Background

The Gujarat State AIDS Control Society (GSACS) and the ILO have joined forces to expand HIV testing for migrant workers since 2018 under the joint UN support to Gujarat, coordinated by the Joint UN Programme on HIV and AIDS (UNAIDS) in India.

The Gujarat AIDS Awareness and Prevention unit of ISRCDE (GAP-ISRCDE), a non-profit organization, implemented a project focusing on inter-state and intra-state migrant and industrial workers in five districts of Gujarat. The project, called Shramik Sakshamta (labour empowerment), contributed to the test and treat objective of the National AIDS Control Programme and proved to be a good model of reducing the HIV testing gap amongst men by engaging multi stakeholders such as industries, unions and industrial associations.

        “This project has shown that we can reduce the HIV testing gap amongst men by taking services to work sites. These workers would have hardly come to testing facilities on their own. Besides, involvement of industrial managers and unions created an enabling environment, not just for HIV testing, but also for ending stigma and discrimination which is still a key barrier that stops people from getting tested for HIV. GSACS values its collaboration with the ILO that has allowed us to implement this innovative multi-sectoral project by GAP.”
        - Dr Rajesh Gopal, Additional Project Director, GSACS.

         “This project is a great model to demonstrate how to reach men with HIV prevention, testing and treatment services. It was also interesting to see the attempt to enhance access of social protection to migrant workers. UNAIDS evaluation team visited Gujarat and saw the interventions of GAP. The team was impressed to see the way this project has been implemented by GAP with support from the ILO and GSACS.”
        - David Bridger, Country Director, UNAIDS, India

Salient features of the strategy

The project was implemented in three phases since 2019. Regular capacity building efforts were organized for the GAP team and communication materials were developed, focusing on reducing stigma and discrimination and promoting HIV testing and treatment.

A base line study was undertaken to understand the knowledge, behaviours and attitude of migrant and industrial workers.
State level stakeholders’ meetings were organized involving the Confederation of Real Estate Developers’ Associations of India; Laghu Udhyog Bharati (a small scale industry association) Gujarat Industrial Development Corporation, and Bhartiya Majdoor Sangh (a trade union).

The project team mapped the industries in five districts and organized district level stakeholders’ meetings involving the management of industries, trade union, GSACS and industrial associations.

Having developed relationships with local workplaces, interventions were initiated involving behaviour change communication, counselling and community-based HIV testing in partnership with GSACS and linking workers to care, treatment and support, including treatment for TB, sexually transmitted infections and other health conditions.

Key finding of baseline study:
One in five workers reported having more than one sex partner. Risk behaviour of migrant workers was not very different from local industrial workers. About 28% of workers demanded condoms. About 78% workers indicated they will take the test if it was provided in the workplace

Mukesh Bhai (name changed), 42, from Aravalli district of Gujarat is an industrial worker who accessed HIV testing under the project. Mukesh is one of the 2063 workers registered under social protection schemes. Having tested HIV positive, he was put on antiretroviral treatment. He was also registered under the care and support programme meant for people living with HIV and started getting monthly support for transport to access his medication. His health improved and he started working again. As he is construction worker, the project gave him the information and facilitated his registration under the scheme of the e-Nirman Card (e-Construction card) of the Gujarat Building and Other Construction Worker's Welfare Board. Construction workers registered under the scheme can access land plots from the government of Gujarat at concessional rate for having their own house. He  also get a mortgage on easy terms and was able to build his own house.

“I lost all hopes when I was detected positive for HIV but due to counselling and treatment I am working again. Having an E Nirman card helped me immensely. I got a land to construct my own house. All this happened due to correct information given to me at the right time.”
- Mukesh Bhai

HIV testing and referral to further testing and treatment

 Results

• A total of 112,249 migrant and industrial workers were reached between July 2019 and April 2023. Out of which 85 per cent were males and 15 per cent were females. About half of these were migrant workers.
• A total of 27755 (25 per cent of those reached) volunteered to take an HIV test. Out of these 87 per cent were males and 13 per cent were females.
• The majority - 70 per cent - were first time testers. Also 70 per cent of those who took a test were between 25 and 35 years of age.
• A total of 83 workers tested positive for HIV and were linked with the government’s treatment programme.
• A total of 2063 workers were registered in social protection schemes meant for informal economy workers.
• As for other services, 34 workers were treated for reproductive tract infections / sexually transmitted infections; 123 were referred to TB screening out of which 18 were confirmed with TB infection and were put on treatment.
• As major part of the intervention covered the period of COVID-19, workers were also provided with COVID-19 prevention messages. Close to 20,050 face masks were distributed and workers were also provided access to approved medication.

Lessons learnt

• Testing at worksites is key to closing the HIV testing gap for men, the majority of whom are first time testers and are in the most productive 25-35 years of age group.
• It is important to cover local young workers in sectors such as construction as well as manufacturing. They are at equal risk as migrant workers with less access to HIV information and services.  
• Mapping of industries and advocacy with management helped in securing their support for the programme.
• Workers have welcomed the information about social protection schemes and the ones who got registered have also started receiving benefits of these schemes. One major challenge, however, was to that several workers did not have proof of their income and, therefore, found it difficult to get enrolled in schemes meant for people below the poverty line. 
• Mobilization of local stakeholders helped in reaching out to more industries/workplaces.

Next steps

• Linking the project with GSACS ongoing programmes such as the Link Workers’ Scheme and targeted interventions for sex workers is being attempted to maximize the impact of the project.
• As industries have seen the benefits of the programme, they are willing to continue these services for keeping their workers healthy and productive. GAP is reaching out to these industries to seek funding for sustaining the interventions.
• A state level dissemination workshop with all relevant stakeholders is planned to present the results of the project and discuss the ways of sustaining the interventions.