Ensuring Access to HIV Treatment for Cross-Border Migrants in India from Bangladesh and Nepal

South Asia is home to over two million of the estimated 33.3 million people living with HIV (PLHIV) worldwide. Countries in the region are characterized as having epidemics that are concentrated amongst specific most-at-risk-groups (MARPS) including sex workers, injecting drug users, men who have sex with men and, increasingly, migrants. Many people from Nepal and Bangladesh migrate to India in search of work. Some migrants are HIV+ or become infected while working in India. A study was conducted to assess migrants' access to antiretroviral treatment (ART). Baseline research, using both quantitative and qualitative methods, was conducted between November 2010 and March 2011. Nepali and Bangladeshi migrant workers (N = 2,452) provided information pertaining to access to health services for migrants at source and destination points. The data indicate that migrants are unable to access ART unless they have a valid proof of residence – which most migrants lack. Moreover, migrants are reluctant to access government health and social services because of discriminatory attitudes and behaviors of staff. Many turn to private doctors or hospitals, despite their high costs, where staff offer impartial treatment. Because of the cost of care, many migrants self-medicate and delay treatment until they go home. Nevertheless, access to ART for cross-border migrants is not impossible in India even though channels to access services are complex or unknown to the migrants. Through facilitation of NGOs or PLHIV networks, CARE's EMPHASIS program is setting up a referral mechanism aiming at ensuring access to ART services for cross-border migrants.