Role of Rural to Urban Migrants and Socio-Cultural Factors including Fertility intentions in the Spread of HIV Risk among Rural areas of Bure Woreda,Northwest,Ethiopia.
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Date
2012-03
Authors
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Journal ISSN
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Publisher
Addis Ababa University
Abstract
Background: The AIDS epidemic is global in its span; a particularly heavy burden has fallen
on Sub-Saharan Africa. The consequences of the African AIDS epidemic are growing—not only
just in size—but in complexity. These consequences are no longer just biological; increasingly,
they are also behavioural, social and cultural.
It is well-known that 84% of the population in Ethiopia lives in rural areas relying on the
agricultural sector which plays the central role in the country’s economy. However efforts to
conduct HIV related studies in rural areas of the country remain extremely patchy. So far, there
have been few studies concerning the nature of HIV infection in rural areas resulting in meagre
information on how HIV spreads from urban to the rural areas and how local people perceive the
epidemic and protect themselves from risk factors. The rural people in Bure Woreda are not an
exception.
The negative influences of migration, fertility intentions and other socio-cultural factors in the
spread of HIV in the Amhara region in general and in the present study area in particular are not
known, moreover, overlooked social activities such as leisure activities which may be linked to
HIV risk behaviours among the study population of the rural to urban migrants and non-migrants
in Bure Woreda, North West Ethiopia require due attention and a thorough investigation. The
way in which migration contributes to the spread of HIV risk is complex and not well
understood. Previous studies have focused on the destinations of migrants, or, less often, on the
areas from which migrants come. In this study exploring both ends of migration routes in
atypical rural areas is fundamental for successful interventions
Although subsistence agriculture is the major economic activity in Ethiopia; parents want to have
large numbers of children for assistance in farming activities as well as economic support during
old age. In the rural areas, women’s fertility and HIV infection are not independent of one
another. Conditions and behaviours resulting in high levels of fertility are also likely to impact
upon womens' likelihood of acquiring HIV.
Women and men desire children for their utilitarian–economic, social, and psychological values,
whereas fertility is on the decline primarily due to changes in economic development. Different
segments of the population are at different stages of this transition with different values
attributed to children at each stage. The challenge is will women take measures to prevent HIV infection in themselves and their babies if they perceive themselves at high risk of HIV infection,
or will endeavour to fulfill the utilitarian–economic, social, or psychological dictates of
childbearing.
Objectives: The general objective of this study was to assess and explore the role of rural to
urban migrants (potential bridging population) and socio-cultural factors (including high fertility
intentions) in the transmission and spread of HIV risk to the rural community of Bure Woreda.
Methods: In order to address this general objective, the study assessed factors that affect the
sexual behaviours of rural to urban migrants and non-migrants (rural residents) by comparing the
link between predisposing, and enabling factors with the sexual risk behaviours among rural to
urban migrants and non-migrants and by investigating the leisure activities which are associated
with different levels of likelihood to engage in HIV risk behaviours among rural to urban
migrants and non-migrants. Moreover other sexual and cultural practices of the rural people in
relation to HIV risks including the association of fertility intention (the desire to have children)
with HIV risk were investigated. In this study, HIV-related sexual risk behaviours among rural to
urban migrants and non-migrants is compared and the role of migration in HIV transmission and
socio-cultural practice and norms for the spread of the virus in the rural areas of Bure Woreda is
explored. The detailed methodology included two components: The first one was a quantitative
cross-sectional study which involved 1,310 men (655 men rural to urban migrants, 655 non-
migrants) and 1,380 married women aged 18 to 49 years. The second component was a
qualitative study which consisted of 8 focus group discussions and 25 key informant interviews.
I) Quantitative study: Radom sampling technique was applied to select the required study
units from the rural- urban migrants (road construction sites (Cobble stone), Ethiopian
Commodity Exchange (ECX), commercial agricultural farm employees and rural residents from
the rural kebeles of Bure Woreda.
A total of 2,751 participants, 667 rural men and 1,418 rural married women were drawn from the
23 rural kebeles of Bure Woreda while the remaining 666 rural to urban migrants were taken
from Bure and around Bure town. Because the present study had a number of different outcome
variables so it was necessary to calculate the respective sample sizes separately with different
assumptions. Structured questionnaires were used to collect the quantitative data.
The questionnaires were tested prior to collecting the actual data in order to standardize the flow
and content of the questions. Accordingly, amendments were made depending on the results of
the pre-test that was conducted in the nearby similar areas. Data collection was carried out by
twenty diploma holders who were given three-days of intensive training with practical exercises.
Four health officers/sanitarians were assigned to supervise the data collection process and the
data was analyzed using SPSS version 17 statistical software. The, chi-square test and binary
logistic regression were used to see the association of variables.
II) Qualitative study: This part of the study was aimed at substantiating and complementing
the quantitative study. The selection of participants and formation for focus group discussions
(FGD) were facilitated by the community leaders of the respective kebeles under consideration.
Four rural kebeles were identified for the 8 FGDs and 25 in-depth interviews.
The main data analysis took place on completion of each interview. In this regard, the usual
principles guiding qualitative analysis were taken into account and sequences of interrelated
steps (reading, coding, displaying, data reduction and interpreting) were employed while
analyzing the data. In short, as can be noted from the above explanations, the procedure used to
process the raw data for the purposes of classification, summarization and tabulation was
thematic content analysis. The basic idea here was to identify the extracts of data that were
informative in some way and to sort out the important messages hidden in the mass of each key
informant interview and FGD.
Results: A total of 2,690 participants (response rate, 97.7 %) responded to the questionnaire on
HIV risk behaviours, leisure activities and fertility intention. This study consisted of two groups
655 male rural to urban migrants working in Bure town and rural residents (655 male nonmigrants
and
1,380
married
women).
When the two groups (rural to urban migrants and non-migrants) are compared in terms of
practicing sexual risk behaviours i.e. having of multiple sexual partners, practicing sex with
commercial sex workers, contracting sexual transmitted infections and practicing premarital sex
there is a difference between them. The proportions of rural to urban migrants vs non- migrants
who had multiple sexual partners (31.4 % vs 7.4 %), practiced sex with commercial sex workers
(22.3% vs 13.3%), contracted sexual transmitted infections (11.7% vs 3.2%) and practiced
premarital sex (20.8% vs 14.2 %) were significantly higher in rural to urban migrants than nonmigrants.
Among
those
who
had multiple
sexual
partners,
only
12.7
%
of rural
to urban
migrants
and 9.8 % of non-migrants reported consistent condom use with sexual partners other than their
spouse.
In addition, the findings of the study indicated that both migrants and non-migrants were
engaged in different leisure activities when they did not have work. The first three leisure
activities with the highest rates of participation among migrants were visiting entertainment
installments (76.3%), chatting (64.9%), and listening to radio (31.5%). On the other hand, doing
chores (71.6%), visiting entertainment installments (30.7%) and chatting (29.2%) were among
the activities in which non- migrants were participating most often. The differences noted
between the two groups in terms of the types of leisure activities were statistically significant
(P=0.001). Multiple logistic regression analysis was also done to explore the association between
the eleven leisure activities and each of the five HIV risk behaviours among migrants and nonmigrants.
Among
migrants,
watching
TV, reading
(including
non migrants),
chatting,
watching
videos,
wandering
on streets
(including
non-migrants),
and
visiting
entertainment
facilities
were
positively
associated
with
most
of
the
five
HIV
risk
behaviours.
Listening
to radio
for
migrants
and
chatting
and doing
chores
in
non
migrants
were
negatively
associated
with
some
of
the
HIV
risk
behaviours.
The association of rural married women to HIV perceived risk, child mortality and desire to have
children and the link to HIV risk was assessed. Overall, 32.8 % of subjects expressed desire for
future pregnancy, 8.8 % perceived themselves at high risk for HIV infection and 26.7% reported
the death of at least one child in the past five years. In multiple logistic regression analysis,
reporting at least one child's death (OR=6.92; 95% CI=4.91 to 9.47) was significantly associated
with a higher desire higher to become pregnant. Furthermore perceived high risk for HIV
infection (OR=2.08; 95% CI= 1.35 to 3.19) was found to be associated with the desire to get
pregnant. Being currently married, having no education, being of low parity and having low
household expenditure were significantly associated with having the desire for more children.
The qualitative part of this study identified a number of social factors and cultural norms and
practices that impact on HIV/AIDS. The first category consists of factors that were said to
promote the spread of HIV/AIDS such as alcohol drinking and drunkenness. To that effect, all
social and cultural functions that involve large gatherings such as holidays and wedding
ceremonies, alcohol drinking and dancing were seen to greatly contribute to the spread of
HIV/AIDS.
The second category is of factors influencing the reduction in the risk of HIV transmission such
as promotion of virginity and arranged marriages. Interestingly, some of the main social factors,
cultural norms and practices that increase the risk of HIV transmission were seen to also play
significant roles in risk reduction; church gatherings, weddings, and burials were singled out as
major avenues for promoting positive sexual behaviours while some people use them to engage
in risky behaviours.
HIV/AIDS and the social and cultural set-up of communities have impacted upon each other. In
the context of HIV/AIDS, social and cultural practices play dual roles, on one side enhancing
HIV transmission while on the other facilitating reduction in incidence. However, social factors,
cultural norms and practices were seen more as facilitators than inhibitors of HIV transmission,
while low awareness about HIV/AIDS and lack of supportive services such as VCT and
knowledge of condoms remain major limitations to sustain behaviour change. Accessibility to
these services is also limited to the majority in the rural areas
Conclusions: As both rural to urban migrants and non-migrants are at risk for HIV infection,
intervention program targeting both groups are recommended. However, in order to contain the
bridging effect on HIV transmission from urban to rural areas particular attention should be
given for the rural to urban migrant population.
Effective HIV prevention programming must reach and serve populations at risk. This study
shows that male migrants are at high risk of HIV due to risky sexual partnerships and low
condom use. Additionally, their high mobility and multiple partnerships potentially contribute to
the spread of HIV to the rural areas. Sero-prevalence data should be collected to complement
behavioural data and enable tailored programming to reach this vulnerable group. Employers
should be engaged in HIV prevention for this population.
Socially desirable and constructive leisure activities such as listening to the radios among
migrants and doing chores and chatting among non-migrants may prevent them from being
engaged in HIV risk behaviours while leisure activities such as visiting entertainment
installments and watching videos may increase the odds for migrants to be engaged in HIV risk
behaviours. However the evidence in this study strongly suggest that migrants who are detached
from family and home environment may be exposed to leisure activities possibly associated with
HIV risk behaviours. Therefore, given the high mobility of migrants, it is very important to
strengthen work place intervention in their destination places
High perceived risk of HIV infection was associated with high desire for future pregnancy.
Moreover women seem to have a higher desire for a future pregnancy to replacing a dead child
that may have lost its life as a result of HIV infection. This finding indicated the crucial role of
desire for fertility by a married woman irrespective of the risk for acquiring HIV infection. This
implies that there should be further research to address the issue and the utilitarian-economic,
social, and psychological values attributed to children by both women and their male sex partners.
The involvement of men as partners in childbearing should be explored, as their desire for children
may be the primary barrier to protective behavioural change among women. In order to change
rural Ethiopian parents’ perception of values of children, child education needs to be compulsory
so the cost of raising children will increase and inhibit a further high desire for pregnancy.
In the area the prevailing cultural practices and norms encourage large families and discourage the
use of condoms. In such settings, there is the need to find appropriate mechanisms that could help
increase the use of all types of contraceptives. As contraceptive use increases, it is likely that the
use of condoms for AIDS prevention and also for family planning purpose would increase..
According to the qualitative findings some striking characters were noted - these are the mobility
of commercial sex workers from large town to small towns such as Bure or adjust rural villages in
order to attract a wider or different client base, for adventure and to conceal illnesses which might
be associated with HIV/AIDS, drinking alcohol while on ART drugs to pretend as HIV free and
involve in sexual activity, desired to be considered as a HIV positive in order to get the support
given to PLHI, underline the needs for further investigation due to their possible contribution for
sustaining the HIV epidemic. Although there are some prevention activities to fight HIV/AIDS in
the rural areas, most of them were inappropriate in terms of convenience in time, place and target
groups. For instance, HIV educations are given only in weekends, holidays and around the church
areas where most of the young people are not available. The finding has programmatic
implications as it misses the young who are vulnerable to HIV infections. The needs and priorities
in prevention of HIV/AIDS are two fold: to enable community members to be fully informed
about the disease and reduce potentially risky behaviour; and to secure viable rural livelihoods
which would reduce the need for people to move into potentially HIV-risky environments.
Description
Keywords
Fertility Intention, HIV risks, Leisure activities, Migrants, Non-migrants, Sexual risk.