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.
Below: Routes to HIV diagnosis for migrant men and wives of migrant men. (a) Dominant pathway to testing for migrant men. (b) Dominant pathway to testing for wives of migrant men.
Below: The structural, social and individual factors delaying HIV diagnosis and access to care for HIV-positive migrant workers and their partners.
Full article at: http://goo.gl/hCnj5x
By: Rai T1, Lambert HS2, Ward H1.
1a School of
Public Health , Imperial College London , London , UK.
2b School of
Social and Community Medicine , University of Bristol , Bristol , UK.
More at: https://twitter.com/hiv_insight
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