Background An estimated 2.3 million people are living with HIV in India. Although free testing and treatment is available, <20% of HIV-positive people access treatment at its antiretroviral treatment (ART) centres. Short-term labour migrants have been identified as at risk of acquiring and transmitting HIV.
Aim To explore the pathways to HIV testing and treatment for people with a history of short-term circular migration, and their partners.
Methods A qualitative study at an ART centre in northern India, using in-depth interviews. Data were analysed using framework and thematic content analysis.
Results 34 people were interviewed, 20 men and 14 women. Men commonly reported becoming unwell while working away from home and enduring a prolonged period of sickness during which they received various temporary symptomatic treatments from private medical providers. Their HIV was only diagnosed and treatment started when their illness overwhelmed them and they returned home as a consequence of a medical or financial emergency. In contrast, female participants were more likely to be tested following a positive diagnosis of their husband. Individuals who were now on ART felt insecure about migrating again given the instability of the migrant labour market and fears about ability to adhere to treatment at destination.
Discussion Diagnosing and treating HIV infection early is an important way to slow down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite migrant-focussed awareness campaigns, migrant workers and their partners are not accessing testing and treatment until they become sick. The cultural preference for private treatment, the insecurity of migrant work and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.