Patna: HIV-positive Santosh Srivastava's haunted eyes stare from his shrunken face as he talks about how much he regrets visiting prostitutes while working away from his home state.
"I just did not think about what I was doing," said 48-year-old Santosh.
Santosh is one of the millions of Biharis who have migrated over the years to work in more prosperous and industrialised regions in west and south India.
GROWING RISK: Millions of Biharis have migrated over the years to work in more prosperous regions.
Monday is the United Nations' International Migrants Day and HIV is rampant in many areas of Bihar, where more than 1 per cent of adults infected in Maharashtra and Andhra Pradesh.
Many migrants pick up the virus from prostitutes in cities like Mumbai or Bangalore and carry it home to their wives in Bihar, a crowded state of 85 million people, prompting calls for special awareness campaigns.
According to the United Nations, 5.7 million Indians are living with HIV/AIDS, the world's largest caseload.
"You can't expect all these millions to remain celibate when working outside their state," said Denis Broun, India head of UNAIDS, the United Nations anti-AIDS agency. "We need specific prevention campaigns aimed at migrants in Bihar and in the states where they work."
Though Bihar is classified as low prevalence with 0.3 percent of adults living with HIV/AIDS, or around 135,000 people, its eight out of its 38 districts have reported an infection rate of over 1 per cent.
"It is poverty that is fuelling HIV in this state," said Bihar's health minister Chandra Mohan Rai, adding that actual numbers were probably higher because of poor surveillance techniques and the stigma attached to the disease.
More than 42 per cent of Biharis live under the official poverty line against an all-India figure of 26 per cent.
Employed by a tractor company in Bangalore and Orissa, Santosh returned to Bihar after he found he was HIV-positive.
The father of four is also suffering from tuberculosis, and his wife, who is HIV-free, kicked him out of their home earlier this month after arguments about his health.
"My wife's action really hurt me," he said, sitting hunched in a dinghy room where volunteers give him medicine. "We were supposed to be life partners."