Labor Migration and HIV Risk: A Systematic Review of the Literature

To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health
and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %),
Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was
associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual
practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial
status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV
risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated
with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices
most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV
knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health
and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across
multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better
inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes
prior methodological limitations and focuses on building new contextually tailored interventions and policies.