High-Risk Sexual Contacts in Nepal and India Among Male Labor Migrants: Findings from the 2024 National Survey in Nepal.

The first national HIV bio-behavioral survey in men who work as migrant laborers in India was conducted in 2024 in all seven provinces in Nepal. We aimed to determine the levels of risky sexual behaviors, including contacts with female sex workers (FSW). Household-level multi-stage cluster-based sampling was used to recruit 1872 male labor migrants (MLM). Sampling was done in 14 districts (two per province) that had the highest seasonal labor migration to India. All participants were offered an HIV test, while syphilis testing was done in those with symptoms of sexually transmitted infections and testing for viral hepatitis C (HCV) in those who reported ever injecting drugs. Stata 17.0 statistical package was used to calculate weighted population estimates with 95% confidence intervals (95% CI). Multivariable logistic regression analysis was used to assess correlates of having sex with a FSW in the past 12 months before the survey. The mean age of MLM was 31 years, ranging from 28.1 in Madhesh to 35.9 years in Bagmati. The most common educational level attained was basic education (58.3%), while 11% had no education. Ever having sex with a FSW was reported by 13.5% of MLM while in the past 12 months by 6.6%. There was a substantial variation across provinces in reporting sex with FSW, ranging from 1.1% in Lumbini to 8.0% in Karnali and 10.3% in Sudurpaschim. Reported condom use at last sex with a FSW in the past year in Nepal was 63.9% while substantially higher (93.8%) at last sex with a FSW in India. HIV prevalence was 0.2%. Syphilis prevalence among those with STI symptoms was 2.1%, while HCV prevalence was 38.4% in those who ever injected drugs. A sizeable proportion of MLM reported contacts with FSW, which underscores a need for raising awareness about risks of HIV and sexually transmitted infections and promotion of consistent condom use during high-risk sex.