|An estimated 2.4 million Indians are HIV positive, 83% of which are aged between 15-49 years (2009). India’s HIV epidemic is largely confined to a few industrialized states in the country’s south and west. Maharashtra is with its 420,000 affected people the second highest affected state, and accounts with the other southern states of Andra Pradesh (500,000), Karnataka (250,000), and Tamil Nadu (150,000) for 55% of India’s HIV infections.
The Indian HIV epidemic has not yet taken hold of its general population and is largely concentrated in a few high-risk groups, spreading first and foremost through unprotected sex between sex workers and their clients (such as migrants and long distance truck drivers), and through the use of contaminated injecting equipment when taking drugs. (Source: Worldbank, 2012)
HIV prevention in India:
- National Level: National Aids Control Organisation (NACO) – In Control of Aids programmes across the country
- State Level: Mahrashtra State Aids Control Society (MSACS) – funding agency
- Local Level: Programmes are being implemented through local NGOs ie. IIYW receives grants from MSACS
Main target groups for HIV/AIDS programmes:
- Female Sex Workers (FSW) – core target group
- Long-distance Truckers
- Intravenous Drug Users (IDU)
IIYW is the only organization in Nagpur offering HIV projects for 3 different high-risk target groups, namely FSWs, Migrants, and Truckers. IIYW’s 3 HIV projects are collaborating through monthly meetings in order to share ideas, as well as organizing a joint health camp every 6 months. The statistical information on HIV/AIDS cases in Nagpur reveals that cases of HIV/AIDS are increasing day by day and this an alarming situation persisting for the past years. Through this project IIYW intends to undertake massive awareness campaigns on HIV /AIDS to generate awareness among short stay migrant laborers.
“Being mobile in and of itself is not a risk factor for HIV infection. It is the situations encountered and the behavior possibly engaged in during mobility or migrating that increase vulnerability and risk regarding HIV/AIDS”.
For the purpose for HIV and migration, migrants are people who seek better livelihoods and move from their place of origin in rural areas (source) to a town or city (destination), with the intention of settling temporarily or semi-permanently and return back to their origin for up to 3 – 6 months.
The IIYW migrant project focuses on destination intervention and specifically targets labour migrants, aged 15-45, who are staying in Nagpur for 6-12 months.
The main pull factors for migrants in Nagpur are the many job opportunities for labourers. Nagpur has the area’s biggest merchant’s market, as well as around-the-year job opportunities in construction and pandalwork.
The migrants are highly vulnerable to HIV infections, due to residing in Nagpur’s slum areas for 5-7 months during their stay, with very poor hygiene and health conditions. the migrants become isolated due to long working hours and absence from home for many months at a time. In order to satisfy their sexual needs they resort to unsafe methods of sex. Most of the migrant laborers are illiterate and they tend to ignore their health in order to save money to take back home. The level of awareness on infectious diseases is very low.
The migrant project works in 23 labour point sites, where the migrants traditionally meet before being send to their work sites by a contractor. The project employs one Project Director, one Project Manager, one Counselor, five Out Reach Workers (ORW), one Accountant, and one person responsible for Monitoring and Evaluation.
The project is currently active at the following sites:
- Cotton Market
- Empress city
- Panchsheel Square
- Ranidurgawati nagar
- Mhada Baidyanath Square
- Punj llyod
- Man Infra
- Zingabai Takli
- Modell mill
The migrant project generally organizes one health camp per month through which they reach 100 migrants at a time. Hospital staff will attend these health camps in order to offer STI/HIV testing and counseling. The blood samples will be tested in ICTCs (Integrated Counseling and Testing Centres).
Additionally, IIYW’s migrant project organizes street plays to raise awareness about HIV/AIDS, and during big events the project runs games and competitions related to raising STI, HIV/AIDS awareness.
Furthermore, the project aims to put HIV patients and those living below the poverty line in touch with government schemes targeted at HIV patients or those living below the poverty line.
The projects key stakeholders are:
AIM and OBJECTIVES
- Primary stakeholder: Target group (ie. Migrants)
- Secondary stakeholders: Shop owners, local leaders, labour contractors. This group has a vested interest in reducing the HIV prevalence rate in their community/workforce. They sell socially marketed condoms (at a no-profit basis) and encourage the migrants to seek information and testing through the project.
- Tertiary stakeholders: government offices in the area, such as police stations, and electricity departments etc. If the project organizes big events, this group will support their work through handing out necessary permits
To prevent and reduce the further spread of HIV/AIDS/STI/STDs by generating awareness and prevention services among migrant labourers of selected labour points in Nagpur City.
- To saturate and increase utilization of Integrated Counselling and Testing Centres (ICTC), and STI care, support and treatment services among Migrants in Nagpur City.
- To scale up prevention activities regarding STI, HIV and AIDS to saturate (85 to 90%) coverage of high-risk groups and vulnerable populations through by initiating BCC (behaviour change communication) activities in Nagpur city.
- To promote the effective usage of condoms and ensure availability and accessibility of the same among the migrant population.
- To ensure the sustainability of the program in Nagpur city by building capacity of CBO, staff, various stakeholders and service providers.
- To create an enabling environment through Advocacy & Networking in the project area.
- To sustain behavioral change among high risk groups through communication initiatives.
- Migrants have become aware of STI/HIV/AIDS
- There has been a good response to the project’s health drive
- There has been a good participation in community programmes
- Migrant youths have shown interest in becoming peer educators
- The project has been able to serve the majority of Nagpur’s migrants by covering the main construction sites in the city.
- Through the capacity building of ORW’s they are working to a high standard, spreading awareness on STI/HIV/AIDS to the community. They have become a ray of hope to the community.
- Volunteers act as a link between migrant workers and use ‘Targeted Intervention’ (TI) methods to facilitate local participation.
- Through the use of street plays, more people could be reached and higher numbers came for treatment in the health camp.
- Through a large entertainment event the project covered a large number of people who received massages on STI/ HIV/AIDS. Through the event the project introduced itself to a different migrant group, working as vendors in the Cotton Market area. Subsequently, they all benefited of an STI camp.
- Advocacy work has been done with local the government, health department, the corporate sector like RTO, Police, various school and colleges, and other government agencies for organizing various programmes.
- The project has built a strong network with other NGOs and government institutions working in the same field.
- Lack of space to conduct health camps at the labour points
- Difficulties faced in organizing advocacy meeting.
- In order to provide adequate STI care it is crucial to treat both affected partners. However, the majority of the target group is single, which makes it very difficult to treat the sexual partner.
- Testing Kits for HIV were not available in the ICTC centers, which meant that we could not achieve our target for HIV testing.
- Due to a lack of audio visual privacy, some clients cannot give proper information about their risk behavior.
- Refresher Training workshop for all staff.
- Refresher MIS training
- Updated Information on HIV/AIDS.
- Training on BCC
- Training on Documentation.
For the year 2013-2014, the project will retain its target of reaching 10000 people.