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hiv africa

Professional Hazard: Migrant Miners Are More Likely to Be Infected with HIV

Damien de Walque's picture

Gold mine in Johannesburg, South AfricaSwaziland and Lesotho are among the countries with the highest HIV prevalence in the world.
Recent nationally representative estimates reveal an adult HIV prevalence equal to 26% in Swazilandand 23.2% in Lesotho2.

These countries have two other main features in common: they are small countries bordering South Africa and, during the past decades, they were exposed to massive recruitment efforts to work in South African mines. For more than a century, about 60 percent of those employed in the mining sector in the Republic of South Africa were migrant workers from Lesotho and Swaziland3.

In a recent paper4 with Lucia Corno, we started from this set of facts and investigated whether the massive percentage of migrant workers employed in the South Africa’s mining industry for a long period might be one of the main explanations for the high HIV prevalence observed in Swaziland and Lesotho.

HIV/AIDS, the silent war in Africa

Damien de Walque's picture

Under-5 mortality is often used—perhaps implicitly—as a measure of “population health”.  But what is happening to adult mortality in Africa? 

In a recent working paperi , we combine data from 84 Demographic and Health Surveys from 46 countries, and calculate mortality based on the sibling mortality reports collected from female respondents aged 15-49. The working paper is available here and the database we used for the analysis can be found here.

We find that adult mortality is quite different from child mortality (under-5 mortality)1.   This is perhaps obvious to most readers, but is clearly illustrated in figure 1. While in general both under-5 and adult mortality decline with per-capita income, and over time, the latter effect is much smaller for adult mortality, which has barely shifted in countries outside Africa between 1975-79 and 2000-04.

But in sub-Saharan Africa, contrary to under-5 mortality everywhere and to adult mortality outside of Africa, adult mortality increased between 1975-79 and 2000-04 and the relationship between adult mortality and income became positive in Africa as indicated by the upward sloping line in 2000-04.

This diverging and dramatic trend for sub-Saharan Africa is mainly driven by the HIV/AIDS epidemic. 

What caused the HIV epidemic in Africa?

Shanta Devarajan's picture

Damien’s earlier post called into question one commonly-held view of the cause of the spread of HIV in Africa, namely male promiscuity. 

A paper by Pauline Leclerc and others (hat tip to Mark Gersovitz) seems to show that there is even greater uncertainty.  Leclerc and co-authors tried to simulate the dynamics of the epidemic in Zambia but found that the parameters needed to fit epidemiological models were beyond what the data would allow. 

In short, thirty years later, it appears as if we still don’t know what caused the disease to spread the way it did on the continent.  Perhaps there is no single set of causes, and that the evolution of the disease is different in different parts of Africa.  Perhaps we should move beyond epidemiological models and look to other disciplines for the answers. 

At any rate, to fight the epidemic effectively, we need to know how and why it became an epidemic.