Covariates of HIV/AIDS Prevalence among Migrants and Non-migrants in India

Migration has been considered as an important marker of HIV epidemic in any community due to its potential to bridge the risk of STI/HIV infection among low, moderate and high-risk population irrespective of the places of origin or destination. This paper aims to analyze various contextual and behavioral factors influencing pathways linking migration and HIV/AIDS using data collected as part of the third round of Indian Demographic and Health Survey (2005-06, NFHS-3). The age-adjusted prevalence of HIV/AIDS among migrants was 1.4 times higher (44%) as compared to non-migrants (32%). Youth were more venerable to have HIV/AIDS irrespective of their migratory status. Frequent alcohol use and high-risk sexual behavior among migrants were other cofactors increasing the vulnerability of HIV infection. Lack of comprehensive knowledge and stigma about HIV/AIDS were found to have positive impact on the prevalence of HIV/AIDS among migrants. These findings demonstrate that the HIV prevention policy instruments should focus on addressing risky sexual behavior of migrants, especially among youth irrespective of their migratory status and they should be capacitated with knowledge and stigmas about HIV/AIDS. Introduction According to the Sustainable Development Goals, the world has committed to ending the AIDS epidemic by 2030. Annual HIV/AIDS-related deaths have decreased by 43%. The most affected region in the world is eastern and South Africa. Globally, 36.7 (34.0-39.8) million people were living with HIV/AIDS, 2.1 (1.8-2.4) million people newly infected with HIV/AIDS and 1.1 (94000-1.3) million people died from AIDS-related illnesses at the end of 2015. People infected with HIV/AIDS since the start of the end of 2015 is 78 million and 35 million people died from AIDSrelated illnesses since the beginning to of the end of 2015 (UNAIDS, 2015-16). In Asia and Pacific region, 5.1 (4.4-5.9) million people were living with HIV/AIDS, 300000(240-380) new HIV infections in the region and 180000 (150000-220000) people died of AIDS-related causes at the end of 2015. New HIV infections declined by 5%, and the number of HIV/AIDS-related deaths decreased by 24% from 2010 to 2015 (UNAIDS, 2015-16). In India, people living with HIV/AIDS have a share of 6% of total world HIV/AIDS patients and 8% of whole world HIV/AIDS-related deaths. India is the fourth largest country in the world that had persons living with HIV/AIDS and the third largest country for HIV/AIDS-related deaths. Indian contribution in Asia Pacific region is 43% of total persons living with HIV/AIDS, 51% of HIV/AIDSrelated deaths and 38% of total new infection till 2013 (UNAID Gap report, 2014). HIV prevalence among adults (15-49 years) in 2016 is estimated at 0.26% (0.22%-0.32%), among males 0.30% and among females 0.22%. The adult HIV prevalence at national level has continued its steady decline from an estimated peak of 0.38% in 2001-03 through 0.34% in 2007 and 0.28% in 2012 to a final low of 0.26% in 2015. However, some of the states show HIV prevalence has increased or is constant, for example, Bihar, Chhattisgarh, Gujarat, Mizoram, Rajasthan, and Uttar Pradesh have stable HIV/AIDS prevalence, but Assam Chandigarh, Delhi, Jharkhand, Punjab, Tripura, and Uttarakhand show increase HIV/AIDS prevalence (NACO, 2015-16). NACO shows that the annual new HIV/AIDS infections in India are estimated to be around 86(56-129) thousand in 2015, which shows 66% decline in new infections from 2000 and 32% decline from 2007 (NACO, 2015-16). Migration leads to economic benefits or provides better opportunities to migrants and their households, but the negative impacts of migration on the HIV epidemic are well documented (Camlin et al., 2010). Initially, HIV/AIDS case erupted in developed countries and later in developing countries. The movement of individual and population remains an important factor in the spread of the virus (Haour et al. 1996). Migration is bridging the low and high-risk population. The problem of HIV/AIDS has profound social and economic roots, and hence its impact reaches far beyond the