Can new policies reverse this trend?
Kounteya Sinha, Health Editor at the Times of India proposes that “mass migration is the greatest threat to India’s HIV control programme” and asks how this can be combatted.
India’s 2001 census showed that a third of the population are migrants (up from 27.4% in 1991). And worryingly, India’s National AIDS Control Organisation (NACO) found that they have a 3.6% prevalence of HIV, 10 times that of the general population.
In the Indian state of Maharashtra, studies from 2009 showed that 18.6% of migrants had sexually transmitted infection symptoms, of which 45% did not seek treatment. 76% did not even perceive any risk of HIV and as such, only 13% had been tested for the infection.
India’s health ministry fear HIV prevalence will worsen due to migrants’ “risky sexual behaviour”, lack of social and economic security and “risk taking activities”. Plus a recent study found that migrants were 1.68 times more likely to contract HIV than non-migrants.
Studies have shown that four times as many informal workers have casual sexual partners or visit sex workers, compared with those who are faithful to their spouses. Plus, only 25% of these workers use condoms, compared to 42% by others.
To combat this, NACO is implementing a new migration policy covering the main railway stations in India where migrants usually board long distance trains. The primary focus is on informal labourers with a high prevalence of HIV. NACO hope this programme will help to interrupt the transmission from rural migrants to high urban risk groups, but concludes that “language, cultural norms and available timings for migrants to access services” may present a challenge.
Personal View: “Mass economic migration: the greatest threat to HIV control in India”, Kounteya Sinha.
BMJ 2013;346:f474 doi: 10.1136/bmj.f474