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Resource centre on India's rural distress
 
 

HIV 10 times more prevalent among migrants than general population by Kounteya Sinha

Migration is fuelling India's HIV epidemic. National AIDS Control Organisation's latest figures show that besides high risk populations like sex workers, the highest burden of HIV is among migrants - 3.6%, which is 10 times the HIV prevalence among the general population. 

With migration rates increasing, the prevalence will only get worse. According to the 2001 census, 30.1% of the population was considered to have migrated (314 million) - a considerable increase from 27.4% in 1991. NACO has, therefore, identified 108 railway stations - which are both source and destination of migrants travelling in search of work. These are now the focus of the country's anti-HIV fight. 

Red Ribbon Express (RRE), which chugs out of Delhi on Thursday, will stop at most of these 108 identified stations to test migrants for HIV besides carrying out counselling and spreading anti-HIV messages. During it's year-long journey, RRE will traverse through 23 states, cover 30,000 km and stop at 162 stations. 

Speaking to TOI, a NACO official said, "Migrants are one of the major focus areas this time with the RRE. Last year, RRE stopped at 152 stations and reached out to 8 million people directly. This time, around 30-40 stops will be to mainly address migrants." 

NACO has identified 122 districts with high out-migration across 11 states which are on priority for starting up community level interventions. Another 75 important transit locations have been identified across these 122 districts from where these migrants usually board long distance trains/buses to reach their destinations. 

Studies on the relationship between migration and HIV conducted by NACO in three popular migration corridors - Ganjam-Surat, Darbhanga-Delhi and Azamgarh-Mumbai - threw up shocking findings. It showed that two to four times more number of informal workers had non-regular partners or visited sex workers with only 25% using condoms. Around 5% male migrants and 13% female migrants reported sexually transmitted infections, nearly double the national average. 

According to NACO, the risk of HIV infection for migrants seems to arise from a multitude of factors -- risky behaviour, lack of social and economic security and involvement in peer driven risk taking activities. 

In a recent study by UNDP (through Population Council), the risk of HIV among migrants was reported to be 1.68 times more likely than non-migrants. Majority of migrants are also often poorly educated, with majority reporting less than five years of formal education. This contributes to limited knowledge of HIV transmission. 

A study conducted in 30 villages in the northern parts of Karnataka revealed that 40% of single men and 35% of married migrant men had non-marital sexual relationships in the last 12 months. 

For a long time, India has lived with the belief that migrants are at risk only at destination sites when they are away from home and their spouse. However, recent evidence proves otherwise. Returned migrants continue to fuel the epidemic since most infected migrants tend to return to source when they are sick. 

A study of married men found returned migrants were 3.86 times as likely to be HIV positive as compared to active married migrant men. Among men reporting sex with a non-spousal unpaid female sex partner in the past year, only 19% of men reported consistent condom use. This impacts the women and spouses of informal workers/migrants at the source, making them vulnerable to infections from their husband. 

RRE has been recognized as the world's largest mass mobilization drive on HIV. Last year, around 80 lakh people were reached through the train and outreach activities. 

Around 81,000 district resource persons were trained, 36,000 people got themselves tested for HIV and 28,000 people received general health check-up services. 

Impact assessment of RRE indicated that the comprehensive knowledge of routes of HIV transmission, methods of prevention, condom use, STI prevention and treatment was significantly higher among respondents exposed to the RRE project compared to those not exposed.