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ABSTRACT
This article demonstrates how the spread of HIV/AIDS in Mozambique may gave been affected by internal and external population movements which, in turn, contributed to the pronounced regional differences in adult HIV prevalence among the three regions of the country observed today. Further population movement may put certain individuals at higher risk of HlV infection but, even if these movements were to stop, in the absence of effective interventions to prevent new infections, HIV prevalence would remain high and perhaps continue to rise. The current regional differences in HIV prevalence and duration of the epidemic present different challenges for the development and implementation of prevention and mitigation services.
INTRODUCTION
It is well known that population movements can facilitate the spread of disease: returning Crusaders probably spread the plague across Europe and European settlers introduced measles and smallpox in the New World (McNeil, 1976). Over the past 35 years, Mozambique has experienced three major types of internal and external population movements which may be responsible for the regional differences now observed in the HIV/AIDS epidemic which, in turn, present different challenges for the development and implementation of prevention and mitigation strategies.
Located on the eastern coast of southern Africa, Mozambique is comprised of three geographic regions. The South region borders on South Africa, Swaziland, and Zimbabwe and includes the central city of Maputo. The Center region includes the port city of Beira and borders on Zimbabwe, Zambia, and Malawi. The North region borders on Malawi and Tanzania. The official 1997 National Census counted 5,019,848 residents in the North, 6,300,011 in the Center, and 3,958,475 in the South (INE-National Statistics Institute, 1999).
Documenting the spread of HIV in Mozambique is hampered by lack of data: AIDS testing and notification are low and uneven, death registry information is largely unavailable, and there are no national seroprevalence surveys. Like other countries in Africa, Mozambique relies on antenatal clinics in government health facilities to provide blood samples for biennial HIV screening. A national prevalence survey conducted in 1982-83 found no seropositive cases. Reasonable time series data for HIV seroprevalence are available only from the capital, Maputo City which suggest that the epidemic in this area remained low and stable from the mid-1980s through the early 1990s. Since 1994,...