Much of the discussion on the epidemiology of HIV/AIDS in the past has focused on specific issues such as unsafe sex and drug use. While these issues undoubtedly play a role in the spread of HIV and its impact on women, they do not identify the cause itself.

One of the major factors in of the spread of HIV through East and Southeast Asia is the mobility of its people. If the spread of the infection is to be contained in the region, the factors that influence people's movement and high-risk situations should be addressed. These factors are largely developmental: such as poverty, income differentials and landlessness, all of which impact severely on women.

The Need for Early Warning

Imagine for example that due to a drought, authorities in a certain province decide water resources must be redirected from farming to industrial and urban needs. Such a decision can have a domino effect, by preventing farmers from planting their second crop at the appropriate time. This can then trigger out-migration; young men might migrate to the sea as fishermen, to cities in search of work, or find solutions in crime. Young girls may also search for unskilled work, but many could end up in the commercial sex sector.

As this example illustrates, the chain of events is a complex one, but both cause and effect need to be acknowledged, and identified as early as possible.

An Early Warning system is one way to do this.

Such a system can help governments, authorities and other organizations to identify emerging vulnerabilities, and also help them to prepare a suitable and timely response.

Poverty, Mobility and HIV

Poverty can be the reason for women's movement, forcing them to travel to find other work. Being dispossessed of land and other means of production at home, and without enough formal skills to participate in economic activities, affects both the vulnerability and the mobility of women.

Poverty, however, can also limit mobility. Lack of economic resources can force women to stay in situations where their physical and emotional wellbeing is at risk.

Poverty limits women's choices, and in turn their ability to protect themselves from the risk of HIV infection.

While there is considerable variation throughout the region, research on internal migration indicates that it is single, young women aged 15-29 who most often move into urban areas. [i] When women migrate from rural communities to urban environments, the shift is more than simply geographic; it can also change the form of their relationships. For example, in rural Thailand social relations are likely to be expressed in terms of family relations, whereas in urban Thailand, social relationships are more contractual and sexual relations may become a mechanism for social mobility. This, coupled with the shift to heterosexual transmission as the dominant mode of transmission of HIV in most countries, increases women's vulnerability to HIV infection.

New Roads - New Risks

The Lao PDR is fast becoming the hub of land transportation for the Greater Mekong Sub-region. Newly built roads passing through Lao PDR link Thailand, Cambodia, China, Myanmar, Viet Nam and by extension, Malaysia and Singapore. Within these opening channels of communication lies an enormous potential for the rapid spread of HIV, whether it is via carriers such as workmen moving to previously isolated areas to build roads, or via the increasing numbers of truck drivers, businessmen and other individuals using the roads.

Men's Mobility Increases Women's Vulnerability to HIV

Current evidence suggests the environment in well-travelled border crossing areas and international fishing ports fosters more risk-taking behaviour than other towns. Moreover, females who live at cross-border locations are at a significantly higher risk of HIV as they are more likely to have sex partners who are mobile males, who, in turn are at high risk of carrying HIV.

Travel between the countries in the region is increasingly facilitated by new highways, growing trade and tourism, economic policies, and relaxation of requirements for travel documents which make countries more open than previously. In many border communities men outnumber women. This gender disparity and the fact that many men migrate alone creates an unusually high demand for commercial sex.

Establishments Frequented by Mobile Men

Ban Ko Noy in Lao PDR is an ethnic Lue village located 14 kilometres west of Route 13. Nang P runs a roadside beer garden in the village frequented mostly by men from a nearby construction camp and occasionally truck drivers. Girls are available at her establishment on request. Nang P is 20 years old and not married. She has been to a lecture on AIDS but was reluctant to discuss the issue as the main point was a demonstration of condom use with a banana. The average age of the girls at her hotel was 17-18. Most have little awareness of AIDS. Condoms are used entirely at the discretion of the man. Free condom distribution has been prohibited by the province.

HIV Vulnerability and Population Mobility in the Northern Provinces of the Lao People's Democratic Republic (UNDP SEAsia HIV and Development Project)

Women's vulnerability is also influenced by male labour migration. When mobile men return to their rural households they re-establish sexual relationships and increase the possibility that HIV/AIDS will be transmitted to rural women.

This problem has been demonstrated recently in Thailand, Indonesia and Malaysia. Many young men who migrated from the countryside to the cities during the economic boom, were forced to return home during the economic crisis of the late 90s by unemployment. With higher HIV and STD rates in the cities, this reverse-migration may bring HIV into previously untouched areas and homes.

Trafficking

Unfortunately not all human migration is voluntary. Another well documented form of migration is human trafficking, which is rapidly increasing in Southeast Asia. Whilst there is no single victim stereotype, the majority of trafficked women are under the age of 25, with many in their mid to late teens. The fear of infection from HIV has driven traffickers to recruit younger girls, some as young as seven, erroneously perceived to be too young to have been infected.

Women trafficked into sex work are particularly vulnerable to HIV. They tend to work in lower class, often underground brothels, where conditions are worst. They may be forced to service several clients each day, and often have no power to insist on condom use, even if they understand the risk of HIV/AIDS and other STDs.

Human trafficking is increasing in all countries in the Mekong Sub-region. Since trafficking is an underground criminal enterprise, there are no precise statistics on the extent of the problem. But even conservative estimates suggest the scope of the problem is enormous, with the largest number of victims trafficked internationally coming from Asia. The numbers are rising steadily.

Causes of the Rise in Trafficking

The high demand, worldwide, for trafficked women and children for sex work, cheap sweatshop labour, and domestic workers.
The inadequacy and inconsistency of laws and law enforcement in most origin, transit, and destination countries.
The continuing subordination of women in many societies.

[i] Guest, P. (2000): "Population Mobility in Asia " in Population Mobility in Asia: the Implications for HIV/AIDS Action Programmes (UNAIDS-APICT, April 2000)

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