AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #139 - Migration: A determinant of HIV/AIDS, TB and other diseases among the Gaborone poor urban residents in Botswana
Authors: Presenting Author: Dr/Mrs Esther Kip - Umoyo Public Health & Research Consultants
Additional Authors: Dr. Peter Kip,
Aim: Gaborone, the capital city of Botswana, is often described as Africa’s fastest growing city because it is experiencing an increased influx of migrants from rural and neighbouring countries. Over half (54%) of Botswana’s population currently lives in the urban settlements. The majority of the migrants are unemployed women who end up in commercial sex networking for economic survival while fuelling the HIV/AIDS epidemic. Migration has been identified as an independent individual risk factor for the acquisition of HIV in a wide range of settings and circular migration impacts on the propagation of HIV between communities. Tuberculosis (TB) is posing a huge threat in these overcrowded poor urban suburbs. The presence of the HIV/AIDS epidemic has also resulted in the resurgence of TB, which is the number one killer of AIDS patients. This is mainly due to HIV/AIDS co-infection with pulmonary TB and the rise of multidrug resistant TB (MDR-TB). The HIV prevalence is 17.6% in the general population and is concentrated in the urban settlements. The MDR-TB prevalence has risen from 0.8% in 2004 to 3.5% in 2009. This purpose of this survey was to determine the common health challenges among the Gaborone poor urban residents in Botswana.
Method / Issue: Quantitative descriptive and qualitative designs. A multi-stage sampling procedure was used. Representative governorate was identified as stratum. Sample points were selected randomly within the community. Structured interviews were conducted with convenience sample of 302 individuals between January and mid March 2011. Six focus group discussions were carried out among men and women. In-depth interviews were conducted among health care providers (8) and 10 teachers working in the same community. Quantitative data were analysed using SPSS version 13. Chi-square and p-value calculations were done to test significance of the relationships between categories or variables. Tesch’s open coding method was used to analyse the qualitative data.
Results / Comments: All interviewed respondents reported HIV/AIDS, tuberculosis, sexually transmitted infections, sexual abuse, teenage pregnancies, provoked abortions, alcohol and substance abuse, diarrheal diseases, skin infections, hypertension, diabetes and respiratory infections as the common health challenges. The perceived root causes as indicated by the respondents were poverty, overcrowding, unsafe sex, unemployment, multiple concurrent partners, many ‘shebeens’ resulting in alcohol and other substance abuse, domestic violence (gender-based violence), child abuse, non-adherence to antiretroviral and anti-TB therapies and poor health care services.
Discussion: Despite the fact that urbanization has benefited Botswana’s economic and social development, it has also generated a wide range of social determinants of health. The government of Botswana has put a lot of effort in the fight against HIV/AIDS. Old Naledi is in the process of being upgraded however the community is still facing so many health challenges. HIV/AIDS and TB are the major health challenges of Old Naledi community. The Botswana government need to design specific interventions to combat HIV/AIDS and TB in this community. HIV/AIDS interventions should be incorporated with livelihood security. The Botswana National TB program needs to introduce Directly Observed Therapy (DOT) supporters and strengthen community TB care.
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