War, Forced Migration, and HIV/AIDS Risks in Angola Victor Agadjanian Department of Sociology and...
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War, Forced Migration, and HIV/AIDS Risks in Angola War, Forced Migration, and HIV/AIDS Risks in Angola Victor Agadjanian Department of Sociology and Center for Population Dynamics Arizona State University, Tempe AZ 85287-4802, USA [email protected] This research is supported by a grant from the National Institute of Child Health and Human Development (USA), R03-HD045129. The data collection and processing were carried out by the AIP-Angola Institute for Socioeconomic Research, Luanda, Angola. Does war-induced migration in sub-Saharan Africa make migrants more vulnerable to HIV/AIDS risks? How do forced migrants in cities compare to city natives in exposure to HIV/AIDS risks? How do forced migrants compare to voluntary (“economic”) migrants in the city? How does duration of residence in the city affect forced and voluntary migrants’ exposure to HIV/AIDS risks? How do the differences in forced migrants’, voluntary migrants’, and non-migrants’ exposure to HIV/AIDS risks vary by gender? Multivariate Results Multivariate Results ( ( contd.) contd.) Background Background •Migration is commonly implicated in the rapid spread of HIV/AIDS. •Literature typically paints forced migrants as socioeconomically and epidemiologically disadvantaged at places of destination. •Yet little systematic data exist on the HIV/AIDS implications of forced migration Setting Setting Luanda, Angola’s capital and by far the largest city Home to up to a quarter of the nation’s population Luanda’s population grew rapidly largely due to the influx of forced migrants displaced by civil war (1975-1991, 1992- 1994, 1998-2002) Forced migration exacerbated problems typical of many sub-Saharan cities: overcrowding, unemployment, infrastructure decay, traffic congestion, environmental pollution, etc. Luanda’s adult HIV prevalence: c. 5% Data Data A survey in two peripheral urban municipalities (municípios) of Greater Luanda—Samba and Viana— conducted in May-June 2004. Samba: closer to the city center, older neighborhoods, fewer forced migrants Viana: more distant and less urbanized, more forced migrants Survey sample: approximately 1080 people, about equal number of men and women The sample of households was drawn separately in each bairro (subdivision of the município) using a random walk algorithm. Each bairro’s subsample size was proportional to the bairro’s estimated population size. In one half of the selected households a randomly selected man aged 15-59 was interviewed; in the other half a randomly selected woman aged 15- 49 was interviewed. The survey instrument contained the following modules: Migration history; Sociodemographic characteristics; Marriage and sex life; Health and reproduction; HIV/AIDS; Social networks; Community involvement; and Gender attitudes. HIV/AIDS risk-related indicators by HIV/AIDS risk-related indicators by migration status migration status Outcomes Outcomes Statistical Model Statistical Model Logistic regression for binary outcomes Main predictor—Migration status Main predictor—Migration status City natives (including those who migrated as small children), CNs Migrants who came to the city because of civil war, “Forced Migrants,” FMs Migrants who came to the city for reasons directly not related to war, “Voluntary Migrants,” VMs Duration of life in the city (in models for migrants only) Other predictors/controls Other predictors/controls Sociodemographic Profile Sociodemographic Profile FMs had a higher share of men than the other two groups FMs were disproportionately concentrated in Viana, whereas the shares of CNs and voluntary migrants (VMs) were similar in both municipalities FMs had the lowest educational level, while CNs were best educated FMs had the highest rate of labor force participation, whereas CNs had the lowest FMs were least likely to have electricity, piped water, or a TV set at home, whereas CNs were the most likely. FMs were most likely not to have eaten meat or chicken in the previous seven days CNs were least likely to have a live- in partner, but FMs and VMs did not differ much Age at first sex didn’t differ among three groups FMs reported a slightly higher level of community involvement but the differences among the three groups were small 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks: All three groups were similar in familiarity with HIV/AIDS cases and displayed similar levels of concern FMs were least likely and CNs were most likely to agree that a woman can insist on condom use with husband if she thinks he is infected 2. Access to HIV/AIDS prevention information: FMs did not differ much from the rest in exposure to formal HIV/AIDS education FMs were less likely to have been tested for HIV, to know where one could be tested for HIV, and to know where one could get/buy condoms D iscussion ofHIV/AIDS w ith partnerand peers (percent) 0 20 40 60 80 Talked to partnerabout AIDS Talked to others about prevention CNs VMs FM s 3. Discussion of HIV/AIDS with partner and peers: CNs were most likely to have talked about HIV/AIDS with partners and somewhat more likely to have talked about HIV/AIDS with others. No difference between the two migrant groups. 4. Risky sexual behavior: FMs were more likely than the rest to engage in casual relationships FMs were more likely than the rest to have had unprotected casual sex in the past 12 months 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks: FM women felt more at risk than VM women. No difference among men FM men were more worried that CN men. No difference among women. 2. Access to HIV/AIDS prevention information: No gender-specific effects 3. Discussion of HIV/AIDS with partner and peers: CN women appeared more likely to talk with partners about HIV/AIDS than FM. No differences among men. VM men were less likely than FM to have talked about prevention with others. No differences among women. 4. Risky sexual behavior: FM men were more likely than VM or CN men to engage in casual sexual relationships. No differences among women. FM men were more likely than VM or CN men to engage in unprotected sex with casual sexual partners. No differences among women. FMs were more likely to know an AIDS patient than VMs, but were not different from CNs. No differences in perceptions of own risks, but FMs were more likely to worry about getting HIV than CNs and (possibly) VMs. No difference in opinion on condom use with infected husband. CePoD CePoD Discussions of HIV/AIDS with partner and peers (odds ratios) No difference between FMs and VMs CNs were more likely than FMs to have talked about HIV/AIDS with partners. Risky sexual behavior (odds ratios) FMs were significantly more likely than CNs and possibly VMs to have engaged in casual relationships FMs were significantly more likely than the other two groups to have had unprotected casual sex in the past 12 months Conclusions Conclusions Research Questions Research Questions 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks: Knows at least one person with AIDS Considers herself at high risk of HIV infection Worries about getting infected Thinks that wife can insist on condom use with husband if she thinks he is infected 2. Access to HIV/AIDS prevention information: Attended an HIV/AIDS educational event recently Has ever been tested for HIV Knows where one can get tested for HIV Knows where one can get/buy condoms 3. Discussions of HIV/AIDS with partner and peers: Has talked about AIDS with partner (only those in union) Has talked about AIDS prevention with someone other than partner 4. Risky sexual behavior: Having a casual partner in the past 12 months Having unprotected casual sex in past 12 months Municipality of current residence: Samba or Viana Gender Respondent’s age (continuous) Respondent’s education: completed years (continuous) Dwelling has piped water: Yes or No Household has a working TV set: Yes or No Ate meat or chicken in past seven days: Yes or No Currently has a live-in sexual partner: Yes or No Currently works for income outside the home: Yes or No Participated in any activities for communal benefit in past 12 months: Yes or No HIV/AIDS risk-related outcomes by HIV/AIDS risk-related outcomes by duration of city life (FMs and VMs duration of city life (FMs and VMs only): highlights only): highlights 1. Knowledge, perceptions and attitudes regarding risks: No systematic effects of duration 2. Access to HIV/AIDS prevention information: Recently arrived FMs were less likely to know where to get/buy condoms) than earlier arrivals. No such relationship for VMs. Longer duration of city life was associated with higher likelihood of having been tested and knowing where to get tested, regardless of migration type. 3. Discussion of HIV/AIDS with partner and peers: No effects of duration 4. Risky sexual behavior: Duration had no effect on risky behavior for either group of migrants Forced migrants display considerable socioeconomic disadvantage relative to city natives and voluntary migrants (despite higher levels of labor force participation) The socioeconomic and demographic differences explain differences in access to prevention information and resources but do not explain forced migrants’ greater likelihood of engaging in risky sexual behavior, compared to city natives and voluntary migrants. Duration of city life has little systematic effect on HIV/AIDS-related outcomes The higher risks of forced migrants are concentrated among men. Women display no net migration-status differences in the probability of risky behavior. Overall, women have no less information about HIV/AIDS and prevention than men. Although disadvantaged in access to prevention, women feel at lesser risk of HIV infection than do men. Women are less likely to discuss HIV/AIDS risks and preventions with others (non-partners) Involvement in community life (collective communal activities, etc.) is associated with less risky behavior, higher level of risk No net differences in any indicator except for possibly better knowledge about HIV testing places by CNs. Access to prevention information (odds ratios) S urvey sam ple breakdow n C ity natives (C N s) 36% Forced m igrants (FM s) 29% Voluntary m igrants (V M s)35% Multivariate Results Multivariate Results Knowledge and perception of risks (odds ratios) Note: * significant at p<.05; + significant at p<.1 0.9 1 1.1 1.2 1.3 1.4 1.5 Talked to partner aboutAID S Talked to others aboutprevention CNs VMs ns ns * FM s 0.4 0.6 0.8 1 CNs VMs * + C asual partnerin pastyear U nsafe sex in past year FM s * * 0.9 1 1.1 1.2 1.3 1.4 1.5 CNs VMs ns ns + ns ns ns ns Attended AID S educ. event H as been tested for HIV Knows w here to gettested Know s w here to get condom s FM s 0.5 0.6 0.7 0.8 0.9 1 1.1 CNs VMs * + * ns ns ns ns Know s som eone with AID S Feels at risk of AID S Worries about getting H IV W ife can insiston condom FM s Risky sexualbehavior(percent) 0 5 10 15 20 Casual partnerin pastyear Unsafe sex in pastyear CNs VMs FM s Sociodem ographic profile (percentages) 0 10 20 30 40 50 60 70 80 90 Samba resident Viana resident W oman Man W orks(age 20+) Electricityat home Pipedwater HasTV Nomeat or chickenin past week Liveinpartner (age20+) Activein neighborhood Percent C ity native (C N) Voluntary m igrant(VM ) Forced m igrant(FM ) M ean age 0 10 20 30 C am e due to w ar C am e forotherreasons City native M ean years ofeducation (age 20+) 0 2 4 6 8 C am e due to war C am e forotherreasons City native 0 20 40 60 80 100 Attended AID S educ. event H as been tested for HIV Know s w here to get tested Know s w here to get condom s CNs VM s FM s Access to H IV /A ID S prevention inform ation (percent) Know ledge,perceptions,and attitudes regarding H IV/A ID S risks (percent) 0 20 40 60 80 100 Know s som eone w ith AID S Feels at risk of AID S W orries about getting HIV W ife can insiston condom CNs VM s FM s M ean age atfirstsex (those w ho ever had sex) 16 16.2 16.4 16.6 C am e due to war C am e forotherreasons City native Gender differences: highlights Gender differences: highlights
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Transcript of War, Forced Migration, and HIV/AIDS Risks in Angola Victor Agadjanian Department of Sociology and...
War, Forced Migration, and HIV/AIDS Risks in AngolaWar, Forced Migration, and HIV/AIDS Risks in Angola
Victor AgadjanianDepartment of Sociology and Center for Population Dynamics
Arizona State University, Tempe AZ 85287-4802, [email protected]
This research is supported by a grant from the National Institute of Child Health and Human Development (USA), R03-HD045129. The data collection and processing were carried out by the AIP-Angola Institute for Socioeconomic Research, Luanda, Angola.
Does war-induced migration in sub-Saharan Africa make migrants more vulnerable to HIV/AIDS risks?
How do forced migrants in cities compare to city natives in exposure to HIV/AIDS risks?
How do forced migrants compare to voluntary (“economic”) migrants in the city?
How does duration of residence in the city affect forced and voluntary migrants’ exposure to HIV/AIDS risks?
How do the differences in forced migrants’, voluntary migrants’, and non-migrants’ exposure to HIV/AIDS risks vary by gender?
Multivariate Results Multivariate Results ((contd.)contd.)
BackgroundBackground• Migration is commonly implicated in the rapid spread of HIV/AIDS.
• Literature typically paints forced migrants as socioeconomically and epidemiologically disadvantaged at places of destination.
• Yet little systematic data exist on the HIV/AIDS implications of forced migration
SettingSetting Luanda, Angola’s capital and by far the largest city
Home to up to a quarter of the nation’s population
Luanda’s population grew rapidly largely due to the influx of forced migrants displaced by civil war (1975-1991, 1992- 1994, 1998-2002)
Forced migration exacerbated problems typical of many sub-Saharan cities: overcrowding, unemployment, infrastructure decay, traffic congestion, environmental pollution, etc.
Luanda’s adult HIV prevalence: c. 5%
DataDataA survey in two peripheral urban municipalities (municípios) of Greater Luanda—Samba and Viana—conducted in May-June 2004.
Samba: closer to the city center, older neighborhoods, fewer forced migrants
Viana: more distant and less urbanized, more forced migrants
Survey sample: approximately 1080 people, about equal number of men and women
The sample of households was drawn separately in each bairro (subdivision of the município) using a random walk algorithm. Each bairro’s subsample size was proportional to the bairro’s estimated population size.
In one half of the selected households a randomly selected man aged 15-59 was interviewed; in the other half a randomly selected woman aged 15- 49 was interviewed.
The survey instrument contained the following modules: Migration history; Sociodemographic characteristics; Marriage and sex life; Health and reproduction; HIV/AIDS; Social networks; Community involvement; and Gender attitudes.
HIV/AIDS risk-related indicators by migration statusHIV/AIDS risk-related indicators by migration status
Outcomes Outcomes
Statistical Model Statistical Model Logistic regression for binary outcomes
Main predictor—Migration statusMain predictor—Migration status City natives (including those who migrated as small children), CNs Migrants who came to the city because of civil war, “Forced Migrants,” FMs Migrants who came to the city for reasons directly not related to war, “Voluntary Migrants,” VMs
Duration of life in the city (in models for migrants only)
Other predictors/controlsOther predictors/controls
Sociodemographic ProfileSociodemographic Profile
FMs had a higher share of men than the other two groups
FMs were disproportionately concentrated in Viana, whereas the shares of CNs and voluntary migrants (VMs) were similar in both municipalities
FMs had the lowest educational level, while CNs were best educated
FMs had the highest rate of labor force participation, whereas CNs had the lowest
FMs were least likely to have electricity, piped water, or a TV set at home, whereas CNs were the most likely.
FMs were most likely not to have eaten meat or chicken in the previous seven days
CNs were least likely to have a live-in partner, but FMs and VMs did not differ much Age at first sex didn’t differ among three groupsFMs reported a slightly higher level of community involvement but the differences among the three groups were small
1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks:
All three groups were similar in familiarity with HIV/AIDS cases and displayed similar levels of concern
FMs were least likely and CNs were most likely to agree that a woman can insist on condom use with husband if she thinks he is infected
2. Access to HIV/AIDS prevention information:
FMs did not differ much from the rest in exposure to formal HIV/AIDS education
FMs were less likely to have been tested for HIV, to know where one could be tested for HIV, and to know where one could get/buy condoms
Discussion of HIV/AIDS with partner and peers (percent)
020406080
Talked to partner aboutAIDS
Talked to others aboutprevention
CNs
VMs
FMs
3. Discussion of HIV/AIDS with partner and peers:CNs were most likely to have talked about HIV/AIDS with partners and somewhat more likely to have talked about HIV/AIDS with others. No difference between the two migrant groups.
4. Risky sexual behavior:FMs were more likely than the rest to engage in casual relationshipsFMs were more likely than the rest to have had unprotected casual sex in the past 12 months
1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks:
FM women felt more at risk than VM women. No difference among men
FM men were more worried that CN men. No difference among women.
2. Access to HIV/AIDS prevention information:
No gender-specific effects
3. Discussion of HIV/AIDS with partner and peers:
CN women appeared more likely to talk with partners about HIV/AIDS than FM. No differences among men.
VM men were less likely than FM to have talked about prevention with others. No differences among women.
4. Risky sexual behavior:
FM men were more likely than VM or CN men to engage in casual sexual relationships. No differences among women.
FM men were more likely than VM or CN men to engage in unprotected sex with casual sexual partners. No differences among women.
FMs were more likely to know an AIDS patient than VMs, but were not different from CNs. No differences in perceptions of own risks, but FMs were more likely to worry about getting HIV than CNs and (possibly) VMs. No difference in opinion on condom use with infected husband.
CePoDCePoD
Discussions of HIV/AIDS with partner and peers (odds ratios)
No difference between FMs and VMs
CNs were more likely than FMs to have talked about HIV/AIDS with partners.
Risky sexual behavior (odds ratios)
FMs were significantly more likely than CNs and possibly VMs to have engaged in casual relationships
FMs were significantly more likely than the other two groups to have had unprotected casual sex in the past 12 months
ConclusionsConclusions
Research QuestionsResearch Questions
1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks:Knows at least one person with AIDS Considers herself at high risk of HIV infectionWorries about getting infectedThinks that wife can insist on condom use with husband if she thinks he is infected
2. Access to HIV/AIDS prevention information:Attended an HIV/AIDS educational event recently Has ever been tested for HIVKnows where one can get tested for HIVKnows where one can get/buy condoms
3. Discussions of HIV/AIDS with partner and peers:Has talked about AIDS with partner (only those in union)Has talked about AIDS prevention with someone other than partner
4. Risky sexual behavior:Having a casual partner in the past 12 monthsHaving unprotected casual sex in past 12 months
Municipality of current residence: Samba or VianaGenderRespondent’s age (continuous)Respondent’s education: completed years (continuous) Dwelling has piped water: Yes or No Household has a working TV set: Yes or NoAte meat or chicken in past seven days: Yes or NoCurrently has a live-in sexual partner: Yes or No Currently works for income outside the home: Yes or NoParticipated in any activities for communal benefit in past 12 months: Yes or No
HIV/AIDS risk-related outcomes by duration of HIV/AIDS risk-related outcomes by duration of city life (FMs and VMs only): highlightscity life (FMs and VMs only): highlights
1. Knowledge, perceptions and attitudes regarding risks:
No systematic effects of duration
2. Access to HIV/AIDS prevention information:
Recently arrived FMs were less likely to know where to get/buy condoms) than earlier arrivals. No such relationship for VMs.
Longer duration of city life was associated with higher likelihood of having been tested and knowing where to get tested, regardless of migration type.
3. Discussion of HIV/AIDS with partner and peers:
No effects of duration
4. Risky sexual behavior:
Duration had no effect on risky behavior for either group of migrants
Forced migrants display considerable socioeconomic
disadvantage relative to city natives and voluntary migrants
(despite higher levels of labor force participation)
The socioeconomic and demographic differences explain
differences in access to prevention information and resources but
do not explain forced migrants’ greater likelihood of engaging in
risky sexual behavior, compared to city natives and voluntary
migrants.
Duration of city life has little systematic effect on HIV/AIDS-
related outcomes
The higher risks of forced migrants are concentrated among
men. Women display no net migration-status differences in the
probability of risky behavior.
Overall, women have no less information about HIV/AIDS and
prevention than men. Although disadvantaged in access to
prevention, women feel at lesser risk of HIV infection than do men.
Women are less likely to discuss HIV/AIDS risks and preventions
with others (non-partners)
Involvement in community life (collective communal activities,
etc.) is associated with less risky behavior, higher level of risk
awareness, and better information about prevention options.
No net differences in any indicator except for possibly better knowledge about HIV testing places by CNs.
Access to prevention information (odds ratios)
Survey sample breakdown
City natives (CNs) 36%
Forced migrants (FMs) 29%
Voluntary migrants (VMs) 35%
Multivariate ResultsMultivariate Results
Knowledge and perception of risks (odds ratios)
Note: * significant at p<.05; + significant at p<.1
0.91
1.11.21.31.41.5
Talked to partnerabout AIDS
Talked to othersabout prevention
CNs VMs
ns ns
*
FM
FMs
0.4
0.6
0.8
1
CNs VMs
* +
Casual partner in past year Unsafe sex in past year
FMs* *
0.91
1.11.21.31.41.5
CNs VMs
ns ns
+
ns ns ns ns
Attended AIDS educ. event
Has been tested for HIV
Knows where to get tested
Knows where to get condoms
FMs
0.5
0.6
0.7
0.8
0.9
1
1.1CNs VMs
* +* ns nsns ns
Knows someone with AIDS
Feels at risk of AIDS
Worries about getting HIV
Wife can insist on condom
FMs
Risky sexual behavior (percent)
0
5
10
15
20
Casual partner in past year Unsafe sex in past year
CNs
VMs
FMs
Sociodemographic profile (percentages)
0102030405060708090
Sam
bare
side
nt
Vian
are
side
nt
Wom
an Man
Wor
ks (a
ge20
+)
Elec
trici
ty a
tho
me
Pipe
d wa
ter
Has
TV
No m
eat o
rch
icke
n in
past
wee
k
Live
in p
artn
er(a
ge 2
0+)
Activ
e in
neig
hbor
hood
Perc
ent
City native (CN) Voluntary migrant (VM) Forced migrant (FM)
Mean age
0 10 20 30 40
Came due to war
Came for other reasons
City native
Mean years of education (age 20+)
0 2 4 6 8 10
Came due to war
Came for other reasons
City native
020406080
100
Atte
nd
ed
AID
Se
du
c.e
ven
t
Ha
s b
ee
nte
ste
d fo
rH
IV
Kn
ow
sw
he
re to
ge
tte
ste
d
Kn
ow
sw
he
re to
ge
tco
nd
om
s
CNs
VMs
FMs
Access to HIV/AIDS prevention information (percent)
Knowledge, perceptions, and attitudes regarding HIV/AIDS risks (percent)
020406080
100
Kno
ws
som
eone
with
AID
S
Fee
ls a
tris
k of
AID
S
Wor
ries
abou
tge
ttin
gH
IV
Wife
can
insi
st o
nco
ndom
CNsVMsFMs
Mean age at first sex (those who ever had sex)
16 16.2 16.4 16.6 16.8 17
Came due to war
Came for other reasons
City native
Gender differences: highlightsGender differences: highlights
