Globalization and HIV;

Migration, Economic Expansion, and Lack of Infrastructure

Juan Landeros-Tavera

ABSTRACT
Globalization and the increase of migration to urban centers has had the effect of increasing incidence and
prevalence of HIV amongst economically disadvantaged individuals. The increase in risky sexual behavior, increase
in sex work, and lack of infrastructure needed to treat and prevent HIV increase infection rates amongst all residents,
but seem to affect the urban poor disproportionately. Education and transfer of knowledge could potentially have
mitigating effects and lead to an increase in condom use, lowering of stigma, and increase in accessing treatment,
but without the proper medical infrastructure needed to prevent and treat, it is difficult to see the overall mitigating
effects that education and knowledge have on economically disadvantaged residents of newly urbanized areas.

INTRODUCTION

The purpose of this brief review is to asses the available evidence on the effects of
globalization on the incidence and prevalence of human immunodeficiency virus. This review
aims at addressing the following areas: (1) The effects of globalization on health, (2) The link
between urbanization and communicable diseases, (3) Current data on the negative and positive
impacts of globalization on the incidence and treatment of HIV, (4) The identification of future
lines of research.

BACKGROUND
According to Ayoh (qtd. In Labonte) Globalization is “[a] pattern of transnational
economic integration animated by the ideal of creating self-regulating global markets for goods,
services, capital, technology, and skills”. This has lead to an increase in the flow of people,
information, capital, trade and pathogens (1). This spread has been propagated by the force of
economic globalization. In countries and regions of low socio-economic status, changes in
policies used to enter the global market also lead to “currency devaluations, privatization,
financial and trade liberalization, implementation of user charges for health services and
implementation of user charges for education.” These forces work together and have detrimental
effects on health (2). The economic ramifications of these policies lead to rapid urbanization,
with emerging economic opportunity centralized in major cities, and currency devaluation
driving migration, people move to urban areas. This rapid urbanization strains local
infrastructure, reducing the availability of services, and coincides with an increase in risky sexual
behavior, increasing the incidence of HIV infection. All the forces associated with economic
globalization that work within economically disadvantaged countries work together to create and
foster health disparities, and ultimately lead to lowered health outcomes and increases in disease.
It is important to note that the ease of access, as well as exchange of ideas and knowledge, along
with economic growth could have some mitigating effect against these lowered health outcomes,
but as quoted in a WHO study, “economic growth, by itself, will not be enough to improve
population health, at least in any acceptable time.” (2)
METHODS

An independent literature review was conducted through PubMed/Medline database

using the following search terms: “Globalization”, “Globalisation”, “HIV”, “Urbanization”, and
“Global Health”, “Sex work”. Nine articles within the past 10 years were found relevant to the
search criteria.

RESULTS

A study on how educational attainment and sexual reproductive health interact found that
education played an important role in sexual reproductive health, but that the positive effects of
education also relied on structural factors in the region, including access to sexual health
services, access to information on sexual health, and access to sexual networks (3,4). A study on
HIV testing technologies found that in developing countries there is a lack of infrastructure that
hinders HIV treatment and care, and that stigma had an effect of HIV prevention activities as
well (5). Another study that used data from a malaria and HIV/Aids survey in Tanzania found
that women in urban areas who were of low socioeconomic status, were less educated and had
more than one sexual partner had an increased rate of HIV infection as compared to similar
women in rural areas. (6) Three more studies found a higher prevalence of communicable
diseases, including HIV, among individuals migrating from rural areas to urban areas. (7,8,9)
One of these studies also found a lower prevalence of HIV amongst migrants who returned to
rural areas, suggesting that HIV infection lead to staying in urban areas, weather this was due to
increased access to services or less stigma was not discerned (7). A study of male sex work
found that stigma played an important role in access to HIV care and incidence of condom use,
with stigma increasing rates of sexually transmitted infections (10). Globalization seems to
increase the rate of sex work in urban areas. One study found that “transactional sex is perceived
to be a lucrative economic strategy that allows [people] to not only ward off hunger, but to
access the fashionable images that are necessary for social survival.”(11) All of these aspects of
globalization intersect and create challenges for HIV prevention, increase incidence and
prevalence of HIV.

DISCUSSION

There is growing evidence that globalization has created flows of information, capital,
technology, people, and disease. These flows have the effect of increasing migration of poor
people to large cities, where they are more likely to be exposed and infected with HIV due to
increased sexual partners, increased prevalence in HIV amongst urban residents, and a lack of
infrastructure to treat and prevent HIV. An increase in sex work among urban areas, and sex
work as a survival tactic for the poor population also plays a role in increasing the incidence and
prevalence of HIV amongst residents of urban areas. While these flows also lead to an increase
in knowledge and the potential for better access to medical care and treatment for HIV, there is
evidence that there is a lack of medical infrastructure and capital needed to fully address and
prevent the incidence of HIV in these urban areas.

CONCLUSION

Globalization and the entry into the global market has created a myriad of issues that
influence health. The devaluation of currency and centralization of economic power coincide
with the loss of local industry, which drives migration of the rural poor into urban centers. This
has led to an increase in HIV prevalence and incidence amongst the urban poor. The rise in sex
work, increase in sexual partners, and lack of infrastructure needed to treat and prevent HIV has
increased the burden of HIV among economically disadvantaged individuals in areas with rapid
economic expansion. Education and sexual health have the effect of increasing knowledge on
HIV, but further study on the mitigating abilities of education needs to be done to assess its
effect. The creation of infrastructure and increase in capital seem to be other areas through which
the burden of HIV can be mitigated, but further study needs to be done to fully understand how
the effects of globalization intersect, and to find more effective ways of preventing HIV in
rapidly growing urban areas. Until then, globalization will continue to have the effect of
increasing incidence and prevalence of HIV among the newly urban poor.
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