HIV/AIDS Work with Truck Drivers in Orissa

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Koraput district in Orrisa is a center for industries both large and small, and the hub of a highway network. Many young men migrate there from rural areas seeking jobs. The population is very mobile and there is a high demand for commercial sex. These conditions are risk factors for the spread of HIV/AIDS and other sexually-transmitted infections (STIs). Oxfam’s partner organization, South Orissa Voluntary Action (SOVA), has been working in and around Koraput since 1996. SOVA’s research showed that knowledge of HIV/AIDS and of STIs was low and that safe sex was not practiced. Truck drivers were identified as a key high-risk group on which to focus. However, experience has shown the value of widening this focus.
  HIV/AIDS WORK WITH TRUCK DRIVERS IN ORISSAIntroduction In India the HIV/AIDS epidemic is more than 15 years old. The national HIVprevalence rate has risen from 0.1 per cent in 1986, to 0.8 per cent in 2001 – aneight-fold increase in 15 years. Conservative estimates by the government say thatperhaps as many as 4.5 million Indians are living with HIV/AIDS. In six states, morethan one per cent of the population is HIV positive. Given India’s large population,each 0.1 per cent increase in the prevalence rate would increase the number of adults living with HIV/AIDS by over half a million people. As elsewhere in the world, itis poor and marginalized people, and especially women, who are most vulnerable.Oxfam’s work on HIV/AIDS is being implemented through local Indian NGOspartners. This leaflet looks in more detail at work with one partner in the State of Orissa. Programme background Koraput district in Orrisa is a centre for industries both large and small, and the hubof a highway network. Many young men migrate there from rural areas seeking jobs.The population is very mobile and there is a high demand for commercial sex. Theseconditions are risk factors for the spread of HIV/AIDS and other sexually-transmittedinfections (STIs). Programme Oxfam’s partner organisation, South Orissa Voluntary Action (SOVA), has beenworking in and around Koraput since 1996. SOVA’s research showed thatknowledge of HIV/AIDS and of STIs was low and that safe sex was not practised.Truck drivers were identified as a key high-risk group on which to focus. However,experience has shown the value of widening this focus.SOVA selected and trained committed truck drivers as “peer educators” on HIV/AIDSand STIs, with 72 drivers trained so far. It involved both the truck drivers’ union andthe truck drivers’ employers’ association to take more responsibility for enablingdrivers to seek information and support services, including condoms and treatment,with 800 drivers so far having been assisted.But SOVA realised that focusing on “high risk” groups failed to address the risks tolarger population groups, notably the wives of men who may have multiple sexpartners. It therefore decided to work to reduce high-risk behaviour across all groupsin both rural communities and in towns. In order to reach these wider groups, andrespond to the different ways in which people learn. It uses a wide range of methods,including stalls at weekly markets, and theatre.It had already worked to establish self-help groups (SHGs) in tribal villages, with theinitial aim of helping villagers, mostly women, to save money collectively to purchaseseeds or fertilisers or manage the government ration scheme. These SHGs havehelped to empower women with greater individual and collective strength, and SOVA  realized that they could play a major role in increasing people’s knowledge aboutreproductive health and HIV/AIDS, and this is happening. Impact The SHG structure has enabled women to achieve greater autonomy in their sexualrelations. For example, wives concerned that their husbands may have visitedcommercial sex workers are more able to negotiate safe sex.There is increased demand for condoms. Initially, SOVA distributed condoms free-of-charge but now sells them, at a low price, through the peer educators and throughsmall shops, youth clubs and other outlets. Commercial sex workers are much morelikely now to refuse to have sex without condoms.There has been a reduction in HIV-related social stigma because of greater awareness that simply having an infected member in the family need not lead toother family members becoming infected. Lessons learned It is important to recognise the need to reduce high-risk behaviour through workingwith the extended community, rather than focus on so-called “high-risk” groups.Indeed, focusing just on “high-risk” groups may actually increase fear and stigmaand push them underground. It is a challenge to maintain contact with truck driversand the community approach is particularly useful in this regard. IntegratingHIV/AIDS into general reproductive health-care programmes definitely increases thecoverage and impact. Partner treatment of STIs is critical for prevention andreducing risk. This type of work requires a good understanding of the communitiesand their structures.Taking action to prevent HIV/AIDS infection requires a degree of autonomy in sexualrelations, so it is important that programmes contribute to the empowerment of women.Peer education is a key strategy for sustainability and impact. Challenges The epidemic is in its early stages in Orissa. One of the biggest challenges SOVAfaces is sustaining interest in its work in areas where HIV/AIDS is not visible. On theother hand, many truckers have been infected already but treatment is hindered bylack of resources both in the district health authority and among non-governmentalorganisations. Conclusion The programme approach has to be inclusive. It has to cater to the needs of theinfected and the affected and strengthen the capacity and skills of wholecommunities. People living with HIV/AIDS need programmes that address rights andlegal issues, and also information and training for alternative livelihoods. Peer education is a key strategy for behaviour change. HIV/AIDS work needs to beintegrated with reproductive health care.  But for this to happen, the programme providers also have to work inclusively. Thatmeans government doctors, health workers and other authorities, NGOs andtraditional providers have to work more closely together and reinforce each other’sskills. This in turn also requires networking and advocacy with district legislators andother political stake-holders who can establish policies and resources from the top inorder to create “friendly” services.
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