strengths)

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

Lack of access to food

Sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in JohannesburgHIV

pressure to remit

FOOD SECURITY HEALTH STATUS

natural

What are the shocks that urban migrants face?– Loss of income; death of a family member; arriving in

Johannesburg• Poor food access

– Specific sickness episode, HIV and Aids

Shocks causing food shortage

0

10

20

30

40

50

60

Loss of job Death in thefamily

Just arrived inJHB

Unreliableincome

Food securityis always poor

Reason for food shortage

Rela

tive

frequ

ency

(%)

InformalFormal

Chi-square 52.788; p = <0.0001

Food shortage:respondents residing informally are more likely to have

experienced a food shortage in the last 12 months

0

10

20

30

40

50

60

70

80

Yes No

Have you experienced a food shortage in the last 12 months?

Perc

enta

ge (%

)

Informal

Formal

Sickness and HIV

Shocks

– A specific sickness episode which may be related to HIV or Aids

– This sickness can affect the respondent, a household member in the city, or a household member back home

Sickness and HIV:if the individual in the city becomes too sick to work,

the majority will return back home

Support

54%

67%

Importance of

food Burden on the household back

home.

Urban livelihood that supports

another household ‘back home’ would

be affected. 65% informal48% formal

An interlinked livelihood system

SICKNESS

Johannesburg

Family back home

Provision of care, including food

ASSETS(strengths)

Stressor

Shocks

Remittances stop

StressorShocks

Sickness

Another place

Sickness and HIV:if someone ‘back home’ becomes sick with HIV/AIDS

Send money home

Return home to provide

care

33% 19%

Nothing

34%

Bring to JHB

14%

63% 11% 6% 21%

Informal

Formal

n = 457Chi-square = 40.796; p = <0.001

An interlinked livelihood system

Johannesburg SICKNESS

Another place

Family in JHB

ASSETS(strengths)

Stresses

ShocksStresses

Shocks

Sickness

Send money

Travel home

Bring them to the city

Remittances

ASSETS(strengths)

Outcome

StressorsShocks

financial physicalhuman social

hunger

Lack of access to food

Sickness: themselves and those back home

Urban migrants• Internal South African migrants

• Cross-border migrants

• Always lived in JohannesburgHIV

pressure to remit

FOOD SECURITY HEALTH STATUS

natural

Outcomes of the livelihoods system: – Health status– Urban food security (DDS)

Health status

perc eiv ed health s tatus

1%5%

15%

65%

10%

very poor poor average good very good

0

10

20

30

40

50

60

70

Yes: it is better now Yes: it is worse now No: no change

Has your food access changed since moving to Johannesburg?

Perc

ent

Informal

Formal

Food access:respondents residing informally are more likely to report

that their food access has worsened since moving to Johannesburg

Chi-square 32.170; p = <0.0001

24 hours Dietary Diversity Score:respondents residing informally are more likely to

have a deficient dietary score

0

10

20

30

40

50

60

70

Deficient Sufficient Diverse

Rela

tive

frequ

ency

InformalFormal

Chi-square 89.880;

p = <0.0001

Score 0 - 3 Score 4 - 6 Score 7 - 9

24 hour Dietary Diversity Score

24 hour Dietary Diversity Score migration status

Chi-square 19.252; p = 0.0007

0

10

20

30

40

50

60

Cross-border migrant South African internalmigrant

Always lived inJohannesburg

Migration status

Rel

ativ

e fre

quen

cy (%

)

Deficient (0 - 3)Sufficient (4 - 6)Diverse (7 - 9)

Linkages to the National Strategic Plan• South African NSP (2007 – 2011)

– Recognition of migrants (internal and cross-border, refugees, asylum seekers and undocumented);

– Emphasis on informal settlements and recognition of highest HIV prevalence.

• However:

– Lack of guidance for how to implement action at the local level;

– This research contributes to generating such a framework –through dialogue with policy makers and practitioners, including local government.

Policy engagement• Local - City of Johannesburg

– Ongoing engagement through FMSP and MRC linkages– Forthcoming dissemination workshop

• Regional - SADC– SADC Parliamentarian Meeting on migration– Regional guidelines on migration and HIV

• Multi-disciplinary national technical advisory group• Medical Research Council• University of the Witwatersrand• Population Council• IFPRI - RENEWAL

– Research planning, analysis, discussion, engagement, use of data

Policy recommendations

• The importance of an interlinked livelihood system– Rural-urban linkages– The meaning of ‘home’– Rural development must engage with the

urban, and urban development must engage with rural

Ongoing and future research• Ongoing research:

– Student projects– Wits– MRC/Centre for Health Policy

• Research needs:– Rural sending communities– The role of social networks within the livelihoods

system– Intra-household dynamics

• Migration decisions• Resource use

– Intervention Research: process evaluations