BackgroundCOVID-19 hit millions of migrant workers hard in India. They lost livelihoods and were at a heightened risk of COVID-19 during the lockdown. Recognizing that large inter-state and rural to urban migration also aggravates the risk of HIV infection, migrant workers are a key focus of the National AIDS Control Programme in India.
The Gujarat State AIDS Control Society (GSACS) and the ILO have joined forces to expand HIV testing for workers under the voluntary counselling and Testing (VCT@WORK) Initiative since 2018.
The Gujarat AIDS Awareness and Prevention unit of ISRCDE (GAP-ISRCDE), a non-profit organization with years of experience of implementing HIV and AIDS programmes for workers in the informal economy, including truckers and migrants, has been a key partner in this endeavour. In 2019, GAP implemented a project with the support from the ILO and GACS in three districts of Gujarat reaching out to migrants and daily wage labourers with community-based HIV screening organized at work sites.
In 2020, after the partial relaxation in the COVID-19 lockdown, the ILO and GSACS provided further support to GAP to scale up the efforts to five districts of Gujarat and implement a community-based HIV screening programme, dovetailing with information on COVID-19 prevention, from August 2020 to November 2020.
“This innovative project allowed us to continue with HIV screening amongst migrant workers, and ensure that HIV testing is not disrupted during the testing times of COVID-19. GSACS values its collaboration with the ILO that has allowed us to expand HIV testing amongst migrant workers, particularly the difficult- to- reach men, under the VCT@WORK Initiative.”
Dr Rajesh Gopal, Additional Project Director, GSACS.
Dr Rajesh Gopal, Additional Project Director, GSACS.
Salient features of the strategy:
Capacity building and communication: GAP organized a three-day training programme on HIV and AIDS, COVID-19 and communication skills. This included face-to-face training and some online webinar sessions with experts from GSACS and ILO. GSACS provided testing kits as well as training on community based HIV screening to GAP staff. Communication materials were developed on HIV and AIDS, HIV testing and its benefits; and prevention of COVID-19.
During awareness sessions, workers were also educated on maintaining social distance, wearing masks and washing hands properly and regularly. Masks were distributed along with immunity strengthening homoeopathy medicines approved and provided by the state government. Workers were also screened for body temperature and oxygen levels during the awareness sessions.
Engaging key workplace stakeholders:GAP mobilized supervisors, managers and builders as a first step. Successful advocacy with them allowed the GAP staff to conduct awareness and screening sessions at work sites during working hours. Supervisors and managers welcomed the integrated approach of COVID-19 and HIV and themselves participated in several programmes.
GAP organized health camps for community-based HIV screening, using the kits provided by GCACS. Considering the situation of COVID-19, only 40 persons were screened in each camp, following safety protocols as per the guidance of GSACS and the state health department and national guidelines on pre and post-HIV test counselling. Those found positive were referred to nearest Integrated Counselling and Testing Centre (ICTC) for confirmatory test. All workers found HIV positive were registered for starting the anti-retroviral treatment. GAP also followed up to trace the sexual partners of HIV positive workers and offered HIV testing to them as well.
Community-based HIV screening
- Between August and October 2020, a total of 8054 workers (6363 male and 1691 female) were reached against an envisaged target of 7500. Majority of these were in construction and manufacturing sectors, but also included workers in transport, catering and other daily wage earners.
- Over 5000 workers were provided with masks and over 3000 were provided with immune booster homeopathic medicine.
- In 78 health camps, 3116 workers (2697 male and 416 female) took the HIV test. All 11 who tested positive during community screening were confirmed at ICTC and have been registered for starting the treatment.
Lessons Learnt- Migrants as well as their supervisors/managers welcomed an integrated service delivery approach under which they received information and services on COVID-19 as well as HIV. Without this integration, it would have bene difficult to continue with HIV testing services in this time of crisis.
- Capacity building of the implementing partner is key in adopting an integrated approach. GAP’s presence in the communities, experience of HIV programme particularly the behaviour change communication, came in very handy for integrating COVID-19 services, with additional capacity building undertaken by GSACS and ILO.
- Around 87% of those who took HIV test were men. This shows that with careful targeting VCT@WORK has a huge potential of filling in the gaps in HIV testing for men.
- Partnerships were key to the success. Apart from GSACS, ILO and health department, GAP’s ability to mobilize the support and ownership of local industries, contractors and managers played a critical role.
- Discussions will be held between GAP, GSACS and ILO on how to scale up this initiative to more districts.
- The next phase will aim at:
- strengthening the referral system with ICTCs and get the data of migrants who test directly at the ICTC after attending the awareness sessions organized by GAP; and
- Strengthening partnerships with local industries and managers of work sites where migrants works and secure their tangible contribution into the programme.