Migrants and AIDS: Risk Management versus Social Control: An Example from the Senegal River Valley
Lalou, Richard, Piché, Victor, Population
Although numerous studies have already shown the existence of an association between geographic mobility and AIDS (Lalou and Piché, 1994; Decosas and Adrien, 1997; Kane et al., 1993), the complex processes underlying this association are still poorly understood (Soskolne and Shtarkshall, 2002). Since the beginning of the epidemic, analyses of the relationship between AIDS and migration have frequently borrowed customary interpretations from public health to account for the health of migrants. In this context, AIDS is either a "pathology of importation" and the migrants are its carriers, or a "pathology of adaptation" and the migrants accumulate vulnerabilities favourable to the infection when subjected to a stressful environment - that of their host area (Gentilini and Duflo, 1986; Gentilini, Briicker and de Montvalon, 1986). In the first case, containing the epidemic implies controlling the migrant population; in the second case it depends on an awareness of the plight of migrants, and on fair access to treatment. The approach shifts from a mode of stigmatization to one of compassion.
The first point of view - that of the pathology of importation - is mostly present in research concerned with the epidemiological aspects of AIDS. Like other infections, HIV is transmitted from one person to another and circulates according to the direction and rhythm of human moves. For sub-Saharan Africa, a significant number of studies have confirmed these clear associations between the epidemic's spatial dynamics and labour migration (Painter, 1992; Hunt, 1996; Prothero, 1996), forced migration (Prothero, 1994), urbanization (Lydie et al., 2001), and major roads (Marck, 1999). The geography of AIDS, as that of many epidemics of the past, confirms the existence of such a relationship (Prothero, 1977; Amat-Roze, 1989 and 1993; Lydié et al., 1998).
Admittedly, this interpretation has the merit of shedding some light on the epidemic's dynamics. However, it also addresses the association between migration and AIDS in a mechanical manner, without explicit reference to the modes of transmission. Here, the body of the migrant is an infected and contagious body. It is the vehicle for a virus looking to conquer other bodies and other territories. It is also a body separated from its social and cultural reality. Sexual behaviour, i.e. the practices that connect the intimate with the social and through which the virus is transmitted, is subordinated to the essential characteristic of the migrant, mobility. From this point of view, it can be said that the analysis belongs to the biological rather than to the social plane, and that it is less interested in the association between migration and AIDS than in the migration of AIDS (or the spread of HIV).
The second interpretation of the association between migration and AIDS, which is commonly opposed to the epidemiological model, fits into a psychosocial and sociological approach. This analysis highlights the social and behavioural mechanisms through which migration increases the risk of HIV infection and places the migrants' vulnerability at the core of the explanations. For some authors labour migration, initiated during colonization with the introduction of capitalism, contributes in sub-Saharan Africa to a long and thorough process of disorganization of societies, families, and behaviour (Descloîtres, 1972; Doyal and Pennell, 1981; Hunt, 1989; Lalou and Piché, 1994). These studies are generally based on examples of international migration in western and southern Africa that focus on Côte d'Ivoire and South Africa respectively. Here, labour migration fundamentally produces insecurity and vulnerability as a result of the migrants' legal and social outsider status, their socio-demographic characteristics, and the restrictions imposed by the economic and social organization of the receiving area. These factors in turn create a change in the migrants' sexual behaviour, resulting in a multiplication of sexual partners and resort to prostitutes (Hunt, 1996; Packard and Epstein, 1992; Anarfi, 1993; Lalou and Piché, 1996; Lurie et al. …