Understanding the complexities of mobility and HIV in eastern Africa
High levels of mobility in sub-Saharan Africa pose a widespread challenge to HIV response efforts. People are driven to move around for a variety of reasons, including work, environmental pressures or cultural practices. Whether that mobility is short- or long-term, it can link geographically spread HIV epidemics, leading to sustained HIV transmission. Mobility also can disrupt bonds between people and HIV care systems, leading to poor health outcomes. New Bixby Center research aims to better understand the dynamics of mobility in rural communities across three regions of eastern Africa.
The ‘Mobility in SEARCH’ (Sustainable East African Research in Community Health) study team found major differences in mobility across regions, by sex and by HIV status. The largest magnitude of mobility in communities was in western Kenya, followed by southwestern Uganda and eastern Uganda. These were also the areas with the highest HIV burden.
There were clear differences by gender. Men overall were more likely than women to migrate, and women predominated in only the most localized forms of migration (moving residences over a county or district border.) Men traveled more for labor-related reasons, while women were more likely to travel away from home for reasons like caregiving or seeking, attending a funeral, visiting family or schooling. Both men and women living with HIV tended to be more mobile and more likely to have recently migrated, but HIV prevalence was especially high among people who traveled for work-related reasons.
This research adds important dimensions to discussions of the intersection of mobility and HIV. It demonstrates that not only conventional measures of mobility, but also shorter-term local forms, are associated with prevalence of HIV infections. A key finding is that short-term mobility for purposes related to livelihood is associated with HIV infection, particularly for women. Focusing only on permanent changes over wide boundaries would leave out a large and disproportionately female population. Data on origins and destinations of mobility in specific settings also provide opportunities for strategically placing locations for HIV interventions and targeting the key populations.
The relationship between population mobility and risk of HIV is highly complex. This research aims to advance understanding of the complicated and highly gendered nature of mobility and its association with HIV in eastern African settings. These high levels of mobility in regions with a greater burden of HIV present a major challenge to test and treat programs. However, the SEARCH approach to community-based testing and treatment shows promise: it has led to increased proportion of HIV-positive adults who achieved viral suppression, and higher rates of HIV diagnosis and initiation of antiretroviral therapy. Continued innovation is needed, including interventions, policies and health system improvements to maximize engagement of mobile people in HIV care and prevention.