This mentored research project will investigate an under-researched aspect of HIV in Africa: the HIV prevention needs of female migrants. Migration and HIV research has almost exclusively focused on HIV risks to male migrants, often failing to measure the risks to women via their involvement in migration. Yet across the region, women's levels of participation in migration have met or exceeded those of men. Moreover, the few studies which have examined HIV risks to female migrants found higher risk behavior and HIV prevalence in migrant compared to non-migrant women. My dissertation study found that migration was associated with a higher risk of HIV infection in women than in men in South Africa. The finding warrants confirmation in East Africa, where HIV/AIDS is devastating communities and the sex disparity in infection risk is striking. HIV prevalence levels in Nyanza Province, Kenya are among the highest in Africa. Previous studies have found high levels of participation in migration by both men and women in Kenya and higher sexual risk behaviors among migrants than non-migrants. However, little is known about the mechanisms through which participation in migration leads to higher risk behavior in women. My proposed plan will address this gap. It is comprised of two phases: a secondary data analysis, and an in-depth qualitative study in Kenya. These two 'modules' will address the following aims: (1) Assess the degree to which HIV infection in women in Kenya is influenced by their participation in migration, and identify explanatory mechanisms by which women's migration may increase their HIV risks. I will use secondary data from Kenya Demographic and Health and AIDS Indicator Surveys and demographic surveillance field sites to carry out analyses to achieve this aim. Using 'HIV Triangulation', I will evaluate these findings along with information from other sources in participatory workshops with local stakeholders in Kenya. This exercise will inform the design of the qualitative study to be carried out in Aim 2: (2) Characterize social and psychological aspects of women's migration experience in Nyanza Province, Kenya which facilitate their risks of acquiring and transmitting HIV infection. I will use participant observation and in-depth interviews to characterize the spatial and social features of the common destinations of female migrants, and identify the structural and psychological aspects of women's migration that influence their HIV infection risks. These antecedents to HIV infection in female migrants serve as potential points of HIV prevention intervention, thus laying the groundwork for Aim 3: (3) Develop a preliminary plan for a multi-level HIV prevention intervention with female migrants in Nyanza. In participatory workshops with local stakeholders, I will critically evaluate the cumulative findings of this research, identify potential points of intervention with female migrants, assess acceptability of various options, and develop a preliminary intervention plan. At the start of year 4 I will submit an R34 application to the NIMH for a formative study to develop and assess the feasibility and acceptability of the intervention.
The research proposed in this application examines the overlooked role that women's participation in migration may play in sustaining an enormous HIV epidemic in sub-Saharan Africa. This research will be significant because it will provide the first comprehensive investigation of the mechanisms through which migration increases HIV risk among women in the region. A better understanding of women's patterns of migration and mechanisms through which migration increases HIV risk is necessary both to improve our capacity to control HIV and to respond to future emerging infectious disease threats.
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