Understanding HIV-risk behavior among migrants vs. non-migrant workers in Nepal

Background: Seasonal migration of Nepali workers to India is common in Nepal. Unsafe sex and alcohol/drug use behaviors of migrant workers, both in India and Nepal, has led to a high HIV-prevalence among this group. This study compared HIV-risk behaviors between migrant and non-migrant workers and examined the role of migration in HIV transmission in Nepal.

Methods: We conducted a cross-sectional study to assess HIV-related knowledge, attitudes and behaviors of migrant (n=20) and non-migrant (n=20) workers in Janakpur, Nepal - a neighboring region to India with high male-migration. We used migration-status stratified regression models to explore association between migration and various HIV-risk behaviors.

Results: Migrants were found to be significantly older than non-migrants (38-years vs. 29-years). Mumbai, Delhi, and Punjab were the most popular cities of destination, where HIV-prevalence among sex-workers is high. Compared to non-migrants, migrants were more likely to engage in sex with sex-workers (90% vs. 60%), have multiple sex-partners (85% vs. 60%), inconsistent condom use (“always-used-condom”: 0% vs. 35%), and drink alcohol before sex (55% vs. 35%). Among migrants who never used condom, “didn't think it was necessary” was the key reason for non-use. Migrants had substantial deficits in HIV/AIDS knowledge, and safe-sex skills vs. non-migrants. Post-migration social isolation was found to play a significant role in increasing HIV-risk behaviors.

Conclusions: Migrant workers tend to have greater HIV-risk behaviors vs. non-migrant workers. Thus, there is a need for comprehensive HIV/AIDS programs tailored to address migrant workers in order to reduce the risk of spreading HIV.