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

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.

Inequalities in addressing the HIV epidemic: the story of the Indonesian Ojek community

“…Globally, general mobility patterns, including migration, have also been reported as determinants of susceptibility to the HIV infection (UNAIDS, 2001;IOM, 2003;ADB, 2008;Anh et al, 2008;Halli et al, 2008;Saggurti et al, 2011). Mobility and/or migration, including migration to another country for any reason, have each been associated with significant challenges, such as economic pressure, discrimination and social isolation.…”

Men’s Heavy Alcohol Use and Risk of HIV Acquisition and Transmission to Sexual Partners within Marriage in India

“…The relationship between men's heavy alcohol use and wife's HIV sero-status persisted even after controlling for socio-demographic and other characteristics. Results of the association between men's heavy episodic drinking and their wife's HIV sero-status provide empirical evidence for suggestions made in studies in India and South Africa that husbands are more likely to be infected with HIV than their wife in discordant couples and are more likely to transmit HIV to their spouse in the presence of vulnerability factors [16,[18][19][20].…”

“…A study conducted in STI clinics in Mumbai, India documents an increased risk of HIV and other STI among men who reported consuming alcohol before visiting a female sex worker [5]. Investigation into the linkages between heavy episodic drinking and HIV acquisition and transmission is particularly important in the Indian context, especially in light of an increasing trend of alcohol use by the general population [3] and the presence of a number of HIV sero-discordant couples in the general population [16]. Therefore, this study examines whether married men's heavy episodic drinking is associated with their sexual risk behaviors, their HIV serostatus and their wife's HIV sero-status.…”

Spatial distribution and cluster analysis of risky sexual behaviours and STDs reported by Chinese adults in Guangzhou, China: a representative population-based study

“…Worldwide, epidemiological studies observed a high prevalence of risky sexual behaviours among immigrants. 21 In China, rural-to-urban migrants may have different sexual norms, and limited knowledge about either contraception and reproductive health or protection against STDs/HIV, which suggests that migrants are particularly vulnerable to STDs. 22 In addition, most migrants who move to urban regions without their families may cohabitate with rural companions, and an estimated 52% may have temporary husbands or wives to search for social support, which may increase risk of STD/HIV transmission.…”