rapid assessment of hiv risk and vulnerability among migrant workers

Rapid Assessment among migrant workers in Construction Sector on HIV/AIDS Risk and Vulnerability in

Raigad dist., Maharashtra

Shankar Talwar (Ph.D.)Consultant

ILO, New Delhi

25 November, 2008

Objectives of the assessment

Conduct mapping exercise to identify potential sites and provide information on geographical areas where migrant construction workers are present, their origin and size

Carryout a knowledge, attitude, behavior and practice (KABP) study to assess the level of risk for HIV infection among the migrants at the potential intervention sites, and

Carryout stakeholder analysis at the identified destination sites to assess their role in reducing HIV risk among the migrant construction workers.

MethodologyMapping conducted in the identified geographical areas (not

the entire taluka) carried out at three types of locations where

migrant construction workers congregated (Nakas) /worked (Construction sites)/ lived (Bastis).

Conducted using Primary Key Informant Interviews Trained NGO workers conducted mapping Information gathered during mapping included –

estimated number of migrants, migration behavior, risk factors and HIV/AIDS services available

MethodologyKABP Survey conducted using a standardized

questionnaire developed by ILO for workers in the unorganized sector

Conducted at 15 locations in Panvel taluka (6 Nakas, 6 Construction sites, and 3 Bastis) identified for intervention

Among a sample of 380 using random sampling with PPS approach at each location

Trained NGO workers conducted the fieldwork

MethodologyStakeholder analysis conducted using in-depth interviews Stakeholders consisted of Contractors, Mukadams (group leaders of construction workers), and NGO workers (NMS) associated with construction workers.

Findings

Mapping Size estimation and migration behavior HIV/AIDS risk factor HIV/AIDS services aware and used

Estimating size

In all, 86 locations were mapped (6 Nakas, 31 Construction sites and 49 Bastis)

There were 36,571 migrant construction workers in these locations

Nakas had high mean no. of workers per location (783) compared to Bastis (586) and construction sites (144)

No. of migrants increased by 10-15% during peak seasons (April-May, Oct.-Nov)

Two-third of the migrant construction workers were men

Most of the workers were from the weaker sections of the society

Where do migrant construction workers come from?

51.0

14.0

12.0

11.0

12.0

Maharashtra

Uttar Pradesh

Karnataka

Bihar

Others

Migration behavior

% Seasonal workers % Living singly0

10

20

30

40

50

60

70

8071

22

76

67

52

25

59

33

Naka Constructin site Basti Basti (NFN)

HIV related risk factors

Two-third of the locations had sex workers operating nearby (brothels, etc.)

Women construction workers reported to work as part-time sex workers in one-tenth of the locations (mostly Nakas)

More than half consumed alcohol About 1.5% of the construction workers in

Basti injected drugs

HIV/AIDS related services

General health care seeking from private allopath (80%) and govt. facilities (28%)

Among a dozen NGOs/CBOs operating in the area, very few provided HIV related services

In less than half of the locations condoms were available (very low in Nakas and sites)

Workers in only about one-tenth of the locations knew about VCT services

FindingsKABP Survey Background characteristics of the respondents Knowledge of HIV transmission and

misconceptions Knowledge of prevention methods Attitude towards HIV+ co-workers Knowledge of STI symptoms in women and men Awareness of HIV/AIDS services at workplace,

and services received Sexual risk behavior Condom use

Background characteristics of respondents

Three-fourth of the respondents were men While 45% were 21-30 yrs old, 29% were 31-

40 yrs old 63% were married While 34% were illiterate, 25% had studied

from 1 to 5 standard, 21% from 6 to 8 standard Duration in construction work varied from 1 to

8 years Only about half of the respondent reported

living with their spouse currently

% knowing all 4 routes of HIV transmission*

Naka (n=162) Construction site (n=103)

Basti (NFN) (n=115)

Total (N=380)0

5

10

15

20

25

30

35

40

45

26.5

42.7

27.8

31.3

* Sex, blood, mother to child, and needle/syringe

% endorsing all 4 misconceptions of HIV transmission*

Naka (n=162) Construction site (n=103)

Basti (NFN) (n=115)

Total (N=380)0

1

2

3

4

5

1.9

3.9

2.6 2.6

* Using toilet, mosquito bite, touching, sneezing nearby

% knowing any 3 HIV prevention methods*

Naka (n=162) Construction site (n=103)

Basti (NFN) (n=115)

Total (N=380)0

10

20

30

40

50

60

70

32.7

58.3

49.6

44.7

* A, B, C, sterilized needle, M-C treatment, safe blood

Attitude towards HIV+ person (%)

Willing to work alongside co-worker who is +ve

Willing to use toilet used by co-workers who is +ve

Willing to eat food with co-worker who is +ve

Willing to share tools with co-workers who is +ve

Willing to hold hands with someone who is +ve

Willing to share a room with someone who is living with HIV/AIDS

HIV+ children should be allowed to study in schools

Agree to live in the same house with a family member who is +ve

0 10 20 30 40 50 60

47.1

44.2

43.2

52.1

51.6

44.7

57.4

50.5

Knowledge of STI symptoms in women and men (%)

Naka (n=162) Construction site (n=103)

Basti (NFN) (n=115)

Total (N=380)0

2

4

6

8

10

12

14

2.5

1.0

3.5

2.4

9.9

12.6

11.3 11.1

% of respondents knowing at least 2 STI symptoms in women

Awareness of workplace HIV/AIDS services (%)

HIV prevention education

Condom availability

STI treatment information

VCT information

Care and support information

0 5 10 15 20 25

11.8

22.9

2.9

0.8

2.1

HIV/AIDS services received in workplace (%)

HIV/AIDS education

Information on STI treatment

Information on VCTC

Information on Care and support

Required condom

0 2 4 6 8 10 12 14 16 18 20

11.8

10.8

11.3

10.5

18.2

Sex with anybody other than spouse (%)

Naka (n=162) Construction site (n=103)

Basti (NFN) (n=115)

Total (N=380)20

21

22

23

24

25

26

27

25.9

25.2

22.6

24.7

Condom use and partner reduction

% used condom in last 2 sex acts % intentinally reduced partners0

10

20

30

40

50

60

70

80

90

78.6

52.4

65.461.5

76.9

46.2

74.5

53.2

Naka (n=42) Construction site (n=26)Basti (NFN) (n=26) Total (N=94)

Findings

Stakeholder analysis

Role of stakeholders

Key stakeholders included – Builders, Contractors, Mukadams, NGO workers

Builders interacted with workers only on financial matters (pay for work, compensation). Kept strict vigil on the premises.

Contractors had a key role in hiring workers, negotiating pay, providing civic amenities at sites

Mukadams being team leaders, managed and controlled workers

Contractors and Mukadams were willing to support HIV/AIDS intervention by providing space and letting their workers to participate in program

To sum up .. Presence of substantial number of single male

construction workers who fit the definition of NACO Mapping indicated HIV/AIDS vulnerability – sex workers

nearby, part time sex work by women workers, high alcohol consumption, some amount of drug use

Poor knowledge of HIV transmission, prevention methods, and STI symptoms

Lack of HIV/AIDS services in workplaces in the construction sector

About half of the workers did not have favorable attitude to HIV infected co-workers

Clear evidence of high risk sexual behavior, and relatively low consistent condom use

Need to work closely with all the stakeholders associated with construction workers