STATE TRAINING AND RESOURCE CENTRE
OPERATIONAL RESEARCH ON: Knowledge, Attitude and Practices on HIV/AIDS among Migrant Workers in Delhi NCR
SOCIAL WORK, UNIVERSITY
A Study on:
Knowledge, Attitude and Practices on HIV/AIDS among Migrant Workers in Delhi NCR
I am pleased to place the Operational Research on “Knowledge, Attitude and Practices on HIV/AIDS among Migrant Workers in Delhi NCR” done by STRC supported by NACO, DSACS for the year 2012-13. STRC is the fourth extension unit of the Department. Delhi School of Social Work consecutively been ranked as number 2 among the top 15 professional colleges of social work in the country in 2012-13 there is no denial that we received merit where STRC had its own role. STRC is four year old and responded to the needs of capacity building for targeted intervention program under National AIDS Control Program Phase III, its outcome is more than enough. In 2012-13, our main focus has been training of TI personnel by imparting quality training at various levels. This year, we plan to take up other initiatives for creating other innovative opportunities forth capacity building in the area of HIV/AIDS in general and Targeted Intervention in particular. I am grateful to all those individuals, groups, institutions who had supported us in making this Operation Research effective. I would like to thank my colleagues at Department and Prof. Sushama Batra (HOD- DSW) who has contributed at all stages of building and running STRC. I will be failing in my duty if I don‟t acknowledge support and guidance of NACO specially to Dr. Subash Gosh, Ms. Garima Sharma and DSACS officials specially Project Director, Dr. C.L.Garg and Dr. J.K. Mishra, JD (TI) & Migrant TIs staff for their support and guidance in making our activities effective and successful. Finally, I would like to thank the team of STRC, Mr.Narender Sindhi, Ms Tripti Oberai, Mr. Sham Lal, Mr. Vikram Kaul and Mr. yogesh Kumar. I look forward your continuous support and guidance, critical comments as well as suggestions to make this STRC a Centre of Excellence in the area of capacity building.
Prof Sanjai Bhatt (Project Director) STRC Delhi
Acquired Immuno Deficiency Syndrome
Behaviour Change Communication
Department for International Development
Focus Group Discussion
Family Health Institutional
Human Immuno-deficiency Virus
Injecting Drug Users
Information Education Communication
Jawahar Lal Nehru University
Municipal Corporation of Delhi
Men having sex with men
Non Governmental Organization
Obstetrician and Gynaecologist
Out Patient Department
Public Call Office
People Living with HIV/AIDS
Private Medical Practitioner
Prevention of Parent-To-Child Transmission
Registered Medical Practitioner
Reproductive Tract Infection
South Asian Research and Development Initiative
Sexually Transmitted Infection
United Nations for Development Programme
Video Compact Disk
Voluntary Counselling and Testing Centres 4
State Training and Resource Centre (STRC) has been setup by NACO at Delhi School of Social Work, University of Delhi. The centre is a part of NACO‟s strategy to develop a sustainable system for the capacity building of NGOs/ Civil Societies implementing targeted intervention program under NACP III. STRC provides high quality training to partner organizations implementing Targeted Intervention projects for High Risk Groups (HRG) with Delhi State AIDS Control Society (DSACS)
GOALS • Ensuring need based training of TI partners as per NACP III‟s technical and operational guidelines
A centre of excellence to provide capacity building opportunities through innovation
• Enhancing the capacity of NGOs and civil society organizations in proposal development for NACP funded targeted intervention projects; • Undertaking operational research and evaluation of TIs.
The STRC Delhi became functional in August, 2008 .During its first year of operation, STRC Delhi has been recognized as centre of repute in the area of capacity building on HIV/AIDS in general and Targeted Intervention in particular. STRC Delhi has become a recognized resource centre for proving quality training to those who work in the area of TI /HIV/AIDS
OUR APPROACH A comprehensive capacity development strategy was adopted to translate the overall objectives of targeted intervention into actual task with capacity building as the guiding principle.
THE KEY APPROACHES
a) Training, orientation, induction and refresher courses b) Onâ€?site training support and experiential learning c) Networking with model projects for exposure d) Development of human resource pool and community mentors to provide Handholding at the field level e) Setting up of Resource Centre to generate, manage and share the knowledge on TIS and other relevant areas which may useful f) Development of self learning innovative tools to enables TI staff to pursue self improvement in the area most essential to improve their efficiency g) To ensure development of managerial as well as technical capacity of human resources working in TI, STRC Delhi identified and developed a pool of h) human resources consisting of subject experts, trainers, community i) Consultants/mentors, academia etc. It has developed partnership with other Organizations including regional training organizations j) The Training methods were kept as simple and participatory with focus on Competency building. This include, icebreaking, group discussion, brainstorming, Group work, mini lectures, roleâ€?playing, case studies, games, and field visits etc.
VISION: To enhance the skills of human resources working in TI and HRG population in order to ensure quality and better learning.
Introduction An important source of HIV related vulnerability is mobility and migration, mobility being defined as a change of location and migration being defined as a change of residence. India, home to the third highest number of HIV positive people in the world, is characterized by widespread and fluid migration and mobility. More than 2 million Indians do not live in the place of their birth. While mobility in other parts of the world is inhibited by national boundaries, there are few land masses the size of India with such a good transport infrastructure as this country. Once migrants reach their destination, language and other difficulties lead to feelings of discontinuity and transition that enhance loneliness and/or sexual risk taking. Such risk taking may be reinforced by a lack of HIV/AIDS awareness, information and social support networks at both source and destination points, which cumulatively contribute to a migrant‟s vulnerability. Back home, spouses of migrants are also vulnerable to HIV if their husbands return on a regular basis and have become infected with HIV. Some wives also have their own sexual networks during their husband‟s absences. Movement within the nation is on the rise due to inequitable distribution of wealth and resources as well as services and opportunity in India and other counties of the world. Rural people movement to urban cities has contributed significantly to explosive growth to urban cities in India. According to 2001 census of India, 307 million are migrants by place of birth and 314.5 million are migrants by place of last residence. There is huge increase of migrants in last 6 decade as 144 million were migrants by place of birth as per 1961 census, which increased up to 307 million in 2001. The broader transmission of HIV beyond high risk groups (or HRGs, which include FSWs, MSM and TGs, IDUs) often occurs through their sexual partners, who also have lower risk sexual partners in the “general” population. For example, a client of a sex worker might also have a wife or other partner who is at risk of acquiring HIV from her higher risk partner. And a migrant woman who engages in sex work at her destination point may return to her spouse/partner at home, putting him at risk of HIV infection. Individuals who have sexual partners in the highest risk groups as well as other partners of lower risk (general population) are called a “bridge population”, because they form a transmission bridge from the key population to the general population.
Men are an important bridge population in HIV epidemics for several reasons: Men are more likely to have multiple partners than women Men influence the „demand‟ side of sex work which determines the size and distribution of sex worker populations at destinations
Delhi (5.6 million) is the second states in India after Maharashtra (7.9 million) with highest number of inter- state in migrants in the country. Migration and mobility within inter- state and intra- states have been associated a risk factor for transmission of HIV. Migration and mobility of population have 4 stages comprising of source: native place of people, where they came from and relationship maintain with home when they are at source states, transit: travelling, places passes during and how they maintain at the time of travelling, destination: where people leave, stay and their attitude with the people they meet and their living and working conditions, return: with their home state with their family. Migrant population generally moves back and forth through these stages often with courses of weeks and months, both within country and between states. Migration doesn‟t have direct vulnerability factors for STI/ HIV transmission. Risk behavior (indulge in unsafe sex behavior and practices) and risky environment (where a female migrant worker has to do unsafe sex for getting labor work or need of money in time of no work) are concomitant factor to spread the HIV and STI infection in migrant population. It is assumed that single male migrant; migrants live without their wives and sexual active age group concentration lead to greater risk seeking behavior patterns among migrants. In migrant workers, unsympathetic and forlorn environments along with separation from family, lack of information and services, low level of education and sexual practices make them susceptible to HIV exposure. Migrant and HIV, both are issues of public health concern, not in India, but also the other countries of the world. HIV in India is mainly concentrated among most at risk population (TG, MSM, IDU and FSW) and bridge population (Migrant and Truckers). HIV prevalence rates 8
among migrant is eight times more compare the general population. Two to four times of migrant workers visit to sex worker or non permanent partner and only less than 30 percent use condom in those sexual encounters, 5 percent of males and 13 percent females reported the STI symptoms (Migrant operational guideline of NACO).
Rationale for the OR: National AIDS Control Programme (NACP) Phase II had identified Migrants as one of the risk populations to be reached, in order to accelerate the HIV prevention response in the country. In the third and ongoing phase of NACP, the migrants along with truckers are reached out to as „bridge population‟ (link between the core transmitter group and the general population). Interventions amongst migrants and HIV can be broadly classified under:
Targeted Interventions, led by NACO and SACS
Non TI migrant HIV programmes, implemented through NGOs
Work place programmes, addressing unorganized labour
Targeted interventions, led by NACO/SACS: National AIDS Control Program in India has been implementing migrant interventions since Phase II of the program. Efforts are focused on 8.64 million temporary, short duration migrants who frequently move between source and destination areas. By the year 2010, National AIDS Control Organization (NACO) has been implementing 196 migrant targeted interventions (TI) in 124 districts across the country, reaching out to approximately 1.5 million single migrant informal workers engaged in construction, manufacturing, stone cutting and daily wage agricultural labour. While the NACO TI guidelines are largely followed by most interventions there are different programmatic strategies used by implementers. Details of the program strategies are given below.
Outreach & Communication: Peer-led, NGO-supported outreach and behaviour change communication (BCC), differentiated outreach based on risk and typology, large-group
format activities (e.g. street theatre, games, etc.) and interpersonal behaviour change communication (IPC) ď‚ˇ
Services: Promotion of condoms, linkages to STI (sexually transmitted infection) services and other health services (e.g. ICTC, ART, drug/alcohol de-addiction) and referral and follow-up system
Enabling Environment: Advocacy with key stakeholders/power structures and linkages with other programmes and entitlements
Community Mobilisation: Building capacity of migrant groups to assume ownership of the programme and having project centers
Migrant workers are in high risk of acquiring STI and HIV, because of their long stay away from family, higher burden of work, unhygienic working and living condition and no mean for entertainment. Various studies have proved that migrant workers are indulging in unsafe sexual behavior. HIV prevalence among migrant workers is higher compare to general population. There is an imperative that those workers infected with the HIV may spread to infection to their wives and girl friends. Keeping these things in mind, we designed this operational research study to improve the already running TIs programmes on migrant workers. Purpose and specific objectives Overall objective of Operational Research To assess the knowledge, attitude and practices among migrant workers related to HIV/AIDS in the state of Delhi. Specific objectives of Operational Research 1. To assess the knowledge level of migrant workers about HIV/AIDS. 2. To understand the effect of knowledge on safe sexual behavior among study population. 3. To know migrant worker behavior who have knowledge but still indulging in unsafe sexual practices and vice-versa. 4. To assess awareness level on method available for safe sexual practices for migrant workers.
Operational definition of migration, migrant, Knowledge, attitude, practice and Operation Research: Migration: As per UN multilingual dictionary defines â€œmigrationâ€? as spatial mobility between one geographical unit and to another, involving a permanent change of residence. Migrant: A person, who has changed his usual place of residence from one geographical defined area to another, at least once during the migration interval (interval may be a year, five year, ten year or so). It involves two characteristics, first, place of origin, second, place of destination. As per National AIDS Control Organization (NACO), Migrants are people who seek better livelihood and move from their place of origin in rural areas (source) to a town or city (destination), with the intention of settling temporarily or semi-permanently and return back to their origin for up to 3-6 months. Risk profile of migrants should include their period of stay, mobility, risk exposure, risk pattern (National AIDS Control Organization) Knowledge: Understanding on a particular topic possessed by a community/group of people. Attitude:
It refers to approach toward a subject which includes any preconceived idea
community people thought regarding the subject. Practice: Practice means how the people demonstrate their knowledge and attitudes toward their deed/action. Operational research: International Union Against Tuberculosis and Lung Disease (The Union) and Medicines Sans Frontiers (MSF) define OR as research into strategies, interventions, instrument or understanding that can improve the excellence, coverage, efficacy or concert of the health scheme or programmes in which research is being conducted.
RESEARCH METHODOLOGY It is important to note that not all migrants are at equal risk of HIV. It is those men who are part of sexual networks at their destinations – either with female sex workers (FSWs) or with other men (MSM) or transgender (TGs) – who are more prone to HIV infection. Similarly, those female migrants who take up transactional sex at destination locations are at greatest risk of HIV. Classification of migrants from an HIV vulnerability perspective is based on the following key criteria:
Intersection with high risk sexual networks
Pattern, degree and duration of mobility and migration
Whether moving singly or with family
Route of migration
Destination of migration
Based on these criteria 13 TI partners are working on migrant issues in Delhi/ NCR out of which 5 has been newly registered in the month of December, 2012. S.no
Name of NGOs
Social Action Foundation
Urivi Vikarm Charitable Trust
St. Thomas Multipurpose Educational Society
Ekta Siksha Sansthan
Rural Education and Welfare Society
Anchal Charitable Trust -3
Empowerment For Rehabilitation Academic & Health (EFRAH)-2
MRYDO-Model Rural Youth Delvelopment Orgnisation
Urivi Vikram Charitable Trust -2
Study Area and study population Over all Operational area for the OR was on migrant population of East, North West, west, south west and South districts TI NGOs implementing the Targeted intervention program for migrant workers. On the basis of highest coverage and proximity in the area, the study was conducted under the areas of NGOs named as Ekta Siksha Sansthan, Rural Education and Welfare Society, Urivi Vikram Charitable Trust, St. Thomas Multipurpose Educational Society and Rasta, As per the total coverage estimated till march, 2013 was 1.30000 out of which 1,11,835 were registered and seeking the services. Out of the population, the sample size of 201 (0.024%) was collected from the above said NGOs empowering the migrant services at field level.
Study tool and sample technique: The tool used for the operational research was pilot tested before the commencement of the research.
comprised of 9 dimension included personal information, income and expenditure, social and community life, migrant workers knowledge related to health, knowledge about STI/RTI, Knowledge on HIV/AIDS, usage of condom, and Sexual behavior among migrant workers. Purpose sample technique was used to pick the desired number of migrant from NGOs implementing targeted intervention project on migrant workers. Table illustrates the sample taken for the operational research.
Migrant contacted with any service
Proportion of sample taken from the district
No of samples
Data collection In order to carry out the Operational study, a tool was designed to collect the information at field level. Initially orientation of TI partner were carried by STRC staff at their working sites which further tends to reflect the needs and components for the findings of the research. Later on A pilot testing was conducted by STRC Team with the help of NGOs staff and the community members which turns to get the information which was necessary as per the tool and requirement. The tool was later finalized by the core team led by various experts and was put forwarded in to the field as a frame of in-depth interviews with the migrant population.
Constitutution of Research Team
Data was collected by personally by visiting NGOs working and implementing targeted intervention program in 5 sample districts. An in-depth interview with the help of TI staff was conducted to assess the knowledge, attitude and practices on HIV/AIDS in the migrant population.
Research Findings Out of the sample size of 201, taken for the purpose of the study from 5 districts of Delhi NCR, 30.8 percent samples were taken from East district, 17.4 percent from North West district, 30.8 percent from West district, 15.9 percent from South West and 5 percent from South districts of Delhi. District
Proportion of sample taken from the district
No of samples
As the in-depth interviews were held to assess the environmental proximity of the respondents, it was observed that out of the 201 of sample size of 133 were mealy the natives of Bihar,, 44 were from Uttar Pradesh, 7 from Rajasthan and Kolkata respectively, 4 from Jharkhand, and 2 from Faridabad, Shimla, and Chandigarh each. The demographic trend of Bihar and Uttar Pradesh were much seen in the migrant population in the given area. Where as in order to adapt in the current place, the young population of age between 21-30 yrs was in trend. It was estimated that 45.8 % falls under this age group where as 35.3% of the population caters the age group of 31-40 years. As per the risk revealing criteria the above mentioned group falls under the same as per their age factor as well as their socioeconomic environment including the literacy level. As per the gender considerations, it was observed that the maximum of the respondents were males with 94.5 % where as the female respondents were as low as 5.5%., with 41.1% from the general community, 28.4 % from Schedule Caste, 10% from Schedule tribes, and 20.4 % from 15
other backward classes. It has been observed that in 21st century, 60 % of the population tends to migrate for livelihood, which clearly reflects the castism barriers within the society. It was seen that, 19.9 percent respondents were illiterate, 4..0 percent literate (either write or read), 7.5 percent educated under 5th class, 15.4 percent were educated till 5th standard, 23.9 percent from till 8th standard, 22.9 percent were from up to 10 standard, 5 percent were till 12 standard and only1.5 were percent respondents were studied up to graduation. Overall 98.5 percent respondents were partially educated. In term of occupation of migrant respondents, 25 percent were respondents were rickshaw pullers, 16.9 percent respondents were construction labor, 13.4 percent respondents were private job holder, 44.3 percent respondents were others included, housemaid, jobless, coolie, private job etc. And 66.2 percent respondents were married, 26.9 percent respondents were unmarried and rest 7 percent respondents were divorced, separated, deserted and Gona Nahi Hua etc. As per living status of 30.3 percent respondents didnâ€&#x;t tell about their status, 32.8 percent living without their partner, 21.1 always lived with wives and rest 14.9 sometimes lived with their partner and sometimes without partners. As per the wage criteria 47.3 percent respondents got their wages daily which is approximately 50 percent, which showed that they worked as daily wager, 30 percent respondents got wages on monthly basis, 15.4 percent respondents got their wages fortnightly and rest 6.5 respondents have no fixed time to get their wage. It was observed that 48.3 respondents were living alone where as 48.8 percent reported that they either lived with friends, relatives and co-workers etc, 3 percent does not disclosed their status. As 48.3 percent respondents are living alone and under productive age which could leads them to risky behavior.
Demographic Profile of Migrants Shimla
It was observed that the maximum migrant respondents were from Bihar and Utter Pradesh with the number of 133 and 44 respectively. .
Age Wise Classification 50.0 40.0 30.0 45.8
8.0 15-20 years
Result shows the prone age group (21-30 Years) are 45.8% which shows their high risk behavior as per their socio economic terms. Here the risk also covers the risk of (31-40 Years) which is merely 35.3%.
Sex of Respondents 94.5
100.0 80.0 60.0 40.0 20.0
94.5% of the respondents were a male which shows their much dominance within the society.
Educatinal Status 30.0 25.0
20.0 15.0 10.0 5.0 0.0
Upto12th Graduate 5.0
Data shows maximum respondents 23.9% are having basic knowledge of reading and writing and 27.9% have attained secondary level education where as only 1.5% of the respondents tend to be graduate. It was observed that 19.9%respondents were uneducated.
Occupational Status of Respondents 0.0
Pvt job Sex worker
Labour - construction
House maid Bricks - labourer
Others (husemaid, jobless, collies etc)
Graph indicates most of the respondents are Rikshaw Pullers with 25.4%, Laborers 16.9% and it was also seen that 1% among the sample size of 201 are in to sex work.
Marital status of Respondents 0.0
Result shows that 66.2% respondents were married but most of them are away from their families.
Wages Pattern of Respondents 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0
15.4 5.5 1.0 No Response
No fixed period
Data shows that 47.3% respondents were daily wagers. Henceforth they donâ€™t have stability in their location thus are more prone to high risk.
Living Status of Repondents 60.0 48.8
50.0 40.0 30.0 20.0 10.0
0.0 No Response
It was observed that 48.8% of respondents reside with their friends, coworker etc where as 48.3% lives with their families
Social and Community Life The data with table and graph indicate that more than half (51.35 %) of respondents were living alone. 48.8 % were living with someone and 3% were not tell about their living states. It may be noted most of the respondent are more prone to get HIV infection because they fall in the age group of 31-45 which is productive and sexual active age.
The data indicates that flow of migrant population more than half 72.12% is living in their destination point within six months, 12.4% are here within a year, 6% are here from one and half years and 5.5% respondents are in Delhi from more than two years. It could be due to their work
structure most of them are Rickshaw Puller and at the time of crops cutting they use to go to their native places once in six months some of them are construction workers they usually go once in a year due to contractual obligations very less are going after a year. Result shows 27.9% were not sure about the person whom they stay, 15.4% lives with their spouse, 4% with kids 28.9% with their friends and 10.4% respondentâ€&#x;s lived with their coworker. 27.9% were donâ€&#x;t have fixed partner with whom they stay most of them 51.2% stay in between one to four male partners on sharing basis Findings shows that 70.1% get spare time and most of them 28.9% spend time in watching TV Hearing radio and 24.9% spend time with friends and their friends have sexual relations either before or after marriage except their own partners for money or through mutual consent and 37% were not sure about their friends sexual behavior. 27.9% expressed that their friends are going for sex once or twice in a month and 39.3% were not revealing their friends status. 36.3% were accepted they use to go with their friends for sexual intercourse clearly indicated about their sexual drives. Long time out of home no means of entertainment and in the company of friends these behavior become prominent due to poor way of living they are not much aware about healthy sexual practices so probability of getting infection through sexual roots could be common among them due to the life style they follow. Result shows 60.2% consume alcohol once or twice in a week; they use to take maximum 22.4% with close friends, 20.4% with coworker and 17.9% alone. 3.0% use other drugs and 32.2% are reported not taking alcohol and rarely do they go for some other drugs 1.5%. This clearly indicates they takes alcohol than other drugs in the company of close friends or alone.
Living Status Others
Relatives Brothers & Sisters WIth Parents With Kids
1.5 1.0 4.0 15.4
Husband and wife
28.9 % of the respondents live with their friends, which mean they are free to come under high risk. Whereas 27.9% does not reveal their status which further might fall under the high risk
30.0 25.0 20.0 15.0 10.0 5.0 0.0
Activities in spare time 27.4 18.9
No See Response Movies
TV & Radio viewing
Visit Others friends and relatives
27.4 % population spend their spare time with Television/Radio, 18.4 % spend their free time with friends.
Consumption of alcohol
0.0 No Response
Kah Nahi Sakte
60.2 % of the population consumes alcohol and might have sexual contacts which could lead to unhealthy sexual practices.
Health Seeking Behavior of Migrants: Health and Hygiene is the up most priority that has to be taken care in the migrant population as the bridge population is much prone to various diseases due to the instability of the environmental conditions. As per the study conducted, Health behavior in migrants is eventually taken care off and out of which we concluded that approximately 4.5 % of the population are frequent drug users due to prone illness and the frequency and typology of sickness is assessed as:
Once in a months
Cold & Cough
Once in two months
Once in 6 months
Once in a year
No specific period
On assessing the frequency and typology of sickness, we administered for the medico consultation to which 14.4 % were regular visitors to a medico practitioner, 44.3 % visits often and 41.3 % have less frequency. As per the affordability a highest amount of Rs. 500 is utilized by 12.9 % of population on their health. On an average 31.8 % population prefers secondary care of health & hygiene. To assess the risk towards HIV, it has been observed that only 3.5 % of population had undergone for blood transfusion out of which 4.5 % believed that blood bank is the optimum source for getting the uninfected blood. In order to check the service delivery of healthcare, 34.3 % population prefer Government hospitals for their treatment where as 25.4 % opt for private one where as 40.3 % of population prefers both depends on the affordability factor.
While assessing the accessibility of a health centre, we came with the below mentioned
Less than 1 km
Between 1 to 5 km
On an average the accessibility if a health centre from the migrant population is around 1km of distance.
Trend Analysis Frequency of sickness No specific period
Once in a year
Once in 6 months
Once in two months
Once in a months
Frequency of sickness is within a time of 1 year with 25.9%. which means that almost 25% population fall sick within a time period of 1 year.
Types of sickness
Ped tik nahi rahna/dasth
While questioning the tyes of sickness, Headache (31.4%) and Fever (26.4%) are major types of sickness that are reflected.
How much priority do you give to spending on health 14.4
donâ€™t Say/ Donâ€™t know
Medium priorty 17.9
High priorty 4.0
No Response 0.0
5.0 10.0 15.0 20.0 25.0 30.0 35.0
When asked for the priority of the health seeking behavior in migrant population, Medium priority was the common response in 31.8% of population that was reflected while survey.
Due to your migration, have you ever faced problem while peforming health test
74.6 80.0 60.0
40.0 20.0 0.0
It was reflected that, 74.6 % of population does not face any problem for health check ups, during migration
You have more faith on:govt hospital or private
30.0 25.0 20.0 15.0 10.0 5.0 0.0 Both
40.3 % of population reflects their interest in both Govt. & Private Hospitals for treatment, as per the availability, where as 34.3 % still prefer government hospitals as per their convenience.
Knowledge about STI/RTI As we know that the bridge population is much prone to the infections and the most common infection the above said population is Sexually Transmitted Infection, we conducted a study to judge the knowledge of the population for STI with the 66.7 % of positive response. Most of the population were aware of the symptoms as per the below table with percentage of population seeking knowledge.: No response
White/Yellow discharge from private parts
Scars on Penis
Burning sensation in urination
Lower abdominal pain
Out of the above mentioned population 20.4% have an adequate knowledge or the source of treatment for the prone infection, with the below mentioned treatment points: Govt. hospital/clinic
Pvt Dr MBBS Degree holder
Registered Practitioner Ayurvedic/Homeo Practitioner
jhole chap doctor
As per the trend, below are shown the graphical response of the interviews :
Knowledge about STI/RTI No Response
This intervenes that 67% of the migrant population are aware about RTI/STI.
Knowledge about the symptoms of STI 28.8 22.8
22.3 11.9 7.9
It was assessed that much of the population were aware about the symptoms of STI, still 28.8 % of population did not respond for the question due to the social barriers or hesitation.
Feel any symptoms of STI Ped ke niche hisse me dard
Burning sensation in urination
Ling me dhag
White/Yellow discharge from private parts
As per the partial information regarding the topic, 44.8 % of respondent were able to provide the personal experience for the symptoms of STI.
Source of treatment for STI
Only few of the respondents revealed that they prefer hospitals or health centers for their treatment.
KNOWLEDGE OF HIV/AIDS in Migrants: As we talk about the socioeconomic condition and literacy level of the migrant population in the given area, we precisely assessed the knowledge of HIV AIDS, with a result of 91% of knowledge among the migrant population with known symptoms. Out of the sample size of 200 migrant population, 27.3 % population believe that extreme weight loss is the major symptom of HIV, whereas 20.4 % believes in continuous fever. On the other hand 5 % of population believe that HIV is a prolonged disease which can never be cured. While assessing the knowledge for the various modes of transmission of HIV in humans, the sample comes up with the following responses:
Infected Mother to Child
Infected blood transfusion
Unsafe sex with an infected person
As per the trend in above table, it is clear that the population is aware from the modes of transmission but not clear about the basic aspects. While questioning them with the prevention of HIV, 28.9% population responses with the use of condoms, 4.5 % responded with single partner relationship, 1% of population considered the age factor related to the sexual behavior of an individual, 1.5 % responded with use of disinfected syringe, 1 % with safe blood transfusion. Almost 10 % of population were neutral with no response while as 53.1 % were either unaware or they were not comfortable on making any comment on the topic like HIV/AIDS. While enquiring about the source of information regarding the HIV/ AIDS, the below mentioned responses comes out from the study: Radio
It was observed that most of the migrant population are aware about the but some socio barriers were observed due o which they are hesitating to discuss with the topic of HIV. When we discussed about the discrimination and stigma on HIV/ AIDS, we came to the conclusion that only 22.4% believe that an HIV positive person has a right to get married and 29.3 % agrees that HIV positive person can have a child also. As on general discussion 49.3 % does not have problem to share their meal with HIV positive while as 26.9 % were reciprocal. TREND REPRESENTATION:
Knowledge of HIV/AIDS Yes
It was observed that 91% of the population is aware about the knowledge of HIV/AIDS.
symptoms of HIV 27.8
Kah nahi sakthe/Nahi janthe
Continuous fever in one month 13.4
Wt loss of 10kg without any reason
As the population is much aware about the Infection but maximum of them are not aware of the symptoms of STI. Where the most common symptom recognized was prolonged fever.
Modes of Transmission 6.5
Kah nahi sakthe/Nahi janthe
Unsafe sex with an infected person 6.5
Samkramik khoon ka ek se dusare sarir me jana
Samkramik ma se paitha hone wale bache me
Infected needle/blood/skin me cheth
Unsafe sex (14.9%) was the mot common mode of transmission, which the respondents narrate.
Preventive Methods from HIV/AIDS
Sambok ke samay kondom ka nimith isthemal karna
Sambog kewal ek sathi ke sath
Sahi umer sui evom koon ka ek Kah nahi me sambog syringe ko se dhusare saktha/nahi karna garam pani saris me janthe se upalna dalne se pahle janj
As the preventive methods are considered, the most common option opted by respondents were the use of condoms (28.8%).
Source of HIV information 14.9
Swasth Abiyan/camp 3.9
The main source of information of HIV were observed through Friends, televisions, Health Practitioner, and other sources.
Can HIV positive person marry ? No response
As per the myths in the society, 55% of population believe that a HIV positive should marry and can lead a normal life.
Is it possible for HIV positive to have child No response 16%
No 10% 29%
Where as , 45% believe that HIV positive can bear a child, with a normal sustainability of life. USE OF CONDOM
As we know that one of the best preventions of HIV is the use of condom. As this is the most important component of our study which states us the knowledge and practice for the use of Condoms in day to day life. While conducting the Individual interviews we came to know that 94% of the population has heard about condoms and when we asked for the use of condoms, the output was as under: STI/HIV/AIDS
While assessing the usage of condoms, we came to know that 57.2 % of population uses condoms and while discussing about their last usage we concluded that 13.9 % answered with last week, 10.4 % with last month, 12.9 % in 6 months, 3.5 % from 6-12 months, 9 % with more than 12 months, where as more that 50 % of population were unaware about their last usage due to the casual living structure and unawareness towards the importance of condoms. It was also seen that 23.9 % of population believes that condom is used for unwanted pregnancy and 17.4 % for STI and other skin diseases, which shows the partial understanding of the condoms among the population while as others did not disclose their status.. While talking about the accessibility and availability of condoms, 39.3 % responded that condoms are available in medical stores, 6 % in pan shops, 9 % in anganwadi centers, and 0.5 % in health clinic outside village or city. As per the affordability matters it was observed that 16.9 % population gets free condoms, where as 27 % purchased and others were not interested to discuss on the topic.
As we know that there are lots of myths regarding the condoms in the society and in order to analyze the myths within the society, we asked for the reasons for not using the condoms to which the below responses were available.
Felt guilty while purchasing condoms
Want to get/partner conceived
Using other contraceptive
Felt not necessary
Pane me dikat
Fengane me dikkat
Isthemal nahi janthe
Kah nahi sakthe/nahi janthe
Where 35.3 % did not response due to hesitation. The above mentioned analysis revealed that the population is aware of condoms but not ready to follow the trend due to socioeconomic, religious, psychological circumstances.
Do you have infromation about condom No response
It was observed that almost 94% of population are aware about the use of condoms.
Condom should be used for ?
Kah Nahi Sakthe/Nahi janthe Others
2.9 1.9 22.8
Anjah Garbhadharan rokne ke liye
STI/HIV/AIDS se bajana No response
It was seen that 30.3% population believe that condom should be used for preventing STI/HIV/AIDS.
Use Condom? No Response
Almost 57 % of the population uses condoms while having sexual contact with respective partners.
Last Use of Condom 15.9
Kahnahi sakte/yad nahi 8.9
Morethan 12 months 7 to 12 months
2 to 6 month Last month
The above trend reflects the last usage of condoms for respondents.
Why used condom last time? 32.8 23.8 17.4 5.9
To stop pregnancy
To escape from STI/HIV/AIDS
23.8% population reveals that condom should be used to stop pregnancy; where as 17.4 % goes with to escape from STI/HIV.
Use of Free/Purchased condom? No Response
It was observed that 17 % of population gets free condom supply where as 28% purchase the condoms from market. 42
Condom Availability Kah nahi sakthe/nahi janthe
Anganwari/health clinic outside the city/village
Anganwadi/Health Centre 5.9
Accessibility reveals that 39.3 % of population found condoms in medical stores where as 42 % of population remain silent on the above question.
Reason for not using Condom? 35.3 18.45 2.4
While assessing the reasons for not using the condoms, it was observed 16.4 % believe that condoms give less pleasure where as 18.45 % feels shy on purchasing the condom.
While concluding our study, we interview the people about the major component of the study and that is there sexual behavior. While interviewing we came to know that 82.1 % revealed their positive response for their sexual status within the maximum age group of 20-28 years, which lies in the High risk behavior and much prone to HIV/ AIDS. While discussing about the extra marital sexual behavior in past 12 months, around 32.8 % revealed that they had a physical relationship in spite of their spouse and 15.4 % revealed their sexual contacts with female sex workers whils others felt shy while responding..
14.4 % of sample size revealed that they make the sexual contacts with sex workers or other partners at the same place or city where they are currently residing, which describes their need and the behavioral structure of an individual. While assessing the frequency of their paid and unpaid partner, we also came to know about the frequency of the usage of the condoms while having the sexual intercourse : The data are as:
Most of the time
Due to the above mentioned table, we further assessed the frequency for the use of condoms In last encounter and we found that 31.8 % of the population reverts with a positive response, while discussing with others for not using the condoms, we found the below mentioned responses: No Response
Partner Not Agreed
Donâ€&#x;t feel Like
Both partners does not want
Unavailability of condom
No knowledge of condom
Not felt necessary
While analyzing the risk in the sexual activity we enquires about the frequency of drugs and its typology, to which we came to know much of the population prefer to consume alcohol while 45
having inter course. 42.8 % are regular consumers of alcohol where as 5.5 % are the least consumers of charas/bhang/ ganja, which nearly shows the risk behavior and vulnerability in migrant population. Trend Analysis:
Do you ever have sex? No Response
As per the trend, 89% of population revealed their positive sexual status.
Do you have sexual relationship outside of your marriage in last 12 months No Response
22% 28% 33% 17%
As to know about the sexual behavior of the population, 33% of the sample revealed that they had sexual relationship outside the marriage in last 12 months.
With whom do you have sex, commerc ial sex worker or non commercial 49.7
Sathi (Vina paise ka)
Kah nahi sakthe/nahi janthe
To count the risk factor among the population 15.4 % revealed their relationship with a sex worker, which tends them at high risk.
freqency of sexual relationship (Paid partner) 50.7
Naukri dena wale
As per the sexual frequency, 23.8 % revealed their mingling with coworkers.
Frequency of Condom usage Yadh nahi/kah nahi sakthe
Kabi kabi 6.4
As per the sexual frequency of the population, only 12.4 % population are regular condom users while having intercourse.
why not the use of condom Nahi Jhanthe/koi jawab nahi
Jaruri nahi samajthe No knowledge of condom Condom azani se upalapt nahi tha
2.4 1.4 8.9
Hum dhono nahi chaha
Mene nahi chaha Sathi ne nahi chaha
In order to know the less usage of condom, we came to know that 8.9 % of population is not willing for it as they do not feel comfortable in using the condom where the other reasons were, less knowledge, partner satisfaction, not necessary etc.
frequency of Drug usage Kah Nahi sakthe/nahi jhanthe
Kabi Kabi Bahut bar Always
7.4 8.4 20.8
To assess the risk and vulnerability behavior among the migrants, a study on drug usage were conducted which further results into 31.3 % populations which revealed that they sometimes consume drugs while having sex with their partner, where as 27.3 % completely oppose for consumption of the drugs.
CONCLUSIONS AND RECOMMENDATIONS Present study contributes to the growing literature on sexual among population in destination migrants. Findings documents that a higher number of migrants indulge in unsafe sexual behavior with paid and non paid partners. This finding also corroborates that programmes for migrant should require multiple strategist to prevent them from indulging them from risky sex behavior at place of origin as well as place of destination. Migrant workers who are moving for the purpose of living and better living standard engage in risk sexual behavior, which leads to higher risk of their wives and to be born children. Prevention effectiveness on migrant population requires holistic approach with intervention at every level: place of origin, place of destination along with route of their movement to make the program efficient. Joint approaches, where government as well civil society organizations work together with improved coordination could able to reach to migrant to reduce their high risk behavior and further spread of infection (STI/HIV) to their spouses. The study suggested way of reducing the spread of STI and HIV in migrant population in Delhi NCR regional. It recommends a broad based intervention approach comprising of Prevention of STD through condom usages, information, education and communication, abstinence and delayed sexual activity among migrants, screening, detection and treatment, social and economic reforms to provide economic security to migrant workers. As the study was conducted with a sample size of size of 201, the below given conclusions were found while interviewing with the community population. ď‚ˇ
Although it was observed that the most of the population is partially aware of the disease and understands the risk, but due to lack of knowledge and socioeconomic barriers, they are not sustaining the risk behavioral structural in adapting environment.
Health seeking behavior is much low in migrants as they prefer their health as secondry priority.
Condom use has found to be low among this high risk group.
There is a high level of wrong believes & among them such as that HIV can be transmitted by mosquitoes.
Only few women complaining of STI symptoms had sought treatment due to lack of awareness and socioeconomic barriers.
Recommendations Community Mobilization
Unseen population (Women migrant) which is 5.5 percent is to be relooked at all level, NGOs, TI, TSU, STRC and DSACS.
Education classes at field level or NGO level can be focused during the TI intervention as 20 percent from the total respondents is illiterate.
Most of the population were seen to be self dependent and are not stable to their environmental adaptations, thusforth they are much prone towards the health and hygiene issues, which further need to be strengthened by introducing the schemes like RSBY, GRC Schemes etc.
Health camps should be organized in such a way that the migrant population should take keen interest in attending the same with appropriate planning at TI level.
DIC‟s which are far away from the migrant sites should be community oriented.
To build capacities of migrants through vocational training and placement assistance To sensitize migrants towards social, economic and legal rights at source and destination end To sensitize Panchayats and Urban local bodies towards rights of migrants and their families as well as take action towards building legitimate identity of the migrants Building and strengthening collectives of migrant families at source level for social security and enhanced access to goods and services. Building and strengthening trade based collectives of migrant at destination for social security and protecting rights of migrants
NGO must focus on HIV/AIDS transmission, routes of transmission and STI/RTI awareness through various modes of IPC/BCC approaches.
The population should be sensitized towards the topic at the door steps in order to bridge the gaps and awareness regarding the topic. Community should discuss the topic in a hassle free manner.
Symptomatic and Asymptotic treatment should be focused.
Linkages with referral units should be enhanced and proper list should be provided to the community leaders and short talks on the health issues should be organized for the unseen population.
Behavioral communication change :
DSAC S with IEC division can focus on migrant population through Radio FM, Radio IGNOU, and University‟s FM Radio to create awareness. Potential individual and groups from different community and areas (UP, Bihar, Jharkhand, Haryana, Faridabad, Rajasthan, Gujarat, and Kolkata) could be traced through TI and to be linked with IEC division for making IEC material in their own language or they can be used as community mentors in our programmes.
As the trend shows, we are covering, nearly 45.9 percent population under the age of 2130 years, which shows that all the NGO must focus on this age group by implementing IPC methods, Nukkad nataks and other method could be prepared in such a way as they must come under the potential risk behaviors.
As 32.8 percent population has extra marital relation and they are under high risk group. Programme should focus on this segment of population while creating awareness among population.
60.2 percent population is taking alcohol and 1.5 percent taking other drugs, for precautionary measures NGO can start working on harm reduction and alcohol treatment by developing linkages with IDU intervention.
Health and hygiene issues are very poor in migrant, so they health competition during community health camps and project WASH can be linked with TI project.
Condom promotion :
Although 94 percent population is aware about condom availability at various levels, but they are not using while going for sexual activity with partners and friends, there is strong need to focus on proper usage of condoms, demonstration and re-demonstration among these respondents.
Since 42.8 percent population are not using condom while sex worker, which is alarming, at all level and TI must focus during their community outreach, health camps and training programmes.
FGD‟s on regular interval must be conducted within the community for much awareness and better understanding of the same said topic.
Mr. Narender Sindhi Ms. Tripti Oberai Mr. Sham Lal Mr. Vikram Kaul Mr. Yogesh Kumar