Understanding HIV-Related Risk Behaviors Among Returnee Male Migrant Workers in Nepal

Background: Migration of Nepali workers to India is a longstanding phenomenon. Studies have indicated that migrant workers are at higher-risk of HIV infection due to their engagement in unsafe sexual and substance use behaviors, while abroad. This study aims to evaluate the possible association between migration and increased prevalence of HIV-risk behaviors among Nepali migrant workers and their vulnerability to HIV/AIDS. Methods: A cross-sectional study was conducted among male migrant workers (n=40) in Dhanusha district of Nepal - a neighboring region to India with high levels of male-out-migration. The interview questionnaires assessed participants’ socio-demographics, migration characteristics, loneliness, HIV/AIDS knowledge and HIV-risk behaviors. For data analysis, descriptive statistics were used for all variables and chi-square test, odds ratio and 95% CI were used to assess the association between the variables. Results: Most of the respondents were in the age group of 35-44 years (mean=34 years). Nearly half (45%) had migrated before age of 20 years. Mumbai and Delhi were the most common cities of destination, where HIV-prevalence among sex-workers is high. The participants had a moderate level of HIV/AIDS knowledge (mean=70% of correct answers out of 16 questions). The majority of migrants (77%) reported feeling either extremely or moderately isolated. Forty percent of the respondents had their first sexual encounter at an early age (15-19 years). While in India, about two-thirds (65%) of them had sex with female sex workers (FSWs) with an average of four FSWs visitation per migrant. Only 15% of the respondents consistently used condom and lack of knowledge about safe sex was the main reason for not using a condom. Of the total respondents, 20% of them reported having sex with FSWs after drinking alcohol and 17% of them after taking illegal drugs. The level of HIV-risk behaviors varied significantly according to socio-demographic and migration characteristics, social isolation, and HIV/AIDS knowledge and attitudes. Conclusions: The findings suggest that migrant workers are a high-risk group due to various HIV-related risk behaviors. Thus, there is an urgent need for effective HIV/AIDS programs directed toward migrant workers in order to reduce the risk of spreading HIV in Nepal