Abstract
BackgroundRecent 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.MethodsA 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.ResultsThe 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.ConclusionFindings 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.
Highlights
In the context of global industrialization and urbanization, migration for work is increasing around the world [1,2,3]
A number of studies have documented that migrants have higher risky sexual behaviors than non-migrants [4,5,6,7,8,9,10,11,12] and that they serve as bridge population for spreading HIV from destination areas to their place of origin [13,14,15,16]
A recently conducted study in the southern states of India of male migrants at their place of destination found that more than 30 percent had sex with women who were not their married partner in the place of origin [1,22] and about 10 percent had sex with sex workers. These results suggest that sex with sex workers is not limited to the city/town where migrant men work; rather such practices exist in the place of origin; it is not known whether these men initiate such risky behaviors in the place of destination or the place of origin
Summary
In the context of global industrialization and urbanization, migration for work is increasing around the world [1,2,3]. Such research studies in India as well as other parts of the world suggest that migrants initiate and engage in risky sexual behaviors in places of destination due to separation from their family and spouse for extended periods [21,23,26,28,29], isolation coupled with loneliness [26,29], socio-cultural norms and the anonymity of living in a city [21,26,30], illegal residential status [29] and the nature of work [23,26,29] These studies recommend that the destination areas and the work place are appropriate sites to reach migrant workers with HIV prevention interventions. 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
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