icsw - s.h.i.p. seafarers health information programme topic 7 : stis, including hiv / aids

ICSW - S.H.I.P.

Seafarers’ Health Information Programme

Topic 7 : STIs, including HIV / AIDS

Maritime Sector

>90% of World Trade is transported by Ship

± 1.2 million people work at sea:• 450,000 officers = 2-5% shortage• 750,000 ratings = 10-15% surplus• 60 % from Asia• >20% from The Philippines

Maritime Industry

Global sector:– fierce competition >> low wages – harsh working conditions– manning countries = cheap labor countries– manning agencies for recruitment and

contract

Maritime Sector

Threats and Challenges

Maritime Regulators

• IMO: • Standards on Training, Certification &

Watchkeeping STCW ’95 treaty 1995• International Shipping & Port facilities Security

ISPS Code 2001• SOLAS: Safety of Life at Sea• MARPOL

• ILO:• Maritime Labor Convention 2006

Seafarers’ Health

Plenty occupational, physical, chemical and other health hazards:

• Construction, cargo, isolation, climate changes• Noise, vibration, radiation• Loading, discharging, cleaning, painting• Travelling, accidents, infections, unsafe sex

Why S.H.I.P.?

• To stimulate seafarers to take responsibility for their health in the living and working environment onboard

• Healthier, fitter, safer…

Ten Topics

• Food Safety• Fit on Board• Safe travel• Healthy food• Malaria• Overweight• STI, HIV / AIDS• Mental Care• Dental Care• Skin Care

How?

• Pre-employment examination: clinics• Health Policies: Shipping Companies• Transit points: seafarers’ centers• Ship visitors in ports• Courses• Website• Sportsevents: ISS• …

Contact pointsContact points

An intervention has to involve:

• Shipping Companies• Unions• Welfare Organizations• IMHA• ILO / IMO / WHO

Seafarers and STIs, HIV / AIDS

– Shipping Companies:C.S.R. = Corporate Social Responsibility

– Unions– Welfare Organizations– IMHA– ILO / IMO / WHO


C.S.R.

• “The essence of corporate social responsibility (CSR) is that companies should not seek profits alone; they must conduct their business activities with consideration of society, the environment, and human rights, and strive for sustainable growth as part of the global and local community”

• “Corporations are one of the building blocks of modern society. And we have seen time and time again that when a company loses the trust of society, it is quite difficult to recover”

C.S.R. & Health• Health of employees is an integrated part of the

organisation

• People are the most important asset in the organisation

• Every employee, on any level, has a unique contribution to create and maintain a healthy work environment and promote a healthy lifestyle

• Care for health of employees is an essential part of the success of an organisation

• Healthy employees improve the performance of the organisation

– Shipping Companies– Unions

• ITF = International Transport Workers Federation– “Highway of Hope”– AIDS coordinator

• ITF Seafarers’ Trust: startup funding for S.H.I.P.

– Welfare Organizations– IMHA– ILO / IMO / WHO


– Shipping Companies– Unions– Welfare Organisations

• International Committee on Seafarers’ Welfare• Faith-based Organisations:

– AOS, MTS, BISS, DSM …

• Seafarers’ Centres

– IMHA– ILO / IMO / WHO


What Are We ?What Are We ?

– A Charity registered in the UK

– An international umbrella organisation dedicated to the implementation of the ILO Instruments on Seafarers’ Welfare.

• Convention 163• Recommendation 173

– Shipping Companies– Unions– Welfare Organisations– IMHA

• Maritime Medical Professionals• Expertise & Research • 2007 IMHA & ITF join to condemn HIV discrimination

at sea

– ILO / IMO / WHO


ILO / IMO / WHO

• 1988 IMO resolution A.639 (16): undesirability of HIV screening of crews and passengers on ships

• 1989 IMO/IMO/ WHO joint consultation: seafarers are not at particular risk of HIV infection in their occupational environment



HIV / AIDS is a maritime issue. Not only because it affects the workforce, but also because ships have a role to play in the wider struggle to limit the spread and effects of the epidemic

Seafarers and STIs,HIV / AIDS

Risks and vulnerabilities:• Working and living away from spouses and

partners• Working in isolation with limited social interaction

and limited health facilities• Single-sex working and living arrangements

dominated by men, where women are in a small minority

• Limited control by the individual on protection against infection

The number of HIV positive seafarers is thought to be quite low, because of:

• Shorter turnaround time in ports• Stringent duty and watch systems• High workload ~ crew reduction• Port facilities far away from town centers• ISPS code: more stringent security systems• Increased dangers and hostilities faced by seafarers

in some regions

…/…


• Mandatory pre-employment testing in major manning countries

• Higher education and training level:– …Making choices…

• Drug and Alcohol policies:– “dry” ships

“Healthy worker effect”

True for all Seafarers?


Prevalence:

• Not enough facts and figures• HIV prevalence among seafarers is

not higher in most studies• Prevalence of other STI is higher in

most studies

“Absence of evidence ≠ evidence of absence”


Prevalence:

The Philippines:2002

2006 HIV + n=1611 n=2484

OFW 28% 50-60%

Seafarers 38% (n=171)

UNAIDS estimate: n=12,000


Prevalence:

• Higher in certain sailing areas? • Patchy pattern of high prevalence? • Like “Corridors” in road transport• Higher in certain types of trade:

e.g. cabotage?


Knowledge, Attitude, Behavior and Practice:

• Small group: sexually very active

• Large group: occasionally unsafe sex

• Small group: no risk at all


Knowledge, Attitude, Behavior and Practice:

• Knowledge: misconceptions

• Peers are more important than knowledge for behavioral change

• Use of condoms varies from 20% to 60% depending on the study


Challenges of a Maritime STI, HIV / AIDS Awareness Campaign:

• Neutrality of the message: – Tone, level, technicality– Culturally indifferent– No stigmatization

• Faith-based welfare organizations• Participation of sector and community

Seafarers and STI, HIV / AIDS

• Guidelines on the Prevention of Sexually Transmitted Infections including HIV and AIDS Onboard Merchant Ships

• STI, you are part of it!...

• Trailer

• Three posters

• Questionnaires

• Health Promotion in a Shipping Company + PP


A Campaign in Seven Steps

1. Why a Campaign on STI HIV AIDS for seafarers?

2. How to handle this?

3. What is important?

4. What needs to be done?

5. Start the campaign!

6. Have the goals been achieved?

7. Keep the momentum going!



1. Create support for a STI HIV AIDS campaign

2. How to handle this?









2. Set up a structure for a STI HIV AIDS campaign










3. Investigate what the target group needs and wants










4. Make a plan for a STI HIV AIDS campaign










5. Implement the campaign










6. Evaluate










6. Evaluate

7. Adapt and continue

Key elements

• Website– www.seafarershealth.org– www.seafarerswelfare.org (ICSW)

• E-mail– [email protected]

• Campaign material

http://www.seafarershealth.org/

http://www.seafarerswelfare.org/

mailto:[email protected]

VII. THOU SHALT TAKE AND WEAR THY PROPHYLACTICS

icsw - s.h.i.p. seafarers health information programme topic 7 : stis, including hiv / aids

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