Abstract:
Introduction: There are significant knowledge gaps concerning complex forms of
mobility emergent in sub-Saharan Africa, their relationship to sexual behaviours, HIV
transmission, and how sex modifies these associations. This study, within an ongoing
test-and-treat trial (SEARCH, NCT01864603), sought to measure effects of diverse
metrics of mobility on behaviours, with attention to gender.
Methods: Cross-sectional data were collected in 2016 from 1919 adults in 12
communities in Kenya and Uganda, to examine mobility (labour/non-labour-related
travel), migration (changes of residence over geopolitical boundaries) and their
associations with sexual behaviours (concurrent/higher risk partnerships), by region and
sex. Multilevel mixed-effects logistic regression models, stratified by sex and adjusted
for clustering by community, were fitted to examine associations of mobility with higherrisk behaviours, in past 2 years/past 6 months, controlling for key covariates.
Results: The population was 45.8% male and 52.4% female, with mean age 38.7 (median
37, IQR: 17); 11.2% had migrated in the past 2 years. Migration varied by region (14.4%
in Kenya, 11.5% in southwestern and 1.7% in eastern and Uganda) and sex (13.6% of
men and 9.2% of women). Ten per cent reported labour-related travel and 45.9% nonlabour-related travel in past 6 months-and varied by region and sex: labour-related
mobility was more common in men (18.5%) than women (2.9%); non-labour-related
mobility was more common in women (57.1%) than men (32.6%). In 2015 to 2016,
24.6% of men and 6.6% of women had concurrent sexual partnerships; in past 6 months,
21.6% of men and 5.4% of women had concurrent partnerships. Concurrency in 2015 to
2016 was more strongly associated with migration in women [aRR = 2.0, 95% CI(1.1 to
3.7)] than men [aRR = 1.5, 95% CI(1.0 to 2.2)]. Concurrency in past 6 months was more
strongly associated with labour-related mobility in women [aRR = 2.9, 95% CI(1.0 to
8.0)] than men [aRR = 1.8, 95% CI(1.2 to 2.5)], but with non-labour-related mobility in
men [aRR = 2.2, 95% CI(1.5 to 3.4)].
Conclusions: In rural eastern Africa, both longer-distance/permanent, and
localized/shorter-term forms of mobility are associated with higher-risk behaviours, and
are highly gendered: the HIV risks associated with mobility are more pronounced for
women. Gender-specific interventions among mobile populations are needed to combat
HIV in the region.