Wednesday 25 September 2013

Summary Presentation for Theme- Women and HIV

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Kurnool DAPCU Response to the Theme- DAPCUs and Stigma and Discrimination

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The District AIDS Prevention & Control Unit, Kurnool had conducted a so many activities for addressing stigma & Discrimination with the involvement of District Level network and all Govt department Key officials and elected political leaders. Dr.U.Rajasubba Rao, Addl. DM&HO (A&L) and Mr.Ali Hyder, District Program Manger, DAPCU contacted Sri.Ramsankar Naik. I.A.S, collector & District Magistrate Kurnool and discussed in detailed on these activities and got approval with detailed action plan.

The following activities were implemented:
  1. Conducted community feast with CLHA and PLHAs
  2. Setup IEC Stalls at District Head Quarters as well as where the rallies & meetings conducting.
  3. Sanitization to all APSRTC Depots staff (Drivers, Conductors and  mechanical  staff)
  4. Conducting  Competitions at Educational institutions 

Community Feast (Tiffin) with CLHAs & PLHAs:

The community feast was started at Regional Training centre (Female), Kurnool at 8.30 am with involvement of CLHAs & PLHAS.  In this occasion Sri. S.V.Mohan Reddy, MLC, and Sri.Ramsankar Naik,I.A.S collector & District Magistrate, Kurnool, Dr.U.Rajasubba Rao, ADM&HO(A&L), Smt.Zubeda begum, Project  Director-ICDS,  DAPCU Staff, Network Staff, CCC Staff, PLHAS, CLHAs, TI NGOs, ART Staff, Cultural teams were took part in this program for the purpose of to reduce stigma & discrimination  with the connection of World AIDS DAY-2011 theme.

{Sri.S.V.Mohan Reddy, MLC & Sri .Ramsankar Naik.I.A.S Dist.Collector, CLHAS, PLHAs Participated in Community Fest.}
{Dr. U. Rajasubba Rao, ADM&HO (A&L) & Smt.S.Zubeda begum, Project  Director – ICDS, Kurnool took part}
Role play on Stigma & Discrimination by cultural teams
















Sensitization to APSRTC Staff:

The DAPCU conducted a sensitization workshop to all 7 APSRTC Depot Manager including Regional Manager at Kurnool APSRTC Regional training institute on HIV/AIDS, Stigma  & Discrimination  issues  with PLHAs during accepting Buss Passes, which is implementing in A.P state with the co ordination of SERF & APSRTC department.  After completion of this workshop all the depot Managers extended their support and come forwarded voluntarily to conduct the sensitization meeting to their staff depot wise. The following staff involved for conducting the meeting District Level Network, local ICTC, PPTCT, TI Partner staff.  The entire district was covered on war foot base, with this activity the APSRTC sanctioned bus passes to the PLHAS without any discrimination and allowing them with respectable manager.                       


North Delhi DAPCU Response to the Theme- DAPCUs and Stigma and Discrimination

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AIDS-related stigma and discrimination is a pervasive problem worldwide. People living with HIV/AIDS (PLHA) in India, as elsewhere, face stigma and discrimination in a variety of contexts, including the household, community, workplace, and health care setting. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services.


Roles and Responsibility of DAPCU with respect to Stigma and discrimination relating to HIV:


The main role and responsibility of DAPCU is to prevent and control HIV-AIDS in the district. DAPCU plays a significant role in reducing Stigma and Discrimination relating to HIV-AIDS in the District in the way of:
  1. Co-ordination among HIV-AIDS facilities of the district to provide better services to HIV-AIDS positive clients.
  2. Monitoring and supervision in the district by doing field visits at the HIV-AIDS facilities. 

DAPCU North is fully active in reducing Stigma and Discrimination relating to HIV-AIDS in North District. For this following activities are done at DAPCU level:

  • Actively participation in Mega Health Camps organized by Mission Convergence under the chairmanship of Deputy Commissioner in the District:

DAPCU North has actively participated in Mega Health Camps organized by Mission Convergence under the chairmanship of Deputy Commissioner in the District. Counseling services, distribution of condoms, distribution of IEC material services were provided in the Mega Camp. DAPCU arranged MITWA van and Nukkad Natak Team from DSACS to participate in Mega Health Camp.

  • Sensitization Programme of Hospital staffs:

DAPCU had organized full site ICTC Sensitization Program in North and South West Districts. The Medical Officers, Staff Nurses and other supportive staff were sensitized in the Program. 
Objectives of Full Site ICTC sensitization Programme were:

1. AWARENESS ON NACP
2. IMPROVE UTILIZATION OF RESOURCES
3. STRENTHENING LINKAGES & REFERRALS

  • Session on the topic of HIV-AIDS to various Line Department like - Delhi Jal Board staff, CRPF Camp, Delhi Police etc.:

DAPCU staff took session on the topic of HIV/AIDS at various line departments like Delhi Jal Board staff, CRPF Camp and Delhi Police in North and South West District.

  • Through DAPCC Meeting at district level:

With the help of District Administration we have sent a Circular to Medical Superintendent of Hospitals and Medical Officer In-chage of Maternity Home of North District for:
  1. Providing all available health services in the facility to people infected and affected by HIV / AIDS
  2. ANC who is detected to be HIV positive in the district should be delivered within district hospital, sub hospital and maternity homes.
  3. Prophylaxis should be provided to both mother and baby. 




Tuesday 24 September 2013

DAPCU Coimbatore Response to : Stigma-Discrimination and DAPCU

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Role and responsibilities of DAPCU with respect to stigma and discrimination:
Main role is positive prevention which benefits and helps to reduce stigma and discrimination.
Common reasons for stigma and discrimination are described to help counsellors understand the causes behind family and community attitudes and behaviour towards PLHIV. Self- stigma and enacted stigma are both discussed in detail and an assessment tool is provided that enables counsellors to identify the kind of stigma experienced by PLHIV. The DAPCU plays co- ordination of strategies to help clients cope with self and enacted stigma, such as communication skills and exercises to improve self- esteem.

Functions  &  Roles of DAPCU                                    
Coordination :

  • Coordinate with PLHIV and reiterate the need for positive prevention.

Monitoring/supervisory :

  • Reiterate the counsellors in providing positive prevention counseling to PLHIV.
  • Reiterate the need to include prevention at every opportunity in prevention, care and support service delivery. 

    Measures:
PLHIV can easily access to DAPCU and DPM on all days and their grievance are meeted out.
In health care settings for surgery and LSCS, Delivery of PLHIV’S attention is immediately given by the DPM by talking to CMO, RMO, DEAN and JDHS.
Inter department meeting was conducted and same was discussed and their coordination and help was sought by the DAPCU.
In community setting advocacy work shop was held to minimize stigma and discrimination.
Complaints was received from the PLHIV and the remedial measures had taken like we got ration card for a PLHIV in ONE DAY which was given by the COLLECTOR, This  PLHIV’s was under stigma by not getting ration card for the past 8 years. 
THADCO loan, Self- Help group formation was done and the bank people hesitated and discrimination was there for giving loan which were settled by DAPCU and loan were given to PLHIV’s.
To remove stigma and discrimination, PLHIV’s participated in Grama saba meetings and PRI members assured them to give houses for rental amidst common community.
  

Tuesday 17 September 2013

Response to the Theme Akola DAPCU: Stigma & Discrimination and DAPCU.

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People living with HIV/AIDS (PLHA) are stigmatized and looked at negatively by people at large. Stigma, discrimination, and prejudice extend its reach to people associated with HIV-positive people such as health providers, hospital staff, as well as family member and friends.  DAPCU plays a major role in reducing stigma and
discrimination related to HIV/AIDS in the district. 
      Akola DAPCU coordinates various activities to reduce Stigma and Discrimination in the district viz.
1) Sensitization programs for the Line departments and peoples representatives: 
DAPCU with the help of District Administration arranged the sensitization programs for the line department. Akola DAPCU has conducted awareness programs for the revenue department, education department, panchayat members, SHG’s, police departments and health staff. Every year the annual action plan for sensitization program has submitted to SACS.
2) Maximum utilization of Electronic and Print media to prevent any issue related to S&D:  
DAPCU routinely connected with the print media and local electronic media of the district. DAPCU publishes the activities related to HIV/AIDS and also highlight the positive living of the PLHA.
3) IEC Activities : 
SACS has organized permanent hoarding at hot spots of the district. Twice in a year SACS has arranged the folk troupe campaign for HIV awareness and to reduce stigma & Discrimination in the society. At healthcare facility DAPCU pasted the hoarding and banners for sensitization of health facility. A big event like RRE also arranged twice in the district to aware general population.
4) Positive Speakers Contribution:
If any stigma and discrimination issue noted in the district that issue jointly handle by the DAPCU and PLHIV network. In every event DAPCU arranged positive speaker. The involvement of the positive speakers was really appreciable in the RRE event. 
5) Strengthening of PLHIV:
DAPCU provided care, support and treatment to the PLHIV by fascinating social benefit scheme approach. DAPCU Akola also run a intervention for strengthening of PLHIV in which PLHIV got a technical training for self employment. DAPCU formed the GIPA committee for sorting out any crucial issue at the district level.

Thursday 12 September 2013

Coimbatore Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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Intervention package for high risk migrants is outlined below

Outreach and Communication.
Peer-led, NGO-supported outreach and behavior change communication (BCC).
Differentiated outreach based on risk and typology.
Large-group format activities (e.g. street theatre, games, etc.)
Interpersonal behavior change communication(IPC)
Services.
Promotion of condoms.
Linkages to STI(sexually transmitted infection) services and other health services (e.g., ICTC, ART, drug/alcohol de-addiction)
Strong referral and follow-up system.
Enabling Environment.
Advocacy With Key  stakeholders/power structures
Linkages with other programmes and entitlements.
Community Mobilization.
Building capacity of migrants group to assume ownership of the programme.
Prevention is done with the help of migrants programme by one to one and VPL involvements.
Peer educators involvement.
The migrants counselor  of various outreach workers distribute pamphlets printed in Telgu, Kannada , Malayalam ,and Tamil with the help of mobile ICTC.
With the help of self help group follow up and facilities available in district like ICTC linking to ART treatment adherence follow up of MIS and LFU are done with help of M&E, PO & field workers with ART and with DAPCU and it is discussed in monthly review meeting of DAPCU every month.

Experience:
PPTCT services in Coimbatore are done new prophylaxis regimen is started (e. g 1) Name X of Bihar found positive and  then case was referred to ART centre and  CD count done and ART initiated on JULY 19.
 A case Bombay was delivered in CMC  case and ART prophylaxis was  initiated.
 A case Kerala  was delivered in CMC and both the cases PPTCT services were done.

Wednesday 11 September 2013

Bhavnagar DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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Prevention & Early Detection
  • In the migration group, it is difficult to detect early because of mobility. But we can try to prevent and detect early e. g. identifying the migrant’s area in the city; district and state then we can start an intervention.
  • We try to contact with community leaders and connect and involve them in the programme.
  • Develop the IEC and BCC material in their own languages.
  • Establish the facility either in or near to their areas.
  • We also try to meet owner of their work places, industries; shads to obtain the permission to organize a programme. Also request them to provide the leaves to migrant workers for taking services.
  • We also plan our service schedules as per their availability, holiday etc. 


Linking  to ART, Treatment Adherence, Follow-up of MIS & LFU
  • Arrange the meeting with president of association of industries, owner of work place for giving permission and leave for taking treatment.
  • Setting ARTC’s time schedule according to migrant’s time & availability.
  • Prepare IEC,BCC material in their own languages and as per their social aspects.
  • In the cases of MIS’ & LFUs we have tried to contact with their state’s sacs and also particular district’s ARTC; where the first visit of MIS was done.
  • Sharing a line list of migrant MIS & LFUs among ARTCs.
  • Contact with leaders of communities to track migrants, because many time leader has more authentic information about place of migrations.
  • Establish on-line system for transfer out patients.  
PPTCT services
  • Develop the peer educator system, specially for migrant ANCs. Because non-awareness of migrant females about services provide by PHCs, CHCs and other healthcare centers.
  • She doesn’t know the name and address of ASHA Workers of their areas.
  • She feels loneliness in these types of situations.


Kolhapur DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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The critical most part of NACP is the ART Linkages amongst Migrant Population.

Kolhapur DAPCU has linked many inter state migrant cases by coordinating among DAPCUs. e.g. – in the month of June, 2013 an ANC case from Karnataka migrated to Kolhapur. Concerned ICTC counselor shared this information with Belgaum DAPCU and with Karnataka SACS. It was further coordinated with MSACS by KSACS. MSACS forwarded details of the client to Kolhapur DAPCU. The DAPCU shared client’s details with the nearby ICTC counselor where she had been migrated. Finally, this client was traced out by collective efforts of DAPCU and PPTCT NGO. And in such a way linked to Kolhapur GMC ART Center.

Kolhapur District’s NGO, Lotus Medical Foundation migrants project played a vital role in giving preventive measures and has taken innovative efforts to create awareness through social activities.

Along with MSPSS NGO for migrants is also taking special efforts with the help of ICTC staff for STI/HIV screening and doing appreciable work in referral and linkages.


A pilot project is going to be held by NACO and MSACS for seasonal Migrant i.e. sugarcane cutters of Kolhapur District’s Sugar Factories. Preliminary meetings has been done under the chairmanship of  Hon. Project Director, MSACS, Mr. Prakash Sabade, on 17th April, 2013 in the presence of District Collector, Joint Director, Civil Surgeon, DHO & Labour Welfare Officers from sugar factories. The project will be commenced from 1st Oct, 2013 for next 6 months. It will cover HIV/ STI/ ANC screening along with routine physical check up.

Tuesday 10 September 2013

East Delhi DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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Comprehensive HIV/AIDS Service are provided to the HIV Positive Migrants:

East District Delhi is situated in border of Uttar Pardesh (Ghaziabad & Noida).  Patparganj & Jhil Mil industrial areas are also situated in East District, Delhi. The migration pattern is basically due to migration of Industrial workers. 

Services to Migrants Client: 

If any migrated client found positive ART counselor provide him all the services i.e. counseling, Pre-ART registration, CD4 testing etc.

Other District:

If client from other district found positive, that client is linked to ART center for pre ART registration CD4 count and if found eligible then on ART, if client is willing to continue the treatment from his own district then he can be transferred and informed to concerned ART.

Other State:

If positive client from other state found positive, the client is linked to ART center for Pre ART registration CD4 count and if found eligible then on ART, if client is willing to continue the treatment from his own state then he can be transferred and informed to concerned ART. Counselors note the permanent address of the client and provide the same to Concerned SACS.

Prevention and Early Detection:

DAPCU– East arrange IEC activity like Full Site Sensitization Programme, Mega Health Camps, Poster, Nukkad Natak etc. with co-ordination of DSACS, Youth Awareness by Nukkad Natak, Session regarding HIV-AIDS in Delhi Police, lectures on HIV-AIDS in schools, I.T.Is, awareness campaigning at Metro Station, Railway Station & I.S.B.T, Condom promotion activities in Industrial Areas & also maintain the line list of discordant couple and ensure their testing every 3 months.

Linking to ART center, Treatment adherence, follow-up of LFU/MIS and PPTCT Services:

We try our level best to ensure linkages. In ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the client, family counseling is given to the positive client so that he / she should not face any discrimination.

Follow-up of LFU/MIS:

Collecting line list of Clients from ART center and trace out the same through Outreach workers and TI NGOs and after that share with respective ART centre.

 

 

Kodague DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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1.        Prevention & Early Detection:

In Karnataka is Kodagu District is a rural region with most of the economy based on agriculture, plantations and forestry. Coffee processing is a major economic contributor. Most of the people are engaged in coffee plantation work, which is the backbone of this economy. The major industries are Coffee Curing industries, Spices, Honey and Wax products. In recent years, tourism has begun to play a role in the economy, which has let to mushrooming of hotels and hence has attracted significant number of migrants from across the state and country.As Kodagu  is largely a coffee growing district, it attracts large number of estate workers from across the state and sometime from other states. 
  • In the present situation, there are lots of Migrant population in the District. Most of them come as labourers to work in plantation and construction sites. from Orissa, West Bengal, Assam, U.P, Chathisgad, Rajasthan, Delhi, Andhra Pradesh, Tamil Nadu, Kerala  & Bellary, Chamarajnagar & other  parts of Karnataka.
  • Most of them come to work, leaving their family in their own native, where there may be a chance of High Risk Behavior.
  • HIV positive cases are found in the ICTC Centre’s & most of them are illiterates & lack Health education including HIV-AIDS & STI.
  • In order to prevent further infection & also to provide care, treatment & services to the infected, the need of HIV-AIDS awareness along with the services were felt in the Kodagu District.
  • Asha KiranaTI-NGO is working for migrant workers at the construction sites & in the Plantation Sector.
  • In this regard  In co-ordination with DAPCU, Asha Kiran TI-NGO & Concerned heads of the site,  Special Health Check-up camps were held with awareness on HIV-AIDS, STI , Dental Check-up & General Health were held in different Estates  & Migrant Sites. So that we can create awareness on HIV-AIDS among the migrant workers and also we reduce the risk of transmission. Those who are found positive can be identified at the earliest to provide proper treatment, care & support.

2.        Linking  to ART, Treatment Adherence, Follow-up of MIS & LFU:
  • Those found Positive are linked to the ART Centre at the earliest with proper counselling by the ICTC & ART Counsellor.
  • Continuous follow-up is done through the outreach workers of TI-NGO, when the leave the District on work they will be transferred out to the nearest ART Centre. 

3.        PPTCT services:
  • As per the PPTCT Guideline all the Registered ANC’s are referred for HIV Counselling & Testing services. And the Positive Clients are  linked to the ART at the earliest & will be given necessary PPTCT services
  • In Kodagu sometimes we get clients from out of Districts (either Parents House or Husband’s House or the native of those Districts) like Mysore, Dakshina Kannada, Mandya etc. Such cases will be informed to the concerned District, for follow-up for delivery, treatment & MB Pair follow-up.
  • Some time we get cases from other District for Delivery & further follow-up , such cases will be provide proper care, treatment & Support

4.        Challenges in Providing HIV/AIDS services to the Migrant Clients:
  • It is difficult to link them to ART, especially if their stay in the Place is for a short period
  • Language barrier if the client is from North Eastern States where they will not knowing any other language other than their mother tongue.
  • Poor Adherence & Follow-up for treatment & more chances of MIS & LFU of out of state Clients. 
  • Difficulty in tracing the clients from out of state as they are migrants they will not going back to their native instead they will go to different site on work.


Amravati DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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Amravati district is having Border of Madhya Pradesh and all the district of Amravati division like, Akola, Yavatmal, Washim and Buldhana also a border of Nagpur and Wardha District. In Amravati the PLHIV migrants from adjoining district are more because the divisional head quarter are in Amravati.
  1. For the prevention and early detection the regular medical checkup camp in the migrant area.
  2. At the time of medical checkup camp the two addresses of migrant with permanent contact no. should collect.
  3. The reactive client link ART center immediately if the client found in medical camp or the PLHIV migrant from other district.
  4. The choice available to client where he/she are convenient to take the treatment.
  5. In within district the follow-up of LFU/MIS client take through the ORW of NGO/Network and the ICTC staff.
  6. In other district the details of the client mail to the concert DAPCU and the Network.
  7. In other State the details of the client mail to DAPCU SACS and the concert DAPCU and Network.
  8. In PPTCT services the problem of PLHIV migrant are common because the lady are came for delivery in her mother’s home and if found reactive she return her husband’s home after delivery. On this cases we collect the both the address of reactive ANC and transfer the information to concert DAPCU for remaining services.
  9. The responsibility of migrant PLHIV should give to concert program NGO like if the client is ANC the responsibility gives to PPTCT NGO, For FSW it gives to TI-FSW.
  10. But after all it is very crucial to cover PLHIV migrant.

The coordination of the DAPCU with other NGO, Network, CBO and other DAPCU are playing important role to cover migrant PLHIVs.


Angul DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

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Angul a centrally located District in the state of Odisha with 12.70 lakhs  population and is a most advanced district due to vast coal mines located in abode and also big industries like NALCO, NTPC, JSPL, MCL, ADANI Monnet, UCL is working in the same district.  Due to vast coal mines and big industries number of migrant population is increasing day by day.

        HIV/AIDS and migration are two of the crucial social issues increasing today’s changing world.  In Angul two TI NGO namely U.S.S. and SARC is working for migrant population since 2008 to till date. SARC working area is Talcher, NTPC, South Balanda, Bhusan site, CPP, Nalco and working  for 12000 target population and presently it covers 16216 migrant population & with the referral of  SARC to ICTC 23  numbers of migrant labourer were detected as HIV positive and their details status are given below:

Pre ART
On ART
Death
Out of State / Migrant
16
09
02
05

           USS working areas is inside the JSPL Plant and working for 10000 target population and presently covered 15176 migrant populations & with the referral of U.S.S. to ICTC 25 numbers of migrant laborer were detected as HIV Positive and their details status are given below:

Pre ART
On ART
Death
Out of State / Migrant
14
08
01
10

            Every month, DAPCU Angul staff closely supervise the work of TI, verified their record, visited the Hotspot, DIC and collected various information from the clients regarding the TI work, attended the meeting/ awareness meeting / Health check up camp organised by TI and both ICTC supervisor and DPM attended the PMC meeting and discuss their problem and their problem was also highlighted in the DAPCC meeting and action was taken accordingly.
           
           It was observed by. DAPCU Angul that generally the HIV/AIDs intervention strategy in Angul district is focussed on following stages of migration.

-          Pre departure
-          Migration
-          Adaptation
-          Settle period
-          Remigration
           
         For providing comprehensive HIV/AIDS service to the HIV positive migrants and for prevention and control of HIV/ AIDS within the district the two TI NGO working for migrants are given emphasis on following points    

-          Group meeting
-          One to one contact
-          Mid media activity / IEC campaign
-          Health Camp
-          Hot spot level  meeting
-          DIC level meeting
-          Condom promotion
-          STI/RTI  Treatment
-          Referral / linkage  to ART centre/ DIC/CCC/DSRC’/ RNTCP
-          Advocating meeting
-          Legal support
-          Linkage with various social benefit scheme  etc

After detection of HIV positive the migrant workers / clients were refer to ART centre for pre ART regd. /CD4 test / on PRT registration/DMC etc. During follow up of the client,  the TI partner /  DAPCU staff  /ICTC counsellor gave stress on  inadequate adherence to ART treatment is associated with detectable viral land, decreasing CD4 count , disease progression, episode of OIS and poorer health out come.
           
           Again MIS case and LFU case of Angul ART Centre was divided into ICTC wise and in the monthly HIV-TB.  Meeting the same MIS case / LFU case was distributed to concerned ICTC counsellor for follow up of the same client.

For providing comprehensive PPTCT Services to HIV positive migrant women emphasis was given by TI/ DAPCU/ ICTC counsellor on following point: 

·  Institutionalisation of delivery  of positive women
·  Prevention of unintended pregnancies among the HIV   infected migrant women.
·  Prevention of HIV transmission from HIV infected migrant women to their infants
·  Care and support to HIV infected migrant women, their children, 

     Again in Angul district during Dasahara, Laxmipuja and Kalipuja festival time, most of the outside migrants clients were return back to their native place of Angul District.  So to provide HIV/AIDS services  to their doorstep, health check up- camp/ STI/RII treatment/ HIV / AIDS  counselling  and testing/condom distribution / Exhibition  was  organised by DAPCU Angul  with the  support of NRHM MHU van & with team of doctors/ paramedical staff/ counsellor/ LT of ICTC  in different villages during the same time.

Out of District:

           Out of Angul district migrant clients also tested their blood in Angul CTC and regd. their name in ART centre. In case of LFU and MIS case   of out of district migrant client   their details name / address was given to the concerned counsellor of other District and the concerned counsellor of the same district flow up of the same client.

Outside State:

All sorts of support / linkage / referral services are also provided to migrant clients of outside state. If the client leave the district then their name and address was given to OSAS/ BBSR for further   follow up. 

Over all sort of social / medical / psychological / moral / legal support was provided to HIV positive migrant workers/ clients.