J Immigrant Minority Health (2010) 12:940946

DOI 10.1007/s10903-010-9329-5

ORIGINAL PAPER

HIV Awareness of Outgoing Female Migrant Workers

of Bangladesh: A Pilot Study
M. Mofizul Islam Katherine M. Conigrave
Md. Shahjahan Miah Kazi Abul Kalam

Published online: 13 February 2010

Springer Science+Business Media, LLC 2010

Abstract Female migrant workers face a growing scale

of unsafe migration, which increases their risk of HIV.
Despite this, increasing numbers of women are migrating
from Bangladesh to other countries as contractual workers.
The aim of the study is to establish a baseline for the sociodemographic status of female migrant workers and the
extent of their HIV/AIDS awareness along with the factors
that determine it, and to discuss the need for effective HIV
awareness programmes. During JuneJuly 2008 data were
collected by a questionnaire from 123 participants by
approaching a cross section of women at the airport who
were ready to fly to take up an overseas job. A total of 87%
had heard of HIV/AIDS. Participants who had completed

an education level of year C8 were more likely to have

been informed about HIV than others. The average score in
correct identification of modes of HIV infection was 1.6
(out of 4) and for preventive measures 1.8 (out of 5).
Television and health workers were the major sources of
HIV related knowledge. HIV-knowledge among the
potential female migrant workers seems to be poor. As
growing numbers of female workers are moving overseas
for work, government and other concerned agencies must
take a pro-active role to raise their awareness of HIV/AIDS
infection and of effective preventive measures.
Keywords HIV/AIDS
Migration

Female migrant workers
Overseas employment

Introduction
M. M. Islam
School of Public Health & Community Medicine,
University of New South Wales, Sydney, NSW, Australia
M. M. Islam (&)
K. M. Conigrave
Drug Health Service, Royal Prince Alfred Hospital,
Missenden Rd, Camperdown, NSW 2050, Australia
e-mail: mikhokan143@yahoo.com;
m.m.islam@student.unsw.edu.au
K. M. Conigrave
Sydney Medical School, University of Sydney,
Sydney, NSW, Australia
K. M. Conigrave
National Drug and Alcohol Research Centre,
University of New South Wales, Sydney, NSW, Australia
Md. S. Miah
K. A. Kalam
Ministry of Expatriates Welfare & Overseas Employment,
4th Floor, Building-7, Bangladesh Secretariat,
Dhaka, Bangladesh

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Recent years have witnessed an increasing feminisation of

the migration process. It is estimated that almost half
(49.6%) of all migrants across the world are women [1].
Along with this increased migration, the world has also
witnessed a feminisation of the HIV epidemic [2]. As more
and more women migrate within and across countries, their
vulnerabilities to the epidemic increase proportionately.
Apart from biological increased risk, which researchers
believe is due to greater exposed surface area in the female
genital tract [3], vulnerability rises because of low socioeconomic status, lack of access to information and poor
knowledge about sexual health, and limited access to
information about safe migration. Undocumented workers
run even greater risk [4]. Well-intentioned attempts by
governments to protect women by limiting or banning their
migration through legal channels ironically only heighten
their vulnerability as women are forced to move through

Migration for Work from Bangladesh

Bangladesh is a labour surplus country and it contributes
significantly to the labour resource in the global market
mainly to the Middle-Eastern and Southeast Asian countries. Short-term labour migration is the commonest form
of population movement from Bangladesh. The Bureau of
Manpower Employment and Training (BMET), the executive agency for processing labour migration, estimates the
average number of outgoing migrant workers has grown
from 225,000/year in the 1990s to 879,952 in 2008 [10].
The remittance in terms of GDP is also on a steady rise and
reached 8.74% in the 20062007 fiscal year [11]. Bangladeshi migrants are predominantly male. However, in
recent years increasing numbers of women are migrating to
other countries as contractual workers (Fig. 1). The rate of
female migration increased sharply from 2003 after lifting
the ban, imposed in 1998, on female migration to Saudi
Arabia as domestic workers. Accordingly, based on BMET
figures in 2003 the total number of female workers left
Bangladesh for overseas job was 2,353. This figure
increased sharply to 11,259 in 2004, then to 13,570 in
2005, 18,045 in 2006, continued to grow to 20,842 in 2008.
A significant subgroup of women is reportedly also
migrating through unofficial channels. The government ban
on emigration of less skilled women has been identified by
studies as the major reason behind such unofficial migration flows [6].
The increasing number of women migrating to pursue
better earnings and a better life face a growing scale of
unsafe migration, with an increased risk of HIV. The
problem is particularly bad for women of poor countries
like Bangladesh, as vulnerabilities are multifold rising from
poverty, gender inequalities, unemployment/underemployment [12], natural disaster and unrest. Bangladeshi
women migrants tend to integrate into the lower

Total Employment

illegal channels and depend on dubious middlemen who

exploit them and may, in many cases, traffic them [57].
In Bangladesh HIV prevalence is still at a relatively low
level (\1%) among the most-at-risk population groups and
concentrated mainly among injecting drug users in Dhaka
city [8]. However, when the passively-reported cases are
analysed, another population group that appears to be
especially vulnerable is migrant workers who leave their
families and travel abroad for work [8]. Zaidi et al. [9]
reported that most of the positive cases identified through a
Voluntary Counselling and Training clinic acquired HIV
while working abroad, or from their spouse who worked
abroad. Up to mid 2008 over half (54.2%) of 371 HIV
positive cases identified by that clinic were returneemigrants, suggesting that migrants working away from
their families may be particularly vulnerable to HIV.

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5000 10000 15000 20000 25000

J Immigrant Minority Health (2010) 12:940946

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

Year

Fig. 1 Overseas employment of female workers of Bangladesh by

year (source: The Bureau of Manpower, Employment and Training)

employment and socioeconomic strata in their migration

destinations. Most of them are employed in sectors in
which citizens of the destination state are reluctant to work,
e.g. about 90% are working as housemaids. Around 40% of
Bangladeshi people live under the poverty line, and the
incidence of poverty is greatest among women [11]. In
these circumstances, migration is a major coping strategy
for poor people to enable them to earn a livelihood.
The awareness of HIV/AIDS in the Bangladeshi population remains low. One recent survey found that only 19%
of ever-married women and 33% of currently married men
had heard of AIDS [13]. As knowledge of HIV/AIDS for
the outgoing women migrant workers is of huge importance, the government has adopted some initiatives to
impart basic information about HIV to potential workers.
However, the effectiveness of programmes among women
is unknown. Although a previous study with overseas jobseekers endeavoured to assess the knowledge, attitudes and
beliefs about HIV, none of the participants was a woman
[14]. The study found an insufficient AIDS awareness
among overseas job seekers, only 26% of the respondents
knew of AIDS.
Our study aims to establish a baseline for the sociodemographic status of women who were ready to fly to take
up an overseas job and the extent of their HIV/AIDS
awareness, along with the factors that determine it, and to
discuss the mandatory HIV awareness programme for
Bangladeshis leaving to work abroad.

Study Sample and Method

During JuneJuly 2008 over a period of 10 days data were
collected by a questionnaire from a convenience sample of
123 participants by approaching women at the airport who
were ready to fly for an overseas job. All contractual
workers must get clearance from the welfare desk of

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BMET located at the airport. An interviewer approached

and invited women to participate once clearance had been
approved. An average of 55 female migrant workers left for
overseas job during that period. The response rate was
estimated as 22%. Participation was completely voluntary.
The interviewer did not approach women who were in a
rush mainly because they reached the airport at the very
last moment for boarding flights. The interviewer administered the questionnaire. Interviewing was conducted
standing outside the Welfare Desk. The study methods
were approved by the Ministry of Expatriates Welfare &
Overseas Employment. As one of the authors is from
Sydney, Australia, methods were also approved by the
Ethics Review Committee of the Sydney South West Area
Health Service.
Variables that were inquired about included demographic information (age, sex, number of members in the
family, education level completed, destination etc.), reasons for going, source of migration cost, knowledge about
the job to be done abroad (if received job related information and required training), where obtain help if difficulties arise, HIV/AIDS related knowledge (perceived
modes and preventive measures, source of knowledge).
Most of the questions had closed-type categorical responses. Data were entered into STATA for analysis. A summary score was developed for two groups of questions:
knowledge of modes of HIV infection and preventive
measures against HIV, by assigning one point for each
correct response and zero for each incorrect response.
Chi-square test and odds ratio were calculated for finding possible association between some variables and outcome factors. In one case Fishers exact test was carried
out to determine the significance of difference between two
averages. Two tailed P value of 0.05 was used as the criterion of statistical significance. However, as it is a pilot
study with only 123 participants, in most of the cases
simple percentages or numbers are used for reporting
findings.

Results
The respondents were from all 6 divisions of Bangladesh,
with the highest number from Dhaka (65.9%) and lowest
from Sylhet (3.3%). The median age was 29 (range 2050).
More than half (57%) were married, over a quarter were
unmarried (26%) and 17% were divorced. Less than one in
ten (9.8%) had completed education to year 10 level or
more. A little more than half (50.4%) had heard about this
job opportunity from relatives, 28% from neighbours, 7%
newspapers and 19% from other sources. Participants who
had completed education level 8 or more were more likely
to have been sufficiently informed about the job than those

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J Immigrant Minority Health (2010) 12:940946

with less education (OR = 4.1; P = 0.003). Only a

minority (26.8%) of workers themselves had made the
decision to migrate (Table 1). In most cases the husband or
family members had made this decision. Just under twothirds (65.9%) had received little or no information about
the job they were going to.
Knowledge About HIV/AIDS
A total of 87% had heard of HIV/AIDS. Participants who
had completed education level 8 or more were more likely
to have been informed about HIV than others (v2 = 8.51;
P = 0.003). Only 13 (6%) out of 214 responses on
potential modes of acquiring HIV infection were incorrect
(Table 2), of which sharing kitchen appliances with an HIV
infected person was selected by 10, sneeze and cough by
two and mosquito bite by one worker. However, a little less
than half (49.1%) of the participants could correctly identify at least two and only six could identify all four correct
modes of infection listed without choosing any wrong
mode. One in two correctly believed that the appearance of
an HIV positive person might not be unhealthy, while 46%
responded do not know and 3% said appearance would
be unhealthy. Regarding complete recovery from HIV/
AIDS if someone is infected, two-thirds viewed that it was
not possible, 30% did not know the answer and only 4
(3.7%) participants believed it was possible. Disturbingly
none could correctly identify all five preventive measures
listed, three participants picked up one or more wrong
answers along with five correct measures. However, just
over half (51%) responded C2 correct measures without
picking any wrong answer. Less than a half (46.3%)
mentioned unprotected sex as a potential mode of HIV
infection and less than a third (28.3%) identified the condom as a method of prevention. Television and health
workers were the major sources of HIV related knowledge.
In identifying potential modes of HIV infection the
average score of 107 participants, who had heard of HIV,
was 1.9 (out of 4). Considering all 123 participants this
score stands at 1.6. Similarly the average score for the 107
who had heard of HIV, in identification of preventive
measures, was 2.1 (out of 5), and considering all 123 this
score was reduced to 1.8. The mean score of HIV-knowledge of those who received job related training was 1.7 and
of those who did not get training was 1.5. Difference
between this two group-means was 0.2 (t = 1.0; P = 0.3).

Discussion
This pilot study suggests a low level of HIV awareness
among the participants. Thirteen percent of the participants
had not heard of HIV. None could correctly identify all 5

J Immigrant Minority Health (2010) 12:940946

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Table 1 Demographic characteristics of the participants

Indicator

Table 1 continued

Bangladesh Mission there

61

43.3

2-4

47

38.2

BMET

26

18.4

5-7

58

47.1

Others

5.0

8-10

13

10.6

11?

4.1

No education
Level 5

10
64

8.1
52.0

Level 8

37

30.1

Level 10

6.5

Level 12

3.3

No of family members in household

Education level completed

Destination
Kingdom of Saudi Arabia

27

22.0

United Arab Emirates

57

46.3

Lebanon

29

23.6

Oman

7.3

Italy

0.8

No job here

22

17.9

Poor salary here

55

44.7

Reason for choosing this overseas job

Jobs overseas are secured

3.3

31

25.2

Others

7.3

Poor salary here ? have relatives there

1.6

Decision maker
Myself

33

26.8

My husband

19

15.5

Family members

71

57.7

Myself

20

16.3

My husband

12

9.7

Family members/relatives

49

58.5

Borrowed

42

15.4

Have relatives there

Source of migration cost

Received information about job environment/condition

Yes

42

34.1

No

13

10.6

A little

68

55.3

Yes

72

58.5

No

51

41.5

Has received job related training

Would solve problems (if there is any difficulty) by seeking help of*
Relatives

47

33.3

Indicator

* Some participants provided multiple answers

preventive measures listed. Disturbingly, less than a half

(46.3%) mentioned unprotected sex as a potential mode of
HIV infection, and less than a third (28.3%) identified the
condom as a method of prevention. Clearly there is significant gap in their knowledge of HIV. One of the reasons
for low awareness could be that most of the participants
would be working as domestic workers, cleaners, the jobs
usually preferred by those with low education level. Less
than one in ten (9.8%) of our participants completed education level ten and only 3.3% did level 12 or above.
General education has a significant correlation with the
HIV knowledge of this sample.
This study was carried out in a time when receiving
training and passing an oral test were mandatory for
potential domestic workers. Some technical training centres and NGOs offer training for would be domestic
workers. That training includes a module of HIV related
information. However, there was no significant difference
of the mean scores on HIV knowledge between those who
received job related training and who did not. There could
be several explanations for this. Exactly how many of our
participants were domestic workers could not be ascertained. Perhaps we received more participants of other
trades, for which training was not mandatory. It could be
that the domestic workers HIV training module and/or the
method of imparting that information was not effective.
The authors (MI, MM and KK) experience of working in
the Ministry of Expatriates Welfare and Overseas
Employment (MoEW&OE), Bangladesh suggests that in
the oral test almost no question about HIV is asked. Clearly
further research is required to clarify this point and take
necessary measures to improve training based on these
findings. Furthermore participants HIV related knowledge
should be examined in the oral test.
Although BMET runs a pre-departure education session
including information of HIV through one center for the
outgoing workers, clearly it is not enough. A recent study
by UNDP with returnee (n = 125) and current women
migrant workers (n = 70) of Bangladesh that included
workers in the garment industry, bar and nightclub, and
hotel-based sex-workers found that only 9% attended the
official pre-departure briefing [15]. The BMETs briefing
module includes rules and regulations that migrant workers
are supposed to abide by in host countries and very little

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J Immigrant Minority Health (2010) 12:940946

Table 2 HIV knowledge of the participants

Indicator

Heard of HIV/AIDS
Yes

107

87.0

No

16

13.0

Perceived modes of HIV infection (from an HIV infected person) *

Sneeze and cough

0.9

Unprotected sex

99

46.3

Sharing needle-syringe

57

26.6

Sharing kitchen appliances

10

4.7

0.5

Receiving HIV infected blood

28

13.0

Mother to baby infection

17

8.0

Mosquito bite

Would appearance of a HIV infected person be unhealthy

Yes

No

54

50.0

2. 8

Dont know

51

47.2

Is total recovery from HIV possible?

Yes

3.7

No

71

65.7

Dont know

33

30.6

Secure and trusted sexual relation

80

33.3

Condom in sexual intercourse

68

28.3

Sterile needle-syringe

41

17.1

3.8

HIV-prevention method *

Cleanliness
Avoiding sharing of kitchen utensils

11

4.6

Treating STIs

13

5.4

Always receiving safe blood

15

6.3

Avoiding mosquito bite

0.4

Avoiding drug use

0.8

Television

60

29.8

Radio

35

17.4

Health workers

67

33.3

Newspapers

12

6.0

Friends

17

8.5

Textbook

0.5

Others

4.5

Source of HIV-knowledge *

* Some participants provided multiple answers

health information. Clearly BMETs current 2-hour briefing program should be replaced with a well-designed predeparture orientation/training program.
Despite a current low prevalence, Bangladesh has all the
potential for a rapid spread of HIV [16, 17]. In the

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Philippines, according to the National HIV Registry of the

Department of Health, 34% of the registered PLWHA had
been Overseas Filipino Workers (OFWs); moreover, as of
December 2007, female domestic workers comprised 17%
of HIV cases among OFWs. Thus there is a growing
concern that an epidemic of HIV could occur in Bangladesh in the manner witnessed in Philippines.
Migration itself is not a risk factor for HIV infection.
However, as the epidemic spreads across the continents,
the linkages between migration and HIV are being recognised globally. A study by UNDP, in partnership with
people living with HIV/AIDS (PLWHA) groups in the
AsiaPacific region, found that nearly 67% of the participants (PLWHA) reported unsafe and unprepared migration
was the main factor that rendered them vulnerable to HIV
and that better access to information and services would
have protected them [18].
Like most other developing countries, vulnerability of
Bangladeshi female migrants starts in the source community itself, where the decision to migrate is often guided by
desperation, an absence of choices, misinformation and
often unrealistic expectations. Generally, literacy levels are
low and access to information to guide decision-making
about migration, as well as information on HIV/AIDS, is
very limited. Women leave for overseas work under unsafe
conditions, live in very difficult circumstances, and are
often targets of sexual exploitation and violence before
they leave Bangladesh, during their transit and stay in host
countries and on return to their countries of origin [15].
Many women migrants are deceived by traffickers who
promise good jobs; only to find out that they have been
trafficked for sex work once it is too late [7]. Moreover,
gender relations and cultural norms of masculinity and
femininity greatly influence individual sexual attitudes and
behaviours, often placing women at greater risk of HIV
infection than men [19]. With little or no access to health
services and social protection, these factors combine to
make Bangladeshi women migrants vulnerable to HIV.
For some women, migration can provide an escape from
limitations imposed by traditional society. They may also
feel freed from the social norms that guided their behaviour
in their home family, community and culture. Conversely,
it influences them to engage in more risky behaviours.
Lack of social control and recreational outlets, peer pressure, normal sexual needs and lack knowledge of sexual
health or protection combine to make them vulnerable to
HIV [7]. Migrants in some Arab states may face the possibility of being tested for HIV against their wishes or
without their knowledge. If they are found HIV positive,
they face deportation to their countries of origin resulting
in severe economic loss, discrimination and social isolation
in addition to the difficulty of finding alternative livelihoods [15]. Embassy staff, labour attaches, and welfare

J Immigrant Minority Health (2010) 12:940946

staff must be trained to be sensitive to the needs of women

migrant workers, especially those who test positive for
HIV.
Currently, there is no mechanism in place to address
sexual abuse and exploitation of domestic workers. Since
domestic work is not covered by labour-laws in Arab
states, domestic workers have scant protection when their
rights are violated. In the face of abusive situations,
domestic workers sometimes resort to running away, which
increases their vulnerability to other forms of exploitation,
including forced sex work, as fleeing immediately renders
them illegal by host countries, as mandated by the kafala
(sponsorship) programme. The embassies of countries of
origin must proactively protect the rights, and promote
the well-being of their migrant workers. Almost all the
research participants of UNDPs recent study said that they
had no knowledge about support services provided either
by the Bangladesh Embassy or other agencies [15]. Very
few domestic workers approach the embassy for support;
even if they need it. Concerned authorities of Bangladesh
should pursue incorporation of domestic workers rights
into the labour laws of host countries.

Limitations of the Study

Several limitations of our study should be acknowledged. It
is a pilot study, and the total sample size and the participation rate was small. Most of the refusals to participation
were because of the limited time participants had at the
airport and the pressure they experience before boarding
the flight, as most were flying for the first time. Questions
regarding participants sexual behaviour could not be asked
due to the cultural sensitivity and lack of a private location
for interviewing. The questionnaire has not been tested for
validity and reliability; however, most questions have high
face validity. Given these limitations our findings must be
interpreted with caution. However, work experience in
MoEW&OE of three of the authors and other available
information [6, 15, 18, 20] suggest that these findings are
likely to be generalisable. Furthermore, even if the participants had lower overall knowledge than non-participants, it is of concern that this significant number of
individuals are leaving for overseas work with such poor
knowledge.

Conclusion
HIV vulnerability of outgoing migrant workers is enormous. Despite a small sample size this study suggests that
HIV knowledge among the potential female migrant
workers is inadequate. As growing numbers of female

945

workers are migrating for overseas jobs, government and

other concerned agencies must take a pro-active role to
make them aware of the HIV/AIDS infection and effective
preventive measures. BMETs current 2-h briefing program
should be replaced with a well-designed pre-departure
orientation/training program. Vigorous evaluation of the
job related training; particularly the effectiveness of HIV
related modules, including teaching methods, are required.
Furthermore Embassy staff, labour attaches, and welfare
staff must be trained to be sensitive to the needs of women
migrant workers, especially those who test positive for
HIV.
Acknowledgment We would like to thank Mr. Md Mansur Reza
Chowdhury, Joint Secretary of the MoEWOE, and Dr. Nurul Islam,
Director of BMET for their support. We express our gratefulness to
the reviewers for their thoughtful and constructive comments.

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