Mobility, migration, and HIV: not always what you assume

The Silk Road health project: how mobility and migration status influence HIV risks among male migrant workers in central Asia. 

El-Bassel N, Gilbert L, Shaw SA, Mergenova G, Terlikbayeva A, Primbetova S, Ma X, Chang M, Ismayilova L, Hunt T, West B, Wu E, Beyrer C. PLoS One. 2016 Mar 11;11(3):e0151278. doi: 10.1371/journal.pone.0151278. eCollection 2016.

Objectives: We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex).

Methods: We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics.

Results: Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants.

Conclusion: Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.

Abstract [1]  Full-text [free] access  [2]

Editor’s notes: The 14 participants selected as seeds in this respondent driven sampling (RDS) strategy generated two large chains that made up 90% of the recruited study sample of 1324 male labour market workers at the Baraholka Market in Almaty, Kazakhstan. An estimated one million labour migrants enter Kazakhstan each year from neighbouring Central Asian countries that lack employment opportunities. However they face stigma, discrimination, police harassment, and lack of access to services. Finding out whether they are resilient to risk of exposure to HIV and other sexually transmitted infections (STIs) or are more likely to acquire HIV/STIs is key to designing effective HIV prevention strategies in a country that saw HIV incidence rise 25% between 2001 and 2009. This study looked at associations between HIV and STI risk and mobility – defined as having travelled outside Almaty in the last 90 days. The study was among three groups at the market: external migrants, internal migrants, and non-migrants. The analysis adjusted for both sociodemographic and-structural risk environment factors (legal status, income, debt, policing, homelessness, loneliness, social support, access to medical care, and alcohol use). Overall, 5.2% were positive for any STI. These included 2.1% of external migrants, 7.5% of internal migrants, and 8.8% of non-migrants. The authors hypothesise that mobility was not associated with increased STIs and a range of risk behaviours in external and internal migrants because these men travel primarily to visit their families and because they are goal-oriented and focused on fulfilling their roles as major wage earners for their families. These findings are in contrast to those of other studies that suggest that migrants are at higher HIV risk and challenge perceptions of migrants as a source of disease transmission within host countries. They underscore the importance of prevention strategies in unique venues such as markets, including peer-led prevention messaging, mobile clinics, and confidential HIV/STI testing. However, to address the factors that put migrants at risk for HIV, the authors argue for labour agreements, a legal registration process, and other measures to sustain their rights, prevent violence against migrants, and reduce marginalisation. 

Stigma and social exclusion [4]
Asia [5]
Kazakhstan [6]
  • [7]