CARE Nepal's Focus on Migrants
Globally, migrants have been identified as one of the high-risk populations for HIV/AIDS and STIs transmission due to their increased vulnerabilities of involvement in unsafe sexual practices. Seasonal migration to India from Far-Western Nepal is widespread over the several decades. Migration from Bajhang and Doti districts is apparent (at least one member from 40 to 90 percents households migrate to India). Persons living with HIV/AIDS (PLWHAs) among migrants have been seen sporadically that rationalize the possible epidemic of HIV/AIDS in those districts.

A baseline study conducted by CARE in Bajhang revealed that 5% married women had heard of HIV/AIDS; 3% of them knew HIV transmission could be prevented and 1% expressed that appropriate condom use can protect from contracting HIV.

Further anecdotal reports indicate low level of awareness on HIV/AIDS and low level of safer sex practices among migrants, which may compel toward HIV transmission eventually. Study conducted in Doti suggested 27% 'Treponema Pallidum', 29% 'Chlamydia Trachomatis' and 10% HIV prevalent among migrants (N=99).

Brief Findings of Rapid Community Assessment (RCA) Conducted by CARE Nepal in Bajhang and Doti Districts in 2002

• Locally migration is understood as 'Deshajaane'
• 80-90 percents male members and at least one from each household migrate to India
• Mostly migrants are Dalit but some of them also come from upper castes. Majority of migrants are married males.
• Migration has been further fueled due to conflict situation in Far-Western districts.
  Preferred destinations of migrants are Mumbai, Solapur, Punjab, Gujarat, Delhi and some parts of Uttranchal Pradesh
• Migrants work as porter, Chaukidar/Watchman and work in restaurants, hotels, garages etc.
• They need Nrs 600-1600 to migrate India
• Migrants earn I.C. Rs. 800 to 3000 per month
• They visit to movie, friends, involve in drinking alcohol and playing cards and also involve in sexual activities during leisure periods.
• Sexual activities often undertake at brothel, public places e.g. parks and migrants' own room
• Found only two migrants out of 32 used condom on sexual contacts.
• Reasons of not using condoms were 'maja audiena' ( unpleasurable sex), unnecessary complications
• Migrants perceive sexually transmitted infections as blisters, boils, itching, bruises on genitalia and shared many of them had such signs and symptoms.
• Community people said 10-12 people had died of HIV/AIDS in each VDC
• Many people do not visit health institutions to treat STIs due to lack of medicines, health workers being irregular, and in most cases positions are vacant
• Many people treat STIs in Mumbai, Banglore, Delhi and Punjab
• Government health facilities lack adequate number of condom stocks.

• Primary: Migrant workers (males), their wives and potential migrants
• Secondary: Female sex workers and their clients

Objective
Reduce HIV/STI related high-risk sexual behaviors of target populations through community based behaviour change interventions.

Geographical Coverage
35 VDCs of Bajhang and 10 VDCs of Doti

Strategies

Major Accomplishments

• Awareness created to 9314 people on various aspects of HIV/AIDS, modes of HIV/STIs transmission and ways of protection through interactions and 23 events of VDC level orientations.
• Information on HIV/AIDS disseminated to 26594 individuals via 51 events of cultural programs comprised of song competition, street drama and others
• A total of 4958 IEC materials of various categories on HIV/AIDS/STIs were distributed to the targeted individuals
• 23 staff from three NGO partners were provided 5 days HIV/AIDS orientation training of trainer (TOT)
• 44 health care providers (government/NGOs) from project area of Bajhang and Doti districts were provided 5 days training on sexually transmitted infections (STIs) case management on syndromic approach
• Referred 42 targeted individuals for STI treatment
• 249 peer educators have received basic orientation training and 89 of them have received refresher training.
• A total of 2065 individuals received one day HIV/AIDS orientation. These individuals include members of S/HP management committee, FCHV/TBAs, VDC leaders and key persons, schoolteachers, non-formal education (NFE) members, students/JRC members, active male migrants/METS, shopkeepers and female sex workers)
• 3158 targeted people were educated on proper condom use through 807 events of condom demonstration. 12234 condoms were distributed to the target people. 22 migrants reported using condom consistently.

Major Changes

• Increased motivation and skills amongst NGOs staff - led to more interactions and acceptance at community levels.
• Targeted members share their concerns with outreach teams and peer educators.
• Migrants wives groups- forefront in disseminating messages to family and community.
• Enhanced support from district AIDS Coordination committee (DACC), line agencies, NGOs/CBOs.
• Interaction with S/HP management committee has influenced toward strengthening health cares (STI cares) at VDC levels.