Behavior towards HIV among the Spouse of Male Migrants in Mid-western Nepal-A cross-sectional study

Results: Almost all respondents had heard of HIV and AIDS and 55% had poor comprehensive knowledge on HIV prevention; 32% perceived HIV could transmit through mosquito bite; sharing meal of infection person (59.3%). The women ever discussed about sex with their husbands were 25.3%, among them 77.1 percent of spouse of male migrants doesn’t use condom during sexual intercourse during husband’s last visit at home. Major reason was they didn’t think it is necessary (88.1 percent) to use.


Introduction
In Nepal, after the detection of first case in 1988, HIV situation has evolved from low prevalence of cases to epidemic concentrated among the key affected population i.e.Injectable drug users (IDUs), Female sex workers (FSW) and their clients and men who have sex with men (MSM) 1 .By 2011, total 50,200 estimated people were living with HIV and increasing number of infection was being recorded among low risk general population.Among 15-49 years people, it has prevalence of 0.30 % 2 .
Foreign labor migration has over the years, become major features of Nepal's economy and society.Being a poor economic status, majority of migrants are from the hill and Terai region and destination of one third male migrants is India and other popular countries are middle-east and Malaysia 1 .Due to long term detachment from their family, study suggest that, 9.7% among the migrants of western and 21.7% among the migrants of mid-far western region had made the sexual contact with female sex worker.Unfortunately 66.7%-80% migrants didn't use condom during the last sex with FSW and 82.8% during last sex with their spouse 3 .The prevalence of HIV among wives of migrants as per Integrated Biological and Behavioral Surveillance Survey (2008) was 3.3%.So, it was important to study the HIV related knowledge and vulnerability of these women.Comprehensive knowledge on HIV and AIDS means consistent condom use and having just one uninfected faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about HIV transmission in Nepal: that HIV can be transmitted by mosquito bites and that HIV can be transmitted by sharing food with a person who has AIDS.

Material and methods:
The present cross-sectional study was carried out in randomly selected Dhanauri VDC located in Dang District.Sampling unit consists of female aged (15-49) years whose spouse has spent at least three month in India or other gulf countries and returned home, at least once in the last three years using purposive sampling method.A total of 150 samples were enrolled in the study.Women have aged (15-45) years and above, who gave their consent for participation in the study was selected as sample in the study.Ethical approval was obtained from Institution review committee, Manmohan Memorial Institute of Health Sciences prior to study.Data was analyzed by using SPSS ver.15:00.
Descriptive analysis was done for Sociodemographic variable, knowledge on HIV, Condom accessibility and use, interpersonal communication regarding HIV/AIDS and private part problem, knowledge on HIV testing and their uses.Chi-square test was done to report association.

Socio-Demographic Characteristics:
Out of 150 Sample, Mean age of the spouse of male migrants was 26.1(±7.11)years.Among them, (25-29) year's age group comprised one third i.e. 34.7% of total no of spouse of male migrant's.Ethnic group which includes, Brahmin,Chhetri were almost 68% of total population but ethnic group which includes Tharu, Dalit, Magar, Kumal and Bote were 32% of total population.Finding shows, 88.7% were literate where as 11.3% were Illiterate.Almost one third of spouse of male migrants of total population had passed S.L.C and above.
As shown in Table 1 shows the 100% respondent follows the Hindu religion.

Comprehensive Knowledge on HIV:
Questions on monogamous sexual relationship can prevent from HIV and AIDS, consistent condom use during each sex can prevent from HIV/AIDS, A healthy-looking person can be infected with HIV was asked among 150 respondent, only 65%,71.3%,69.3%respectively were aware on it.Likewise, 59.3% of total respondent were aware about the HIV is not transmitted while sharing a meal with an HIV infected person and 32% of total respondent were aware about a person cannot get the HIV virus from mosquito bite.
Table 2 shows that 17.3% of total respondent have poor comprehensive knowledge on HIV and AIDS.Similarly, 38.0% respondent's knowledge was below average and 32.7% respondent has average comprehensive knowledge on HIV and AIDS.Only 12.0% respondent has excellent comprehensive knowledge on HIV and AIDS.

Source of Information on HIV and AIDS:
From table 3, Radio/FM accounts major source of information for spouses of male migrants that was 88.0%.Another major source of information for spouse of male migrants was FCHV which accounts for 47.3%.Next by, Peer/friends was another major source of information which account for 42.7%.IBBS survey 2010 among wives of migrants in four district of far-western Nepal also showed that Radio/FM and FCHVs were the major source of information.

Spousal Communication
Question that was asked to spouse of male migrants on communication on HIV/AIDS and private part problems to their spouses showed that among one hundred fifty, 25.3% women had communicate either about HIV/AIDS or Private part problems to their spouses and 74.7% did not.From table 5, women who had communicate on HIV/AIDS, Most of the spouses of male migrants communicate on preventive measures i.e. 92.1%.After that, Mode of transmission (MOT) of HIV accounts 63.2% among total responses.

JMMIHS-9
Most of the respondents (74.7%) had sexual contact with their husbands during their last home visit.Only 22.9 percent respondent had used condom during last visit.Among them only 12 percent of respondent used condom all of the time.Almost 72 percent of respondent used condom sometimes only.Major reason of not using condom during sexual intercourse was didn't think it was necessary (88.1%) which is mentioned below table 4.

HIV testing:
Table 4 shows, 33.3 percent of total female respondents had known about HIV testing facility, among them only 6 percent of women had done HIV test and only 3 percent of their husband had done HIV test after their last visit and 3 percent women had not known about completion of HIV test of their husband.

Discussion
On the knowledge related findings found that term HIV and AIDS was universally heard.It could because of the several sources of information.Study shows that radio/TV act as the major source of their information due to their easy access.However, comprehensive knowledge on HIV and AIDS was relatively poor among the female respondent.According to the NDHS report 2010 comprehensive knowledge on HIV and AIDS was 21 percent and 12. 5  Almost all (97.3 percent) of respondent had heard about condom and main source of information was Radio (90.4 percent), Husband (56.8 percent) and FCHVs (48.6 percent).Mean time to get condom was 9.49 percent.But similar research conducted at far-western region showed that 97.5 percent respondent had heard about condom which is almost same as this research findings and main source of information was also radio (61.6 percent), FCHV (59.4 percent), and Husband (18.3 percent).
According to findings of this research, 74.9 percent of respondent had sex with their husband at last home visit, but 77.9 percent of respondent did not use condom during sex.Among respondent who had use condom (22.9 percent), only 12.0 percent of respondent use condom all of the time.But According to the IBBS survey 2010, 97.4 percent respondent had sexual contact among them only 17.2 percent used condom but only 10.5 percent of respondents used condom all the time.So, IBBS survey support this research where result are almost same.
Almost all (97.3 percent) of respondent had heard about condom and main source of information was Radio (90.4 percent), Husband (56.8 percent) and FCHVs (48.6 percent).Mean time to get condom was 9.49 percent.But similar research conducted at far-western region showed that 97.5 percent respondent had heard about condom which is almost same as this research findings and main source of information was also radio (61.6 percent), FCHV (59.4 percent), and Husband (18.3 percent).

JMMIHS-10
According to findings of this research, 74.9 percent of respondent had sex with their husband at last home visit, but 77.9 percent of respondent did not use condom during sex.Among respondent who had use condom (22.9 percent), only 12.0 percent of respondent use condom all of the time.But According to the IBBS survey 2010, 97.4 percent respondent had sexual contact among them only 17.2 percent used condom but only 10.5 percent of respondents used condom all the time.So, IBBS survey supports this research where result is almost same.

Conclusion
Comprehensive knowledge on HIV and AIDS was relatively poor among the spouse of male migrants and almost more than halve doesn't use condom during sexual intercourse during husband's last visit at home.These finding shows spouses of male migrants are at high risk of HIV and there should extensively conduct the HIV and AIDS awareness program along with screening program.

Table 3 :
Source of Information on HIV and AIDS and spousal communication status.

Table 4 :
condom use with husband during last visit and HIV testing status Sexual contact with husband during his last visit (n=146):