.
Past civilisations could have scarcely imagined the bustling metropolises in which we now live. The ever increasing urbanisation of the planet has already changed the social and environmental dynamics of every continent across the globe and will continue to do so in the future. For the first time in history over half of the world’s population lives in towns or cities and by 2030 the urban population will reach almost five billion. Rural to urban migration has become the common global phenomenon which has propelled the 21st century into the age of the city. But as it does so, new (and old) health problems are emerging including the increased spread of sexually transmitted infections (STIs).
At the start of the previous century, in 1900, only 13% of the world’s populations lived in urban areas and London was the largest city in the world. Today London scarcely compares—it has been grossly outpaced by urban growth in the developing world. In Africa for example the urban population is expected to triple in the coming years. Indeed, there are now over 30 mega-cities across the globe each populated by more than 10 million inhabitants. From Lagos to Mumbai ever more centers are gaining the title of mega-cities, the largest of which, Tokyo, hosts almost 38 million inhabitants. These mega-cities are continually growing—almost 200,000 people become new urban residents each day, with strong trends in rural to urban migration being increasingly evident. In China approximately 250 million rural migrants have moved from the countryside provinces to cities looking for better working and living conditions. Large population movements are also happening from city to city: in Sao Paulo, Brazil, a third of all population growth can be attributed to migration from other cities. These huge movements of people are changing the demographic makeup of cities, with inevitable health impacts.
Urbanization typically comes hand in hand with economic growth and the health benefits that are reaped from this. Cities generally experience better child survival rates and longer life expectancies. However, the hurried evolution of cities into mega-cities in many cases has not been structured. Large slum areas trace the outskirts of cities like São Paulo and in Lagos, Nigeria, urban development and planning has utterly failed to keep pace with population growth. Indeed, in some countries over 90% of urban residents now find themselves living in shanty towns and slums and by 2030 the number of people living in such places globally will reach almost 2 billion. These urban poor are always at risk of disease.
Conditions in slums are often squalid, with open sewage and overcrowded housing. With such conditions disease is easily spread. Tuberculosis thrives in overcrowded, poorly ventilated places and without proper sewage systems cholera becomes a major concern. Research from the University of Otago, New Zealand, has already shown that every 1% increase in overcrowding can lead to an 8% increase in TB incidence in that housing block. Without proper planning and infrastructure cities quickly become the epicentres of disease. In an increasingly globalised society diseases now have potential to rapidly propagate from city to city with tourism and migration.
Our knowledge of sexual and reproductive health in mega-cities is slowly increasing and a clearer picture of the impact mass urbanization has on sexually transmitted disease has now come to light. The results are not promising; urban poverty has been linked to high rates of unintended pregnancies and STIs and HIV has boomed in urban centres. In some cities HIV rates are so extreme that they compare to the national HIV figures of some countries. Although the situation varies from country to country, data has shown that even in countries that are still mostly rural, cities tend to have a disproportionately high prevalence of HIV. The city of Monrovia in Liberia for example is home to 80% of the people living with HIV nationally.
Young urban dwellers are particularly at risk. In Kampala, Uganda, a recent study showed that 20% of girls and 13% of boys were infected with at least one sexually transmitted disease. Furthermore, city environments can put young women at risk of sexual abuse and violence. In Tanzania for example, for one fifth of girls in urban centres their first sexual experience was forced, and as a result HIV rates for girls were double that of their peers in the countryside (UNFPA 2012).
Cities can also act as hubs for the sex trade. Young people frequently move to the city to provide income for their family; if they don’t find work, they can be drawn into commercial sex as a way of making money. Far from their homes, migrant workers can feel isolated and become vulnerable to risk behaviours like unprotected sex with multiple partners—several papers have indicated that China’s millions of rural-urban migrants are contributing to the country’s AIDS epidemic.
Some cities have also developed reputations for “sex tourism”; Bangkok for example is infamous for its brothels and sex workers there are known to have high rates of HIV. Bangkok is also a major destination for sex trafficking. Women and children are regularly taken from rural areas and trafficked into the urban sex trade, where exploitation and abuse are rife—in Southeast Asia as many as 250,000 women are thought to be trafficked each year. Many come from poor villages and are lured with promises of a good job in the city. The risk of STIs, including HIV is extremely high among trafficked women, since many are forced to have unprotected sex with many customers and are especially vulnerable to violence and rape. In Cambodia, the United Nations Development Program found that over 70% of trafficking survivors had a sexually transmitted infection. Trafficked women are furthermore extremely difficult to access with reproductive health care and education programs. They are often marginalized within communities and are given little access to outside health care by their exploiters.
In general, knowledge of STIs and sexual health tends to be higher in cities than in rural areas and people use condoms more frequently. Urban residents are more exposed to advertising campaigns for disease prevention and health clinics are more local. There are therefore clear opportunities for prevention in urban areas, which are simply not possible in rural areas. However, there are strong disparities between richer and poorer urban areas when it comes to reproductive health. In India, contraception use has been shown to be far lower in slums compared to other urban districts. It is these areas that are in the greatest need of public health interventions and disease education and far more must be done to reach these marginalized communities. The huge expansion in urbanisation has changed the face of everyday living and will continue impacting on the health profiles of urban inhabitants. Sexual health needs to become a major consideration for town counsels to prevent more infections in the future.
About the author: Elizabeth Maclean is a Research Officer at the International Centre for Migration Health and Development in Geneva, Switzerland.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.
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Sex and the Cities: The Impact of Urbanisation on Sexually Transmitted Disease
April 11, 2016
Past civilisations could have scarcely imagined the bustling metropolises in which we now live. The ever increasing urbanisation of the planet has already changed the social and environmental dynamics of every continent across the globe and will continue to do so in the future. For the first time in history over half of the world’s population lives in towns or cities and by 2030 the urban population will reach almost five billion. Rural to urban migration has become the common global phenomenon which has propelled the 21st century into the age of the city. But as it does so, new (and old) health problems are emerging including the increased spread of sexually transmitted infections (STIs).
At the start of the previous century, in 1900, only 13% of the world’s populations lived in urban areas and London was the largest city in the world. Today London scarcely compares—it has been grossly outpaced by urban growth in the developing world. In Africa for example the urban population is expected to triple in the coming years. Indeed, there are now over 30 mega-cities across the globe each populated by more than 10 million inhabitants. From Lagos to Mumbai ever more centers are gaining the title of mega-cities, the largest of which, Tokyo, hosts almost 38 million inhabitants. These mega-cities are continually growing—almost 200,000 people become new urban residents each day, with strong trends in rural to urban migration being increasingly evident. In China approximately 250 million rural migrants have moved from the countryside provinces to cities looking for better working and living conditions. Large population movements are also happening from city to city: in Sao Paulo, Brazil, a third of all population growth can be attributed to migration from other cities. These huge movements of people are changing the demographic makeup of cities, with inevitable health impacts.
Urbanization typically comes hand in hand with economic growth and the health benefits that are reaped from this. Cities generally experience better child survival rates and longer life expectancies. However, the hurried evolution of cities into mega-cities in many cases has not been structured. Large slum areas trace the outskirts of cities like São Paulo and in Lagos, Nigeria, urban development and planning has utterly failed to keep pace with population growth. Indeed, in some countries over 90% of urban residents now find themselves living in shanty towns and slums and by 2030 the number of people living in such places globally will reach almost 2 billion. These urban poor are always at risk of disease.
Conditions in slums are often squalid, with open sewage and overcrowded housing. With such conditions disease is easily spread. Tuberculosis thrives in overcrowded, poorly ventilated places and without proper sewage systems cholera becomes a major concern. Research from the University of Otago, New Zealand, has already shown that every 1% increase in overcrowding can lead to an 8% increase in TB incidence in that housing block. Without proper planning and infrastructure cities quickly become the epicentres of disease. In an increasingly globalised society diseases now have potential to rapidly propagate from city to city with tourism and migration.
Our knowledge of sexual and reproductive health in mega-cities is slowly increasing and a clearer picture of the impact mass urbanization has on sexually transmitted disease has now come to light. The results are not promising; urban poverty has been linked to high rates of unintended pregnancies and STIs and HIV has boomed in urban centres. In some cities HIV rates are so extreme that they compare to the national HIV figures of some countries. Although the situation varies from country to country, data has shown that even in countries that are still mostly rural, cities tend to have a disproportionately high prevalence of HIV. The city of Monrovia in Liberia for example is home to 80% of the people living with HIV nationally.
Young urban dwellers are particularly at risk. In Kampala, Uganda, a recent study showed that 20% of girls and 13% of boys were infected with at least one sexually transmitted disease. Furthermore, city environments can put young women at risk of sexual abuse and violence. In Tanzania for example, for one fifth of girls in urban centres their first sexual experience was forced, and as a result HIV rates for girls were double that of their peers in the countryside (UNFPA 2012).
Cities can also act as hubs for the sex trade. Young people frequently move to the city to provide income for their family; if they don’t find work, they can be drawn into commercial sex as a way of making money. Far from their homes, migrant workers can feel isolated and become vulnerable to risk behaviours like unprotected sex with multiple partners—several papers have indicated that China’s millions of rural-urban migrants are contributing to the country’s AIDS epidemic.
Some cities have also developed reputations for “sex tourism”; Bangkok for example is infamous for its brothels and sex workers there are known to have high rates of HIV. Bangkok is also a major destination for sex trafficking. Women and children are regularly taken from rural areas and trafficked into the urban sex trade, where exploitation and abuse are rife—in Southeast Asia as many as 250,000 women are thought to be trafficked each year. Many come from poor villages and are lured with promises of a good job in the city. The risk of STIs, including HIV is extremely high among trafficked women, since many are forced to have unprotected sex with many customers and are especially vulnerable to violence and rape. In Cambodia, the United Nations Development Program found that over 70% of trafficking survivors had a sexually transmitted infection. Trafficked women are furthermore extremely difficult to access with reproductive health care and education programs. They are often marginalized within communities and are given little access to outside health care by their exploiters.
In general, knowledge of STIs and sexual health tends to be higher in cities than in rural areas and people use condoms more frequently. Urban residents are more exposed to advertising campaigns for disease prevention and health clinics are more local. There are therefore clear opportunities for prevention in urban areas, which are simply not possible in rural areas. However, there are strong disparities between richer and poorer urban areas when it comes to reproductive health. In India, contraception use has been shown to be far lower in slums compared to other urban districts. It is these areas that are in the greatest need of public health interventions and disease education and far more must be done to reach these marginalized communities. The huge expansion in urbanisation has changed the face of everyday living and will continue impacting on the health profiles of urban inhabitants. Sexual health needs to become a major consideration for town counsels to prevent more infections in the future.
About the author: Elizabeth Maclean is a Research Officer at the International Centre for Migration Health and Development in Geneva, Switzerland.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.
