War, Forced Migration, and HIV/AIDS Risks in Angola Victor Agadjanian Department of Sociology and Center for Population Dynamics Arizona State University, Tempe AZ , USA This research is supported by a grant from the National Institute of Child Health and Human Development (USA), R03-HD The data collection and processing were carried out by the AIP-Angola Institute for Socioeconomic Research, Luanda, Angola. Does war-induced migration in sub-Saharan Africa make migrants more vulnerable to HIV/AIDS risks? How do forced migrants in cities compare to city natives in exposure to HIV/AIDS risks? How do forced migrants compare to voluntary (“economic”) migrants in the city? How does duration of residence in the city affect forced and voluntary migrants’ exposure to HIV/AIDS risks? How do the differences in forced migrants’, voluntary migrants’, and non-migrants’ exposure to HIV/AIDS risks vary by gender? Multivariate Results (contd.) Background Migration is commonly implicated in the rapid spread of HIV/AIDS. Literature typically paints forced migrants as socioeconomically and epidemiologically disadvantaged at places of destination. Yet little systematic data exist on the HIV/AIDS implications of forced migration Setting  Luanda, Angola’s capital and by far the largest city  Home to up to a quarter of the nation’s population  Luanda’s population grew rapidly largely due to the influx of forced migrants displaced by civil war ( , , )  Forced migration exacerbated problems typical of many sub- Saharan cities: overcrowding, unemployment, infrastructure decay, traffic congestion, environmental pollution, etc.  Luanda’s adult HIV prevalence: c. 5% Data  A survey in two peripheral urban municipalities (municípios) of Greater Luanda—Samba and Viana—conducted in May-June Samba: closer to the city center, older neighborhoods, fewer forced migrants Viana: more distant and less urbanized, more forced migrants  Survey sample: approximately 1080 people, about equal number of men and women  The sample of households was drawn separately in each bairro (subdivision of the município) using a random walk algorithm. Each bairro’s subsample size was proportional to the bairro’s estimated population size.  In one half of the selected households a randomly selected man aged was interviewed; in the other half a randomly selected woman aged was interviewed.  The survey instrument contained the following modules: Migration history; Sociodemographic characteristics; Marriage and sex life; Health and reproduction; HIV/AIDS; Social networks; Community involvement; and Gender attitudes. HIV/AIDS risk-related indicators by migration status Outcomes Statistical Model Logistic regression for binary outcomes Main predictor—Migration status  City natives (including those who migrated as small children), CNs  Migrants who came to the city because of civil war, “Forced Migrants,” FMs  Migrants who came to the city for reasons directly not related to war, “Voluntary Migrants,” VMs  Duration of life in the city (in models for migrants only) Other predictors/controls Sociodemographic Profile  FMs had a higher share of men than the other two groups  FMs were disproportionately concentrated in Viana, whereas the shares of CNs and voluntary migrants (VMs) were similar in both municipalities  FMs had the lowest educational level, while CNs were best educated  FMs had the highest rate of labor force participation, whereas CNs had the lowest  FMs were least likely to have electricity, piped water, or a TV set at home, whereas CNs were the most likely.  FMs were most likely not to have eaten meat or chicken in the previous seven days  CNs were least likely to have a live-in partner, but FMs and VMs did not differ much  Age at first sex didn’t differ among three groups  FMs reported a slightly higher level of community involvement but the differences among the three groups were small 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks:  All three groups were similar in familiarity with HIV/AIDS cases and displayed similar levels of concern  FMs were least likely and CNs were most likely to agree that a woman can insist on condom use with husband if she thinks he is infected 2. Access to HIV/AIDS prevention information:  FMs did not differ much from the rest in exposure to formal HIV/AIDS education  FMs were less likely to have been tested for HIV, to know where one could be tested for HIV, and to know where one could get/buy condoms 3. Discussion of HIV/AIDS with partner and peers:  CNs were most likely to have talked about HIV/AIDS with partners and somewhat more likely to have talked about HIV/AIDS with others. No difference between the two migrant groups. 4. Risky sexual behavior:  FMs were more likely than the rest to engage in casual relationships  FMs were more likely than the rest to have had unprotected casual sex in the past 12 months 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks:  FM women felt more at risk than VM women. No difference among men  FM men were more worried that CN men. No difference among women. 2. Access to HIV/AIDS prevention information:  No gender-specific effects 3. Discussion of HIV/AIDS with partner and peers:  CN women appeared more likely to talk with partners about HIV/AIDS than FM. No differences among men.  VM men were less likely than FM to have talked about prevention with others. No differences among women. 4. Risky sexual behavior:  FM men were more likely than VM or CN men to engage in casual sexual relationships. No differences among women.  FM men were more likely than VM or CN men to engage in unprotected sex with casual sexual partners. No differences among women.  FMs were more likely to know an AIDS patient than VMs, but were not different from CNs.  No differences in perceptions of own risks, but FMs were more likely to worry about getting HIV than CNs and (possibly) VMs.  No difference in opinion on condom use with infected husband. CePoD Discussions of HIV/AIDS with partner and peers (odds ratios)  No difference between FMs and VMs  CNs were more likely than FMs to have talked about HIV/AIDS with partners. Risky sexual behavior (odds ratios)  FMs were significantly more likely than CNs and possibly VMs to have engaged in casual relationships  FMs were significantly more likely than the other two groups to have had unprotected casual sex in the past 12 months Conclusions Research Questions 1. Knowledge, perceptions and attitudes regarding HIV/AIDS risks: Knows at least one person with AIDS Considers herself at high risk of HIV infection Worries about getting infected Thinks that wife can insist on condom use with husband if she thinks he is infected 2. Access to HIV/AIDS prevention information: Attended an HIV/AIDS educational event recently Has ever been tested for HIV Knows where one can get tested for HIV Knows where one can get/buy condoms 3. Discussions of HIV/AIDS with partner and peers: Has talked about AIDS with partner (only those in union) Has talked about AIDS prevention with someone other than partner 4. Risky sexual behavior: Having a casual partner in the past 12 months Having unprotected casual sex in past 12 months  Municipality of current residence: Samba or Viana  Gender  Respondent’s age (continuous)  Respondent’s education: completed years (continuous)  Dwelling has piped water: Yes or No  Household has a working TV set: Yes or No  Ate meat or chicken in past seven days: Yes or No  Currently has a live-in sexual partner: Yes or No  Currently works for income outside the home: Yes or No  Participated in any activities for communal benefit in past 12 months: Yes or No HIV/AIDS risk-related outcomes by duration of city life (FMs and VMs only): highlights 1. Knowledge, perceptions and attitudes regarding risks:  No systematic effects of duration 2. Access to HIV/AIDS prevention information:  Recently arrived FMs were less likely to know where to get/buy condoms) than earlier arrivals. No such relationship for VMs.  Longer duration of city life was associated with higher likelihood of having been tested and knowing where to get tested, regardless of migration type. 3. Discussion of HIV/AIDS with partner and peers:  No effects of duration 4. Risky sexual behavior:  Duration had no effect on risky behavior for either group of migrants  Forced migrants display considerable socioeconomic disadvantage relative to city natives and voluntary migrants (despite higher levels of labor force participation)  The socioeconomic and demographic differences explain differences in access to prevention information and resources but do not explain forced migrants’ greater likelihood of engaging in risky sexual behavior, compared to city natives and voluntary migrants.  Duration of city life has little systematic effect on HIV/AIDS-related outcomes  The higher risks of forced migrants are concentrated among men. Women display no net migration-status differences in the probability of risky behavior.  Overall, women have no less information about HIV/AIDS and prevention than men. Although disadvantaged in access to prevention, women feel at lesser risk of HIV infection than do men.  Women are less likely to discuss HIV/AIDS risks and preventions with others (non-partners)  Involvement in community life (collective communal activities, etc.) is associated with less risky behavior, higher level of risk awareness, and better information about prevention options.  No net differences in any indicator except for possibly better knowledge about HIV testing places by CNs. Access to prevention information (odds ratios) Multivariate Results Knowledge and perception of risks (odds ratios) Note: * significant at p<.05; + significant at p<.1 Gender differences: highlights