Presented at the Regional RENEWAL 3 Workshop at the Glenburn Lodge, South Africa

1. Theme 1:
AIDS, Agriculture and
Livelihood Security

2. Projects under Theme 1
1. Risks and Vulnerabilities to HIV and AIDS within the Plantation
Systems of the Lake Victoria Basin (ongoing with AMREF);
2. Quantifying the Impact of HIV/AIDS on Government Agricultural
Extension Service Delivery in Zambia and Malawi (ongoing);
3. Urban-Rural Linkages in Three African Cities (winding up);
4. Longitudinal Tracking in Kenya-Nairobi Urban Slums (winding
up); and
5. Changing Livelihoods in the Face of AIDS (CLIVIA) (beginning
with HEARD).

3. Urbanisation & Urban-Rural Links
• Emphasis on “livelihoods” as opposed to “rural
livelihoods”
• Acknowledging changing systems and increased
urbanisation (Durban, Mbekweni, Nairobi, Jo’burg,
Windhoek, Addis Ababa)
• Focusing on urban-rural linkages incl migration
• Considers HIV and AIDS and food insecurity as
key dimensions of these areas – eg. informal
urban areas (SA)

4. PLANET OF SLUMS?
6% of urban pop in developed countries live in slums
78% of urban pop in the least developed
countries live in slums
The Challenge of Slums –
UN-HABITAT Report
!
Kibera, Nairobi
Swilling, M. 2007

5. Recognising the complexity of African cities:
the importance of diversity
• UR Links study engages complexity :
– Adopts an “ecohealth” approach
– Focus on different types of migrants: Internal & external
– Complex linkages; people, food, money, goods (reciprocity)
– Diverse settlement types
• Mixed methodology:
– Quantitative surveys in Addis Ababa, Johannesburg &
Windhoek
– Qualitative research with different groups including children
– Engaged decision makers throughout

7. Migration, HIV and food security
A focus on Johannesburg
through a livelihoods lens
Jo Vearey and Lorena Nunez
University of the Witwatersrand
Forced Migration Studies Programme
Health and Migration Initiative

8. African cities are characterised by
rapid urbanisation – including
high rates of in-migration:
Internal (from within South Africa)
Circular migration
Cross-border

9. Urban informal settlements
have double
the HIV
prevalence of urban
formal areas.

10. African urban environments
1. High rates of migration;
2. Increasing pressure on appropriate housing;
3. High urban HIV prevalence rates – highest in urban
informal areas;
4. Dependency on survivalist livelihoods located
within the informal sector;
5. Increasing urban inequalities that impact ‘urban
poor’ groups.

11. Objectives
To explore the linkages between HIV, migration
and urban food security through a livelihoods
lens.
To better understand differences in urban
livelihood systems between:
• Those residing informally and those residing
formally;
• Internal and cross-border migrants.

12. Johannesburg study sites
Workshop
venue
Sol Plaatjies
informal
settlement Berea, Jeppestown and
Hillbrow
n = 200
n = 300
5

13. Methodology
Cross-sectional household survey (2008)
487 households:
– Johannesburg: a complex urban context
–• Purposively selected areas across urbanmigrants and
60% (n = 293): South African internal informal
formal
• 3 (n = 150): Cross-border migrants
• 31%inner-city suburbs
• 1 informal settlement
• 9% (n = 44): Always resided in Johannesburg
• Administered questionnaire;
• Cluster-based random sampling.

14. Shocks Stressors
lack of access to pressure to remit
food
Urban migrants
sickness: • Internal South African migrants
HIV
themselves and • Cross-border migrants
those back home • Always lived in Johannesburg
Unreliable income
loss of income
hunger
death of a family ASSETS
member (strengths) natural INFORMATION:
SOCIAL CAPITAL HIV testing and
HOUSING
human social
ART
SOCIAL INCOME financial physical
REGULAR
PROTECTION FAMILY BACK
HIVEDUCATION HOME
TESTING Outcome
FOOD SECURITY:
HEALTH STATUS
(access to food, dietary diversity score & food shortage)

15. Shocks Stressors
Lack of access to pressure to remit
food
Urban migrants
• Internal South African migrants
Sickness: • Cross-border migrants
themselves and HIV
• Always lived in Johannesburg
those back home
hunger
ASSETS
(strengths) natural
human social
financial physical
Outcome
FOOD SECURITY HEALTH STATUS

16. Who are the migrants?
80
70
Relative frequency (%)
60
50
Informal
40
♀
Formal
30
20 ♂
10
n = 293 n = 150 n = 44
0
South African Cross-border Always lived in
internal migrant migrant Johannesburg
Migration status
n = 487
Chi-square = 62.4; p = <0.001

17. Who are the migrants?
Distribution of age among the respondents
160
140
Absolute frequency
120
100
80
60
40
20 N = 487
0
10 20 30 40 50 60 70 80
Age (yrs)
• The average of respondents is 33 yrs old and half of them have less than 30 yrs old
• Female cross-border migrants are the youngest group (median, 25 years)
• Men who have always lived in Johannesburg are the oldest (median 36 years).

18. Shocks Stressors
Lack of access to pressure to remit
food
Urban migrants
• Internal South African migrants
Sickness: • Cross-border migrants
themselves and HIV
• Always lived in Johannesburg
those back home
hunger
ASSETS
(strengths) natural
human social
financial physical
Outcome
FOOD SECURITY HEALTH STATUS

19. What are their assets?
– Income
– Social protection
– Social capital
– Housing
– Regular HIV testing and knowledge of ART

20. Distribution of number of incomes
in the household within each
migration status group
70
60 internal migrants
Percentage (%)
50
40 cross-border
30 migrants
20 always lived in JHB
10
0
e
e
es
es
m
m
m
m
co
co
co
co
in
in
in
in
0
1
2
3

21. Social protection
Grants
50
45
40
Relative frequency (%)
35
30
25
20
15 n = 83
10
5 n = 27
0
Informal Formal
Residential area

22. Housing
90
80
70
Relative frequency (%)
60
50 Informal
40 Formal
30
20
10
0
Own Self-constructed Rent RDP
Tenure n = 479
Chi-square = 364.696; p = <0.0001

23. Repeated HIV testing and
knowledge of ART
70
60
50
Relative frequency (%)
National HIV prevalence in urban informal
40 settlements is double that of urban formal
Informal
areas: 18% compared to 9% (HSRC, 2005)
Formal
30
20
10
0
Yes No
Have you ever tested for HIV? n = 485
Chi-square = 18.420; p = <0.0001

24. Shocks Stressors
Lack of access to pressure to remit
food
Urban migrants
• Internal South African migrants
Sickness: • Cross-border migrants
themselves and HIV
• Always lived in Johannesburg
those back home
hunger
ASSETS
(strengths) natural
human social
financial physical
Outcome
FOOD SECURITY HEALTH STATUS

25. What stressors do urban migrants face?
– An interlinked livelihood
• Perception of risk of HIV
• Pressure to remit

26. Perception of risk of HIV
70
Relative frequency (%)
60
50
40 Informal
30 Formal
20
10
0
No Risk Risk
Perception of risk of HIV
Chi-square = 14.221; p = 0.0002

27. Linkages and pressure to remit
70
60
50
Relative frequency (%)
40 Internal South African migrant
Cross-border migrant
30 Always lived in JHB
20
10
0
Send money Send food Send goods
Remittance

28. An interlinked livelihood system
Stressors
ASSETS
Provision of (strengths)
remittances
Johannesburg Another Receiving
place remittances

29. Shocks Stressors
Lack of access to pressure to remit
food
Urban migrants
• Internal South African migrants
Sickness: • Cross-border migrants
themselves and HIV
• Always lived in Johannesburg
those back home
hunger
ASSETS
(strengths) natural
human social
financial physical
Outcome
FOOD SECURITY HEALTH STATUS

30. What are the shocks that urban migrants
face?
– Loss of income; death of a family member; arriving in
Johannesburg
• Poor food access
– Specific sickness episode, HIV and Aids

31. Shocks causing food shortage
60
50
Relative frequency (%)
40
Informal
30
Formal
20
10
0
Loss of job Death in the Just arrived in Unreliable Food security
family JHB income is always poor
Reason for food shortage
Chi-square 52.788; p = <0.0001

32. Food shortage:
respondents residing informally are more likely to have
experienced a food shortage in the last 12 months
80
70
60
Percentage (%)
50
Informal
40
Formal
30
20
10
0
Yes No
Have you experienced a food shortage in the last 12
months?

33. Sickness and HIV
Shocks
– A specific sickness episode which may be
related to HIV or Aids
– This sickness can affect the respondent, a
household member in the city, or a household
member back home

34. Sickness and HIV:
if the individual in the city becomes too sick to work,
the majority will return back home
54%
67%
Urban livelihood Support
Importance of
that supports
another household food Burden on the
household back
‘back home’ would
be affected. 65% informal home.
48% formal

35. An interlinked livelihood system
Shocks
Stressor
Sickness Shocks
Remittances stop
SICKNESS Another place Provision of
care, including
Johannesburg
food
Stressor
ASSETS
Family
(strengths) back
home

36. Sickness and HIV:
if someone ‘back home’ becomes sick with HIV/AIDS
Return
Send home to
money provide Bring to
home care JHB Nothing
Informal 33% 19% 14% 34%
Formal 63% 11% 6% 21%
Chi-square = 40.796; p = <0.001 n = 457

37. An interlinked livelihood system
Shocks
Stresses
Shocks
Sickness
Johannesburg SICKNESS
Another place
Send money
Travel home
Stresses
Bring them to the city
ASSETS Family in
(strengths) JHB
Remittances

38. Shocks Stressors
Lack of access to pressure to remit
food
Urban migrants
• Internal South African migrants
Sickness: • Cross-border migrants
themselves and HIV
• Always lived in Johannesburg
those back home
hunger
ASSETS
(strengths) natural
human social
financial physical
Outcome
FOOD SECURITY HEALTH STATUS

39. Outcomes of the livelihoods system:
– Health status
– Urban food security (DDS)

40. Health status
65%
15%
10%
5%
1%
very poor poor averag e g ood very g ood
perc eiv ed health s tatus

41. Food access:
respondents residing informally are more likely to report
that their food access has worsened since moving to
Johannesburg
70
60
50
Percent
40 Informal
30 Formal
20
10
0
Yes: it is better now Yes: it is worse now No: no change
Has your food access changed since moving to
Johannesburg?
Chi-square 32.170; p = <0.0001

42. 24 hours Dietary Diversity Score:
respondents residing informally are more likely to
have a deficient dietary score
70
60
50
Relative frequency
40
Informal
Formal
30
20
10
0
Deficient Sufficient Diverse
Score 0 - 3 Score 4 - 6 Score 7 - 9
Chi-square 89.880;
24 hour Dietary Diversity Score
p = <0.0001

43. 24 hour Dietary Diversity Score
migration status
60
50
Relative frequency (%)
40
Deficient (0 - 3)
30 Sufficient (4 - 6)
Diverse (7 - 9)
20
10
0
Cross-border migrant South African internal Always lived in
migrant Johannesburg
Migration status
Chi-square 19.252; p = 0.0007

44. Linkages to the National Strategic Plan
• South African NSP (2007 – 2011)
– Recognition of migrants (internal and cross-border, refugees,
asylum seekers and undocumented);
– Emphasis on informal settlements and recognition of highest HIV
prevalence.
• However:
– Lack of guidance for how to implement action at the local level;
– This research contributes to generating such a framework –
through dialogue with policy makers and practitioners, including
local government.

45. Policy engagement
• Local - City of Johannesburg
– Ongoing engagement through FMSP and MRC linkages
– Forthcoming dissemination workshop
• Regional - SADC
– SADC Parliamentarian Meeting on migration
– Regional guidelines on migration and HIV
• Multi-disciplinary national technical advisory group
• Medical Research Council
• University of the Witwatersrand
• Population Council
• IFPRI - RENEWAL
– Research planning, analysis, discussion, engagement, use of
data

46. Policy recommendations
• The importance of an interlinked livelihood
system
– Rural-urban linkages
– The meaning of ‘home’
– Rural development must engage with the
urban, and urban development must engage
with rural

47. Ongoing and future research
• Ongoing research:
– Student projects
– Wits
– MRC/Centre for Health Policy
• Research needs:
– Rural sending communities
– The role of social networks within the livelihoods
system
– Intra-household dynamics
• Migration decisions
• Resource use
– Intervention Research: process evaluations