A Space for Nepalese Male Migrant Workers to Co-create Internet-based HIV Prevention
Introduction: It is estimated that more than four million male and female Nepalese working abroad are vulnerable to the Human Immunodeficiency Virus (HIV) infection. These migrant workers comprise approximately 13% of the Nepalese population and are predominantly young adults. The estimation shows that male migrant workers, who constitute about 90% of the total number of migrants from Nepal, have an HIV prevalence of about 0.4%, which is about four times the national adult HIV prevalence rate of 0.1%. Globally, migrant workers remain a group vulnerable to HIV infection due to a range of determinants, including belonging to a young and highly sexually-active demographic; being separated from a spouse; prevailing feelings of loneliness and related overuse of alcohol; low-level knowledge of HIV and ways of preventing it; peer influence; and other contextual factors. The large population of Nepalese male migrant workers, who contribute about one-third of the country’s Gross Domestic Product (GDP), is also regarded as a significant cluster responsible for spreading HIV in Nepal. This study provided a space for Nepalese male migrant workers, vulnerable to HIV, to explore their perspectives on HIV prevention, consider the determinants that make them vulnerable to HIV, and to propose strategies relating to internet-based HIV prevention relevant to their needs.
Method: The research employed a critical theoretical perspective broadly based on 21st-century shifts in health promotion, which emphasise both the role of the internet and the changing roles of users and producers of health promotion. Given the emphasis on young migrant men’s voices, the study utilises participatory action research (PAR) methodology and tools to create a participatory and collaborative space for Nepalese male migrant workers from Kaski District, Pokhara, Nepal, to explore HIV risk factors and co-create an internet-based HIV prevention initiative for the community by focusing on the following research question: How can Nepalese male migrant workers contribute to the co-creation of internet-based HIV prevention programmes? Deploying PAR principles, seven migrant men from the Kaski District, Nepal, were recruited as co-researchers whilst they were on leave from their overseas workplaces. The co-researchers participated in a series of action-oriented focus groups, which included their reflections on migrant work experiences; and their stories relating to HIV risk contexts and behaviours. Then, the co-researchers explored strategies involving use of the internet to extend current HIV knowledge and skills, followed by sharing concepts, multi-level practice and, finally, co-created internet-based HIV prevention materials including videos, a PowerPoint presentation, pictures and a social media page appropriate to their contexts.
Results and Analysis: The co-researchers have a perception that current HIV prevention in Nepal and many destination countries has few benefits for Nepalese migrant workers. HIV prevention in Nepal focuses on at-risk communities within the country. At the same time, migrant workers are a low priority in comparable programmes in many destination countries. Also, determinants such as their age, marital status, and Nepalese socio-cultural norms, language and related laws discourage migrant workers from seeking information about, and services on, HIV prevention. These factors have resulted in insufficient knowledge of HIV transmission and prevention methods among these Nepalese male migrant co-researchers. HIV prevention among Nepalese male migrant workers is challenging, given that they are a long way from home. Features of the research that seemed important from the outset were to utilise the internet since young migrants are avid users. Further, health promotion through digital technology is of increasing importance, although not yet fully recognised, and thus the study provided an opportunity for young Nepalese migrant men’s voices and ideas to emerge during the research. In short, the study findings emphasise the need for Nepalese migrants to have friendly and easily-accessible online platforms and strategies which use Nepalese language and social norms which respond to migrant workers’ situations.
Discussion: A voice-based study of Nepalese male migrant workers/co-researchers’ perceptions provided insight into the gaps in current HIV prevention and their impacts on Nepalese male migrant workers. Additionally, the study exhibited the HIV prevention strategies co-created by Nepalese male migrant worker co-researchers. Collaboration with Nepalese male migrant workers in a creative space provided them with an opportunity to be active rather than passive consumers of HIV prevention programmes. This innovative approach, that of prosumerism, was a key contribution of this research.
Conclusion: Collaboration with a target community, such as male Nepalese migrant workers, in regard to HIV prevention, is crucial to understanding the community’s perceptions and experiences, reflecting on their particular experiences, and highlighting the key changes occurring in their societal context. As with other areas of health, health promotion in the 21st century is undergoing a period of rapid disruption. This means that new ways of conducting research and developing new evidence-based solutions to health problems are crucial. In particular, digital technology is playing an ever-increasing role, including in HIV prevention, and it is vital to engage with typically hard-to-reach groups, such as Nepalese male migrant workers, to find ways to maximise the opportunities offered through a co-creation process which reflects and encourages a shift towards the empowered user.