title: Sexual behavior and vulnerability to HIV infection among seasonal migrant laborers in Metema district, northwest Ethiopia: a cross-sectional study.
abstract: BACKGROUND
  Poor socio-economic conditions fuel seasonal migration of adult males from Northwestern Ethiopia, but behavioral and other migration-related changes increase their vulnerability to HIV/AIDS. This study examined risky sexual behaviors and associated factors that may lead to increased HIV infection vulnerability among migrant laborers in Metema District, Ethiopia.
  
  
  METHODS
  A community-based cross-sectional study was conducted from July 8-18, 2013 at farms with migrant laborers. We enrolled 756 participants through multistage random sampling. Data were collected using structured questionnaires and analyzed using EPI Info7; bivariate and multivariate logistic regression analyses were performed using SPSS.
  
  
  RESULTS
  582 (77%) migrant workers had sexual intercourse in their lifetime. 68% (397/582) reported non-marital sexual intercourse in the preceding six months. Of these, 74% reported sexual intercourse with commercial sex workers, 49% reported having transactional sex, 49% reported unprotected sexual intercourse with CSWs, 69% reported multiple sexual partners in the preceding six months (mean = 2.9 ± 0.7). Being aged between 20-29 (AOR = 2.15, 95% CI: 1.16, 3.99) and 30 years or older (AOR = 2.51, 95% CI: 1.1, 5.71), receipt of HIV prevention information in the preceding six months (AOR = 1.74, 95% CI: 1.15, 2.63), and staying longer on the farm (AOR = 2.74, 95% CI: 1.46, 5.14) were factors significantly associated with condom use at last non-marital sexual intercourse. Respondents aged ≤19, not receiving HIV information in the preceding six months, or staying on the farm for ≤2 months were less likely to have used condoms at their last non-marital sexual intercourse. Moreover, having daily income above USD 5.00 (AOR = 2.24, 95% CI: 1.14, 4.41), paying for most recent sexual intercourse (AOR = 2.22, 95% CI: 1.36, 3.61), and drinking alcohol during last sexual intercourse (AOR = 1.69, 95% CI: 1.01, 2.83) were significantly associated with having multiple (≥2) sexual partners during the preceding six months.
  
  
  CONCLUSIONS
  Seasonal laborers commonly exhibit risky sexual behaviors likely to increase their vulnerability to HIV infection. Unprotected and multiple sex partners in these populations pose transmission risks to seasonal laborers and onward to their wives and future sexual partners. The findings support the need for targeted HIV prevention campaigns designed for seasonal workers and their sexual partners.
authors.affiliation: Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT-CS) Program Management Sciences for Health, Bahirdar, Ethiopia. kzagoch@gmail.com.
authors.forename: Kassa
authors.initials: K
authors.lastname: Tiruneh
authors.affiliation: Bahirdar University, Department of Epidemiology and Public Health, Bahirdar, Ethiopia. bewassie@gmail.com.
authors.forename: Belaynew
authors.initials: B
authors.lastname: Wasie
authors.affiliation: American Century University, Santa Fe, New Mexico, USA. gonzalez.h@centuryuniversity.edu.
authors.forename: Hector
authors.initials: H
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012621:Seasons; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data*