Predictors of Migration in an HIV Hyper-Endemic Rural South African Community: Evidence from a Population-Based Cohort (2001-2017)

Armstrong Dzomba, University of the Witwatersrand, Johannesburg
Andrew Tomita, University of KwaZulu-Natal
Alain Vandormael, University of Minnesota
Hae-Young Kim, Africa Health Research Institute
Frank Tanser, Africa Centre for Health and Population Studies

We examined migration incidence in rural KwaZulu-Natal, South Africa, using population-based data from the Africa Health Research Institute collected between 2001 and 2017. We followed 113 300 adult participants aged 20-49 at baseline and fitted stratified cox regression models. Overall, the risk of migration was higher, among those HIV+ (positive) and initiated ART (aHR=1.88, 95% CI 1.71 – 2.07) and HIV+ but not initiated ART (aHR=1.83, 95% CI 1.74 – 1.94) compared to those HIV – (negative), with risk increasing by over 80% in both models. Young unmarried women of working age including those HIV positive were more likely to migrate. Our study finds evidence for the changing profile of migrants (i.e. young women, ‘feminisation of migration’), potentially facilitating greater access to areas with high HIV risk. Thus, novel public health interventions tailored to reduce new HIV infections and sustain care for this highly vulnerable population are urgently needed.