1. By Prabodh Devkota Senior Regional Project Director CARE International
HIV Services for cross border migrants in the context of Nepal, India and Bangladesh
By Prabodh Devkota
Senior Regional Project Director
CARE International

2. Cross border mobility contexts in South Asia
(Nepal, India and Bangladesh)
Nepal and India share open border
India and Bangladesh do not share open border
Mobility with in South Asia remains as a historical fact
Enhancing Mobile Population’s Access to HIV Services, Information and Support (EMPHASIS) works in Nepal, India, Bangladesh with research partners in the UK
EMPHASIS experience offers learning from two different cross border contexts of South Asia

3. EMPHASIS Project Sites
Source:
Nepal
Achham and Kanchanpur
Bangladesh
Jessore and Satkhira
Transit
Nepal
Gaddachauki, Nepal
Banbasa and Gaurifanta, India
Bangladesh
Border area of Sarsha, Sub-district of Jessore
Border area of Debhata, Satkhira Sadar & Kalaroa Sub-district, Satkhira
Destination
Mumbai:
Thane, Bandra, Jogeshwari, Mulund, Malad, Borivalli, Andheri, Goregaon, Kalwa, Wadala, Mankhurd, Koper Kairne, Santacruz
Delhi :
Naraina, Ramesh Nager, Kirti Nager, Madipur, Kapashera, Gurgaon, Jhilmil, Kashmiri Gate, Nand Nagri
Kolkata
Bongaon, Barasat, Machhalandpur, Cossipore, Rajabazar, Gardenreach, Madhyamgram

4. EMPHASIS Women Empowerment Collaboration Safe Mobility
Social Mobilization
Health System Strengthening
Remittance
Referral & Peer Education
Capacity Building
Research/Policy advocacy
Cross border referral linkage

5. Living Conditions of migrants

7. HIV and Migration: Bangladesh
According to the NASP Report of 2006, approximately 67 percent of identified HIV-positive cases in the country were returnee migrant workers and their spouses.
NASP on the World AIDS Day 2010 stated that 40 per cent of total new HIV cases reported were from external migrant workers and 34 per cent of total cases were female, of which 24 per cent were wives of HIV-positive men.
In 2011, out of the 445 new HIV infections, 138 (31%) are the external migrant workers and 21.1% are the housewives.

8. EMPHASIS collaborated with Gov Bangladesh to set up two VCT Centers
Total number of tested cases at VCT Centers

9. Status of HIV Test result
All the cases have migration history
Male (6)
Female (11)
Male (408)
Female (244)
EMPHASIS is still in the process of analyzing the context and technicalities of these data in coordination with government and other stakeholders

10. The process to receive ART in India requires the following documents:
Address proof (Ration card/electricity bill) OR
Recommendation letter/undertaking from NGO or Recommendation from employer and Employee ID card
 Key Issues faced by PLHIV in the continuum of Mobility
Lack of Information
Lack of identity proof
Long queue (some time persons) for getting ART (Mumbai/Delhi)
Inadequate time given by ART counsellor though efforts are made to make it easy
Access to medicine other than ART
Accessing services from different points within a hospital
Travel cost-Poor financial status women and widows are on the hardest hit
Language barrier

11. Opportunities
India operates under the principles of universal access to treatment services

12. EMPHASIS Efforts in Destination
Accessing services through regular referral system in India
Male
Female
Total
NMP 85 29
114
BSP 14 27 41 99 56
155
Accessing services through cross-border referral: A Historic Achievement
Male
Female
Total
NMP 28 4 32
BSP 3 5 8 31 9 40
People with HIV in EMPHASIS India
Male
Female
Total
NMP
113 33
146
BSP 17 32 49
130 65
195

13. ART TRANSFER FROM NEPAL TO INDIA
Transfer Letter should mention the following:
Letter on hospital letter head with & phone number of hospital
ART number
Current course of medicine
Date when started ART
Current status of CD4 count
Name of preferred ART centre (asked in Mumbai)

14. Chain of Partners: EMPHASIS Facilitation for Cross Border Referral
RS forwarded an to country team Nepal to act on the issue
On the same day more details sent from Mumbai: Name, VDC, Village and ART site
Reflection:
Linked to ART at destination with in 4 working days
Direct communication among partners (Destination to Source)
Close collaboration with ART at both sides
Hard work regardless of weekend
Nov 24th Saturday
Project Coordinator GaRDeF in Achham received information including a request letter from patient for ART transfer
Nov 23, 2012 Friday
ARC Project Coordinator sent an to Country Team India with a copy to RS
Nov 26th
ART Transfer letter sent from source to destination
Nov 22, 2012
Lali Guras DIC, Mumbai
Nepali Migrant
ART # ; who was travelling every six months to Nepal for CD4 testing and access ART
Nov 29th
Linked to ART site in Mumbai

15. Strategic significance of having a cross border program
EMPHASIS services were provided to migrants at destination in 15 months who were from 67 districts of Nepal at source. This proves the fact that for a cross border program it is important to have programs both at source and destination.

16. Key Learning
Unless Migration is underscored as a key priority within National AIDS Response, reaching migrants will be more challenging
Program at source and destination are strategic to reach the mobile population
Governments, civil society and people’s network can make universal access possible
A comprehensive migration program can make a difference

17. Thank you