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, North West, Ethiopia.
| dc.contributor.advisor | Damen Hailemariam | |
| dc.contributor.advisor | Getnet Mitikie | |
| dc.contributor.author | Melesse Tamiru Semegne | |
| dc.date.accessioned | 2022-06-14T06:16:02Z | |
| dc.date.accessioned | 2023-11-05T15:12:36Z | |
| dc.date.available | 2022-06-14T06:16:02Z | |
| dc.date.available | 2023-11-05T15:12:36Z | |
| dc.date.issued | 2012-03 | |
| dc.description.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-migrantsin 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 inatypical 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 impactupon 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. Differentsegments of the population are at different stages of this transition with different valuesattributed 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 ofchildbearing. Objectives: The general objective of this study was to assess and explore the role of rural tourban migrants (potential bridging population) and socio-cultural factors (including high fertilityintentions) 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 thesexual behaviours of rural to urban migrants and non-migrants (rural residents) by comparing thelink between predisposing, and enabling factors with the sexual risk behaviours among rural tourban migrants and non-migrants and by investigating the leisure activities which are associatedwith different levels of likelihood to engage in HIV risk behaviours among rural to urbanmigrants and non-migrants. Moreover other sexual and cultural practices of the rural people inrelation 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 tourban migrants and non-migrants is compared and the role of migration in HIV transmission andsocio-cultural practice and norms for the spread of the virus in therural areas of Bure Woreda isexplored. The detailed methodology included two components: The first one was a quantitativecross-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 aqualitative 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 studyunits from the rural- urban migrants (road construction sites (Cobble stone), Ethiopian Commodity Exchange (ECX), commercial agricultural farm employees and rural residents fromthe rural kebeles of Bure Woreda. A total of 2,751 participants, 667 rural men and 1,418 rural married women were drawn from the23 rural kebeles of Bure Woreda while the remaining 666 rural to urban migrants were takenfrom Bure and around Bure town. Because the present study had a number of different outcomevariables 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 flowand content of the questions. Accordingly, amendments were made depending on the results ofthe pre-test that was conducted in the nearby similar areas. Data collection was carried out bytwenty 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 thedata was analyzed using SPSS version 17 statistical software. The, chi-square test and binarylogistic regression were used to see the association of variables. II) Qualitative study: This part of the study was aimed at substantiating and complementingthe 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 usualprinciples guiding qualitative analysis were taken into account and sequences of interrelatedsteps (reading, coding, displaying, data reduction and interpreting) were employed whileanalyzing the data. In short, as can be noted from the above explanations, the procedure used toprocess the raw data for the purposes of classification, summarization and tabulation wasthematic content analysis. The basic idea here was to identify the extracts of data that wereinformative in some way and to sort out the important messages hidden in the mass of each keyinformant interview and FGD. Results: A total of 2,690 participants (response rate, 97.7 %) responded to the questionnaire onHIV 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 nonmigrantsand1,380marriedwomen).When the two groups (rural to urban migrants and non-migrants) are compared in terms ofpracticing sexual risk behaviours i.e. having of multiple sexual partners, practicing sex with commercial sex workers, contracting sexual transmitted infections and practicing premarital sext here 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 thosewho had multipl sexual partners, only 12.7 of rural to urban migrantsand 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 wereengaged 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 behaviors among migrants and non migrants. Among migrants, watching TV, reading (including non-migrants) ,chatting, watching videos, wandering on streets(includingnon-migrants),andvisitingentertainmentfacilitieswere positively associated with most of the five HIV risk behaviors. Listening to radio for migrants and chattingand doing chores in non-migrants were negatively associated with some of the HIV Risk behaviors.The association of rural married women to HIV perceived risk, child mortality and desire to havechildren and the link to HIV risk was assessed. Overall, 32.8 % of subjects expressed desire forfuture pregnancy, 8.8 % perceived themselves at high risk for HIV infection and 26.7% reportedthe 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 associatedwith a higher desire higher to become pregnant. Furthermore perceived high risk for HIVinfection (OR=2.08; 95% CI= 1.35 to 3.19) was found to be associated with the desire to getpregnant. Being currently married, having no education, being of low parity and having lowhousehold 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 andpractices that impact on HIV/AIDS. The first category consists of factors that were said topromote the spread of HIV/AIDS such as alcohol drinking and drunkenness. To that effect, allsocial 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 suchas 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 playsignificant roles in risk reduction; church gatherings, weddings, and burials were singled out asmajor avenues for promoting positive sexual behaviours while some people use them to engagein risky behaviours. HIV/AIDS and the social and cultural set-up of communities have impacted upon each other. Inthe context of HIV/AIDS, social and cultural practices play dual roles, on one side enhancingHIV 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 andknowledge 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 begiven for the rural to urban migrant population. Effective HIV prevention programming must reach and serve populations at risk. This studyshows that male migrants are at high risk of HIV due to risky sexual partnershipsandlowcondom use. Additionally, their high mobility and multiple partnerships potentiallycontribute tothe spread of HIV to the rural areas. Sero-prevalence data should be collected to complementbehavioural data and enable tailored programming to reach this vulnerable group. Employersshould be engaged in HIV prevention for this population. Socially desirable and constructive leisure activities such as listening to the radios amongmigrants and doing chores and chatting among non-migrants may prevent them from being engaged in HIV risk behaviours while leisure activities such as visiting entertainmentinstallments and watching videos may increase the odds for migrants to be engaged in HIV riskbehaviours. 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 withHIV risk behaviours. Therefore, given the high mobility of migrants, it is very important tostrengthen 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 childthat may have lost its life as a result of HIV infection. This finding indicated the crucial role ofdesire for fertility by a married woman irrespective of the risk for acquiring HIV infection. Thisimplies 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 childrenmay be the primary barrier to protective behavioural change among women. In order to changerural Ethiopian parents’ perception of values of children, child education needs to be compulsoryso 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 theuse of condoms. In such settings, there is the need to find appropriate mechanisms that could helpincrease the use of all types of contraceptives. As contraceptive use increases, it is likely that theuse 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 mobilityof commercial sex workers from large town to small towns such as Bure or adjust rural villages inorder to attract a wider or different client base, for adventure and to conceal illnesses which mightbe associated with HIV/AIDS, drinking alcohol while on ART drugs to pretend as HIV free andinvolve in sexual activity, desired to be considered as a HIV positive in order to get the supportgiven to PLHI, underline the needs for further investigation due to their possible contribution forsustaining the HIV epidemic. Although there are some prevention activities to fight HIV/AIDS inthe rural areas, most of them were inappropriate in terms of convenience in time, place and targetgroups. For instance, HIV educations are given only in weekends, holidays and around the churchareas where most of the young people are not available. The finding has programmaticimplications as it misses the young who are vulnerable to HIV infections. The needs and prioritiesin prevention of HIV/AIDS are two fold: to enable community members to be fully informedabout the disease and reduce potentially risky behaviour; and to secure viable rural livelihoodswhich would reduce the need for people to move into potentially HIV-risky environments. | en_US |
| dc.identifier.uri | http://etd.aau.edu.et/handle/123456789/31996 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | Addis Ababa University | en_US |
| dc.subject | Fertility Intention, HIV Risks, Leisure Activities, Migrants, Non-Migrants, Sexual Risk. | en_US |
| dc.title | 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, North West, Ethiopia. | en_US |
| dc.type | Dissertation | en_US |