Male Out-Migration: A Factor for the Spread of HIV Infection among Married Men and Women in Rural India

INTRODUCTION Thus far, the reasons for increasing HIV prevalence in northern and eastern Indian states are unknown. We investigated the role of male out-migration in the spread of human immunodeficiency virus (HIV) infection through a case-control study in rural India. METHODS Currently married men and women were recruited from HIV testing and treatment centers across seven selected districts with high rates of male out-migration in eastern and northern India in 2010 using a case-control study design. Case subjects (men: 595, women: 609) were people who tested HIV seropositive and control subjects (men: 611, women: 600) were those tested HIV seronegative. For each gender, we obtained adjusted odds ratios (AORs) and population attributable risks (PARs) for migration, and behavioral factors. RESULTS For men, the prevalence of HIV was significantly higher among those with a migration history (AOR, 4.4); for women, the prevalence of HIV was higher among those with migrant husbands (AOR, 2·3). For both genders, the returned male migration (men: AOR, 3·7; women: AOR, 28) was significantly associated with higher prevalence of HIV infection. The PAR associated with male migration was higher for men (54.5%-68.6%) than for women (32·7%-56·9%) across the study areas. DISCUSSION Male out-migration is the most important risk factor influencing the spread of HIV infection in rural areas with high out-migration rates, thereby emphasizing the need for interventions, particularly, for returned migrants and spouses of those migrants.