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Institute of Ethnology & Anthropology Leninskiy Prospect, 32A Moscow, 119991, Russian Federation Email: 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) Background o 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 services o Most research has focused on male migrants’ risks and behavior o 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 Dynamics Arizona State University Tempe, AZ 85287, USA Email: 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 cities o Migrant women are sampled through respondent-driven sampling o 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. Uzbek o 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) TotalMigrants TotalMigrants Native0.582 ** 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 TotalMigrants TotalMigrants TotalMigrants Native0.724 ** 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 TotalMigrants TotalMigrants 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 TOTAL NativesAll migrantsKyrgyzTajikUzbek Number of sexual partners in past 12 months, mean (of those who had sex in past 12 months, n=652) 1.61.21.41.01.21.3 Had sex while inebriated in past 4 weeks, % (of those who had sex in past 4 weeks, n=564) 3317344422 Trusts that regular partner is faithful, % (of those with a regular partner, n=645) 715449486558 Thinks that regular partner would accept condom use, % (of those in sexually active regular relationship, n=565) 644443523750 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) 554863334650 Worries about contracting HIV, % (of those who had sex in past 4 weeks, n=564) 464153325547 Had an HIV test in past two years, % 614752345651