CONSIDERATIONS FOR MIGRANT PROGRAMMING

It is important to invest available resources most strategically by focusing interventions on high-risk migrant men who are partners of high-risk group (HRG) members (FSW, MSM-T). Mapping exercises (see Chapter 2 below) can identify the confluence of migrant men with HRG networks to keep interventions focused on those migrant men who are actually at risk and at the locations where risk occurs.

Women in general have a high degree of sexual health vulnerability for the following reasons:

• Because of the high-risk behaviour of their husbands and sexual partners

• Many wives of migrant men are illiterate, and because they remain largely within the confines of their homes they are mostly uninformed about STIs and HIV/AIDS.

• Caring for their health is generally not a priority for them or for their male family members.

• They are often unaware of condoms, and even if they are aware, it is generally the decision of their husband/male partner whether to use them or not during sex.

• In the absence of their husbands, they are dependent on the men in the households or on neighbours for help in managing household affairs. This may lead to sexual relationships with other family members or men in the community.

• Women are not supposed to go out alone and hence are unable to seek health services.

The success of migrant programmes at destination will be greatly influenced by whether or not migrant spouses/sexual partners are educated about HIV risks and related issues.

In the source state, based on the mapping data from the destination states (shared between the source and destination SACS), the SACS should take responsibility to cover migrant wives/sexual partners, through link workers and as part of broader SACS-supported HIV/AIDS initiatives in the major pockets of high outward migration.

At the destinations, women migrants who are part of transactional sex networks and at risk of HIV are envisaged to be part of the female sex worker intervention.

Step 1: Review and analysis of existing data sources

This is done through a state-level analysis to locate large pockets of migrants, and a risk assessment study to ascertain if there are significant numbers who are at risk for HIV.

1. Data analysis Analyse data from National Sample Survey (NSS), Census and National Commission of Rural Labour to map major pockets of migrants in the state, where there are 5,000-10,000 single-male circular migrants (as defined in Section 1.1.2 above) living within a radius of 5-10 kilometres. This process should be undertaken by the SACS of the destination states. The review and analysis should be shared with the potential partner agencies to facilitate their understanding and enable them to move on to the next stage.

2. Risk assessment study Contract an agency (preferably a local one and backed by TSU) to conduct a risk assessment study to decide if these migrants are at risk based on the following criteria (see also Annexure 1, Tool for Risk Assessment):

Preliminary mapping (Identifying sub-pockets of risk)

Preliminary mapping provides a general overview of the entire geographic area and is the basis for the refined methods and tools necessary for a detailed mapping study. Mapping is to be done by ORWs who are given training in the methodology, preferably by TSU and/or by an agency hired by SACS. Preliminary mapping will include a geographic area overview and interviews with key informants to help identify:

1. Congregation points of high-risk men

2. Presence of sex workers

3. Presence of elements such as video parlours, youth clubs/mandals, NGOs, temples, hotels, lodges, bars and movie theatres that could be vantage points for target-efficient field communication

The key informants in each area include shopkeepers, cinema hall employees, slum residents, housing colony residents, slum development officers, municipal corporation officers, private doctors, government hospital doctors, NGOs, industry employers and employees, labour contractors, bar owners and clientele, railway station masters and bus depot in-charges.

Detailed mapping (Identifying locations and populations for intervention)

Detailed mapping is needed in order to ensure a target-efficient, streamlined intervention among migrant workers. This study will:

1. Assess the target group size of high-risk migrant men and women

2. Identify target-efficient hotspots/strategic locations

3. Determine possible range of communication activities to be conducted at the identified hotspots

4. Assess the presence of sex workers in the area along with the type of sex work and the typology of the sex workers.

The detailed mapping study will be done by ORWs, preferably trained by the TSU or an agency hired by the SACS, using three primary components:

Understanding source areas for migrants

While conducting mapping at the destination sites, an attempt should be made to identify source states, including the details of village/town/district clusters. This information should be communicated to the SACS of the source state to facilitate outreach to the migrant spouses/sexual partners back home and to returning migrants. See Section 1.2.3 of Chapter 1 for more information.