Programs developed by India's National AIDS Control Organization and its partners have reduced the number of new annual HIV infections by more than 50 percent over the past decade. However, in some districts where HIV was previously rare, HIV incidence has slowly increased in recent years. Men from many of these districts migrate to other states to work (a practice called out-migration). These migrants experience long separations from their wives and may be more likely to engage in transactional sex.
A recent landmark study by the Population Council, the first of its kind in India, examined the role of migration in HIV transmission. In response to study findings, the Population Council worked closely with India's government and other partners to overhaul national policies and programs aimed at reaching people who migrate in search of work.
The Council's study was undertaken in three major corridors of migration: from Ganjam in Orissa to Surat in Gujarat, a distance of more than 1,000 miles (1,600 kilometers); from northern Bihar to Delhi and Haryana, a distance of nearly 700 miles (1,100 kilometers); and from eastern Uttar Pradesh to Thane in Maharashtra, a distance of more than 1,000 miles (1,600 kilometers). These travel corridors were characterized by extensive sex work activity and high HIV prevalence among female sex workers. The researchers, led by Population Council demographer and biostatis tician Niranjan Saggurti, surveyed roughly 800 married men (migrants and nonmigrants) and women from each of these three migration corridors.
Groundbreaking data on male migrant HIV risk behavior
The study showed that in northern Bihar, odds of HIV infection were eight times higher among migrant men than nonmigrant men, after controlling for possible confounding factors. In eastern Uttar Pradesh and Ganjam districts, migrant men were almost four times more likely to be infected with (or to have contracted) HIV than nonmigrants. The survey of women from the three study areas also showed that the odds of HIV infection were higher among women with migrant husbands than among women with nonmigrant husbands.
The researchers found that even when they return to their hometowns, migrant men were more likely than nonmigrant men to engage in unsafe sexual behavior, which raises their risk and their wives' risk of HIV infection. On the basis of these findings, India adopted a national HIV prevention strategy that focuses on corridors of migration, which include hometowns, destinations, and the transit points between them, rather than the destination areas alone.
Quantifying the role of migration in the spread of HIV
Council researchers found that in areas from which men migrate to find work, one-half to three-quarters of HIV infections among both men and women can be attributed to transmission from male migrants. …