Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies.     

HIV Sexual Risk Behaviors and Multilevel Determinants Among Male Labor Migrants from Tajikistan

The purpose of this study was to investigate HIV risk behaviors and their multilevel determinants in male labor migrants from Tajikistan to Moscow. In Russia and Central Asia, where AIDS rates are amongst the world’s highest, conditions in both sending and receiving countries pose serious challenges to HIV prevention. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method study. The quantitative results indicated that male labor migrants were at risk for HIV due to higher sexual behaviors including sexual relations with sex workers (92 %), multiple partnering in the past month (86 %), unprotected sex with sex workers (33 %), and reduced frequency of condom use while drinking alcohol (57 %). Multivariate tests indicated the multilevel factors that increased HIV sexual risks including: pre-migration factors (e.g. used sex workers in Tajikistan); migrant work and lifestyle factors (e.g. greater number of times visited Moscow); migrant sexual and relational factors (e.g. regular partner in Moscow); and migrant health and mental health factors (e.g. increased frequency of alcohol use). Qualitative findings from longitudinal ethnographic interviews and observations of a subset of 40 purposively sampled Tajik male migrants demonstrated how these multilevel pre-migration and migration factors account for HIV risk and protective behaviors in context. These findings underscore the seriousness of HIV risk for labor migrants and call both for multilevel approaches to prevention and for further study.     

The roles of labor migrants' wives in HIV/AIDS risk and prevention in Tajikistan

This study aimed to build formative knowledge regarding labor migrants' wives' knowledge, attitudes, and behaviors regarding HIV/AIDS risk and protection that would inform developing innovative HIV prevention strategies. This was a collaborative ethnography in Tajikistan that included minimally structured interviews and focused field observations with 30 Tajik wives in Dushanbe married to Tajik male migrant workers currently working in Moscow. The results documented the wives' concerns over their husbands' safety in Moscow and the difficulties of living without husbands. In a male-dominated society, gender norms limit the wives' abilities to protect themselves and their husbands from HIV/AIDS. They have some awareness of HIV/AIDS, but limited abilities to speak about sexual activity, HIV/AIDS, condoms, and HIV testing. Wives do not use condoms with their husbands and depend upon their husband's role as their protector. Wives often turn for support to their "circle of friends" or to a primary care nurse for support, but seldom do these relationships focus on preventing HIV/AIDS. To respond to HIV/AIDS risks amongst the wives of Tajik male migrant workers in Moscow, preventive interventions could build upon migrants' wives' role as the primary family caregiver and their existing sources of social support from women's circles and nurses. The overall intervention strategy could be to expand their role as family caregivers to include HIV/AIDS protection, through enhancing their HIV/AIDS knowledge and prevention skills and negotiation strategies with their husbands.     

Unprotected Tajik Male Migrant Workers in Moscow at Risk for HIV/AIDS

This paper focuses on Tajik male migrant workers in Moscow and seeks to address the global public health problem of HIV prevention amongst male migrant workers. To develop feasible and effective preventive interventions for reducing HIV risk behaviors amongst Tajik male migrant workers in Moscow, this study aimed to characterize their HIV/AIDS risk and protective knowledge, attitudes, and behaviors, as well as key contextual factors that would likely impede or facilitate a preventive intervention. This was a collaborative multi-sited ethnography in Moscow that included minimally structured interviews with 16 participants and focus group discussions with an additional 14 participants. The results suggest that many Tajik male migrant workers in Moscow are having unprotected sex with commercial sex workers. Although some of the migrants have basic knowledge about HIV, the migrants' ability to protect themselves from acquiring HIV is compromised by harsh living and working conditions as a consequence of being unprotected by law in Russia. To respond to HIV/AIDS risks amongst Tajik male migrant workers in Moscow, preventive interventions must be developed that respond to their sense of being unprotected in the midst of harsh living and working conditions and that draw upon existing sources of religious, community, and family support.     

Trauma Exposure, PTSD, and HIV Sexual Risk Behaviors among Labor Migrants from Tajikistan

Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.