AIDS, Agriculture and Livelihood Security
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Theme 1:
AIDS, Agriculture and Livelihood Security
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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).
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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)
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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
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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
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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
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African cities are characterised by rapid urbanisation – including
high rates of in-migration:
Internal (from within South Africa)
Circular migration
Cross-border
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Urban informal settlements have double the HIV prevalence of urban
formal areas.
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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.
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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.
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Johannesburg study sites
5
Berea, Jeppestown and Hillbrow
Sol Plaatjies informal settlement
n = 300n = 200
Workshop venue
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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
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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
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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
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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
♀ ♂
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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?
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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
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What are their assets?– Income– Social protection– Social capital– Housing– Regular HIV testing and knowledge of ART
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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
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Social protectionGrants
05
101520253035404550
Informal Formal
Residential area
Rela
tive
frequ
ency
(%)
n = 83
n = 27
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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
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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)
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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
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What stressors do urban migrants face?– An interlinked livelihood
• Perception of risk of HIV• Pressure to remit
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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
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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
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An interlinked livelihood system
Johannesburg Another
place
Provision of remittances
Receiving remittances
Stressors ASSETS(strengths)
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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
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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
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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
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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
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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
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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
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An interlinked livelihood system
SICKNESS
Johannesburg
Family back home
Provision of care, including food
ASSETS(strengths)
Stressor
Shocks
Remittances stop
StressorShocks
Sickness
Another place
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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
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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
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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
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Outcomes of the livelihoods system: – Health status– Urban food security (DDS)
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Health status
perc eiv ed health s tatus
1%5%
15%
65%
10%
very poor poor average good very good
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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
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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
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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)
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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.
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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
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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
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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