Living with HIV on the move: migrant workers in north India

Complex routes into HIV care for migrant workers: a qualitative study from north India.

Rai T, Lambert HS, Ward H. AIDS Care. 2015 Nov 26:1-6. [Epub ahead of print]

Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.

Abstract access [1]

Editor’s notes: Migrant workers who move for work in their own country face challenges in accessing health care and social support. In a country as large and diverse as India internal migration can be particularly taxing. For people living with HIV, or who acquire HIV while migrating for work, the challenges can be immense. This paper sets out concisely the issues these migrants face, trying to access information, treatment and support both in the place they move to and at home. The authors explain how migrant men might delay treatment because of their need to work, and perhaps also to keep their HIV-status secret. For the wives of migrants, this delay can severely affect their own access to health care. Free antiretroviral therapy is available, but as the authors suggest, many migrant workers do not know that. This lack of knowledge highlights the importance of providing better support for migrant workers. Support for access to free, or at least affordable, health care is something many migrant workers require; for migrant workers living with HIV that support is essential.

Asia [8]
India [9]
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