Feature HIV/AIDS

Mass economic migration: the greatest threat to HIV control in India

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f474 (Published 29 January 2013) Cite this as: BMJ 2013;346:f474
  1. Kounteya Sinha, health editor, Times of India, New Delhi
  1. ksinha78{at}gmail.com

A third of Indians are socioeconomic migrants, and unprotected sex far from home and spouses is driving India’s HIV epidemic, reports Kounteya Sinha. Can targeted interventions reverse the trend?

Latika Samaddar’s husband, Ratan, (all names have been changed) pulls a rickshaw in New Delhi railway station while she stays in the village Malda in West Bengal, looking after their two daughters aged 8 and 6. Ratan takes a break and comes home every four months and stays for three weeks. Usually healthy, Latika has lately had a nagging flu. A blood test, prescribed by a doctor who suspected malaria, came as a shock—Latika was infected with HIV.

The doctor asked her whether she had ever had a blood transfusion or was involved in unsafe sex with multiple partners. Latika, a devout housewife, told the doctor that she was completely dedicated to her husband. Latika, however, said that her husband never used a condom. After much questioning, Ratan told the doctor that he had visited sex workers in Delhi. He was diagnosed as having HIV a month before but had decided to keep quiet.

Unlucky women

It seems that mass migration is the greatest threat to India’s HIV control programme. What’s most worrying is that unlucky women such as Latika are becoming victims. The latest HIV/AIDS estimates released last month by India’s health minister, Ghulam Nabi Azad, showed that, of all HIV infections, 39% (816 000) are among women, most of whom are housewives.

More than 200 million Indians do not live at the place of their birth. The 2001 census reported that 30.1% of the population …

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