Migration and Aids: social control, a brake on the spread of HIV in Senegal?

Ever since Aids appeared, migration has been thought to be a driving force behind the epidemic. The disease is often represented either as an “imported pathology”, migrants being the disease (or at least risk), carriers or as a “pathology of adaptation”.

Migrants, mainly young men who move around to find work, are subjected to the constraints of a new environment they find in the host region or country. They therefore become economically, socially and emotionally more vulnerable. This situation encourages changes in their sexual behaviour, like multiplication of casual partners and resorting to prostitutes.

Demographers Richard Lalou (IRD) and Victor Piché (University of Montreal) focused on this relation between mobility and sexual behaviour. Findings of surveys performed in 2000 in the River Senegal Valley, among 1320 persons aged between 15 and 49 years old, provided data on the routes taken by the migrants and their personal situations. The ability of these migrants to handle sexual risks of transmitting HIV differed according to the social contexts of the communities they were going back into.

Two locations with highly contrasting social situations were studied: the urban centre of Richard-Toll (in the lower valley) and the rural area of Matam (in the middle of the valley). At Richard-Toll international emigration was turned towards countries having low HIV prevalence (Mauritania), whereas the Matam area is the source of substantial international emigration towards countries with higher prevalence (Ivory Coast, Central Africa).

In spite of these movements towards countries with high prevalence of HIV seropositive cases, the infection rate in the Matam area remained constant in the years between 1990 and 2002 (about 2%). In these surveys, international mobility, which aims for an African country or another continent, has been distinguished from internal mobility which concerns movements within the country, mainly towards the large towns and cities (Dakar, Saint-Louis and Thiès), and short temporary trips away.

Generally, once migrants arrive in the host community, their sexual behaviour changes to open the way to increased risk of HIV infection. This is the case of migrants from the River Senegal Valley who, with the exception of those on short-term missions, have more frequent sexual relations with casual partners and professionals of the sex trade during their stay than before their departure. On their return, many of these migrants give up their risky behaviour. This tendency is stronger overall among international migrants (80% abandon such practices) than in internal migrants (56%). It is also a little more pronounced in the Matam area than at Richard-Toll (72% compared with 62%).

The migrants who come back to the town of Richard-Toll do not appear to have a sex life any different from fellow inhabitants who had not been away. However, migrants returning to their rural area of Matam would adopt risky sexual behaviour less frequently than people who had stayed put. Social systems and religion (Islam founded on orthodox practices) could therefore favour strict social control, especially in a rural situation (Matam).

Thus, in the Matam region, the international migrants’ choice of fidelity, on their return, does not represent only a concern for health. It responds above all to the wish to respect the social norms of the community, in a guiding principle of conformity, to avoid the risk of being stigmatized. These migrants, who had left their home country, are in fact implicitly accused of being “disease importers”. In parallel, they play an important economic role, owing to the financial power they acquired during their stay away. Indeed, when they come back they have a core place in their community.

In contrast, the migrants who did not leave the country are not considered by society as potential carriers of diseases. They do not therefore necessarily change social status when they return. For them, the risk of contamination is more directly associated with sexual conduct, and therefore with a clearly health-based strategy. Without necessarily giving up relations with different partners, they consequently tend to protect themselves more readily with condoms. In this case, the internal migrants, like their community, do not give their sexuality a social signification any different from before they left home.

The experience of migration alters sexual behaviour only in certain social contexts and depends on the social position of migrants on their return to their original circle. Those who come back, like any other person, adjust their behaviour according to the situation, their itinerary, experience and their perceptions. According to the survey results, migration has not been contributing to conditions favouring HIV infection, at least up to 2000. The social context appears to have an influence that favours control of the epidemic. It partly explains the constant low prevalence of Aids in Senegal. However, the success of programmes for the prevention of HIV transmission depends on individual behaviour but also on a collective protective role of the community with regard to migrants’ wives, who are particularly vulnerable.