HIV Services for cross border migrants in the context of Nepal, India and

Bangladesh

By Prabodh Devkota

Senior Regional Project Director

CARE International

Cross border mobility contexts in South Asia(Nepal, India and Bangladesh)

Nepal and India share open border India and Bangladesh do not share open border Mobility with in South Asia remains as a historical fact

Enhancing Mobile Population’s Access to HIV Services, Information and Support (EMPHASIS) works in Nepal, India, Bangladesh with research partners in the UK

EMPHASIS experience offers learning from two different cross border contexts of South Asia

EMPHASIS Project Sites Source: Nepal· Achham and Kanchanpur Bangladesh · Jessore and Satkhira

Transit Nepal

· Gaddachauki, Nepal · Banbasa and Gaurifanta, India

Bangladesh · Border area of Sarsha, Sub-district of

Jessore · Border area of Debhata, Satkhira Sadar

& Kalaroa Sub-district, Satkhira

Destination Mumbai:· Thane, Bandra, Jogeshwari, Mulund, Malad, Borivalli, Andheri, Goregaon, Kalwa, Wadala, Mankhurd, Koper Kairne, Santacruz

Delhi : · Naraina, Ramesh Nager, Kirti Nager, Madipur, Kapashera, Gurgaon, Jhilmil, Kashmiri Gate, Nand Nagri

Kolkata ·Bongaon, Barasat, Machhalandpur, Cossipore, Rajabazar, Gardenreach, Madhyamgram

EMPHASIS

Research/Policy

advocacy

Safe Mobility

Women Empowerment

Social Mobilizatio

n

Cross border referral linkage

Health System

Strengthening

Capacity Building Referra

l &

Peer

Educatio

n

Collabora

tio

n

Remittance

Living Conditions of migrants

Female

sex

workers

Inje

ctin

g dru

g use

rs

Clients

of s

ex work

ers

MSW

s, tr

ansgender a

nd clie

nts

Oth

er MSM

who d

o not s

ell and/o

r buy

sex

Remain

ing m

ale P

opulatio

n

Male

labour m

igra

nts

Remain

ing fe

male

Popula

tion

0.05.0

10.015.020.025.030.0

1.5 2.24.4

7.2

14.4 16.0

27.0 27.3

% Estimation of HIV Infections by Risk Population Groups(Source : NCASC July, 2012)

Population Sub - Groups (15-49)

Pe

rce

nta

ge

HIV and Migration: Bangladesh

According to the NASP Report of 2006, approximately 67 percent of identified HIV-positive cases in the country were returnee migrant workers and their spouses.

NASP on the World AIDS Day 2010 stated that 40 per cent of total new HIV cases reported were from external migrant workers and 34 per cent of total cases were female, of which 24 per cent were wives of HIV-positive men.

In 2011, out of the 445 new HIV infections, 138 (31%) are the external migrant workers and 21.1% are the housewives.

EMPHASIS collaborated with Gov Bangladesh to set up two VCT Centers

Male Female Total0

50

100

150

200

250

300

350

229

104

333

187

151

338

Frequency distribution of tested cases (n=671)

Jessore Hospital Satkhira Hospital

Fre

qu

en

cy

Total number of tested cases at VCT Centers

Status of HIV Test result

Positive Negative 0

100

200

300

400

500

600

700

17

671

Test Result

Fre

qu

en

cy

All the cases have migration history

Male (408)Female (244)

Male (6)Female (11)

EMPHASIS is still in the process of analyzing the context and technicalities of these data in coordination with government and other stakeholders

The process to receive ART in India requires the following documents:

Address proof (Ration card/electricity bill) OR Recommendation letter/undertaking from NGO or Recommendation from employer and

Employee ID card

 Key Issues faced by PLHIV in the continuum of Mobility Lack of Information Lack of identity proof Long queue (some time 300-400 persons) for getting ART (Mumbai/Delhi) Inadequate time given by ART counsellor though efforts are made to make it easy Access to medicine other than ART Accessing services from different points within a hospital Travel cost-Poor financial status women and widows are on the hardest hit Language barrier

Opportunities

India operates under the principles of universal access to treatment services

EMPHASIS Efforts in Destination

Accessing services through regular referral system in India

Male Female Total

NMP 85 29 114

BSP 14 27 41

Total 99 56 155

People with HIV in EMPHASIS India Male Female Total

NMP 113 33 146

BSP 17 32 49

Total 130 65 195

Accessing services through cross-border referral: A Historic Achievement

Male Female Total

NMP 28 4 32

BSP 3 5 8

Total 31 9 40

ART TRANSFER FROM NEPAL TO INDIA

• Transfer Letter should mention the following:• Letter on hospital letter head with email & phone number of hospital• ART number• Current course of medicine• Date when started ART• Current status of CD4 count• Name of preferred ART centre (asked in Mumbai)

Chain of Partners: EMPHASIS Facilitation for Cross Border Referral

Nov 22, 2012Lali Guras DIC, Mumbai

Nepali MigrantART # ; who was travelling every six months to Nepal for CD4 testing and access

ART

Nov 23, 2012 FridayARC Project

Coordinator sent an email to Country Team India with a copy to RS

RS forwarded an email to country team Nepal to act on

the issue

On the same day more details sent from Mumbai: Name, VDC, Village

and ART site

Nov 24th SaturdayProject Coordinator GaRDeF in Achham received information including a request letter from

patient for ART transfer

Nov 26th

ART Transfer letter sent from source to destination

Nov 29th Linked to ART site in

Mumbai

Reflection: • Linked to ART at

destination with in 4 working days

• Direct communication among partners (Destination to Source)

• Close collaboration with ART at both sides

• Hard work regardless of weekend

Strategic significance of having a cross border program

EMPHASIS services were provided to 13828 migrants at destination in 15 months who were from 67 districts of Nepal at source. This proves the fact that for a cross border program it is important to have programs both at source and destination.

Key Learning

• Unless Migration is underscored as a key priority within National AIDS Response, reaching migrants will be more challenging

• Program at source and destination are strategic to reach the mobile population

• Governments, civil society and people’s network can make universal access possible

• A comprehensive migration program can make a difference

Thank you

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