Abstract
Historically, HIV prevention efforts in Nepal have primarily focused on heterosexual transmission, particularly, among female sex workers and their male clients, with little acknowledgment of the contribution of migrant workers to the epidemic. The very few HIV prevention efforts that have been attempted with migrants have been unsuccessful primarily due to stigma, discrimination, and insufficient availability of culturally relevant evidence-based interventions (EBIs). As an initial step toward addressing this unmet need, we conducted formative research aimed at adapting an evidence-based HIV risk-reduction intervention for implementation among migrants in Nepal. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews with members of the target population and key stakeholders. Between July and August, 2014, we conducted structured one-on-one interview with migrants (n = 5) and key stakeholder (e.g., counselors, field workers, and project coordinator; n = 5), which focused on the HIV risk profiles of the migrants and on ways to optimize intervention content, delivery, and placement within the community-based settings. Data analysis followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis, cross-case analysis, and analytical coding of textual data. Based on formative research, we adapted the Holistic Health Recovery Program, an EBI, to consist of four 30-min sessions that cover a range of topics relevant to migrants in Nepal. The intervention was adapted with flexibility, so that it could be provided in an individual format, implemented within or outside the community-based organization, and it can be delivered in either consecutive or weekly sessions based on time constraints. This paper provides a detailed description of the formative research process in preparation for the adaptation of an EBI - taking into account both empirical evidence and input from target population and key stakeholders - for use with migrants in Nepal. We hope that this study will help to inform similar work in the future as a growing number of EBIs have become widely available, but may not yet be in optimal form for implementation in real-world community-based settings.
Highlights
The migration of people across national borders for employment purposes is a growing phenomenon and an increasingly important aspect of global, regional, and national economies (1)
The results of this formative study suggest that there is a great need for HIV risk-reduction interventions, primarily focused on sex-related risk reduction, tailored for migrant workers in Nepali context
This paper provides a detailed description of the formative research process in preparation for the adaptation of an evidence-based interventions (EBIs) – taking into account both empirical evidence and input from target population and key stakeholders – for use with migrants in Nepal
Summary
The migration of people across national borders for employment purposes is a growing phenomenon and an increasingly important aspect of global, regional, and national economies (1). Several studies have documented that migrants have a higher rate of sexual risk behaviors (2–8) and drug use behaviors (2, 3, 7–9), leading to their increased vulnerability to HIV infection. HIV transmission from high-risk populations to migrant workers and, in turn, to their native sexual partners is accelerating globally. It is widely believed that migrants tend to acquire infection at destination countries because of their engagement in risky behaviors. Upon return to their home country, they continue to have sexual contact with their partners, serving as a bridge population for spreading HIV from destination areas to their place of origin (3, 10). As an initial step toward addressing this unmet need, we conducted formative research aimed at adapting an evidence-based HIV risk-reduction intervention for implementation among migrants in Nepal
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