Internal migration to Nairobi’s slums: Linking migrant streams to sexual risk behavior
Introduction
Given the context of the highest levels of HIV/AIDS – which is worse in urban than rural areas, and the most rapid urbanization of all world regions – clarifying how urbanization, migration, and sexual risk interface in sub-Saharan Africa is critical. Despite a budding interest in the link between urban poverty and risky sexual behavior (Dodoo et al., 2007, Zulu et al., 2002), there is insufficient understanding about how migration into impoverished urban slums contributes to soaring HIV rates in sub-Saharan African countries.
In recent years, scholars have demonstrated that residential context shapes attitudes and behaviors ranging from sexual behavior to educational attainment and aspirations, racial attitudes, family structure, and delinquency. As far as sexual behavior is concerned, local disadvantage has been noted to be a powerful predictor of the risk associated with early sexual debut, low levels of contraceptive use, and having multiple sexual partners (Billy et al., 1994, Brewster, 1994, Brewster et al., 1993, Browning et al., 2005). A further layer of risk seems to come from individuals migrating to disadvantaged areas where risky sexual activity is arguably high; recent studies have illuminated the significance of migration as a predictor of risky sexual behavior and thus HIV infection (Yang, 2005). The rapid migration to slums in the high HIV prevalence contexts of sub-Saharan Africa consequently provokes precisely this concern. We examine how migration between residential contexts (and to Nairobi’s slums) influences sexual risk behavior, and how such effects may be conditioned by the dissimilarity between origin and destination contexts, and the length of time spent in both the current and previous residences.
Section snippets
Migration and sexual risk in sub-Saharan Africa
It is increasingly evident that, across all continents, migrating is associated with riskier behavior, including sexual risk behavior (Baumer and South, 2001, Brockerhoff and Biddlecom, 1999, Li et al., 2007, Pribesh and Downey, 1999, Rumberger and Larson, 1998, Sambisa and Stokes, 2006, Teachman et al., 1996, Yang and Xia, 2008). One probable cause of this is the disruption of social networks upon migration, which can heighten risky behavior by weakening supervision and sanctions against
Recent migrant advantage
There is reason to think that recently arrived slum migrants, regardless of previous origin, may have an initial advantage in terms of less risky behavior because they come from contexts not as economically deprived, socially isolated, or socially disorganized as the poor slum settings that Wilson (1996) posited gives rise to self-destructive risk behaviors. The local opportunity structure and inculcated messages about the likelihood of future success are also relevant (Baumer and South, 2001,
Non-contextual factors
Unequal power relationships and social norms in sub-Saharan Africa pose their own threats to sexual health outcomes, although their impacts on risky behavior may be affected by women’s economic despair and social isolation. Women are frequently in subordinate positions in their social relationships with men, and have less power to request safer sex practices (Zulu et al., 2003). Women in unions may be at greatest risk of unprotected sex, due to their partners’ desires to procreate as well as to
Data and methods
Our analysis uses the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), a weighted cross-sectional representative sample of Nairobi slum households (APHRC, 2002). The NCSS survey was collected by the African Population and Health Research Center (APHRC), and was largely fashioned after the Demographic and Health Surveys (DHS), which were developed to assess demographic characteristics and health concerns of residents of developing nations. A two-stage stratified sampling method was used, with 98
Patterns of sexual risk behavior
Table 1 presents patterns of sexual risk for all respondents, and shows that only 7% of respondents used condoms in their last encounter while 27% had multiple sex partners.
Means and t-tests show variations in sexual risk patterns vary according to migration origin, while Table 2 demonstrates variations across place of origin. Individuals from towns, non-slums, and villages were generally least likely to exhibit risky behavior.
Table 3, Table 4 further disaggregate respondents by length of time
Conclusion
The ravaging effects of HIV and other sexually transmitted diseases on urban slum residents in Africa justify attention to the factors associated with this phenomenon. By understanding a primary cause of HIV infection – risky sexual behavior – scholars can more effectively clarify how to improve the health and life chances of slum residents, a charge of the Millennium Development Goals (MDGs). Although individual characteristics are certainly relevant for predicting sexual risk behavior, this
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