South Africa: Returning Sick -- HIV, Illness, Death and Migration

While migration in South Africa is commonly thought of as rural to urban, the number of ill or seriously ill HIV/AIDS patients who return home to the rural Eastern Cape from Cape Town indicates the traffic goes both ways.

Patricia Fekema, a community worker in the crowded township of Du Noon on the northern edge of Cape Town, said there has been a "tremendous" increase in the migration of sick children and adults back to the Eastern Cape. But once they arrive there, patients are often treated badly by their families and face isolation, she said. In many cases, they do not get enough food and have to walk long distances to access health care.

Nosipho Teyise of the International Organization for Migration said rural communities often are lacking in HIV/AIDS knowledge. Disease-related stigma is high in the Eastern Cape, which 2007 Department of Health figures show has an HIV rate of 26 percent and an unemployment rate estimated at 30 percent.

There is also a strong tradition of urban migrants being buried at their rural homesteads. Bus driver Ryan Xazana, who makes the 16-hour haul from Philippi in Cape Town to the Eastern Cape, said many of the terminally ill are sent via bus because their relatives would rather pay $40 for a fare rather than the $700 it could cost for an undertaker to transport the body back to the Eastern Cape. One such patient died during the journey, he said.

David Neves of the Center for Social Science Research at the University of Cape Town said risk and vulnerability exist in both rural and urban locations. Research conducted in 2008 shows a "multiplicity of factors" are driving return migration, including loss of urban residence, a desire to free one's urban family from the burden of disease, and being fetched by rural kin.

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