Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Population Migration and the Spread of Types 1 and 2 Human Immunodeficiency Viruses
Population Migration and the Spread of Types 1 and 2 Human Immunodeficiency Viruses
Pages 77-98
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From page 77... ...
Of these individuals, ~9 million are men, 6 million are women, and 1 million are infants and children. Two-thirds of all estimated AIDS cases to date have occurred in sub-Saharan Africa, but more recently, HIV infection has increased rapidly in Southeast Asia, with over 2.5 million cumulative HIV infections estimated to have occurred within the last 5 years.
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From page 78... ...
The World Health Organization now estimates that as many as 40 million people will be HIV-infected by the year 2000 (7~. This paper will review the conceptual issues regarding the migration of populations with its associated social changes in certain regions as a major force responsible for the eventual dissemination of HIV infections worldwide.
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From page 79... ...
Some examples of internal migration include rural-rural, rural-urban, urban-rural, and urban-urban, each with its own characteristic features and consequences (Table 1~. AFRICA Following independence in the 1960s, many African countries experienced dramatic demographic changes, which may underlie the movement of HIV infection from potentially remote areas to more populous
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From page 80... ...
By year 2000, the projected proportion of people living in urban centers is expected to exceed one-third of the national populations in all regions except eastern Africa. As a consequence of urbanization, the crude population density increased in every country for which data are available, averaging greater than a 100% increase (8~.
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From page 81... ...
During this period, health officials noted marked increases in sexually transmitted diseases (STDs) , including HIV-1 infection, within the urban centers.
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From page 82... ...
Second, the "migrant labor" hypothesis proposed that HIV diffused from areas of labor demand in urban areas to areas of labor supply in rural districts through a process of return migration (18, 19~. A third hypothesis suggested that the dissemination of HIV-1 in Uganda correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army after the overthrow of Idi Amin some 10 years earlier in 1979 (15, 20~.
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From page 83... ...
The distortion of the urban population profile caused by male migration results in an overall 1:1 female-to-male prevalence ratio of infection. However, as the epidemic spreads into the larger rural population, the absolute size of the most severely affected younger female population is larger than the size of the older male population, which eventually results in a higher number of infections in women.
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From page 84... ...
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From page 85... ...
Interestingly, significant rates of HIV-2 infection have been reported in Angola and Mozambique, two countries located in southern Africa (33~. These countries were formerly Portuguese colonies and maintain ongoing relationships with countries in West Africa such as Guinea-Bissau and Cape Verde, which were also Portuguese colonies.
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From page 86... ...
Because Lagos is the largest cosmopolitan city in Africa, there is constant migratory movement of people into and out of Lagos and a major trade center, thereby providing opportunity for further HIV dissemination. SPREAD OF HIV-2 OUTSIDE OF WEST AFRICA Because HIV-2 infection has been relatively confined to West Africa, its appearance in other areas generally reflects epidemiologic links to West Africa.
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From page 87... ...
Although most countries can link the presence of HIV-2 within their country to ties with West Africa, France and Portugal now report HIV-2 infection among the indigenous population (32, 34~. In Portugal, 60% of HIV-2 cases are no longer directly linked to West African contacts.
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From page 88... ...
Socioeconomic conditions seen among the migrant population of Belle Glade date back for the past 50 years and are responsible for epidemics of STDs. Crowded living conditions, poverty, varying access to health care, and other resulting factors promote HIV transmission in Belle Glade much as they did syphilis 50 years before (50~.
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From page 89... ...
Subsequently indigenous transmission has evolved, and there is increasing evidence for heterosexual transmission within many Latin American countries (54~. One aspect of HIV transmission throughout the region has been the documented high rate of infection among female prostitutes who provide their services in different countries.
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From page 90... ...
Temporary affiliation with commercial sex trade has gained legitimacy in poor regions as a means of addressing the indebtedness of rural families (60~. The circulatory nature of rural-urban migration as well as the substantial patronage of the sex industry by international tourists fueled HIV transmission throughout Thailand and neighboring countries.
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From page 91... ...
This genetic homogeneity contrasts profoundly with the substantial diversity among HIV-1 strains from infected people in all other countries reported so far (62~. The high nucleotide divergence between these two genotypes also suggests that the two variants resulted from separate, independent introductions into Thailand and that they did not evolve from a common progenitor virus already present in the country.
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From page 92... ...
CONCLUSIONS While intense educational efforts need to be focused on behavioral change as one key to preventing further spread, fundamental social change will be required if AIDS control efforts are to succeed. The migration of poor, rural, sexually active young people to urban centers in the Third World clearly played a role in the dissemination of HIV and other infectious diseases.
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From page 93... ...
In summary, the economic recession has further aggravated the transmission of HIV in Africa and Asia by directly increasing the population at risk through increased urban migration, disruption of rural families, poverty, women's subordinate status in society, and prostitution and indirectly through decrease in health care provision (72~. The latter entails not only reduced facilities to care for patients with AIDS but also less effective diagnosis and treatment of STDs and decreased spending on health education programs.
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From page 94... ...
With the associated demographic, economic, and social changes, an epidemic of sexually transmitted diseases and HIV-1 was ignited. Migratory patterns were also responsible for the spread of endemic HIV-2 to neighboring West African countries and eventually to Europe, the Americas, and India.
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From page 95... ...
(1992) in Research Issues in Human Behavior and Sexually Transmitted Diseases in the AIDS Era, eds.
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From page 96... ...
(1985) Southeast Asia?
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From page 97... ...
Population Migration and the Spread of HIV / 97 Tourism Authority of Thailand (1989) Arlnual Statistical Report on Tourism in Thailand (Tourism Authority of Thailand, Bangkok)
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