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

EMPHASIS

HIV Services for cross border migrants in the context of Nepal, India and BangladeshBy Prabodh Devkota Senior Regional Project DirectorCARE InternationalCross border mobility contexts in South Asia(Nepal, India and Bangladesh)

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

Enhancing Mobile Populations Access to HIV Services, Information and Support (EMPHASIS) works in Nepal, India, Bangladesh with research partners in the UKEMPHASIS experience offers learning from two different cross border contexts of South Asia

EMPHASIS Project SitesSource: 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, SatkhiraDestination Mumbai: Thane, Bandra, Jogeshwari, Mulund, Malad, Borivalli, Andheri, Goregaon, Kalwa, Wadala, Mankhurd, Koper Kairne, SantacruzDelhi : Naraina, Ramesh Nager, Kirti Nager, Madipur, Kapashera, Gurgaon, Jhilmil, Kashmiri Gate, Nand NagriKolkata Bongaon, Barasat, Machhalandpur, Cossipore, Rajabazar, Gardenreach, Madhyamgram

EMPHASISResearch/Policy advocacy Safe MobilityWomen EmpowermentSocial Mobilization Cross border referral linkage Health System StrengtheningCapacity Building Referral & Peer EducationCollaborationRemittance Living Conditions of migrants

HIV and Migration: BangladeshAccording 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 Total number of tested cases at VCT CentersStatus of HIV Test result All the cases have migration historyMale (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 stakeholdersThe 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 MobilityLack 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 easyAccess to medicine other than ARTAccessing services from different points within a hospitalTravel 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 DestinationAccessing services through regular referral system in IndiaMale FemaleTotalNMP8529114BSP142741Total9956155People with HIV in EMPHASIS IndiaMale FemaleTotalNMP11333146BSP173249Total13065195Accessing services through cross-border referral: A Historic AchievementMale FemaleTotalNMP28432BSP358Total31940ART TRANSFER FROM NEPAL TO INDIA

Transfer Letter should mention the following:Letter on hospital letter head with email & phone number of hospitalART numberCurrent course of medicineDate when started ARTCurrent status of CD4 countName of preferred ART centre (asked in Mumbai)

Chain of Partners: EMPHASIS Facilitation for Cross Border ReferralNov 22, 2012Lali Guras DIC, Mumbai Nepali MigrantART # ; who was travelling every six months to Nepal for CD4 testing and access ARTNov 23, 2012 FridayARC Project Coordinator sent an email to Country Team India with a copy to RSRS forwarded an email to country team Nepal to act on the issueOn the same day more details sent from Mumbai: Name, VDC, Village and ART siteNov 24th SaturdayProject Coordinator GaRDeF in Achham received information including a request letter from patient for ART transferNov 26thART 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 daysDirect communication among partners (Destination to Source) Close collaboration with ART at both sidesHard work regardless of weekendStrategic 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 challengingProgram at source and destination are strategic to reach the mobile populationGovernments, civil society and peoples network can make universal access possible A comprehensive migration program can make a difference

Thank you

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