Gendered dimensions of population mobility associated with HIV across three epidemics in rural Eastern Africa

Abstract

Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, baseline residential stability and HIV status. Analyses were survey-weighted and stratified by sex, region, and HIV status. In this study, there were large differences in the forms and magnitude of mobility across regions, between men and women, and by HIV status. We found that adult migration varied widely by region, higher proportions of men than women migrated within the past one and five years, and men predominated across all but the most localized scales of migration: a higher proportion of women than men migrated within county of origin. Labor-related mobility was more common among men than women, while women were more likely to travel for non-labor reasons. Labor-related mobility was associated with HIV positive status for both men and women, adjusting for age and region, but the association was especially pronounced in women. The forms, drivers, and correlates of mobility in eastern Africa are complex and highly gendered. An in-depth understanding of mobility may help improve implementation and address gaps in the HIV prevention and care continua.

Keywords: Gender; HIV; Kenya; Migration; Mobility; Population-based; Uganda.

Conflict of interest statement

Declaration of interests

All authors declare no competing interests.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1.. Map of the study communities in Kenya and Uganda

Figure 2.. Magnitude of mobility flows: weighted number of overnight trips per person between origin-destination (county/district-level) pairs, by region and sex

notes: Origin-destination (county/district-level) pairs showing magnitude of mobility (labor and non-labor related trips requiring an overnight stay). Units are the weighted number of trips per person in the six-months prior to interview. Travel to non-study counties is represented at the country level. Origin counties grouped by western Kenya (orange), southwestern Uganda (green), and eastern Uganda (blue).

Figure 3.. Ecological associations between community-level HIV prevalence and community-level prevalence of selected metrics of mobility

notes: Scatter plot showing ecological associations between community-level HIV prevalence and community-level prevalence of mobility (past six months) and migration (past one and five years) for men and women. Loess curves overlaid in black. All metrics adjusted for sampling design.

Figure 4.. Proportions reporting mobility metrics by HIV status, age, and sex

notes: All metrics adjusted for sampling design.

Figure 5.. Adjusted relative risks (aRR) of associations between HIV status and mobility metrics by sex

notes: Adjusted relative risks (aRR) of associations between HIV status and mobility metrics among men and women, adjusted for age and region. Logarithmic aRR scale used. Standard errors are adjusted for clustering by community (N=12).