NIH Grant Focuses on HIV Risk Reduction Among Migrants

Construction crains stand idle next to the shell of the Moscow Concert Hall under construction.
Mary Ellen Mackesy-Amiti headshot.

Labor migration is an important contributor to the continuing global AIDS epidemic and also the movement of HIV across country borders and populations.  Tajikistan, a small country in Central Asia with a high unemployment rate and growing drug epidemic, exports more than a million Tajiks annually, many of whom inject drugs, to work outside of their home country. Russia, with one of the world’s highest drug-related HIV rates, is a major destination for Tajik temporary workers. In 2017, Tajikistan’s population eclipsed 8 million; at any given time, well over a million of those 8 million people lived and worked in Russia and especially within Moscow.   According to Foreign Policy Magazine, in 2015, remittances represented 37 percent of the nation’s gross domestic product.

Russia’s high rates of HIV and Hepatitis C present serious public health complications as migrant workers become infected and also travel home and potentially expose spouses and others to these infectious diseases.  SPH’s Judith Levy, PhD, professor emerita of health policy and administration, worked with colleagues at the Prisma Research Center in the Dushanbe, Tajikistan’s capital, to develop and pilot test an intervention through National Institute of Health funding focused on HIV risk reduction for Tajik male migrants and their network peers in Moscow who inject drugs.  Mary Ellen Mackesy-Amiti, PhD, research associate professor of community health sciences, was the statistician for the project and later as shared principal investigator with Dr. Levy.

Now, a new National Institutes of Health grant project led by Mackesy-Amiti will test the efficacy of this intervention through a clinical trial enrolling 420 Tajik men who inject drugs while working as temporary laborers at 12 recruitment sites in Moscow.   Compared to a control condition, the study will examine how the intervention impacts injection risk behavior, including sharing syringes and other equipment used for injection, and also heavy alcohol use.  HIV and Hepatitis C testing results will function as secondary outcomes of the intervention.

In addition to substance use, the intervention also focuses on some of the specific difficulties migrants face living in Moscow, including poor access to healthcare and unstable housing conditions.

The situation for migrant workers is somewhat precarious, which increases their risk and makes it more difficult for them to engage in harm reduction. The experiences of being away from their home country, in a city where they are not necessarily welcomed with open arms, psychologically it has an impact and affects risk.

Mary Ellen Mackesy-Amiti, PhD  |  Research Associate Professor of Community Health Sciences

Most Tajik temporary laborers in Moscow are employed in Russia’s most dangerous construction jobs or work for low-wages in bazaars and in industrial maintenance. They often are the target of Russian hostility and violence including physical beatings.  They typically reside in crowded substandard living conditions, eat non-nutritious or inadequate meals, and have little or no access to Russian health care if sick or injured.  Insufficient access to sterile injecting equipment and the unavailability of opioid substitution therapy in Russia are significant roadblocks to reducing the risk of acquiring HIV among Tajik migrants who inject drugs.  Meanwhile Tajik migrants form a potential bridge for HIV to move from high-prevalence Russia to low prevalence Tajikistan.

The intervention consists of five weekly educational sessions plus homework assignments delivered to participants recruited as peer educators (PEs) who meet as a group and are asked to share what they learn with at least two of their Tajik migrant peers who also inject drugs. The sessions focus on topics that include risk reduction for HIV and Hepatitis C thorough safer sex and alcohol use, maintaining a healthy life style, safety while living in Moscow, and gaining access when needed to services and diaspora organizations serving Tajik migrants. Results of the pilot study showed that HIV knowledge increased significantly from baseline to six-weeks for both PEs and network members with significant reductions in frequent alcohol use, casual sex without a condom, and syringe sharing. Neither group reported consistently cleaning their syringes at baseline, but all did sometimes at six weeks and 87 percent always at six months.  These findinglend strong evidence as to the potential success of the intervention when tested for efficacy via the newly funded clinical trial.

Tajikistan is not the only country that confronts the challenges of HIV and Hepatitis C transmission through labor migration.

“Migrant workers, and their risk for HIV and Hepatitis C through drug and alcohol use, is an issue in other countries as well, so we’re hoping this intervention could be adapted in countries with similar populations,” Mackesy-Amiti said. “If we can prove a program like this is efficacious and can be implemented on a wider scale, we can reduce prevalence of HIV and Hepatitis among migrant workers and help protect their families at home.”

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