HIV risk behaviours among contracted and non-contracted male migrant workers in India: potential role of labour contractors and contractual systems in HIV prevention

Abstract

To assess the HIV risk behaviours of male migrant contracted and non-contracted labourers in India and to understand the role of contract labour systems for use in HIV prevention efforts. Cross-sectional surveys (N = 11 219) were conducted with male migrant workers, aged 18-49 years from 21 districts in four high HIV prevalence states of India. Analyses involved data from the subsample of contracted labour (n = 3880; 35% of total sample) to assess the prevalence of HIV risk behaviours and sexually transmitted infection (STI) symptoms and further comparisons with non-contracted labourers. Contracted male labourers are largely young; 70% were between the ages of 18 and 29 years. Over half (55%) were married, and a third (34%) resided away from their wives because of migrant work. More than one in six contract labourers (17%) reported having sex with a sex worker, and two-fifths of these reported an inconsistent use of condoms. One in 10 reported sex with both sex workers and non-spousal unpaid female partners in the past year in the places they had migrated to, and 31% reported sex with either a sex worker or non-spousal unpaid female partner in their places of origin over the past 2 years. After adjustment for sociodemographic characteristics, the contracted labourers were significantly more likely to report alcohol use and HIV risk behaviours than non-contracted labourers. The existence of a wide network of labour contractors and a structured infrastructure of the contract system provides opportunities for effective and sustained worksite HIV prevention programmes among contracted male migrant workers in India.