“She mixes her business”: HIV transmission and acquisition risks among female migrants in western Kenya

Abstract

Migration and HIV research in sub-Saharan Africa has focused on HIV risks to male migrants, yet women’s levels of participation in internal migration have met or exceeded those of men in the region. Moreover, studies that have examined HIV risks to female migrants found higher risk behavior and HIV prevalence among migrant compared to non-migrant women. However, little is known about the pathways through which participation in migration leads to higher risk behavior in women. This study aimed to characterize the contexts and processes that may facilitate HIV acquisition and transmission among migrant women in the Kisumu area of Nyanza Province, Kenya. We used qualitative methods, including 6 months of participant observation in women’s common migration destinations and in-depth semi-structured interviews conducted with 15 male and 40 female migrants selected from these destinations. Gendered aspects of the migration process may be linked to the high risks of HIV observed in female migrants— in the circumstances that trigger migration, livelihood strategies available to female migrants, and social features of migration destinations. Migrations were often precipitated by household shocks due to changes in marital status (as when widowhood resulted in disinheritance) and gender-based violence. Many migrants engaged in transactional sex, of varying regularity, from clandestine to overt, to supplement earnings from informal sector trading. Migrant women are at high risk of HIV transmission and acquisition: the circumstances that drove migration may have also increased HIV infection risk at origin; and social contexts in destinations facilitate having multiple sexual partners and engaging in transactional sex. We propose a model for understanding the pathways through which migration contributes to HIV risks in women in high HIV prevalence areas in Africa, highlighting potential opportunities for primary and secondary HIV prevention at origins and destinations, and at key ‘moments of vulnerability’ in the migration process.

Transactional Fish-for-Sex Relationships Amid Declining Fish Access in Kenya

“…This has been branded a key factor in the spread of HIV and broadly discouraged. Yet, with appreciation of the role of resources, particularly property rights, widows who are not inherited are now recognized to be at risk of losing rights to land and property, resulting in migration and subsequent vulnerability to HIV (Camlin et al, 2014;Dworkin et al, 2013). The repudiation of widow inheritance does not have simple or summarily beneficial consequences, and, we suggest, much the same can be expected from treatment of jaboya relationships where participants may balance risks of HIV infection with persistent food insecurity and environmental and economic change.…”

“…HIV/AIDS in fishing communities has a breadth of enduring effects on fisher livelihoods, fishing communities, and the fisheries themselves (Allison & Seeley, 2004a, 2004b. Further, both male and female migration to and around Lake Victoria has compounded fishery gender dynamics, exchanges of sex, and HIV risk Camlin, Kwena, Dworkin, Cohen, & Bukusi, 2014).…”

Economic Globalization, HIV and AIDS and Gender Dimensions in the Lesotho Textiles and Garment Industry

“…This can beter be understood by contextualizing the problem with gender lens. According to Camlin, Kwena, Dworkin, Cohen and Bukusi [34], Sub-Saharan Africa is the only part of the world where HIV prevalence and AIDS deaths are higher for women than for men. They therefore emphasized that gender dimension is crucial to understanding how HIV is spread.…”

Geographical mobility and heterogeneity of the HIV epidemic

“…6,7 The concentrated HIV epidemic in fishing communities in the Lake Victoria basin provides a rich context for these advances in research and understanding (figure). 8–12 The mobility of men who work in the fishing industry is well known, but mobility of women fish traders who circulate between beaches and markets has received less attention. 8,12 Many people who work in the fish industry also engage in a transactional, so called, fish-for-sex economy in which traders exchange sex with fishermen to gain preferential fish access (termed Jaboya in Kenya).…”

“…8–12 The mobility of men who work in the fishing industry is well known, but mobility of women fish traders who circulate between beaches and markets has received less attention. 8,12 Many people who work in the fish industry also engage in a transactional, so called, fish-for-sex economy in which traders exchange sex with fishermen to gain preferential fish access (termed Jaboya in Kenya). Despite stigma surrounding these practices, 8 declines in the fish population in Lake Victoria continue to foster fish-for-sex relationships, reducing relationship durations and women’s bargaining power.…”