Transit based HIV prevention program reach migrants and their spouses going to India from NepalPrakash Pandeya1, Umesh Gahatraj2, Upasana Shakya2 ,Nabesh Bohidar3, Rokaiya Parween3, Prakash Madai4

1CARE International in Nepal, 2CARE Nepal, 3CARE India, 4NEEDS Nepal

Introduction

Materials and Methods

Results

Conclusions

There exists a long tradition of Nepalese migrants going to India for better employment opportunities. Due to the risky sexual behavior while working at destination, Nepalese migrant laborers get infected with HIV and transmit to their wives at home. (NCASC: IBBS among migrants-2012) Recent findings suggest that 41% of all country’s HIV cases were among labour migrants to India (NCASC 2012) Different studies have proved that the prevalence of PLHIV is alarming among this population (save the children IBBS 2012)There are a growing number of people migrating between Nepal and India. Mobility has long been linked with heightened vulnerability to HIV & AIDS. While overall HIV prevalence is low in Nepal, there is a growing concern that vulnerable mobile populations are forming a bridge between high prevalence areas of India and low prevalence areas in Nepal. Enhancing Mobile Populations’ Access to HIV & AIDS Services Information and Support (EMPHASIS) is a regional program being implemented by CARE Bangladesh, CARE India and CARE Nepal and led by CARE International UK (CIUK) to reduce AIDS related vulnerabilities among mobile populations crossing the borders of Bangladesh and Nepal into India.

Project has adopted transit based interventions program to reach migrants with HIV prevention messages. In Nepal, there are two major transit sites (Kanchanpur and Kailali) from where Nepalese migrants use to cross the border largely. These transits are the geographically easy to reach major destinations in India were selected for implementation of this initiative. Transit based interventions at Kanchanpur and Kailali district reach Nepalese migrants and their spouses going to India through Outreach Workers, Peer Educators, migrant information desks and drop-in centers’ (DIC) in coordination with CARE India EMPHASIS project in both transits. 5 outreach educators, 3 DIC facilitators, 10 Peer Educators, 1 migrants’ information desk’s facilitator reached out to migrants from 47 districts of Nepal (out of 75) with HIV prevention messages. Information services of EMPHASIS India have also helped migrants to access services in the destination cities.

Rickshaw pullers providing HIV information to migrants at transit

Transit based intervention practice found as an important learning outcome of the EMPHASIS project. Reaching migrants at transit is always complicated, but transport workers, hoteliers, migrant information desks, drop in centers, cross border learning sharing meeting (peer educators/outreach educators/hoteliers/ transport workers) has strengthened the transit based intervention. Engagement of stakeholders to reach migrants with HIV prevention message has helped to reinforce the migrants to understand and realize the HIV context. Intervention at both side transits (Nepal and India) provided greater space to reach the migrants in terms of time of migrants. The whole efforts done at Indo-Nepal transit have shown the way to reach cross border migrant workers in the similar context in the wider world.

Reaching migrants at transit

From Jan 2012- Jan 2013, 59604 migrants and their spouses of 47 districts were reached (accessed with information) through the transit-based intervention. Among the total migrants and spouses reached 87.5 % men and 12.5% women. Reaching migrants with HIV prevention messages, IEC materials, and service site information of India helped Nepalese migrants to access HIV/AIDS services in India. 27 PLHIV migrants of Nepal accessed ART from India.

Achham

Kanchanpur

Baitadi

Bajhang

Bajura

Kailali

Doti

Bardiya

Surkhet

Dadeldhura

0% 10% 20% 30% 40%

5.80

0.40

7.90

5.80

5.80

37.705.80

4.50

4.30

4.10

Migrants reached at transit by top ten place of origin

Delhi

Mumbai

Banglore

Uttrakhand

Punjab

Himanchal Pradesh

Chennai

Gujrat

Uttranchal

Puna

0% 10% 20% 30% 40%

36.80

14.30

7.60

6.30

6.20

5.70

5.60

4.20

3.30

1.90

Migrants reached at transit by top ten place of destination