Every year, 200,000 Sri Lankans go overseas in search of better-paying jobs to support their families. Most of them are young women who work as housemaids or in garment factories in the Middle East for around $120 a week; their remittances may help boost the finances of households and the country as a whole, but the price they pay can be even higher.
A number of sessions at the 8th International Congress on AIDS in Asia and the Pacific (ICAAP), in Sri Lanka's capital, Colombo, focused on migration as a risk factor in relation to HIV infection, and access to treatment and services.
Asians from developing countries like Indonesia, the Philippines and Bangladesh gravitate towards wealthier destinations like Hong Kong, Malaysia, Japan, the Middle East and even the United States to do the jobs that locals often consider too tedious or poorly paid.
A UN report on international migration estimated that in 2006 there were 53 million migrants in Asia alone.
Very little data is available to gauge the number of migrant workers who have become infected with HIV while overseas, and researchers can only assume that the numerous risk factors associated with economic migration make them more vulnerable.
According to a number of studies, migrants report feeling lonely and isolated as a result of language barriers, their often low social and legal status, and being separated from their regular partners, which can make them more likely to engage in risky sexual encounters.
Personal health and safety are often described as a low priority, while health services are usually unaffordable or difficult to access. Some female migrants report being coerced into sex by abusive employers.
A recent study by the International Labour Organisation (ILO), the global body responsible for drawing up and overseeing international labour standards, in conjunction with Indonesia's Ministry of Manpower and Transmigration, found that most Indonesians preparing to work overseas had low levels of knowledge about HIV, with many believing it was a disease only for sex workers.
Education on HIV was supposed to form part of their pre-departure training, but a survey of the instructors revealed that they knew less about the disease than the migrants.
HIV testing of prospective migrants is mandatory in Indonesia, and a number of other countries in the region because the recipient countries, recruitment agencies and employers require it.
Galuh Sotya Wulan, who presented the ILO study at the Colombo conference this week, noted that some Indonesian migrant workers did not know they were being tested for HIV, nor were they referred to health services if they were found to be positive. Even more worryingly, researchers found that some clinics carrying out the mandatory testing were recycling syringes.
CARAM Asia, a regional network that focuses on migration and health issues, has issued a report on mandatory testing in which it called for the practice to be banned or, at a minimum, to follow some basic best practices, including the provision of pre- and post-test counselling, obtaining informed consent, protecting confidentiality and providing proper referrals to those needing treatment.
"Medical testing should not be used as a screening mechanism to determine which migrants are allowed to work; it should be used to improve migrants' health by acting as a gateway to access health services and treatment," the report commented.
A number of presentations at the conference highlighted the HIV risk to the migrants as well as the spouses and children left behind. The ILO report noted that over a three-month period more than half the husbands of female migrants visited sex workers.
Ian MacLeod, a senior programme officer at the UN Children's Agency (UNICEF), said the biggest HIV risk factor for female migrants might not be what they encountered abroad, but the increased risks their spouses took while they were away.
Children left in the care of a single parent might also be at a greater risk of abuse or exploitation. A pre-departure training programme for migrants and their spouses, run by Sri Lanka's Bureau of Foreign Employment, includes tips on how to address "sexual challenges" and protect children.
"There's no magic bullet, but the starting point is to recognise the vulnerabilities of those left behind, and to target entire communities with interventions," said MacLeod.
Few countries have implemented programmes for reducing the HIV vulnerability of migrant workers and their families. "Governments tend to perceive migrants as nothing more than economic units," commented Brahm Press of CARAM.
"The Indonesian government has the budget because migrants pay a lot of money to go through the pre-departure procedure," ILO's Galuh Sotya Wulan told IRIN/PlusNews, "but they're not using it well."
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