Study on risk factors in high prevalence rates of HIV/AIDS and STIs in the boondocks in Nepal

2001年，我们发现在尼泊尔远西部多提地区的前移徙工人（n=150）中，艾滋病毒（7.4%）、梅毒（22.5%）和乙肝（66.5%）的患病率很高。尽管我们计划在同一地点进行一项知识、态度和行为（RAP）调查和血清患病率调查，其中包括妇女，以确定艾滋病毒和性传播感染（sti）传播的风险因素，并在尼泊尔制定有效的预防战略和疾病控制方案。然而，由于2001年11月毛派再次叛乱，安全局势不允许我们重新进入该地点。因此，我们改变了原来的计划，在博卡拉进行了另一次调查。在博卡拉，在国外工作的人口规模相当大，与尼泊尔其他地方相比，报告的艾滋病毒感染率相对较高。我们团队获得了在研究地点提供免费产前护理的许可进行调查，因此，我们的研究对象是孕妇。共有426名孕妇参与了这项研究，HIV和梅毒的患病率分别为0.2%和L2%，其中30%的配偶在国外工作。出乎意料的是，与多提县的结果相比，患病率非常低。与多蒂人的情况形成鲜明对比的是，移徙工人的主要目的地是中东。为了了解工作环境，我们在同一地点进行了关键线人访谈。结果，我们发现中东地区几乎所有的农民工都是不允许自己外出的，并且存在延迟付款的问题。在目的地，他们无法获得商业性服务。待安全状况改善，确保当地采访者的安全后，我们计划再次对农民工目的地的社会环境进行调查。

In 2001, we found high HIV (7.4%), Syphilis (22.5%), Hepatitis B (66.5%) prevalence rates among former migrant workers (n=150) in Doti district in Far Western Nepal. Although we planned to conduct a RAP (Knowledge, Attitude and Practice) survey with sero-prevalence survey in the same site, which included women, to identify risk factors in HIV and STIs (Sexually Transmitted Infections) transmissions and to establish an effective prevention strategy and the disease control programme in Nepal. However, due to Maoist re-insurgence in November, 2001, the security situation did not allow us to re-enter the site. Therefore, we changed our original plan and conducted another survey in Pokhara.In Pokhara, the population size who work(ed) abroad was quite large and the reported HIV prevalence rate was relatively high as compared to the other places in Nepal. Our team has got permission to conduct the survey by providing free antenatal care in the study sites, thus, our study subjects were pregnant women.Altogether 426 pregnant women participated in the study, the prevalence rates of HIV and syphilis were 0.2% and L2% respectively 30% of their spouses worked abroad. Unexpectedly the prevalence rates were very low as compared the result in Doti district. In marked contrast to the Doti's cases, major destinations of migrant workers were Middle East. To understand the working environment, we conducted key informant interview in the same site. As a result, we found that the almost all migrant workers in the Middle East were not allowed to go out by themselves and problems of delayed payment. At the destination they could not access to commercial sex services.We are planning to conduct another survey on social environment at migrant worker destinations, when the security situation improves and safety of local interviewers is assured.