Population Mobility and Spread of HIV across the Indo-Nepal Border

By Nepal, Binod | Journal of Health Population and Nutrition, September 2007 | Go to article overview

Population Mobility and Spread of HIV across the Indo-Nepal Border


Nepal, Binod, Journal of Health Population and Nutrition


ABSTRACT

The article reviews information on the epidemiology of HIV/AIDS and behavioural networking to examine through a systematic search of electronic databases and web-based information resources, and the review focuses on studies about types of the virus, prevalence of HIV, and sexual and injecting networking. HIV-1 (subtype C) and HIV-2 were identified in Nepal. The prevalence of HIV was higher among male labour migrants and female sex workers (FSWs) who returned from India, especially from Mumbai, than in similar non-migrant groups. In the early 2000s, about 6-10% of Mumbai returnee men, compared to up to 4% of India returnee men and up to 3% of non-migrant men in the far-west Nepal, were identified with HIV. Like-wise, when the prevalence of HIV among sex workers in Kathmandu was found to be 17% in 1999-2000, up to 44% of India returnee and 73% of Mumbai returnee FSWs were identified with the virus. These data are, however, based on small samples with questionable representativeness of the target populations and need to be interpreted cautiously. They also generate a biased impression that HIV was coming into Nepal from India. Recently, the possibility of a two-way flow of HIV across the Indo-Nepal border through injecting and sexual networking have been indicated by serological and behavioural data from a south-eastern cluster of Nepal and a north-eastern district of India. Although similar behavioural networks exist along other segments of the border, serological data are unavailable to assess whether and how extensively this phenomenon has caused the spread of HIV. Collaborative research and interventions covering both sides of the border are desirable to fully understand and address the prospect of HIV epidemics associated with cross-border population mixing.

Key words: Acquired immunodeficiency syndrome; Disease outbreaks; HIV; Injectingdruguse; Migration; Injecting drug use; Sex behaviour; India; Nepal

INTRODUCTION

It has long been assumed that cross-border migration of adult Nepalese, especially the migrants returning from India, could significantly contribute to the HIV/AIDS epidemic in Nepal (1-5). To address this challenge, by the mid-1990s, a few prevention programmes, including cross-border collaborative interventions, were initiated (6). However, the spread of the virus continued. In 1998, Seddon reviewed the status of, and responses to, the HIV/AIDS epidemic in Nepal and speculated that AIDS was an impending crisis in this impoverished country (3). He noted, "The rapid spread of HIV-AIDS in India is of major significance for the future development of the epidemics in its small northern neighbour, Nepal, given the constant movement of people between the two countries and the necessity for the Nepalese economy to maintain these links at all levels--national, regional, and household" (3).

Until 2002, little serological and behavioural data on migrants were published (7). A number of studies conducted in 2001 and later have been made publicly available. A synthesis of these studies will provide an opportunity to empirically assess the evolving connections between population mobility and the risk of HIV across the Indo-Nepal border.

This article reviews information on the epidemiology of HIV and behavioural networking to examine the role of population mobility in spreading HIV across the Indo-Nepal border. It draws data from studies on the molecular epidemiology of the virus, serological and behavioural surveys, and qualitative studies. The article examines the evidence on types of the virus, prevalence of HIV among major subpopulations with special focus on migrants, and cross-border sexual and injecting networking. Lack of representative and longitudinal study data is still a challenge to draw any firm conclusion on the evolution of the HIV/AIDS epidemic in Nepal and the role of mobility in this epidemic. Yet available evidence suggests that interlinked epidemics are evolving along the border areas and in some inland pockets where migration is common. …

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