Influence of migrant status on HIV sexual risk behaviours in Chókwè district, Mozambique

Abstract

Introduction: Migration has been identified as a factor that contributesto the spread of HIV, including in Eastern and Southern Africa. With an adult HIV prevalence of 13%, Mozambique has a generalized epidemic unequally distributed across its 11 provinces, with those located in the southern part of the country bearing the highest rates of infection. Gaza province has the highest adult HIV prevalence (24.4%) and has historically been marked by high trends of out-migration. Regional studies focused on migrant miners have demonstrated possible associations with the epidemic, but little is known in terms of the broader relationship between migrancy and HIV sexual risk behaviours and status beyond the mining sector. Using data from a health demographic surveillance system installed in Gaza ́s district ofChókwè, this study investigated the possible influence that migration hadon sexual risk behaviours and HIV status among men and women who migrated to other regions within Mozambique or to South Africa in the year that preceded data collection. Methods: A secondary analysis was conducted using data gathered in four rounds of HIV surveillance in the Chókwè Health and Demographic Surveillance System, between 2014 and 2017. Descriptive statistics were used to describe the sociodemographic characteristics of migrant and non-migrant populations aged ≥15 years and sexually initiated living in Chókwè district at the time of data collection. Univariate and multivariable analyses were conducted to investigate possible associations between migration experience and sexual risk behaviours and HIV status while controlling for potential confounders such as age and relationship status. Results: A total of 12,581 participants were included in the data analysis, of which 9,031 were women (71.78%) and 3,550 were men (28.22%). About 961 people reported to have lived for more than one month outside of Chókwè district in the 12 months that preceded data collection. Of these participants classified as migrants, 463 (men:210; women:253) were internal migrants and 449 (men:139; women: 310) had migrated to South Africa. Internal migration and migration to South Africa were found to be statistically associated with increased reporting of multiple sexual partnerships among men and women in both the bivariate and logistic regression analysis. Consistent condom use was low among all participants, but it was associated in the bivariate analysis with both internal migrant men and women (p≤0.002). The multivariate logistic regression, however, showed that consistent condom use was only statistically significant among internal migrant men (aOR=1.52, 95% CI 1.07 –2.14, P=0.017). The analysis of symptoms suggestive of a sexually transmitted infection showed mixed results with the multivariate logistic regression demonstrating an association between reporting of abnormal discharge from genitals with internal migrant women (aOR=1.51, 95% CI 1.12 –2.20, P=0.009) and genital sores with men who had migrated to South Africa (aOR=1.71, 95% CI 1.06 –2.75, P=0.025). As for HIV status, a prevalence of 26.73% was estimated among the study’s participants, with a higher rate among women (29.64%) in comparison with men (19.10). At the exception of women who had migrated to South Africa (36.70%), the HIV prevalence was in generally lower among migrant participants, but the logistic regression model showed that the odds of being infected was identical for both migrant and non-migrant participants. Conclusions: Overall, this study has demonstrated that out-migrant populations of Chókwè district have increased sexual risk behaviours that are known to lead to HIV acquisition. It also showed that the odds of being HIV-positive was identical among migrant and non-migrant populations, which should be interpreted considering the epidemiological profile of the Chókwè district marked by a high HIV prevalence and a well-established and matured epidemic. Results point to the need of further investing in health programs that adequately address migrant population sexual and reproductive health needs, and particularly beyond the mining sector and those specific to migrant women.