Migration and HIV vaccine development in Masiphumelele, Western Cape, South Africa
INFORMAL SETTLEMENT ▫ SOUTH AFRICA
Gina M. Clark1 and Leslie Swartz2
2South
of Medicine, University of Iowa, USA, African AIDS Vaccine Initiative and Stellenbosch University, South Africa
1College
Background
• HIV epidemic: 6.57 million South Africans1 • HIV vaccine development:
– Over 30 candidate vaccines and 70 clinical trials around the world2 – South African AIDS Vaccine Initiative (SAAVI)
• To develop accessible, affordable, directly applicable vaccine for HIV1M subtype C, prevalent in southern Africa3 • Focuses on high risk communities including resource-poor townships/informal settlements
• Migration into and out of townships:
– – – – Rapid urbanization Scarce employment opportunities Immigration Circular migration
Vaccine clinical trials: monthly follow-up for 6-24 months
Aim and Hypotheses
• • Aim
– To characterize township migration patterns and their potential impact on HIV vaccine development
Hypotheses
1. Increased mobility will decrease interest in vaccine trial participation 2. Factors related to increased mobility will include:
– Limited employment opportunities – Dissolution of family structure
3. Impact of HIV/AIDS override other determinants of vaccine trial interest
• High impact of HIV/AIDS will relate to high vaccine trial interest regardless of mobility level4
Masiphumelele
Masi
x
Masiphumelele
“Shacks” in “Wetlands”
Methods
• Participants
– 24 Masiphumelele residents
• 11 male, 13 female • Mean age = 29.6 ± 10.4 years • Informed consent obtained
• Procedure
– Semi-structured audiotaped interviews:
• Previous and anticipated moves • Time away from Masiphumelele, e.g. at Christmas • Factors affecting decisions about where to live
– e.g. jobs, education, family, health, home/plot ownership
• Impact of HIV on participant’s life • Personal and perceived community interest in HIV vaccine trials
• Analysis
– Interviews were transcribed – Quantitative and qualitative data analysis
Results
• Mobility
– Duration of residence in Masiphumelele = 6.9 ± 5.3 years – Number of previous moves = 1.9 ± 1.2 – 92% originally from the Eastern Cape, still considered “home”
• 79% go to Eastern Cape for several weeks at Christmas
– 0 participants anticipated moving away from Masi
Factors affecting decisions about where to live
Job opportunities Health Family Own plot/house/leave “wetlands” Crime Education Close to sea Forced during apartheid
When came to Masiphumelele
15 (62.5%) 0 (0.0%) 4 (16.7%) 1 (4.2%) 0 (0.0%) 2 (8.3%) 0 (0.0%) 2 (8.3%)
Currently
20 (83.3%) 11 (45.8%) 8 (33.3%) 6 (25.0%) 2 (8.3%) 1 (4.2%) 1 (4.2%) n.a.
• Job opportunities
– Thought to be plentiful due to proximity to communities where “…there’s a lot of white people. They’ve got some money, they’ve got some [job] opportunities.”
• 23/24 reported that HIV had a big impact on their lives:
– Participant K. (19 y.o. female) was “so afraid of what’s happening here in Masi” – Participant X. (21 y.o. male): “I think it has a huge impact on my life. Some of my family members died from it, so it’s something that I care about because I’ve seen that I need to have responsibility about my life, take my care of myself… think about the future.”
• 22/24 reported interest in vaccine trial participation
– Participant P. (37 y.o. male): “I can manage giving without getting anything. I would volunteer myself because it can be helpful to the people of this community.” – Participant J. (38 y.o. female) who “found out I am also infected with HIV” said community members are “going to be interested because there’s a lot of people who are dying of HIV here in Masiphumelele.”
Discussion
• Impact of migration on vaccine trials
– Good news: Population fairly stable – “Christmas exodus” to Eastern Cape - main migration concern for vaccine trials to accommodate – Jobs a key determinant of residence – Unexpected ceiling levels of reported impact of HIV and interest in trials
• Overriding importance of HIV impact:
– Nearly all participants reported significant HIV impact; nearly all indicated interest in vaccine trials
References
1
South Africa Department of Health: National HIV and Syphilis Antenatal SeroPrevalence Survey. 2005. available online at http://www.doh.gov.za/docs/whatsnew-f.html. Esparza J, Osmanov S. HIV vaccines: A global perspective. Curr Mol Med 2003; 3:183-193. Tucker TJ, Mazithulela G: Development of an AIDS vaccine: Perspective from the South African AIDS Vaccine Initiative. British Medical Journal 2004; 329: 454-456. Stoneburner RL, Low-Beer D: Population-level HIV declines and behavioral risk avoidance in Uganda. Science 2004; 304: 714-718.
2
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Acknowledgments
Mentors Professor Leslie Swartz Dr. Oladipo Kukoyi
Desmond Tutu HIV Centre, Masiphumelele Dr. Linda Gale Dr. Keren Middelkoop Prudence Mthimunye Ntando Yola Lubabalo Vellem Thabisa Maqweqwana
Stellenbosch University Zuhayr Kafaar Anthea Lesch Bonisile Ntlemeza
Funding New York Academy of Medicine University of Iowa College of Medicine