Human immunodeficiency virus and migrant labor in South Africa
Jochelson, K.; Mothibeli, M.; Leger, J.P.
International Journal of Health Services Planning Administration Evaluation 21(1): 157-173
1991
ISSN/ISBN: 0020-7314 PMID: 2004869 DOI: 10.2190/11ue-l88j-46hn-hr0kDocument Number: 315188
This study of HIV and migrant workers in South Africa took place against a background of high rates of sexually transmitted diseases in mine-workers and rising rates of HIV infection in the country. Strategic informant snowball sampling of 20 mine-workers and 24 women who supported themselves through commercial sex work was conducted in a large South African mining town in 1988. Important insights into the impact of the migrant labour system on sexual relationships were derived, revealing the context in which risky behaviour takes place: the numerical imbalance between male and female populations in mining towns; the lengthy separation between mine-workers and their families; and the residence of miners in large single-sex hostels. For the women involved, the exchange of sex for money, goods or comfort is a logical response to economic need and disrupted family relationships. The paper quotes liberally from interviews providing unique insights into the reason for casual sexual encounters and the lack of condom use. Importantly, mine-workers refuse to accept health education messages purveyed by employers, arguing that if the industry really was concerned about their health, then why had it allowed such poor working and living conditions, and their separation from their families, to persist? The authors argue that a focus on behaviour is extremely limited unless it forms part of a campaign to reform the migrant labour system and its harmful consequences.[Although the small sample of individual mine-workers and their female sexual partners cannot be regarded as representative, it nevertheless provides important sociological insights into the determinants of risky behaviour. The authors examine the social context in which risky behaviour takes place. Their study provides lessons for others working in different settings: more work is clearly necessary to define the "high-risk situations" which, in different settings worldwide, will lead inevitably to the rapid spread of HIV infection. Two such risky social contexts are presented here: the migrant male workers and the impoverished women who sell their bodies in exchange for goods and security. Conventional HIV and sex education, emphasizing a reduction in the number of partners, marital fidelity, and the use of condoms, is bound to fail in such settings. An appropriate health promotion approach must recognize the structural determinants of behaviour and must focus attention on the "high-risk situations" responsible. At the same time, context-specific education developed by activists and grassroots workers will help in an attempt to modify risky behaviours. Out of such analyses and practical will emerge appropriate recognition of the more fundamental social change and development necessary if HIV transmission is to be halted.]A. Zwi.