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"Using 1993 data, a study of migrants in Kenya concluded: "Independent of marital and cohabitation status, social milieu, awareness of AIDS, and other crucial influences on sexual behavior, male migrants between urban areas and female migrants within rural areas are much more likely than non-migrant counterparts to engage in sexual practices conducive to HIV infection. In rural areas, migrants [returning] from urban places are more likely than non-migrants to practice high-risk sex."

The risks of HIV/AIDS associated with migration are well known to both men and women. Women in rural Tanzania a few weeks before Christmas told researchers that they lived in fear of their husbands coming home for Christmas since they thought they would be "bringing AIDS." In some places female sex workers return, also with some money and often HIV, and in search of a husband.
"In general, they did not think of AIDS as something terribly new. Rather, they saw it in the wider context of other crises predating it. During and for a few years after World War II, the study area was struck by famine partly due to drought and partly due to rationing imposed by the British colonial government in Tanganyika. ... Most households had to dispose of their assets."
" In the early 1970s, drought led to widespread food shortages in the area particularly in 1973-1974. This was a generalised hunger throughout Tanzania and the situation was made worse by the world oil price shock. . . . A few years later there was olushengo lwa Amin (Amin's war), that is, the 1978-1979 war between Uganda and Tanzania. Although the village is about 72 kilometers from the border it not only received some of the displaced people from the border villages but it suffered the economic disruption wrought by the war. Much of the period from 1970 has been characterized by poor national economic performance and consequently the decline of the coffee crop in the area. The economic downturn has continued with only brief hiatuses in some years."

They often:
1. Further undermined the rural economy, at the cost of livelihoods and nutritional status; they also caused or intensified economic recessions and led to increased poverty and class and gender inequality.
2. Fostered the development of transportation infrastructure to support the heightened export orientation of the economy. Numerous studies from countries in Africa and India document the sexual networking and the high HIV prevalence along the truck routes.
3. Increased labor migration and urbanization. Both of these phenomena, as already emphasized, preceded structural adjustment programs but increased with the emphasis on an export-oriented growth.
4. Mandated cutbacks in spending on health care and other social services. At the beginning of the 1990s, when resources were urgently needed for HIV/AIDS prevention programs, the average annual per capita expenditure on health by African governments was a mere US $2. In many countries, most notably in sub-Saharan Africa, nothing could have been more inappropriate than decreasing access to health services, given the already very high rates of untreated STDs and non-specific bacterial and vaginal infections, a now recognized leading factor in the spread of HIV infection. Cutbacks in funding for public clinics reportedly also encouraged the reuse of disposable syringes, potentially contributing to HIV transmission.
5. Breakdown of household regimes and attendant securities: Decades of changes in economic activity and gender relations have placed women in increasingly difficult situations. HIV/AIDS has accelerated the process and made "normal" sexual relations very risky. Although poorly documented, the range and depth of women's responsibilities have increased during the era of AIDS. More active care-giving for sick and dying relatives has been added to the existing work load. Children (girls first) have been withdrawn from school, both to save on costs and to add to labor within the household. Thus, HIV/AIDS is facilitating a further and fairly rapid differentiation along gender lines.
6. Loss of livelihood: Whether women received remittances from men working away from home, received "allowances", or earned income themselves, AIDS made the availability of cash more problematic. In Malawi, women and men have increasingly taken on work on farms of larger and/or wealthier farmers in order to earn income or in-kind payments, often neglecting production on their own holdings.
7. Loss of assets: Again, although poorly documented, fairly substantial investments in medical care occur among many households affected by HIV/AIDS. These costs are dis- investments to the family and survivors. Household food security is often affected in negative ways. In many parts of Africa, women lose all or most of the household assets after the death of a husband.
8. Survival sex: Low incomes, dis-investment, constrained cash flow all place economic pressures on women. Anecdotal evidence and some studies indicate that these pressures push a number of women into situations where sex is coerced in exchange for small cash or in-kind payments. Along the Thailand-Burma border, many of the sex workers are young women, caught up in the "green harvest" in which their work is a means to repay loans made to their families by money lenders who recruit young women for the sex industry. Most of the young women return home HIV-positive.

HIV news web\Africa HIV-AIDS and Failed Development.htm
Africa: HIV/AIDS and Failed Development
Date distributed (ymd): 001031
APIC Document
HIV/AIDS and Failed Development
Joe Collins and Bill Rau