Migration intensity has no effect on peak HIV prevalence: an ecological study

Abstract

Background: Correctly identifying the determinants of generalized HIV epidemics is crucial to bringing down ongoing high HIV incidence in these countries. High rates of migration are believed to be an important determinant of HIV prevalence. This study has two aims. Firstly, it evaluates the ecological association between levels of internal and international migration and national peak HIV prevalence using thirteen variables from a variety of sources to capture various aspects of internal and international migration intensity. Secondly, it examines the relationship between circular migration and HIV at an individual and population-level in South Africa.

Methods: Linear regression was used to analyze the association between the various measures of migration intensity and peak national HIV prevalence for 141 countries and HIV prevalence by province and ethnic group in South Africa.

Results: No evidence of a positive ecological association between national migration intensity and HIV prevalence was found. This remained the case when the analyses were limited to the countries of sub-Saharan Africa. On the whole, countries with generalized HIV epidemics had lower rates of internal and external migration. Likewise, no association was found between migration and HIV positivity at an individual or group-level in South Africa.

Conclusion: These results do not support the thesis that migration measured at the country level plays a significant role in determining peak HIV prevalence.

Figure 1

Association between national peak HIV prevalence and percent of the working age population that have migrated to a different district to that they were born in. (R² - 0.149; P = 0.038. Migration data from nationally representative household surveys from 35 developing countries [31]. Peak HIV prevalence data from UNAIDS [30]).