West and Central Africa

In West and Central Africa, countries with high rates of emigration and immigration 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 because their numbers are substantial or because their role in the spread of HIV and STDs is known to be important. They are migrant labourers, truck drivers, itinerant traders, commercial sex workers (CSWs), and refugees. It is difficult to estimate numbers of migrant labourers but they are common in West Africa. Principal migration routes flow towards the coast, with three coastal countries constituting the main centres of immigration: Senegal, Nigeria and Cote d'Ivoire. In Central Africa, the most prominent are between Cameroon, Congo, Gabon and the Democratic Republic of Congo (formerly Zaire). The role of truck drivers in the spread of HIV/STDs is well documented in East Africa, but less so in West and Central Africa. Itinerant trading is often a major economic activity for women. Itinerant women traders may be especially vulnerable to infection with HIV and other STDs since their trading activities often involve travelling long distances without their families and selling sexual services to supplement their other trading activities. In West and Central Africa, prostitutes constitute a particular type of migrant, many of whom travel on an international scale. Prostitutes from 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. Finally, the continent has seen large-scale refugee movements in recent years. The research indicates a complex relationship between migration and HIV infection. Clearly not all migrants have the same risk of infection and thus do not contribute equally to the spread of HIV. However, there is little analysis to date on the influences of different types of migration (which might be characterized by duration, frequency of return visits, living conditions, etc.) on the spread of HIV infection. Strong associations between migration and HIV seropositivity have suggested to various authors that migrant workers may be more involved in sexual activities with multiple partners, particularly while away from their home environment. However, few studies verify this hypothesis directly. Practical strategies for preventing the spread of HIV/AIDS among migrant populations in West and Central Africa must aim at providing information before departure, along the communication routes, at the final destination and at the time of their return journey. The degree of concentration at each stage will depend on the characteristics of the population. For example, male migrants should be informed before departure of the risk they take by having non-protected-sexual contacts during their absence. This is perhaps the most effective strategy for truck drivers and seasonal migrant labourers. Whatever strategy is used, however, solid collaboration will be required between countries, particularly with respect to information and prevention campaigns, and to the avoidance of stigmatization of any group, of individuals.