The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia.

Nabila El-Bassel,Gaukhar Mergenova,Sholpan Primbetova,Tim Hunt,Chris Beyrer,Louisa Gilbert,Brooke West,Stacey A Shaw,Elwin Wu,Leyla Ismayilova,Mingway Chang,Xin Ma,Assel Terlikbayeva,Shira M Goldenberg

doi:10.1371/journal.pone.0151278

Abstract

ObjectivesWe examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex).MethodsWe used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics.ResultsMobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants.ConclusionStudy findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.

Highlights

Low- and middle-income countries continue to witness mass internal and external labor migration and mobility[1, 2], which has been associated with risks for HIV and other sexually transmitted infections (STIs)[3]
This paper addresses some of the methodological shortcomings and research gaps in prior studies by examining the extent to which mobility is associated with HIV risks and STIs among a large respondent-driven sample (RDS) of three groups of male market workers in Kazakhstan after adjusting for potentially confounding migration risk environment factors and considering the interaction between mobility and migration status
The study findings have important HIV prevention implications, suggesting interventions and policies should be tailored to external, internal, and non-migrant workers, considering their unique set of mobility patterns and the structural factors that shape their risk for HIV/STIs

Summary

Introduction

Low- and middle-income countries continue to witness mass internal and external labor migration and mobility[1, 2], which has been associated with risks for HIV and other sexually transmitted infections (STIs)[3]. Research has identified higher rates of STIs and sexual risk behavior among labor migrants compared to non-migrant men[4,5,6,7,8]. HIV risk behavior and STIs among mobile migrant workers has been associated with several social, economic and policy risk environment factors such as unstable housing, poor living conditions, adverse employment situations, poverty, negligible access to health care services, lack of social support, loneliness, strict migration policies and policing[3, 14,15,16,17]. Research has yet to examine whether similar mobility patterns increase risk for HIV/STIs among comparable groups of non-migrants or internal migrants

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Conclusion