Institute of Ethnology & AnthropologyLeninskiy Prospect, 32AMoscow, 119991, Russian FederationEmail: nat.zotova@gmail.com

Sexual Risks of Central Asian Migrant Women in the Context of the Russian HIV Epidemic

Victor Agadjanian Natalya Zotova Arizona State University Russian Institute of Ethnology and Anthropology

This research was funded by the NIH/NICHD and the Russian Foundation for Basic Research (Project number RUB1-31086-MO-12)

Backgroundo Cross-national evidence points to elevated STI/HIV risks associated

with migration o Migrants’ high risks typically stem from reduced social control,

socioeconomic marginalization, and limited access to health serviceso Most research has focused on male migrants’ risks and behavioro Among migrant women, migration-related risks may be amplified by

gender ideology and inequality

o Survey of women aged 18-40 working in three sectors of urban economy:

2032 households selected through multistage cluster sampling.

102 clusters include: 16 clusters in Bishkek (capital) 20 other urban clusters 66 rural clusters

o Massive labor migration to the Russian Federation from Muslim Central Asia – mainly Kyrgyzstan, Tajikistan, and Uzbekistan.

o Central Asian migrants can enter Russia without visas, but most stay and work illegally or semi-legally.

Center for Population DynamicsArizona State University Tempe, AZ 85287, USAEmail: vag@asu.edu

o Most migrants go to Moscow and other large cities.o Migrants are subject to widespread discrimination and abuse on

the part of officials, employers, and the general public.o Historically most Central Asian migrants were men, but the share

of female migrants has increased in recent years.

o HIV epidemic remains a major public health concern in Russia.o As acknowledged by the Russian authorities, international migrants

face disproportionate risks of STI/HIV infection.

Context

Data

Survey of working women aged 18-40 (N=940), in Moscow, Novosibirsk, and Yekaterinburg, (October 2012 – January 2013) o Four ethno-provenance groups:

• Kyrgyz (weaker influence of Islam; less established migration)• Tajiks (stronger influence of Islam; more established migration)• Uzbeks (stronger influence of Islam; less established migration)• Russia’s natives (comparison group)

o Three sectors of urban economy where migrants concentrate:• Retail (shops)• Bazaars (рынки)• Eateries (restaurants, cafes)

o Sampling approach: time-location (retail and eateries) and random-walk algorithm (bazaars)

In-depth interviews with a subsample of survey respondents : 20 in Moscow and 20 in Novosibirsk (December 2012 – February 2013):

• In each city: 5 interviews with women of each ethno-provenance

Expert interviews (February - April 2013): Gynecologists (4 in Moscow and 4 in Novosibirsk), both in the private and state sectors, who work with migrant women

Moscow

Yekaterinburg

Novosibirsk

o A new study is underway in two other Russian citieso Migrant women are sampled through respondent-driven samplingo Focus on personal networks as risks barriers and facilitators

Conclusions

Results (bivariate)

o Outcomes: sexual partnerships; exposure to risky sex; relationship with partner; HIV worries; HIV testing

o Main predictor—ethno-provenance

• Migrants vs. non-migrants (natives)

• Within migrants: Kyrgyz vs. Tajik vs. Uzbeko Multivariate analyses: models for entire sample and for migrants only

• Poisson regression

• Binomial logistic regression

• Controls: age, marital status, income, occupation, sector, social ties, legal status (migrants only), study site

o Compared to natives, migrant women, in general, are less likely to engage in potentially risky behavior.

o Migrant women’s STI /HIV risks may increase due to …

• Greater dependence on their sexual partners, reduced ability to influence partners’ behavior and/or to exit risky relationships

• Limited access to SRH services in general and HIV testing and counseling in particular, and misperceptions about HIV risks

o Variations across migrant groups are influenced by their ethnocultural background (esp., the role of Islam-rooted norms) and group-level migratory experiences.

Next steps

Results (multivariate – cont.)

Results (qualitative)

Results (multivariate)

Number of sexual partners and sex while inebriated, Poisson regression and logistic regression parameter estimates (models for the entire sample and for migrants only)

Predictors

Number of sexual partners in past 12

months

 

Had sex while inebriated in past 4 wks (those who had sex in past 4 wks)

 

  Total Migrants   Total Migrants  

Native 0.582 **       0.629 *      

[Migrant]                    

Kyrgyz     0.610 **     3.024 **

Uzbek     0.521 **     2.255 **

[Tajik]

Measures and Method

Relationship with current permanent partner, logistic regression parameter estimates (models for the entire sample and for migrants only)

 Predictors

Trusts that partner is faithful

 

Refused sex with partner (those

sexually active with permanent partner)  

Thinks that partner would accept condom use

  Total Migrants   Total Migrants   Total Migrants Native 0.724 **       0.587 *       0.478 *    [Migrant]                            Kyrgyz     -0.035       1.341 **     -0.523

Uzbek     0.459 +       0.607 *       -0.702 *

[Tajik]Reference categories in brackets; significance: ** p<.01; * p<.05; + p<.1; controls not shown.

 HIV worries and HIV testing, logistic regression parameter estimates

Predictors

Worries about getting HIV (those sexually active in

past 4 weeks)  

Had HIV test in past two years

  Total Migrants   Total Migrants Native -0.033       0.892 ** [Migrant]                  Kyrgyz     1.144 **     0.327  Uzbek     1.128 **     0.956 **

[Tajik]Reference categories in brackets; significance: ** p<.01; * p<.05; + p<.1; controls not shown.

o Migrants note the transformative and usually negative effects of the sociocultural environment and economic pressures in Russia on migrant women’s and their partners’ values, morals, and relationships.

o Fears of cultural and socioeconomic penalties often prevent migrants from exiting partnerships with abusive and unfaithful partners.

o While migrant women express worries about risks of contracting STIs/HIV, they typically think that it could not happen to them.

o How does migration status shape women’s STI/HIV risks?

• Number and type of sexual partnerships?

• Relationship with partners?

• Worries about HIV and access to HIV testing?o How do these outcomes vary across groups of migrants with …

• different ethnocultural backgrounds?

• different migration experiences?

Research Questions

Sexual behavior and risks, descriptive statistics    

 Ethno-provenance

TOTALNatives All migrants Kyrgyz Tajik Uzbek

Number of sexual partners in past 12 months, mean (of those who had sex in past 12 months, n=652)

1.6 1.2 1.4 1.0 1.2 1.3Had sex while inebriated in past 4 weeks, % (of those who had sex in past 4 weeks, n=564)

33 17 34 4 4 22Trusts that regular partner is faithful, % (of those with a regular partner, n=645)

71 54 49 48 65 58Thinks that regular partner would accept condom use, % (of those in sexually active regular

relationship, n=565)64 44 43 52 37 50

Refused to have sex with regular partner at least once in past 12 months, % (those who had sex with regular partner at least once in past 12 months, n=562)

55 48 63 33 46 50

Worries about contracting HIV, % (of those who had sex in past 4 weeks, n=564)

46 41 53 32 55 47Had an HIV test in past two years , %  61 47 52 34 56 51