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

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. 

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

Prevention & Early Detection

Though there is no TI working for migrants, the transit migrant’s intervention is done by TI-NGO at Titilagarh railway station which is major transit point. During intervention counseling (group and one to one) on HIV/AIDS, distribution of free condoms and take home IEC materials are given.

In Balangir district the migrants return during September to October. In that period health camps are conducted in migration prone blocks for free health checkup and HIV / TB / STI etc screening are also done. Suspected clients including their partners are referred to nearest ICTC for HIV testing.

The detected HIV positive client is immediately linked to ART centre for ART registration and in regular interval they are followed up by concerned counselor. During counseling session their destination / duration of stay / cause of migration etc are observed for future tracking and follow up.

Linking to ART, Treatment Adherence, Follow-up of MIS & LFU

By making inter district coordination (Ganjam, VSS, Burla-Sambalpur, Angul) the clients are followed up for LFU/Mis cases and ART registration. Out of 108 nos. of detected migrants, out of them 28 nos. of client have registered out of Balangir. Positive clients from other districts have also registered at Balangir ARTC. We have ensured inter ARTC / LAC coordination during our ART coordination meeting.

PPTCT services

If any ANC found positive and his spouse is migrant, it is always followed up by concerned counselor for institutional delivery and the same information is shared with other DAPCUs where they migrate.

Pictures Related to Health Camp for Migrants

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

Profile of the District: 

Mehsana district is located in North Gujarat, about 75 km from Ahmedabad.The district borders with Banaskantha district in the north, Patan and Surendranagar districts in the west, Gandhinagar and Ahmedabad districts in the south and Sabarkantha district in the east.The major crops of Mehsana are Potato, Cotton, Tobacco, Oilseeds, Castor Seeds, Cumin, Psyllium and Anise .Asia’s second largest dairy ‘Dudhsagar Milk Cooperative Dairy’ and largest market yard ‘Unjha’ is located in Mehsana.‘Sun Temple’ at Modhera is an important tourist destination of Mehsana district. High out-migration to Surat and Mumbai for Diamond work, courier services (Angadiya) and for Transport related work from across the District and abroad also.High in-migration from Rajasthan and other parts of Gujarat.

In Mehsana district generally the positive migrant clients are from Banaskantha, Sabarkantha, Patan & other nearest district and also from Rajasthan state & Maharastra state. Within the District migrant positive clients are linked to ART Center nearer to Patan & nearest district at Govt.District Hospital, Patan, Banaskantha & Sabarkantha for Pre-ART registration, CD4 count.  If CD4 count is less than 350 then efforts are made for registering the positive clients on ART at ART Center.

Whenever any client found positive from other district (Patan, Sabarkantha & Banaskantha), counselor provides option to Client for taking ART treatment according to Client choice. If client is willing to continue the treatment from his own district then Client is transfer out to that particular district ART Center for further treatment, if CD4 count is less than 350 we put him on ART. Counselors note down the permanent, current address & Mobile number of respective client for further follow up.

The MIS/LFU line-list share with the LWS, ICTCs, DSRCs, CSC, Jatan Project for tracking the LFU/MIS patient and revert back them to ART. DAPCU plays a major role for taking the follow-up of such activities.

DAPCU track the migrant ANC delivery as per EDD & also confirm the EID Follow up by tracking PPTCT calendar.

DAPCU & ART Center conduct the Monthly meeting with LWS, ICTCs, DSRCs, CSC, Jatan Project for LFU & Linkages.

Example:

In the month of July-13 one Couple HIV positive Diagnosed (1 is ANC & 1 is General Client) in ICTC Unjha from Banaskantha District, who is ART Registration at ARTC Patan.

            ANCs commonly avail services in two districts viz. at her parents’ home and at her marital home. Tracing and follow up between districts becomes difficult for EID/DBS, 6 weeks, 6 months, 12 months, 18 month.

Example:

In the month of March-13 we had one ANC HIV positive Diagnosed (first test) in FICTC Ambaliyasan from Sabarkantha District, than she go to her parents’ home at Sunsar Ta.Bhiloda Di.Sabarkantha. District Supervisor DAPCU Mehsana informed to ICTC Counselor Bhiloda for Confirmation. She reached to ICTC & Confirmatory test done at ICTC Bhiloda & She found HIV Positive & ICTC Counselor Bhiloda counsel her & she agree for delivery at ICTC Bhiloda. 

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

Prevention:

In the Udupi district usually the high number of migrant cases are from Other Dist,Other States. The District has got various number of Industries which attracts other district and state populations to get migrated to the District. A good amount of Kooli is also great opening to the people. When any migrant found positive, that would be counseled,linelisted and referred to ART centre for the further treatment(CD4,Pre ART, Initiation of ART). Suppose a case from other state comes positive, counseling would be done and according to his convenience, he/She will be transferred to their native places for the further treatment.

Early Detection:

Migrants will be identified in Road constructions, Construction areas, Fisheries area and some residential areas.HIV awareness areas and STI/RTI info will be given.

Once a migrant found positive,ORW’s will take them to counselors where counselor will give necessary counseling regarding positive living. A number of health camps will be arranged in the sites and industries. Where all the migrants will get referred and tested.

For prevention and early detection IEC activity like Full Site Sensitization Programme, Mega Health Camps, Poster, Sessions on HIV Awareness, Street play, Congregation will be arranged.

A positive client will be taken to the ART centre through ORW’s and at ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the patient, family counseling is given to the patient so that he should not face any discrimination within his family. Sometimes patient will be referred to DLN’s to get the services and follow up will be done.

Follow-up of MIS and LFU:

With the help of stake holder labor contractor and from other sources information’s will be collected. On other hand Follow-up of LFU/MIS is ensured by collecting line list of such patients from ART center and then the same is handed over to Outreach workers and TI NGOs so that they can trace out the positive clients detail and then inform the ART centre.

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

DAPCUs ensure comprehensive HIV/ AIDS services that are provided to the HIV Positive Migrants by following means:

1. Within district:

Comprehensive HIV/AIDS services are being provided to the HIV Positive Migrants within the district by DAPCU with the assistance of TI-NGOs, especially those are being working on the Migrants. IEC & HIV/AIDS Service Demand Generation camps are regularly organized by TI-NGOs on the Migrant’s hot spots within the district. HIV-AIDS services like counseling, HIV Testing, providing condoms, referrals and linkages to the other linked facilities are being provided to the migrants through activities performed by TI-NGOs with the co-operation and co-ordination from DAPCU side. Regular follow-up of clients residing in the district are being done by Counselors of ICTCs and ART Centers to minimize the numbers of LFUs and MIS’. If any HIV Positive client is faced problem in the registration at the HIV-AIDS health facilities due to non-availability of Id-Proof then DAPCU with the help of TI-NGOs and District Administration takes efforts to make sure that concern HIV Positive migrant client can availed the Id-Proof.

2. Out of district:

Since, some of biggest and renowned hospitals are situated in the Central District of Delhi, therefore, huge number of clients, not only from other district of Delhi but also from other state of India are came over here and obtained the facilities concerning to the HIV-AIDS from the HIV-AIDS related facilities in the District. Also HIV Positive Clients are given options to choose ART facility as per their convenience either situated in the district or other districts of Delhi for treatment. According to their choice, they are linked with ART Center chosen by them.  Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS and other concern DAPCUs for proper follow-up of LFUs and MIS and ensuring comprehensive services coverage of Migrant Clients of other districts of Delhi. All DAPCUs in Delhi co-ordinate and help one another for the same.

3. Out of State:

Central Delhi is a gateway of migrants from & to Union Territory of Delhi due to presence of two busiest railway stations of the Country i. e. Delhi and New Delhi Railway Stations and also biggest wholesale markets of India i.e. Sadar Bazar, Paharganj, Chandni Chowk, Karol Bagh etc. There is huge number of migrants come in and gone out every day from Central Delhi to another parts of the country. In addition of the above presence of National Level Big Hospital, the numbers of clients are very huge which are obtaining facilities from HIV-AIDS facilities present in the District. As per cited above Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS for proper follow-up and ensuring comprehensive services coverage of Migrant Clients of other states of India. Follow-up of LFUs and MIS of other states are done with the help of DSACS and concern SACS. Also permanent address of the clients’ native place is obtained & recorded during his/her visit at the ICTCs so that follow-up of the same can become trouble-free.