Migration, Sexual Behavior, and HIV Diffusion in Kenya

This material may not be reproduced in any form without written permission from the authors. Abstract The association of migration with the spread of AIDS in sub-Saharan Africa is well documented, yet the social and behavioral mechanisms underlying this relationship remain poorly understood. Using data from the 1993 Kenya Demographic and Health Survey, this paper examines whether migrants are more likely than nonmigrants to have multiple recent sexual partners and not to use condoms with those partners. Results indicate that migration is a critical factor in high-risk sexual behavior and that its importance varies by gender and by the direction of movement. 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 nonmigrant counterparts to engage in sexual practices conducive to HIV infection. In rural areas, migrants from urban places are more likely than nonmigrants to practice high-risk sex. Given the predominance of men in urban migration and the large volume of circulatory movement between urban and rural areas, these results have serious implications for HIV transmission throughout Kenya. Geographic mobility is widely recognized as one of the main facilitating conditions of HIV transmission in sub-Saharan Africa (Fontanet and Piot 1994; Hunt 1989). Numerous studies have established a clear link between elevated HIV seroprevalence and short duration of residence in a locality travel to the region (Hawkes et al. 1994). Massive migration of young, unmarried adults from presumably " conservative " rural environments to more sexually permissive African cities in recent years is regarded as partly responsible for the much higher seroprevalence levels observed in urban than in rural areas (United Nations 1994:8). Although the association of migration with the spread of AIDS in East, Central, and Southern Africa (the " AIDS Belt ") is well documented, the social and behavioral mechanisms that may render migrants more vulnerable to HIV infection in this area remain poorly understood. Aside from migrants who are transport or commercial sex workers, there is scant evidence that migrants have distinct personal characteristics and sexual behaviors, such as high numbers of sexual partners or low condom use, that are conducive to contracting HIV. Since migrants are a large and heterogeneous group, it is crucial to understand not only how these behavioral aspects of infection vary between migrants and nonmigrants, but also how …