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

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

This article highlights the emerging challenges in tackling the HIV epidemic in India attributed to migration.

It is rather unfortunate that no reference is alluded to the immense wealth of published evidence regarding the tremendous strides that India has achieved in reducing the HIV burden through evidence based, targeted interventions over the past decade.

The lessons learned from Avahan-the India AIDS Initiative is that strong data should drive the strategy and delivery of high quality interventions at mass scale is pivotal to take the bull by its horns.

It appears that the current strategy of railway station based interventions is undoing all the learning from the strong data driven approaches from district and statewide mapping and size estimation data, to both locate services and use denominators to estimate coverage.

Another important lesson from the interventions in India and South East Asia is the vital role of community ownership and its impact on sustained demand for HIV prevention services.

It is also important to critically appraise if the strategy of targeting the migrant workers at points of transit would stigmatize them further.
There have been instances of targeted violence against migrant workers in India in the recent past, would the fact that they are individuals exhibiting high risk behavior increase their vulnerability for social ostracization?

Moreover behavior change interventions might not be achievable in a short encounter in a busy railway station setting. The need for repeated reinforcement and peer lead outreach are key lessons learned from the field.

To err is human, but to ignore existing evidence is criminal.

Competing interests: Have undertaken extensive literature review of the interventions to reduce HIV burden in India.

31 January 2013
Oommen John
Consultant Physician and Public Health Researcher
Private Practice
Dwarka, New Delhi
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