Year: 2008
Working paper number: 229
Author: Neves, David
Unit: SSU

This paper examines the impact of HIV/AIDS related morbidity and mortality on return migration to the rural Eastern Cape. The paper begins by discussing the inter-relation between population mobility and HIV and grounds these dynamics within the structural context of underdevelopment in a former homeland region of South Africa. The changing migratory regimes of the post-apartheid era, which have seen formal male labour migration supplanted by increasingly informal and feminized migratory trajectories, between both rural-urban and intra-rural locales, are described. 

Five case studies are presented, and the multiplicity of factors associated with rural return migration in the face of HIV/AIDS related illness delineated. The empirical material suggests illness-induced back migration is driven not only by the search for health and succour, but also by complex amalgams of shifting entitlement and obligation. Understanding the dynamics of rural return requires attention not only to the highly variegated position that urban returnees potentially assume within receiving households, but also the effects of their return on these households. Even within the relatively limited number of case studies presented rural returnees are variously subjects or dispensers of care, either relatively peripheral or crucially central members of receiving households. The evidence simply belies any notion of unidirectional rural return, driven by a universal set of imperatives in response to illness.

The discussion section of the paper elaborates on various salient dimensions of rural return, including local practices of caring, health-seeking and death and dying. The management of stigma and denial that pervades each of these domains, and the decision making and constituting of personal agency by the ill, are both carefully considered. Ill-returnees engage with the search for health and an expansive range of treatment modalities in highly differential ways, accordingly their relationship with the local primary health care infrastructure ranges from embracement to eschewal. Rural return in the context of chronic terminal ill health also reflects social practices surrounding death and dying, which the paper suggests to be underpinned not only by notions of social and cultural appropriateness but also pragmatic concerns around managing the cost of funeral arrangements. The paper concludes by extrapolating from the discussion and elaborating on the dense social networks and dynamics within which ill returnees are incorporated.

Publication file: WP229.pdf