HIV prevalence among farm workers hits 40 percent

The HIV prevalence rate among farm workers in South Africa is about 40 percent, the highest ever recorded in southern Africa, according to a new study.

The survey, conducted between March and May 2010 and commissioned by the International Organization for Migration (IOM), used questionnaires and dry blood spot testing to chart HIV risk behaviour and beliefs – as well as HIV prevalence – among 2,810 farm workers in two provinces, Limpopo and Mpumalanga.

Although 80 percent reported that condoms were freely available on the farms where they worked, fewer than half reported using a condom with their last sexual partner, while less than 10 percent of HIV-positive farm workers reported getting treatment.

According to Mark Colvin of Maromi Health Research, which conducted the study on behalf of IOM, the results are a stark reminder that not all HIV epidemics are created equal.

"UNAIDS is today [23 November] releasing a report that shows that across southern Africa, we’ve seen a drop in HIV incidence but this study shows that there are pockets in the region where HIV is still absolutely rampant,” he told IRIN/PlusNews.

The 23 farms selected to participate in the study are part of the IOM’s ongoing Ripfumelo HIV prevention project, which provides farm workers with HIV information and access to voluntary testing and counselling.

According to Erin Tansey, IOM migration health project officer, these farms’ participation in the IOM project may indicate a greater level of political will among owners to address HIV among their employees and provide better access to services.

Previous research as part of the Ripfumelo project found an HIV prevalence of about 30 percent in Limpopo. Farm workers have historically been considered vulnerable to HIV because of poor working conditions, an inability to access HIV and health services located off-site and increased mobility.

Poor conditions

IOM’s latest research confirmed that conditions remain poor for South Africa’s farm workers, who often sleep in anything from converted shipping containers to abandoned stables and lack access to electricity and running water, said Tansey. The study found that more than half of workers surveyed reported having been food-insecure in the past year, which may explain high rates of transactional sex.

But the report also revealed that relationships between gender and mobility and HIV might not be as simple as previously thought. While HIV prevalence rates were found to be higher in women, the study found roughly equal numbers of men and women reported HIV risk factors, such as sexually transmitted infections, having had sex while intoxicated and being forced to have sex.

This study shows that there are pockets in the region where HIV is still absolutely rampant

Earlier studies have highlighted high rates of forced sex among female farm workers but never reported it among men. While more qualitative research is needed into the drivers of male farm rape, Colvin said that in preliminary interviews, farm workers reported that younger male farm workers were particularly at risk.

Neighbours at risk

While the majority of farm workers surveyed were South African, about 40 percent came from Zimbabwe, Mozambique or Swaziland. The study found no significant association between foreign nationality and positive HIV status. While foreign farm workers had at least double the HIV prevalence of their countrymen, this relationship also held true for South Africans. About 40 percent of South African farm workers were HIV positive, while according to 2009 UNAIDS data, South Africa has a general HIV prevalence of about 18 percent among those aged 15 to 49.

According to Colvin, the new figures point to an evolving relationship between mobility and HIV. In South Africa’s mature HIV epidemic, mobility puts communities – not just individuals – at a greater risk of HIV, he said.

“We’re at a mature phase in the epidemic,” he told IRIN/PlusNews. “There’s no doubt that if people weren’t mobile, HIV wouldn’t move around the world but it’s not just about mobility itself.”

While he stressed that more research was needed, Colvin said factors such as poverty and poor social cohesion could be fuelling HIV infection within farming communities and added that similar theories are increasingly coming to the fore internationally to explain high HIV prevalence in slums and informal settlements.

Among the study’s recommendations were closer cross-border cooperation on HIV and tuberculosis among southern African countries as well as an increased role for agricultural and labour ministries in promoting better wages and living conditions for farm workers.

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