| Abstract: |
<italic>Problem statement</italic>. South Africa faces one of the most explosive HIV/AIDS epidemics in the world
the country also has an extremely mobile population. This dissertation explores the link between migration and the spread of HIV in South Africa. <italic>Methods</italic>. A formative study followed by a cross-sectional behavioural and epidemiological study among migrant men and their rural partners, and non-migrant men and their partners measured whether migration was a risk factor for HIV infection for men and their partners. <italic>Results</italic>. Between October 1998 and November 2000, 256 men and 225 women were recruited. Overall HIV prevalence was 21%. In bivariate analysis, migrant men were 2.4 times more likely to be infected with HIV than non-migrant men (25.9% versus 12.7%
<italic>p</italic> = 0.029
OR = 2.4
95% CI = 1.15.3). Among women, partner of migrants were slightly more likely to be infected with HIV than partners of non-migrants, but this difference was not statistically significant (21.1% versus 16.5%
<italic>p</italic> = 0.39). On multivariate analysis, the main risk factors for HIV infection among men were being a migrant, having two or more current casual partners, ever having used a condom and having lived in four or more places over a lifetime. For women, the main risk factors were reporting more than one regular partner, being younger than 35 and reporting STD symptoms in the last four months. Migrant couples were significantly more likely than non-migrant couples to have one or both partners infected with HIV (35% versus 19%
<italic>p </italic> = 0.026
OR = 2.28) and to be HIV-1 discordant (27% versus 15%
<italic> p</italic> = 0.066
OR = 2.06). In 28.6% (10/35) of the discordant couples the woman was the HIV-infected partner. <italic>Conclusions</italic>. Migration is a risk factor for HIV infection for men. For women, having a migrant partner increased the risk of HIV infection slightly, but not significantly. The direction of spread of the epidemic is not simply from returning migrant men to their rural partners
rather there is evidence that women's sexual networks extend beyond their regular partners and that these networks influence transmission within rural areas. Both migrant men and rural women have high rates of HIV and could benefit from targeted intervention programmes.
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