Dr Bernadette Ssebadduka and Ssengendo John Perceptions of quality HIV services among female sex workers and truckers: A participatory assessment conducted at hotspots along the Kampala – Juba transport corridor in Uganda

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES BACKGROUND Truckers and FSWs acknowledged among the key populations at higher risk of HIV exposure (Uganda National Strategic Plan, National Prevention Strategy) Only 10% of FSWs reached by existing HIV programmes (UNAIDS 2006) Weak HIV programmes targeting truckers and FSWs (IOM 2008) Dearth of information on unmet health needs & desirable quality of services for study populations

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES HIV HOTSPOTS ALONG TRANSPORT CORRIDORS Areas where mobile populations interact with local communities in environments conducive to multiple concurrent sexual partnerships. Such places include truck stops, border posts, and construction sites. For study purposes, all active hotspots along the Kampala – Juba corridor included

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES STUDY OBJECTIVE To map out the health service needs and desirable quality of health services among FSWs and truckers at hotspots along the Kampala-Juba transport corridor in Uganda. Key actions : to consult intended beneficiaries ( to establish what is friendly); map HIV service providers (locations, capacity, existing quality); and to inform referral systems and replication of best practices); and.

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES The study findings have provided information for the design and implementation of quality HIV services for key populations (using FSWs as the core population) at hotspots along transport corridors in Uganda. STUDY OBJECTIVE

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES METHODOLOGY Study conducted in 5 hotspots* along Kampala–Juba route; A combination of methods was used: structured questionnaires, KII, and FGDs; 240 truckers and 254 FSWs were interviewed; 87 respondents in 10 FGDs (5 with FSWs, 5 with truckers at each of the hotspots); Interviewees identified through known contacts.

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES Socio demographics Majority of FSWs have primary or no education. Reverse is true for truckers.

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES Majority of truckers are married

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES Majority of FSWs are young people

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES Multiple sexual partnerships Transactional sex common: 64% of FSWs and 27% of Truckers reported up to 49 partners in the six months preceding the study; 34% of truckers had not used a condom with any of the partners; Inconsistent condom use across partners – trust, need to feel ‘skin on skin’, failure to negotiate, more money offered; No HCT in preceding 12 months: 55% truckers and 35% FSWs. HIV related behaviour and practices

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES HIV not a priority health concern; Private providers are preferred to government; Provider choice was dependent on proximity to truck stop, service availability, affordability & ( 47% of truckers) waiting time Hindrances to healthcare access: high cost of services (36%); unfavourable service hours (35%); do not know service location (24.9%); long distance (25%); long waiting time (23%); and unfriendly providers (14%). Healthcare seeking

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES What services do you need most? TruckersFSWs Malaria treatment (20.9%) Treatment for URTIs (15.8%) Treatment for backache and fatigue (15%) STI diagnosis and treatment (11.7%) Treatment of occupational-related injuries such as cuts and bruises (10.5%) HIV Counselling and Testing (8.4%) STIs diagnosis and treatment (15.8%) Malaria treatment (13.7%) HCT (12%) Treatment for URTIs (11.8%) Post Abortion Care (7.6%) Emergency Contraception (6.4%)

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES HCT (22%), STI treatment (21%), Post abortion care (11%), HIV care and treatment (8%), Health Information (7%). Only 3/13 facilities surveyed stock PMTCT medicines. “We need HIV testing services so that we can test ourselves whenever we want to. The clinics and drug shops around here don’t offer HIV services.” (FSW in Migyera Hotspot) “Many of our friends have passed away because they have abortions and die because they fear going to hospitals.” (FSW in Bweyale Hotspot) What services did you need but could not get?

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES How can we reach you better?

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES What is a quality service? Priority servicesDesirable service qualities Malaria treatment Management for URTIs Treatment for backache and fatigue STI management Management of minor injuries like cuts and bruises HIV counselling and testing Post abortion care Emergency contraception Health information Management of diarrhoeal illnesses Conveniently located within hot-spot Minimal waiting time Opens until late/ at least until midnight Offers a wide range of services Friendly health workers Professional service providers Affordable services Laboratory services available Medicines are available

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES RECOMMENDATIONS Support existing and preferred service providers; Improve coordination – for referral, replication, standardization of services delivery Strengthen partnerships among stakeholders; Build migrant-friendly healthcare systems; Compliment services with BCC; In build M&E at all programming levels.

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES OUR RESPONSE Branded clinic along Kampala-Juba transport corridor

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES OUR RESPONSE

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES OUR RESPONSE Placed IEC and TV in waiting room Improved client flow arrangements Deployed community mobilizers Trained private practitioners in ‘friendly’ healthcare Encouraged staff to wear uniform Extended work hours Marked service areas Repaired clinic floor Linked with government hospital and local NGO (TASO) so they can offer ongoing support supervision and on job training Branded Clinics and Placed clearer signposts

HEALTHY MIGRANTS IN HEALTHY COMMUNITIES CONCLUSION Programs targeting FSWs and their clientele within HIV hotspots should endeavor to offer services that meet a defined quality that incorporates the perceptions of beneficiaries; Quality service standards should be implemented in cooperation with the Ministry of Health and other key partners; Use the priority health needs as an entry to HIV services, place emphasis on those services where there is a high unmet need; Work within a combination HIV prevention framework.

Makerere University College of Humanities and Social Sciences Ugandan AIDS Commission Republic of Uganda Ministry of Works & Transport THANK YOU AND PLEASE GET IN TOUCH Dr. Bernadette Ssebadduka Mobile: +256 (0)