Migration and Social Disruption

Ethiopia’s political, social, and cultural context have shaped the evolution of the HIV/AIDS epidemic. War, famine, poverty, and political turmoil have kept Ethiopia in state of emergency almost constantly since the 1970s, creating many competing urgencies. As a result, Ethiopia’s population has been highly mobile, in terms of rural to urban migration, displacement of millions of people and the mobilization and demobilization of military personnel. (Vaillancourt et al. 2005:3) Ethiopia's mobile populations include the rapidly increasing number of rural residents seeking employment in urban areas, military personnel, those displaced by war, drought and/or environmental degradation, male transport workers, sex workers, traders, orphans and vulnerable children, humanitarian and relief workers and prisoners (Garbus 2003: 7).

In Ethiopia there is a recurrence of famine. The search for food and migration to food aid distribution points spurs population dislocation, which may be accompanied by regroupings of family units and exposure to new sexual networks (Garbus 2003: 8).

In Ethiopia there is also migration associated with work, which includes transport workers, sex workers, miners, merchants, and traders. In 1994, migrants made up about 44.7% of the urban population, most of whom had migrated to look for a job (Tassew et al. 2005: 6). Mobility provides the opportunity for, and increases the likelihood of, having non-regular sexual partners. When people travel they are likely to be lonely, to drink more alcohol and to behave differently than they would in their home community (Whiteside 2005:116) On the other hand, the loss of migrants labor and the lack of their presence can have detrimental economic and social consequences. For example, in a place called Imdibir, Gurage area, the long-term male migration has threatened the direct male participation in family life and presence of appropriate father figures, which, in turn, contributed to the loosen of family ties and the dissemination of HIV/AIDS to spouses (Tadele et al. 2006:64).

A study which has been conducted on a sugar estate located in central Ethiopia, shows that an increase in HIV risk is associated with an increase in age and a decrease in risk associated with history of travel outside of residential areas. (Sahlu et al. 1999: 50) Workers with jobs that involve being away from home and separation from family, for instance, in transport services (long-distance truck drivers, train crews, sailors, etc.) mining, construction, seasonal workers in agriculture and tourism and migrant workers of all kinds without their families, are particularly vulnerable to HIV infection. A study which was conducted in 1994, indicates that of the 233 AIDS cases, 109 (46.78%) were in the transportation sector and 70 (64.22%) were among transport equipment operators. In the same study, 80.73% of AIDS cases employed in the transportation and communication sector came from one coordination station of the Ethiopia Freight Transport Enterprise, which required long-distance travel and a significant amount of time away from home (Bersufekad 1994). A study which was conducted among 995 long distance truck drivers, their assistants, and lorry technicians employed by the Ethiopian Freight Transport Corporation (EFTC) indicates that HIV prevalence rates were 13% among 468 drivers, 12.9% among 209 drivers assistants, and 4.1% among 318 technicians. The study indicated that the long distance truck drivers in Ethiopia practiced frequent contacts with female sex workers, had frequently experienced sexually transmitted diseases and were at a significantly higher risk to acquire HIV/AIDS than the technicians employed at the same corporation (Mehret et al.

1999a). This study indicates that frequent travel promoted high-risk behavior, which in turn increased the risk of acquiring HIV infection in Ethiopia.

Activities specifically associated with agricultural marketing potentially contribute to the spread of the disease. In rural parts of Ethiopia there is significant movement of people associated with markets both into and from rural areas. Weekly rural markets are a major social gathering, drawing people together, typically from a 10 – 15 km radius. Market days are often a source of recreation and are acknowledged as an opportunity to meet secret lovers. Activities escalate during the harvesting season because at this time money is available so commercial sex workers move into market centers. Larger markets attract people from further afield and may result in overnight stays. People assemble from different parts of the locality and many drink alcohol, which often leads to unprotected sex. Specific marketing patterns likely

expose people to HIV risk behavior. For example the marketing of chat¹² requires rapid transport to the point of final sale in major towns in order to preserve quality.

The selling takes place late in the evening, which gives farmers the opportunity, or the excuse, to stay in town overnight. They often spend their evenings chewing chat. Whether this is a potential HIV-risk factor depends on whether it is linked to alcohol consumption. Research shows that seasonal flows of cash contributed to HIV risk behavior during the peak-harvesting season of red peppers in Alaba (October to January) because commercial sex workers from Addis Ababa, Awassa and Adama/Nazareth move into the area. Similarly, it was reported that many male teenagers in Ada’a Liben have their first sexual experience during the summer months after selling the teff harvest in December when money is readily available (Sambrook et al. 2005:253).

A study which has been conducted among female sex workers practicing multi-partner sexual contacts from twenty-three urban areas of the country indicates that previous exposure to other sexually transmitted diseases and frequent change of sexual partners were identified as possible risk factors for HIV infection. Frequent mobility of these females may have played a significant role in HIV transmission between the towns (Mehret et al. 1999c). There are several potential bridging populations who may carry the virus from urban areas into rural communities. This includes seasonal migrant farmers, long-distance livestock traders, long-distance truck drivers and their assistants, professionals working in rural communities and teachers living in rural areas, often unaccompanied by their families.

According to Sambrook and others, in rural Ethiopia there are three types of bridging population, who may link low-prevalence rural areas with higher-prevalence communities. The first are adults and the youth who link their rural communities to higher-risk urban hinterlands for employment, education, or social reasons. Because these activities take place away from home and the confines of community norms, the lack of social cohesion and anonymity may be a contributing factor that encourages them to engage in activities outside their social norm. The group includes seasonal migrants who seek alternative employment during the quiet

12 Chat is a perennial shrub, traditionally cultivated in Ethiopia, Yemen and Kenya, where it is often an important cash crop. The leaves and tender young shoots of the plant are chewed for their stimulant properties. The most important chemicals in chat, in terms of their psychoactive properties, are cathine and cathinone. Both these substances stimulate the central nervous system ( Paul 1998:1).

months in farming, for example, working as casual laborers in the construction industry in Bahir Dar, on major road construction in Amhara, in the industrial zone on the outskirts of Addis Ababa, or on large commercial sesame farms in western Tigray. In Atsbi for example, some men have dual livelihoods, farming for part of the year and working in town as skilled carpenters or masons during the summer months. Long-term migrants include students attending further education and women working as housemaids. Weekly migrants include adolescents attending senior secondary schools usually located in the Woreda town. Ad hoc movements include visits to relatives; school dropouts and military returnees moving between small towns and their rural community; administrators and government employees attending meetings or training outside the Woreda; and farmers staying in town if there are bottlenecks in registration, screening, and disbursement of seeds and credit by the Bureau of Agriculture. People usually stay with relatives or friends, in rented accommodations, or in the home of the employer. Many men leave their wives in the villages and take on a new “wife” in their new residence. They may also stay in local drinking houses. The second bridging populations are those who may carry the virus from outside into rural communities. This includes professionals working in rural communities such as agricultural development agents, teachers, and health workers, who are often unaccompanied by their families; politicians visiting rural areas for sensitization and mobilization purposes for extended periods; the military posted to rural camps; commercial sex workers who follow the seasonal migration of people, seasonal income flows, and the military; long-distance truck drivers and their assistants on overnight stops; seasonal migrants assisting with crop harvests;

long-distance salt traders stopping for one or two nights in Atsbi route while selling salt in local markets; visiting relatives; and distributors of food relief. The third group relates to those moving within and between neighboring rural communities.

Such movement is associated with daily living (such as fetching wood, water, milling, public meetings, and community development works), attending to administrative matters (for example, rural administrators visiting the main Woreda town or elders mediating in conflicts), and social affairs (visiting relatives, attending wedding and burial ceremonies, special church meetings or holidays) (Sambrook et al. 2005: 248-249) .

As Andrew Price-Smith points out, warfare is also an amplifier of disease. Civil war and migration also contribute to the increase in HIV/AIDS prevalence. Ethiopia's political history, civil war, conflicts with Eritrea, and the current food crisis also

affect HIV/AIDS dynamics. (Garbus 2003: 33) In Ethiopia many soldiers contracted HIV/AIDS during the civil war in the 1980s through contact with multiple sexual partners. When the war ended in 1991, thousands of infected soldiers and prostitutes returned home spreading HIV/AIDS in their villages and towns (U.S.

National Intelligence Council 2002).

In addition, according to the UN Office for Coordination of Humanitarian Affairs, the war with Eritrea (1998-2000) displaced one million people, of which 76,000 still have not returned to their homes. (Vaillancourt et al. 2005:3) A study conducted by Berhe, Gemechu and Waal indicate that HIV prevalence among soldiers and civilians in Tigray appears to have risen in the year (1998-2000) during Ethio-Eritrean war. This was associated particularly with the convergence of a very large army and an influx of commercial sex workers (Berhe et al. 2004:10). The rural HIV/AIDS prevalence rate in Ethiopia is 2.6% and it is projected to increase dramatically. According to Economic Intelligence Unit, this might be partly linked to the demobilization of soldiers after the 1998-2000 war with Eritrea and return to their home areas as well as the on going expansion of the road network. (EIU 2006:16) Since the end of the war in 2000, 150,000 Ethiopian soldiers have been demobilized. (Vaillancourt et al. 2005:3) As soldiers demobilize, prostitutes who have even higher rates of infection disperse around the country as well. (U.S.

National Intelligence Council 2002)

3.15.5.4. Multiple Sexual Partners Use of Condoms, Alcohol Consumption and Chat Chewing

Sex abstinence and a mutual faithful partnership are the best ways of protecting oneself from HIV infection. However, for people who cannot limit themselves to any of these methods, use of condoms is the only way to protect themselves against the virus (HAPCO 2003: 23). Researches indicate that the risk of HIV infection rises with an increase in sex and the number of lifetime sexual partners (Mekonnen et al.

2001: 52). Researches show that extramarital affairs are relatively common in Ethiopia where both rural women and men have several concurrent relationships regardless of their marital status. Although communities in Amhara and Tigray may not openly acknowledge multiple sexual relationships, they are widely practiced in secret (Miz-Haseb Research Centre, 2004). In Atsbi Wemberta, it is common for husbands to have several girlfriends (divorcees or widows), possibly as a sign of

status or in the quest for more children. Communities do not tend to associate their customary sexual practices with the risk of HIV infection since they are conducted within community norms, including inherent elements of trust (Miz-Hasab Research Centre, 2004). Sexual contact with multiple partners is amongst the major risk for HIV transmission in Ethiopia.

Condom use is one of the programmatically important ways of preventing the spread of the HIV, and therefore, is continuously advertised in almost every media. Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV/AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other sexually transmitted diseases (STDs). The number of exposures to HIV/AIDS is a result of the number of occasions of unprotected intercourse or the number of condom failures during protected sex.

(Ellis et al. 2003: 13)

Chat chewing and alcohol drinking can lead to behaviors which can expose individuals to HIV/AIDS for it leads to the occurrence of unprotected sex or improper use of condoms. Substance abuse is generally believed to be one of the associated factors for sexual risk behavior in HIV transmission. Hard drugs like heroin and cocaine are very rarely available in Ethiopia. However, Chat, a locally produced psycho-stimulant is commonly and widely used in the country (Kebede et al. 2005). Chat is widely consumed among the youth of Ethiopia as shown by several prevalence studies. A study assessing the magnitude of Chlamydia trachomatis and Neisseria gonorrhoeae infections together with self-reports of sexual risk behavior among youths (15–24 years old) in Addis Ababa, reported that increased sexual activity was significantly associated with being male, aged 20 years or over, out-of-school status, and reported alcohol/Chat consumption (Taffa et al.

2002). A national survey conducted on 20,434 in-school and out-of-school youths aged between 15 and 24 years of age indicates that Chat use was also strongly associated with sexual initiation. The study shows that there is strong association between unprotected sex and alcohol consumption because alcohol's capacity to decrease inhibitions, alter rational decision making, and increase risk-taking behavior. This study has shown that a substantial proportion of out-of-school youths engage in risky sexual behaviors and that the use of Chat, alcohol and other substances is significantly and independently associated with risky sexual behavior among these young people (Kebede et al. 2005). A study which has been conducted

on the Wonji Sugar factory in 2004 indicates that drinking alcohol, chewing chat and the presence of multiple sexual partners expose workers to risk factors of HIV transmission and risk behavior which in turn increases the risk of acquiring HIV.

(Negash 2005:67)