No. 40: Migration and Domestic Workers: Worlds of Work, Health and Mobility in Johannesburg

South Africa is in the middle of a well-documented HIV/AIDS epidemic. Infection rates were calculated to be 22% of the adult population in 2003. A number of different reasons have been advanced to explain the HIV/AIDS epidemic in South Africa. They include poverty and economic marginalization; differing strains of HIV; and high rates of sexually transmitted diseases. However, migration patterns in Southern Africa have also been identified as one of the keys to understanding the high rates of infection in the region. Male migrants have been the focus of research on the relationship between HIV and migration. In the same way that the vulnerabilities of migrant women to HIV have thus far largely remained unexplored, the lives of migrant women have also received far less attention than the lives of their male counterparts. This study examines the migrant and health experiences of domestic workers in Johannesburg, as well as some of their points of vulnerability to HIV. In 2004, domestic work was the second largest sector of employment for black women in South Africa. And, as this study shows, a defining characteristic of domestic workers in Johannesburg is their status as migrant workers. Given the importance of domestic work for women workers in South Africa, and the potential for their working conditions to affect their access to health care and their vulnerability to HIV infection, the study explored questions around migrancy, working conditions, access to health care and the experiences of, and vulnerability to HIV of domestic workers working in Johannesburg. The study is based on interviews with 1,100 female domestic workers employed in the City of Johannesburg. A defining feature of the lives of this cohort of domestic workers was that they were overwhelmingly migrant workers; over 86% had a home outside Johannesburg and over 70% of those with other homes really wanted to be living there. Three-quarters of those with other homes had been working in Johannesburg for more than five years. The majority were from South Africa, and only 6% of the sample came from other countries, all in the SADC. Another defining characteristic of the lives of domestic workers related to their migrant status was separation and isolation. Although the majority of the women interviewed were aged between 21 and 50 years, over 40% identified themselves as single, widowed, divorced or separated. The majority of those with long-term partners or husbands lived apart from their partners and children. Only a quarter of respondents lived with their long-term partner or husband. Over two-thirds lived on their employers’ property. Most of these women were not allowed visits from their families and friends. Their friends were mainly other domestic workers, neighbours and other church members. Their working lives were hard, as many employers were not even meeting the minimum standards of employment set out by the Department of Labour. The majority of the sample worked for one employer (88%) and almost 45% worked six or seven days a week. Most worked between eight and ten hours a day. Their incomes do not reflect their long working weeks. Although over half earned between R501 and R1000 per month, over a fifth earned less than R500 per month. Despite their working conditions, the women did not report problems accessing health services when they got sick. Those who had used health services overwhelmingly used allopathic government clinics and hospitals. Almost a third had used family planning services in the previous year, almost half had visited a clinic, and almost a third a doctor. Only 15% had chosen to visit a traditional healer. Of these, over a third had gone for non-health related matters. Although almost half of the sample were single, only 10% had not had a sexual partner in the past five years. Since only a quarter of those with long-term partners or husbands actually lived with them, opportunities for either partner to have other sexual partners are magnified, and provide opportunities for potentially risky behaviour. These women experienced similar levels of violence in and outside their relationships as other women in South Africa. Almost a fifth had been pushed, shoved, slapped or had things thrown at them in the previous year, 6% had been raped, and 6% forced to have sex by their partner when they did not want to. Violence, rape and coercive sex all increase the vulnerability of women to HIV infection. Another defining characteristic of this group of women was the lack of condom use. Over 60% of the sample had never used a condom in their lives. But, only 12% did not know where they could get free condoms. Also disturbing is that the majority of those who used condoms used them irregularly with only a fifth of condom users saying they used condoms all the time. One of the reasons for low condom usage could lie with the low levels of knowledge around HIV/AIDS issues among these women. Almost a third were unable to describe how to have safe sex. Levels of knowledge around antiretroviral treatment and other HIV/AIDS related issues were also low. Only 16% knew about antiretroviral therapy. Low levels of condom usage could also reflect perceptions of vulnerability, as only 11% said they thought they might have been infected. Less than a third had been tested for HIV and only 26 of the women interviewed had tested positive. Low levels of knowledge and condom use appear to be largely unchanged by the experiences of the women with the virus. Over a third knew someone who had died of AIDS, a similar proportion had a member of their family who was HIV positive, and almost a fifth had physically cared for or supported someone with AIDS. Overall, it seems that migrancy and work shape these women’s lives and affect their vulnerability to HIV. For many, particularly those who live in or on their employers property, their social lives are restricted by their working and living conditions. This social isolation may protect domestic workers as it reduces opportunities for starting new relationships. Conversely, their migrant status, separation from partners, and for many, restrictions on when and where they can see their partners and boyfriends, may make them more vulnerable. Low levels of condom use, given the circumstances of their relationships, and low levels of knowledge around issues related to HIV/AIDS are of concern. The majority of these women look to television and listen to the radio to get information. The majority attend health services at some point during the year. Therefore, it seems that this cohort of women workers in Johannesburg are not being reached by health promotion campaigns relating to HIV/AIDS education, prevention and treatment