Mobility and the spread of HIV / AIDS: a challenge to health promotion.

Mobility affects health because unfamiliar surroundings can cause people to take health risks which they may have avoided in their ordinary environments. The epidemiologic role of mobility in spreading communicable diseases is highlighted by the emergence of a new disease such as HIV infection. The path of HIV can actually be plotted on a map. The disease cannot be stopped at international borders, however, because this is an era of increasing international interdependency. Programs for HIV prevention must consider the mobility circumstance, whether the target population consists of permanent, temporary, or seasonal migrants, non-settling travellers, or involuntary refugees. The vulnerability of each group must be assessed in terms of such issues as exposure, socioeconomic status, and access to health care. Aspects of cultural background, such as language and concepts of sexuality, are important considerations for migrants, as are psychological factors for travellers (pleasure-seeking tourists and relaxation-seeking business travellers) and legal aspects and living conditions for refugees. To date, prevention programs in Brazil, India, Burkina, Faso, Kenya, and Tanzania have targeted truckers. Both national campaigns and specific projects have been addressed to travelers, with high acceptance achieved, for example, in Australia, and, for tourists, in Torbay, England. Migrant male and female prostitutes have been the focus of health services in western European cities in collaboration with the project "AIDS and Mobility." To succeed, collaboration in prevention programs must follow the disease across international borders and cooperation must extend throughout a network of agencies.