Brief Abstract

In the Achham district of western Nepal, poverty has caused a great number of men to migrate to India for temporary employment. This is of great concern to HIV/AIDS and STD treatment and prevention organizations. The increased mobility could contribute to the spread of HIV infection because migrants, due to poverty and unemployment, are more likely to become infected with HIV.

This study, conducted in 2002, was carried out to determine the rate of HIV/STD infection among both migrant and non-migrant males from the Sanfebagar valley of the Achham district. The study measured the relationship between HIV prevalence rates and risk behavior and ascertained the link between migration and HIV/STD transmission in the area.

HIV infection rate surpasses 2%

The overall HIV prevalence rate among the study participants was more than 2%. International migrants had the highest rate of HIV infection (3.7%), followed by internal (3%) and non-migrant subgroups (0.7%). The rate of HIV among the international migrants was associated with the prevalence of STDs and places they visited. Similarly, the prevalence of any STD was significantly associated with contact with sex workers.

Other findings included:

• One in every eight participants currently had some form of STD, and this had a positive correlation with HIV transmission. Herpes was the most prevalent STD, 8.9%.
• Alcohol use during migration was more frequent among HIV infected participants than others.
• The risk of HIV transmission from infected males to non-infected partners was extremely high (After returning home to the Achham district, none of the HIV infected males used condoms during sex with their wives).

In-depth behavioral study recommended

Because of the high risk of HIV transmission from males to their wives, researchers called for a new in-depth study on extramarital, multiple, exogamous, and illicit sexual behavior of the local people. Understanding this behavior and how to change it could benefit future HIV intervention programs. 

Other recommendations included:

• Periodic identifying and monitoring migrants returning from Maharastra, specifically Mumbai, and Hariyana, Gujrat, and Orrisa of India. These migrants should be targeted for HIV/STD control and awareness programs that include rapid diagnosis, couple-counseling, and treatment activities.
• Focus outreach and awareness programs on the extremely high risk of contracting HIV/STDs from sexual contact with sex workers in India, especially in Mumbai.
• Launch an intensive educational program covering the consistent use of condoms during sex with sex workers in both India and Nepal.

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