Vulnerability to HIV/STIs among rural women from migrant communities in Nepal: a health and human rights framework.

Human rights norms and standards can be applied to health issues as an analytical tool and as a framework to identify and shape interventions to reduce the impact of ill-health and improve the lives of individuals and populations. This article discusses how migration, health status, gender-based discrimination and access to education have an impact on HIV/STI vulnerability among rural women from migrant communities in Nepal. It is based on data from a clinic-based HIV/STI prevalence study with 900 women aged 15-49 from two rural communities in Kailali district, Western Nepal, and existing legal and policy data. Existing efforts to address HIV/STI vulnerability and risk in this population focus primarily on risk-taking behaviour and risk-generating situations, and largely fail to address contextual issues that create and facilitate risky behaviour and situations. Respecting, protecting and fulfilling the rights of individuals can reduce vulnerability to HIV/STI infection. Greater emphasis must be given to addressing the gender discrimination embedded in Nepalese culture, the acute lack of access to health care and education in rural areas, and the precarious economic, legal and social circumstances facing many migrants and their families.