West and Central Africa

In West and Central Africa, countries with high rates of emigration and imm igration tend to have higher rates of HIV infection. However, there is one exception, Senegal, an exception demonstrating that high levels of mobility and migration do not necessarily lead to rapid and extensive spread of HIV infection. Five different population groups are considered in this article, either bec ause their numbers are substantial or because their role in the spread of H IV and STDs is known to be important. They are migrant labourers, truck dri vers, itinerant traders, commercial sex workers (CSWs), and refugees. It is difficult to estimate numbers of migrant labourers but they are commo n in West Africa. Principal migration routes flow towards the coast, with t hree coastal countries constituting the main centres of immigration: Senega l, Nigeria and Cote d'Ivoire. In Central Africa, the most prominent are bet ween Cameroon, Congo, Gabon and the Democratic Republic of Congo (formerly Zaire). The role of truck drivers in the spread of HIV/STDs is well documen ted in East Africa, but less so in West and Central Africa. Itinerant tradi ng is often a major economic activity for women. Itinerant women traders ma y be especially vulnerable to infection with HIV and other STDs since their trading activities often involve travelling long distances without their f amilies and selling sexual services to supplement their other trading activ ities. In West and Central Africa, prostitutes constitute a particular type of migrant, many of whom travel on an international scale. Prostitutes fro m Senegal and Guinea Bissau work in Gambia, those from Togo work in Cote d' lvoire, and those from Ghana work in Benin, Senegal and Cote d'Ivoire. Fina lly, the continent has seen large-scale refugee movements in recent years. The research indicates a complex relationship between migration and HIV inf ection. Clearly not all migrants have the same risk of infection and thus d o not contribute equally to the spread of HIV. However, there is little ana lysis to date on the influences of different types of migration (which migh t be characterized by duration, frequency of return visits, living conditio ns, etc.) on the spread of HIV infection. Strong associations between migra tion and HIV seropositivity have suggested to various authors that migrant workers may be more involved in sexual activities with multiple partners, p articularly while away from their home environment. However, few studies ve rify this hypothesis directly. Practical strategies for preventing the spread of HIV/AIDS among migrant po pulations in West and Central Africa must aim at providing information befo re departure, along the communication routes, at the final destination and at the time of their return journey. The degree of concentration at each st age will depend on the characteristics of the population. For example, male migrants should be informed before departure of the risk they take by havi ng non-protected-sexual contacts during their absence. This is perhaps the most effective strategy for truck drivers and seasonal migrant labourers. W hatever strategy is used, however, solid collaboration will be required bet ween countries, particularly with respect to information and prevention cam paigns, and to the avoidance of stigmatization of any group, of individuals .