Male migration and risky sexual behavior in rural India: is the place of origin critical for HIV prevention programs?

<p>Abstract</p> <p>Background</p> <p>Recent studies of male migrants in India indicate that those who are infected with HIV are spreading the epidemic from high risk populations in high prevalence areas to populations in low prevalence areas. In this context, migrant men are believed to initiate and have risky sexual behaviors in places of destination and not in places of origin. The paucity of information on men's risky sexual behaviors in places of origin limits the decision to initiate HIV prevention interventions among populations in high out-migration areas in India.</p> <p>Methods</p> <p>A cross-sectional behavioral survey was conducted among non-migrants, returned migrants (with a history of migration), and active (current) migrants in rural areas across two districts with high levels of male out-migration: Prakasam district in Andhra Pradesh and Azamgarh district in Uttar Pradesh. Surveys assessed participant demographics, migration status, migration history, and sexual behavior along the migration routes, place of initiation of sex. District-stratified regression models were used to understand the associations between migration and risky sexual behaviors (number of partners, condom use at last sex) and descriptive analyses of migrants' place of sexual initiation and continuation along migration routes.</p> <p>Results</p> <p>The average age at migration of our study sample was 19 years. Adjusted regression analyses revealed that active migrants were more likely to engage in sex with sex workers in the past 12 months (Prakasam: 15 percent vs. 8 percent; adjusted odds ratio (aOR)=2.1, 95% CI 1.2-3.4; Azamgarh: 19 percent vs.7 percent; aOR=4.0, 95% CI 2.4-6.6) as well as have multiple (3+) sex partners (Prakasam: 18 percent vs. 9 percent; aOR=2.0, 95% CI 1.3-3.2; Azamgarh: 28 percent vs. 21 percent; aOR=1.9, 95% CI 1.2-3.0) than non-migrants. Contrary to popular belief, a high proportion of active and returned migrants (almost 75 percent of those who had sex) initiated sex at the place of origin before migrating, which is equivalent to the proportion of non-migrants who engaged in sex with sex workers as well as with casual unpaid partners. Moreover, non-migrants were more likely than migrants to engage in unprotected sex.</p> <p>Conclusion</p> <p>Findings of this study document that returned migrants and active migrants have higher sexual risk behaviors than the non-migrants. Most migrants initiate non-marital sex in the place of origin and many continue these behaviors in places of destination. Migrants’ destination area behaviors are linked to sex with sex workers and they continue to practice such behaviors in the place of origin as well. Unprotected sex in places of destination with high HIV prevalence settings poses a risk of transmission from high risk population groups to migrants, and in turn to their married and other sexual partners in places of origin. These findings suggest the need for controlling the spread of HIV among both men and women resulting from unsafe sex in places of origin that have high vulnerability due to the frequent migratory nature of populations.</p

HIV transmission among married men and women in districts with high out-migration in India: Study brief

This brief describes a study examining the links between male out-migration and HIV transmission among married men and women and other mechanisms by which HIV is transmitted within marital relationships in districts with high out-migration

Migration/mobility and vulnerability to HIV among male migrant workers: Maharashtra 2007-08

HIV prevalence in Maharashtra is one of the highest among Indian states. The specific objectives of this study were: to understand the patterns and drivers of migration/mobility of men who migrate for the purpose of work in the state of Maharashtra; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men with particular emphasis on the role of mobility in determining the sexual risk behavior. The present study clearly demonstrates that these male migrants, married or otherwise, retain strong connectivity to their native villages, but also show high levels of sexual activity—including significant levels of high-risk sexual activity—making it imperative to study the situation in the sending districts regarding HIV prevalence and spread. The indication from this study is clear: in the context of high-risk sexual behavior (among both married and unmarried migrants) and the low levels of knowledge, condom use, and risk perception, the chances of sending households and districts becoming areas of high HIV prevalence are great. Further exploration of the sexual behavior pattern in sending areas is necessary to obtain additional insights into the possible routes of HIV transmission

Migration and HIV in India: Study of select districts

Report of a study assessing the important role of migration in the spread of HIV in districts with high out-migration in India. The study suggests a considerable spread of HIV linked to migrants’ extramarital sexual behaviors, and subsequent delay in treatment for infected spouses. In order to control the spread of HIV, the study provides programmatic recommendations made by the study participants and the counselors from ICTCs and ART centers. These suggestions include village-level mapping of at-risk persons, mainstreaming HIV prevention interventions within current health resources, improving various village level HIV prevention programs, and involving women left behind by migrant spouses to participate in these programs

Migration/mobility and vulnerability to HIV among male migrant workers: Karnataka 2007-08

The present study was undertaken by the Population Council and the Karnataka Health Promotion Trust to study the patterns and factors driving migration among men and the extent to which they engage in high-risk activities associated with HIV. The specific objectives of the study were: to understand the patterns and factors driving the migration of men seeking work in the state of Karnataka; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men, with an emphasis on their mobility as one possible factor. Results suggest no relationship between degree of mobility and risky sexual behaviors among the migrants surveyed, and no systematic pattern of a relationship between condom use with the various types of sex partners and degree of mobility, indicating the need for HIV-prevention initiatives in their home areas as well as in their work destinations. Future research is needed to improve understanding of the behavior of men working in specific occupational groups in terms of their sexual networks and HIV-prevention needs

Intimate partner violence and condom versus other modern contraception use among married women in rural India

Background: Data from India document that spousal intimate partner violence (IPV) is associated with both unintended pregnancy and spacing contraceptive use. Analysis of IPV by type of contraception is lacking. Condom use may be less likely than other spacing contraception in the context of IPV, as it is under male control. This study aims to assess associations of physical and sexual IPV with condom and other contraception use among married women in rural India. We hypothesize that women reporting physical and sexual IPV victimization are significantly less likely to report condom use but not other contraception use, relative to women reporting no such victimization. Methods: Study participants were from the randomized control trial evaluation of CHARM, a male-centered family planning intervention for young married couples in rural Maharashtra, India. Baseline data from women (age 18-30, residing with husbands) were used for analyses; data were restricted to those who were not pregnant at interview (n¼867). Surveys assessed socio-demographics, husband’s physical and sexual IPV perpetration, and an item on primary form of contraception used by women in the past 3 months (subsequently categorized as none, condom, other modern spacing contraception). Multinomial logistic regression analyses assessed associations between past 6 month physical and sexual IPV and contraceptive use, adjusting for age, education, length of marriage, caste, parity, and husband’s alcohol use. All participants provided written informed consent; all study procedures were approved by Institutional Review Boards at UCSD, and ICMR. Findings: Participants were aged 18-30 (SD: 2.5), and 17% reported no formal education.12% and 4% of women reported past 6 month physical 218 Social and Environmental Determinants of Health and sexual IPV, respectively. The majority (72%) reported not using any modern spacing method of contraceptive in the past 3 months; 14% reported condom use and other modern spacing contraception, respectively. Physical IPV was significantly associated with condom use (AOR: 1.89, 95% CI: 1.04, 3.28) but not other contraception use. Sexual violence was associated with other modern contraceptive use (AOR: 2.78, 95% CI: 1.11, 7.00), but not condom use. Interpretation: Women contending with sexual violence were more likely to engage in other modern contraceptive use but not condom use. This finding may indicate that women contending with sexual violence may depend on forms of contraception more within their control. To our knowledge, this study is the first of its kind to examine such associations between IPV and contraception use by type of method. These findings are limited due to the cross-sectional nature of the data, and are not generalizable to the larger population of women in India. Further research is needed to explain the association between recent physical IPV and condom use, a finding inconsistent with prior research

Patterns of migration/mobility and HIV risk among female sex workers: Tamil Nadu 2007-08

In past years, considerable research has been undertaken on the role of female sex workers (FSWs) in the transmission of HIV infection. FSWs have been seen as a major “source” of infection, and consequently, have been extensively targeted to prevent its spread. There is, however, a gap in our understanding of the dynamics of sex work, sex workers\u27 patterns of mobility, and the relationship of such mobility with risk of HIV infection and gender-based violence. The Population Council collaborated with its local partner, TNS, to carry out a study in Tamil Nadu to examine the patterns of mobility of FSWs and to study its links with HIV risk. The goal was to provide research-based evidence to inform the formulation of policies and to improve the implementation of programs. Results presented here describe the patterns and drivers of sex workers\u27 migration at their destination points, intermediate points, and points of origin, and their connection to high-risk activities in Tamil Nadu

Migration/mobility and vulnerability to HIV among male migrant workers: Andhra Pradesh 2007-08

The Population Council, in collaboration with TNS India Pvt. Ltd., undertook a study in Andhra Pradesh, India, to examine the patterns of male migration and its links with HIV risk. The goal was to provide evidence to inform the design and implementation of HIV interventions for male migrant workers. The study documented the volume and patterns of mobility, including the social dynamics within the contract system that employs these men as laborers, and the sexual risk behaviors and addictive behaviors of male migrants. The results suggest a predominance of interdistrict movements of men within Andhra Pradesh with a strong positive association between individuals\u27 degree of mobility and their sexual behavior. Moreover, an increase in degree of mobility is linked to inconsistent or nonuse of condoms, and there is limited knowledge of HIV infection among these recent male migrants. The study shows that there is a clear need for implementing interventions to prevent HIV infection in migrant workers and the authors of this report recommend the use of work-contract systems for delivering HIV-prevention interventions

Migration/mobility and vulnerability to HIV among male migrant workers: Tamil Nadu 2007-08

The present study was undertaken by the Population Council in partnership with Annamali University, Tamil Nadu, India to study the broad patterns and motivating forces driving migrant men’s mobility and the contexts that determine and influence their engaging in high-risk activities that increase their vulnerability to HIV. The results indicate large interdistrict movements of working men in Tamil Nadu with a little variation across districts and greater mobility among younger men. Research results suggest that further examination of the contract system under which many of the migratory laborers work is a potential focus for program intervention. Places of origin offer another possible point of intervention because of the workers’ strong connections with their home districts

Patterns of migration/mobility and HIV risk among female sex workers: Karnataka 2007-08

In Karnataka, South India, HIV infection is spreading, with female sex workers (FSWs) a high-risk group. In an effort to gain control over the epidemic, the HIV/AIDS program has made substantial efforts in the last few years toward offering FSWs access to information about sexually transmitted infections/HIV/AIDS and to condoms, clinics, and other medical services. The present study was undertaken by the Karnataka Health Promotion Trust and the Population Council to determine the patterns and factors that drive mobility among FSWs and the association of mobility with HIV risk. The report’s findings—including mobility routes, sociodemographic profiles of FSWs, membership in self-help groups and collectives, and locations for soliciting—will be used to help increase the impact of program intervention