AIDS
Volume 33, Issue 1, 2019, Pages 123-131

Economy, migrant labour and sex work: Interplay of HIV epidemic drivers in Zimbabwe over three decades (Article)

Steen R.* , Hontelez J.A.C. , Mugurungi O. , Mpofu A. , Matthijsse S.M. , De Vlas S.J. , Dallabetta G.A. , Cowan F.M.
  • a Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  • b Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  • c Ministry of Health and Child Care, Zimbabwe
  • d National AIDS Council, Harare, Zimbabwe
  • e Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, BresMed Health Solutions, Utrecht, Netherlands
  • f Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  • g Bill and Melinda Gates Foundation, Washington, DC, United States
  • h Centre for Sexual Health and HIV AIDS Research (CeSHHAR Zimbabwe), Harare, Zimbabwe, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

Abstract

HIV took off rapidly in Zimbabwe during the 1980s. Yet, between 1998 and 2003, as the economy faltered, HIV prevalence declined abruptly and without clear explanation.Methods:We reviewed epidemiological, behavioural, and economic data over three decades to understand changes in economic conditions, migrant labour and sex work that may account for observed fluctuations in Zimbabwe's HIV epidemic. Potential biases related to changing epidemic paradigms and data sources were examined.Results:Early studies describe rural poverty, male migrant labour and sex work as conditions facilitating HIV/sexually transmitted infection (STI) transmission. By the mid-1990s, as Zimbabwe's epidemic became more generalized, research focus shifted to general population household surveys. Yet, less than half as many men than women were found at home during surveys in the 1990s, increasing to 80% during the years of economic decline. Other studies suggest that male demand for sex work fell abruptly as migrant workers were laid off, picking up again when the economy rebounded after 2009. Numbers of clients reported by sex workers, and their STI rates, followed similar patterns reaching a nadir in the early 2000s. Studies from 2009 describe a return to more active sex work, linked to increasing client demand, as well as a revitalized programme reaching sex workers.Conclusion:The importance of the downturn in migrant labour and resultant changes in sex work may be underestimated as drivers of Zimbabwe's rapid HIV incidence and prevalence declines. Household surveys underrepresent populations at the highest risk of HIV/STI acquisition and transmission, and these biases vary with changing economic conditions. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Author Keywords

Zimbabwe Sex work Migrant labour Economic factors AIDS epidemic epidemic drivers generalized epidemic HIV

Index Keywords

Human immunodeficiency virus infection poverty Population Dynamics human economic aspect rural population priority journal unprotected sex sexual transmission sex worker sexually transmitted disease condom use migrant male occupation Zimbabwe prostitution Incidence Article epidemic virus transmission
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064134782&doi=10.1097%2fQAD.0000000000002066&partnerID=40&md5=9dfe1352d7c4e6cc1a3d971313f408f2
DOI: 10.1097/QAD.0000000000002066
ISSN: 02699370
Cited by: 1
Original Language: English