A REPORT ON

NEED ASSESSMENT AND STAKEHOLDER ANALYSIS (NASHA)
     FOR DESIGNING PROGRAMME INTERVENTIONS

                ...
Table of contents


Chapter 1: Introduction
             Programme background
             Aim and objectives
            ...
Chapter 1
                                           Introduction


India, home to the third highest number of HIV positiv...
The TI project was sanctioned for covering target group for Jodhpur district with an
objective to enhance the knowledge ab...
the intervention areas. SHA involves participatory techniques such as social mapping,
focus group discussion, in-depth int...
OBJECTIVES
A need/risk assessment seeks to ascertain whether male migrants in the potential
intervention area are at risk ...
Step 2: sampling process
Systematic simple random sampling technique is used to collect information from
Primary stakehold...
Step 3: Analysis:

With the field level information gathered, mapping of halt points and profile of
intervention sites wer...
Shergarh, Osian and Phalodi and seven tehsils, i.e., Jodhpur, Osian, Phalodi, Bilara,
Bhopalgarh, Luni and Shergarh. The d...
marble products. After handicrafts, tourism is the second largest industry of Jodhpur.
Crops   grown    in   the   distric...
Bhatt Basti, Darbi Colony, Madhuban Housing Board, New power house road and Basni
1st phase at the transport area of Jodhp...
•   Bar in the Area:          Godra Thekha 100 clients/day
    •   NGOs working in the Area:
                            •...
Chapter 3
                               SELECTED SITES AND MIGRANTS:


PRIMARY INFORMATION, NATURE AND CHARACTERISTICS


...
More than half of the migrants are worked as Industrial Labor. Rest 1/4 migrants are
mainly involved in digging, construct...
Almost half of the migrants get this work by having a fixed arrangement with a
contractor for whole or some period of migr...
87 percent overall migrants reported having heard about HIV/AIDS, about 45 percent of
the migrants’ said that the condom i...
Jodhpur. It is common to find the fathers and brothers lining off the earnings of the girls.
Most of the girls in target a...
of only 16 percent. Regarding the availability and accessibility of STI services analysis
of data reveals that only 46% of...
Source of information about condom

                                                     79%
                             ...
Chapter 5
                   SUGGESTIONS AND RECOMMENDATIONS


   Outreach
    -   Staffs should be oriented towards team...
Counsellor Sumitra with Migrants and landlord of residential building




     Community members of Rajiv Ghandhi Basti du...
Discussion with women group




            22
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Target Intervention Need Assessment Report S W C T

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Target Intervention Need Assessment Report S W C T

  1. 1. A REPORT ON NEED ASSESSMENT AND STAKEHOLDER ANALYSIS (NASHA) FOR DESIGNING PROGRAMME INTERVENTIONS UNDER NACP PHASE III FOR TARGETED INTERVENTION (MIGRANTS) PROJECT RUN BY SOCIAL WELFARE CHARITABLE TRUST (SWCT) IN JODHPUR DISTRICT (RAJASTHAN) Duration: July- September, 2009 Project Team: Mr. SP Singh, Director, SWCT Ranjana Vaishnav, Consultant, SWCT Mr. Yogesh, Program coordinator, SWCT Mr. Bhawani, ORW Mr. Dharmendra, ORW Report Submitted to: Rajasthan State Aids Control Society Directorate, Medical& Health Services Swasthya Bhawan, Tilak Marg ‘C’ Scheme, Jaipur 1
  2. 2. Table of contents Chapter 1: Introduction Programme background Aim and objectives Interventions Stakeholders Objectives of the study Methodology: sample selection and tools Chapter 2: Socio-economic and demographic Profile Jodhpur district and study area Chapter 3: selected sites and migrants: Primary Information, Nature and Characteristics Sexual Behaviour of Migrants: Health Care Services: Chapter 4: Summary and Recommendations 2
  3. 3. Chapter 1 Introduction India, home to the third highest number of HIV positive people in the world, is characterised by widespread and fluid migration and mobility. More than 2 million Indians do not live in the place of their birth. Once migrants reach their destination, language and other difficulties lead to feelings of discontinuity and transition that enhance loneliness and/or sexual risk taking. Such risk taking may be reinforced by a lack of HIV/AIDS awareness, information and social support networks at both source and destination points, which cumulatively contribute to a migrant’s vulnerability. Back home, spouses of migrants are also vulnerable to HIV if their husbands return on a regular basis and have become infected with HIV. Some wives also have their own sexual networks during their husband’s absences. It is important to note that not all migrants are at equal risk of HIV. It is those men who are part of sexual networks at their destinations – either with female sex workers (FSWs) or with other men (MSM) or transgenders (TGs) – who are more prone to HIV infection. Similarly, those female migrants who take up transactional sex at destination locations are at greatest risk of HIV. Classification of migrants from an HIV vulnerability perspective is based on the following key criteria: Intersection with high risk sexual networks; Pattern, degree and duration of mobility and migration; Age; whether moving singly or with family; Route of migration; Destination of migration. Based on these criteria, the definition of migrants is: “Single men and all women in the age group of 15- 49 years who move between source and destination within the country once or more in a year.” Those who return to their source location at regular intervals are called “circular migrants”. ABOUT PROJECT Name and address of the organization: Social Welfare Charitable Trust, Jaipur Project Office- 2/32, Kudi Bhagtasani, Jodhpur Chief Functionary Mr. SP Singh Years of establishment Year and month of project initiation July, 2009 3
  4. 4. The TI project was sanctioned for covering target group for Jodhpur district with an objective to enhance the knowledge about HIV/AIDS among the targeted population. Start date Activity against the submitted proposal was commenced from July 2009 and presently running with in the project area. Key components of the project The key components of the project were as follows: • To create enabling atmosphere among the high risk group through assessing the current sexual behaviour, practise and their understanding about HIV/AIDS, • To provide them services related to HIV/AIDS though a holistic approach like behaviour change communication practices, STD clinics services and condom distribution etc. • To create and provide an enabling environment through outreach services for better coverage with minimum standards of quality. End date The end of the project time as per the contract is_____________. DEFINITION OF MIGRANTS FOR TIs UNDER NACP III From an HIV programming perspective under NACP III, migrant TIs: • Are destination interventions for inmigrants (i.e. at the point of destination) and not at the source • Are to focus on high risk migrant men and women (i.e. those who are part of high risk sexual networks, either as clients of sex workers and high risk MSM, or as sex workers themselves) The study titled ‘Need Assessment for Designing Programme Interventions’ has been commissioned for migrant population of transport area of Jodhpur district of Rajasthan state. The purpose of the study was to identify and assess the needs of top most potential hot spots at the area where SWCT project could begin the interventions. A detailed report contained profile of the district and study area, Socio-economic and demographic analysis, Behaviour analysis, Condom data analysis, STI data analysis and Stakeholder analysis. Stake Holder Analysis (SHA) is a part of the needs assessment exercise. Once the area of intervention has been finalised the needs assessment and SHA will be conducted in turn. “Social sanction activities” are helpful to establish an initial rapport with the community before SHA is conducted, for example by organising midmedia activities in 4
  5. 5. the intervention areas. SHA involves participatory techniques such as social mapping, focus group discussion, in-depth interviews/key informant interviews. DEFINING STAKEHOLDERS IN MIGRANT INTERVENTIONS Primary stakeholders (target population) • High risk migrant men and women who are interact with or are part of high risk sexual networks (FSW, MSM/TGs) • Spouses/sexual partners of migrants • Migrants living with and affected by HIV and AIDS Secondary stakeholders • Placement agencies, brokers and others • Families of high risk migrant men and women • Families of migrants living with and affected by HIV and AIDS • Sexual network operators (FSW, MSM/TGs) and power structures • Health care providers (government and private, qualified, unqualified) • NGOs, CBOs and other agencies implementing TIs • Workers associations, employees unions, trade unions • Infected and affected migrants, PLHA networks Tertiary stakeholders • Industrial centres, informal workplace institutions, employers associations, other allied organizations and structures Community level voluntary structures, e.g. migrants and youth forums/clubs, mandals, safe spaces/ drop in centres for migrants (spaces for migrants – SFM) • Decision makers in the community, i.e. social and political leaders, police, elected representatives (PRIs), development functionaries • NGOs, CBOs, CSOs • SACS in both source and destination states • NACO and the donor agencies DEFINITION OF THOSE AT RISK In last 12 months fell into any one of the categories below one or more times: • Had sexual intercourse o With female partner in exchange for money o With female partner in exchange for kind • Had sexual intercourse with male partner in exchange for money • Had sexual intercourse with eunuch in exchange for money 5
  6. 6. OBJECTIVES A need/risk assessment seeks to ascertain whether male migrants in the potential intervention area are at risk by gathering the following information: • Demographic profile of the risk population • Different types of partners among the risk population • Proportion who have correct knowledge about the modes of HIV transmission • Proportion who do not have any myths about the modes of HIV transmission • Condom related indicators • Proportion who suffered from STIs in last 12 months • Proportion who sought treatment from a qualified practitioner for STIs • Proportion who feel high risk with a female partner if they have sex in exchange for money or in kind • Proportion who feel it is important to know HIV status • Proportion who intend to get themselves tested METHODOLOGY The study was carried out following a series of procedural steps. The methods to implement each of the steps are discussed below. Step 1: Preparing an initial list of 10 potential sites A tentative potential list of potential sites (about 10) in transport area, Jodhpur was prepared before the site assessment. The inputs for preparing the list are: • Input from various Key Stakeholders such as SACS, CMHOs, PRIs, and other NGOS of the state. • Inputs from CBOs- associations and industries in the area The inputs received from the sources were collated to prepare a common list of 10 sites, which could satisfy the following two necessary conditions: • High risk migrant men and women who are interact with or are part of high risk sexual networks (250 to 500 migrants live at a time). • There should be adequate scope for another NGO intervention in case some other intervention/ project(s) is going on at the same area. In addition, the following condition is applied as secondary criteria: • Existence of clusters of sex workers or hot spots in and around the site. The secondary criteria are considered only when the first two conditions (i.e. the primary criteria) were met. A site that did not fulfill both the criteria, are not considered for potential list of interventions. 6
  7. 7. Step 2: sampling process Systematic simple random sampling technique is used to collect information from Primary stakeholders such as High risk migrant men and women who are interact with or are part of high risk sexual networks (FSW, MSM/TGs), Spouses/sexual partners of migrants and Migrants living with and affected by HIV and AIDS. It is decided to collect a minimum 10 percent sample from primary stakeholders from each site. In addition, FGDs with five primary, secondary and tertiary stakeholders at each site is conducted. Moreover, observation technique is used to collect preliminary information and In depth interviews are conducted with existing NGOs to collect information of their activities and its coverage. However, one to one method was used to collect information on availability and accessibility of health care services (from health care providers, retailers and chemists) within 3 Km. circles and sex trade from CSWs and Migrants as well. Both Qualitative and quantitative approach was used. The qualitative data were collected through PRA techniques; mapping, focus group discussions (FGD) with youth, women, and community leaders, people working in the field of HIV/AIDS while the Quantitative data collected through personal interviews with the help of a structured questionnaire. Tools of Data Collection: The tools used in the collection of primary data are the structured interview schedule and Focus Group Discussion Guide and in-depth interviews. The structured interview schedule was taken from “Targed intervention for Migrants- NACO Operationational Guidline” The schedule covered information on the demographic social and economic profile of the respondents, public awareness on HIV/AIDS, Beliefs and Misconceptions on HIV/AIDS, Social Distance with PLWHA, Exposure to Communication Channels and People’s Preference on Communication channels. Focus group discussion was carried out to obtain qualitative data and a guide was used. Two FGDs were used one for the leaders of NGOs and personnel working in the field and another for the community leaders, women and youth. Risk Assessment Preliminary Mapping Detailed Mapping FSW Assessment Hotspot Screening (Owners) Hotspot Screening (Patrons) 7
  8. 8. Step 3: Analysis: With the field level information gathered, mapping of halt points and profile of intervention sites were generated into tables. The summary information includes preliminary information on sites, capacity or average number, turn out of migrants, available and accessible health care services, movement of Commercial Sex Workers and their outlets and NGO’s profile for deciding the sites potentially for intervention. Step 4: Mapping Mapping of the existing facilities in and around the sitessuch as, closest town/city, transport centers, Dhabas, petrol pumps, points of contact with sex workers, migrants, village, Government and Non-government health facilities, were done. Chapter 2 SOCIO-ECONOMIC AND DEMOGRAPHIC PROFILE Jodhpur district and study area Rajasthan, the land embellished with infinite imprints of colour and chivalry, harmonious life and lingering music, harmony and hospitality, palaces and pristine nature; has been extending an invigorating invitation to the world, since time immemorial. Jodhpur, the heart of Rajasthan and the majestic jewel of her eternal crown, illuminate the Thar, enriching the desert with entrepreneurship, scholarship and art. Jodhpur is the second largest district of Rajasthan state is centrally situated in Western region of the State, having geographical area of 22850 sq. Kms. It has population of 28.81 lacs as per 2001 census. The district stretches between 2600’ and 27037’ at north Latitude and between 72 55’ and 73 52’ at East Longitude. This district is situated at the height between 250-300 meters above sea level. Jodhpur is bound by Nagaur in East, Jaisalmer in west, Bikaner in North and Barmer as well as Pali in the South. The length of the district from North to South and from East to West is 197 Km.& 208 Km. respectively. This district comes under Arid zone of the Rajasthan state. It covers 11.60% of total area of arid zone of the state. Some of the area of Great Indian Desert THAR also comes with in the district. General slope of the terrain is towards west. Despite its arid climate, Jodhpur is blessed with a variety of flora and fauna. A survey conducted by district administration with the help of forest officials shows 162 flora and 144 fauna at Machia Safari situated only 10 kms from Jodhpur. Administrative Setup: Jodhpur is the largest division of Rajasthan which comprises of six districts i.e. Jodhpur, Jaisalmer, Barmer, Pali, Sirohi and Jalore. For administration and development, the district is divided into five sub-divisions i.e. Jodhpur, Pipar City, 8
  9. 9. Shergarh, Osian and Phalodi and seven tehsils, i.e., Jodhpur, Osian, Phalodi, Bilara, Bhopalgarh, Luni and Shergarh. The developmental activities of the district are being looked after by nine Panchayat Samities, i.e. Mandore, Luni, Osian, Bap, Phalodi, Shergarh, Balesar, Bhopalgarh and Bilara. There 1080 villages and 339 panchayats. There are 4 independent Upa-tehsils for better administration Balesar, Bap, Jhanwar andTinwari. There is one Municipal Corporation (Jodhpur City) and three Municipal Councils Bilara, Pipar City and Phalodi. SDO TEHSIL No. of Area Panchayat No. of Revenue (In Samiti Revenue Villages Hectares) Villges Jodhpur Jodhpur 149 187552 Mandor 109 Luni(Partial) 24 Luni 111 163392 Luni 111 Shergarh Shergarh 264 381288 Shergarh 127 Balesar 137 Pipar Bilara 92 165327 Bilara 90 City Bhopalgarh 123 242787 Bhopalgarh 88 Osian 35 (Partial) Osian Osian 159 350294 Osian 159 Phalodi Phalodi 259 765765 Phalodi 124 Baap 134 Total 1157 2256405 1138 Demographics: As of 2001 India census Jodhpur had a population of 846,408. Men constitute 53 percent of the population and women 47 percent. Jodhpur has an average literacy rate of 67 percent, higher than the national average of 59.5 percent: male literacy is 75 percent, and female literacy is 58 percent. In Jodhpur, 14 percent of the population is under six years of age. POPULATION 2001 Total Population 2886505 Urban Population 33.85% Population of Scheduled Castes 15.81% Population of Scheduled Tribes 2.75% Exponential rate of growth of population:1991 to2001 2.56% Density of Population (Per sp. kms.) 126 Literacy (Total) 56.67 Literacy (Rural) 46.21 Literacy (Urban) 75.54 Economy: The Handicrafts industry has in recent years eclipsed all other industries in the city. By some estimates, the furniture export segment is a $200 million industry, directly or indirectly employing as many as 200,000 people. Other items manufactured include textiles, metal utensils, bicycles, ink and sporting goods. A flourishing cottage industry exists for the manufacture of such items as glass bangles, cutlery, carpets and 9
  10. 10. marble products. After handicrafts, tourism is the second largest industry of Jodhpur. Crops grown in the district include wheat and the famous Mathania red chillies. Gypsum and salt are mined. The city serves as an important marketplace for wool and agricultural products. Human Development: HUMAN DEVELOPMENT INDICES- 2002 Human Development Index (HDI) 0.567 Rank in Rajasthan : HDI 13 Gender Related Development index (GDI) 0.500 Rank in Rajasthan : GDI 13 Profile of the Study Area The targeted intervention project for Jodhpur district was focused on migrant population. The Target area was identified to be Jodhpur district of Rajasthan scattered in seven different high-risk group sites. These are Kudi Bhagtasani, Rajiv Ghandhi Kach Basti, 10
  11. 11. Bhatt Basti, Darbi Colony, Madhuban Housing Board, New power house road and Basni 1st phase at the transport area of Jodhpur distrct. Sub-groups and their size S.No. Migrant Type of Potential site Name of the Sites population Cluster ranking 1 Kudi Bhagtasani 1500 Residential 1 2 Hot Spot/ 1 Rajiv Ghandhi Kach Basti 1500 FSW 3 Hot Spot/ 1 Bhatt Basti 500 FSW 4 Industry/ 3 Darbi Colony 500 workplace centres 5 Madhuban Housing Board 200 Residential 3 6 Industry/ 2 New power house road 600 workplace centres 7 Basni 1st phase 500 Residential 2 Total 5300 • Nearest railway station of the Area: Basani Railway Station, New Pali Road • Nearest Bus Depot of the Area: Near Basani Krishi Mandi • Nearest market in the Area and Number of shops • KK Colony Market 80 shops • Rameshwar Nagar 100 shops • Madhuban 150 shops • Nearest Cinema Hall: Nasarani Bi-scope 4 shows* 150 person/day • Slum in the Area: • Rajiv Ghandhi Kachi Basti: 300 Households (HHs) • Bhat Basti: 150 HHs • Sanjay Colony 150 HHs • Indra Gandhi Kachi Basti: 150HHs • Resediential colonies in the area: • KK Colony • Rameshwar Nagar • Madhuban • Ganga Vihar • Janta Colony • Kudi Bhagtasani Housing Board 11
  12. 12. • Bar in the Area: Godra Thekha 100 clients/day • NGOs working in the Area: • GVSS, Jodhpur • Availability of Video Parlour: No any • Labour Job Posting Points: Location No. of Timings of Peak Type of Area of Time labours Gathering time workers residence spent standing at a time Madhuban Men=30 Whole day 6-7 AM temporary Slums 2 hours Charuaha Women=15 Total Number of mandals: Name of mandal Banjara Samaj Vikas Samiti Location KK Colony, Basani 1st phase Registration 200/jodhpur/06-07 Type of mandal Society No. of members 10 Type of activity Social development Area of operation Relationship with NGOs Satisfactory Perception of community Good Potential for TI? Meeting day and timings Monday, 4 to 6 PM Chairman & Secretary Ghisu Ram, President / Kishan Ram, Secretary Telephone No. 0291-2747411, 9352831140 Comments Total Number of ladies service bars: most of the ladies of Rajiv Gandhi Kachhi Basti and Bhat Basti are carried out the job of serving liquor after 8 PM. Sex Activity Location Rajiv Ghandhi Kachi Basti, Bhat Basti, Sanjay Colony , Indra Gandhi Kachi Basti Type of spot Commercial & residential CSW staying at the spot? yes Type of CSW (Practice at same place, outside) both CSW staying with? family Number of Client/CSW/day 4 to 6 Number CSW Activity place Number of fixed clients/CSW 1-2 Clients from area Migrants, Jodhpur local Activity rate Other:Modus Operandi: 12
  13. 13. Chapter 3 SELECTED SITES AND MIGRANTS: PRIMARY INFORMATION, NATURE AND CHARACTERISTICS Age & sex of the migrants: The majority of migrant workers ranged from 25 to 29 years old and is male. Education & Marital Status of the migrants: It was found that almost one fourth migrants are illiterate and 28% are literate but no schooling. FGDs revealed that most of the migrants came from Bihar state and are illiterate. Study disclosed that most of the migrants are married and if they migrant with family; there is no scope of education for their children. Socio- Economic Status: It was found that thirty four percentage of migrants are belongs to SEC-D and rest 16%, 27% and 23% are belonging to Others, SEC-C and SEC-E category. Geographic origin and language use: Study found that more than half migrants came from Bihar state and use Bihari language than Hindi. 70% were migrated with no family members (alone), 10% migrated with all their family members, 5 % with some family members, but not including spouse and 25% with some family members, including spouse. Among those 31% live with their friends and relatives. It was found that almost one fourth migrants live here from birth and rest came from last six month to 2 years or more. On question about months per year do they spend in nearby towns/cities like these for work, most of them replied that it is depend on the nature and length of the job. Almost 27 % live for six month to 2 years and rest some live for 10 years or more. They spend approximate 2 months at their natal home and mostly at festival time. 13
  14. 14. More than half of the migrants are worked as Industrial Labor. Rest 1/4 migrants are mainly involved in digging, construction labour, road laying and masonry work, and 10 % in Carpentry and Handicrafts (mostly local workers are involved in this job). It was found that not a single migrant work as Agricultural labour. Only 28% migrants have No income at all, 10% earns Up to Rs. 1500, 7% earns Rs. 1501 to Rs. 2000, 48% earns Rs. 2001 to Rs. 5000 and rest earns Rs 5001 to Rs 8000. 14
  15. 15. Almost half of the migrants get this work by having a fixed arrangement with a contractor for whole or some period of migration and 37% get this job with the help of coworker. Rests have to stand in naka everyday, trying to get work. To achieve bread and butter is the major reasons for come to this specific town/city (over others) as a migrant. SEXUAL BEHAVIOUR OF MIGRANTS As regard Migrants’ sexual behavior, it has been assumed that migrants have not back to their homes from last long time, during the time of relaxation from their work they come into contact with various means of entertainment and pleasurable channels, which often includes high-risk sexual practices. The reasons the migrants give: longer duration of stay away from home, and lack of entertainment and recreational facilities often led them to look partners for smoking, drinking, gambling and indulging in other activities. Such activities advance them into sexual relationships and thus make them vulnerable to various infections including HIV. Data on different types of sexual partners in the past 6 months for both married and unmarried respondents revealed that they involve in extra marital relationship with female sex workers. Besides spouse, the most usual extra-marital sexual experience for married migrants at highways with paid female partners. Mostly admitted that they do not have casual sex partners. It was found that almost half of the migrants who are living alone had sex with CSW more than two times in a month during past 3 months than others. More than 50% migrants have ever had any problems such as genital ulcer, urethral discharge, swelling in groin, burning urination, in the last 3 months and seek treatment on their own or suggestion of peers. Most of them still suffer with these problems. The study data revealed that first encounter with unknown person is motivated or influenced by the co-workers, their peers, watching prone movies, desire for a girl, excitement to explore sex, easy availability of sex workers etc. Mostly it is the longer period of abstinence, lack of recreational activities, and boredom during long journeys that increased the sexual urge of the migrants and to look for pleasure. The Migrants who were never involved in any sexual relationships, irrespective of their marital status, stated various reasons for not involving in such practices. Most of the reasons cited by these migrants were related to social and family responsibility, fear of social stigma and infections. 15
  16. 16. 87 percent overall migrants reported having heard about HIV/AIDS, about 45 percent of the migrants’ said that the condom is an effective means of preventing HIV/AIDS/STIs. The reporting indicates that people may have heard of HIV/AIDS but this does not necessarily mean that they know also about the crucial aspects of its prevention. Few percentages of migrants were not even aware of HIV/AIDS/STDs related information and did not think about degree of risk associated in sexual relationship with multiple partners. Till now a large proportion of migrants are unlikely to use condoms during risky sexual intercourse, as they seem to either believe that the condom would not be a helpful protection against HIV or they are ignorant about this. Data revealed that some of them were not bothered about any preventive measures. Most of them mean to use condom as family planning method. The above analysis reveals that the sexual behavior or sex is not only a basic instinct but is also determined by both internal and external social fabric. Therefore, there is a need for family education along with sex education. At the same time, the study warns that mere IEC and awareness activities related to HIV/AIDS programme and promotion of condom usages will not yield fruitful results in the long run. About 12 percent of the migrants reported knowing someone who is affected by HIV/AIDS in their area, it is not clear how they learnt about the HIV status of other individuals. This ‘knowledge’ may have serious negative implications in terms of stigma and discrimination. A large number of migrants were found to consider female sex workers as potential carriers of HIV/AIDS (50 percent). Sexual partners other than the spouse were seen as potential transmitters by a fairly large number of the respondents. Condom and its usage in preventing sexually transmitted infections are well known. No any respondent was found who never seen a condom. They feel it is easy to procure and people can protect themselves from STI/HIV/AIDS by using a condom correctly every time they have sex. Mostly believe condoms avoid pregnancy/ Family planning, protect from infection, protect from STI/HIV/AIDS. Almost all knew about how to use condom and they have used at least once in their life. FEMALE SEX WORKER In Rajasthan caste and home-based sex trade is mostly observed where the sex workers are put up in homes/huts. As traditional entertainers, performing sex work has been accepted as profession of Bhaat community and is a major source of income for the community. They are predominately concentrated in the nearby transport area of 16
  17. 17. Jodhpur. It is common to find the fathers and brothers lining off the earnings of the girls. Most of the girls in target areas stated that, they inherited this profession from their ancestors who were also involved in the same profession. Differences are observed in same caste or community in characteristic and behavioral pattern, working hours, clients per day, per client charge & networking in distances. Now a days some of the caste based sex workers reportedly migrate into neighboring states to carry out the trade when there is the off season. Besides the family or ancestors trade, girls from the other communities also opt this job. The motivational factor behind this is willing to achieve luxurious life and earn more money within short duration and less labor. But when a girl entered in this trade she can’t be overcome from the vicious cycle of her degradation of life. She has not left more energy to involve her in other income generation work after her retirement or menopausal age. FSW entertains five and more clients per day. Home based CSWs gives 15% to 25% of income to land lords from their monthly income (Rs. 200 to 300/client). Little percentage of earning is given to broker. (Usually brothers play roles of a broker). The maximum monthly income that a respondent earns is Rs. 5,000. The degree of financial independence varies among Commercial Sex Workers. Many of them spend a lot on alcohol, tobacco and medicines as well. Some of the respondents also have to support dependents, educate children, marriages of kin etc. Also, they save major part of income for future and invest in the property. “Andhi Kamai Hai, Kabhi Kam to Kabhi Jyada Mil Jata Hai, Grahak Par Nirbhar Hai”, responded one CSW. Most of them wish to continue this trade and also want to keep their children away from this profession to give them a healthy environment. Some of them also want to get married and live with their husbands and keen to find alternative sources of employment to establish them or rear their children. HEALTH CARE SERVICES A higher proportion of respondents (72%) had heard about STI/STD. They called it ‘Garmi Ki Bimari’. Most of them heard about it from their friends or relatives (54%) and from NGO worker (49%). Simultaneously TV, News Paper, Posters, pamphlets, public is also the helpful for them to acquire this knowledge. Most of them (63%) know that STI/STD are other than HIV/AIDS, can be transmitted through sexual contact, with a low 17
  18. 18. of only 16 percent. Regarding the availability and accessibility of STI services analysis of data reveals that only 46% of the respondents opined the service is readily and easily available. More than half migrants opined that treatment services can be availed from RMPs (68%), some of them (22%) get these service by MBBS at government hospitals nearby by SITES or NGOs clinics and also a little percentage (12%) stated that other practitioners like Homeopathy, Siddha, Ayurvedic, Unani and doctors who do not have proper medical qualification are provides such services. Also aware of Service facilities such as government or municipal health clinics, family planning clinics, hospitals, STI or drug abuse treatment centres, primary health care centres, medical colleges, voluntary counselling and testing centres and other health care facilities. Almost more than one fourth of all migrants reported to have experienced Itching, skin rashes, pain on retracting foreskin, Genital discharge, pain/ burning during unionization, ulcers and sores, which are more clear indicators of STIs during the past 6 months. A high proportion of these migrants did not seek treatment. Only seven percent reported having sought treatment from government doctors or dispensaries or else where. Most of them were trying out home remedies. Those who seek treatment from Govt., private or NGOs clinics, regularly counseled for Safe sex, condom usage, and treatment compliance. Of them who did not seeking advice/ treatment mostly was shy/ hesitant and did not think necessary. Some of them did not know where to go, did not trust the service provider, and difficult to get treatment while traveling. Most of them affirmed to utilizing healthier services with regard to STI are provided at SITES including this one. Most of them recommended availability of counseling services for such health care at HPs. When asked whether they have any knowledge about condoms, a huge majority of the respondents, replied in the affirmative. Most of all aware about condoms but it is also come to notice that they are not aware of its perpetuation. Most of them came to know about condoms by NGOs (79%) and TV/Radio (72%). Friends and relatives are also playing a major role in spreading its knowledge by sharing their experiences. It comes in front that rest all sources are secondary. 18
  19. 19. Source of information about condom 79% 72% 62% 10% 14% 10% 10% 10% 7% O r. ily er io s s s er nd D er er G ad m Pe ap N st ck t. ie Fa /R sP ov Po Fr tru TV G ew N Almost more than half migrants agreed to obtain health card containing information about their health status and to receive free/ subsidized health services at various SITES. Some of them were suspected to its effectiveness as they ply on long route. Almost 60 percent of the respondents said that they had certain health problems, the other answered in the negative. Among those who admitted to health problems no body disclosed that they are suffered from HIV epidemic, 40% had Sexually Transmit infection/Diseases, 10% had sexual problems (ulcers) and the rest said they were suffering from general health problems. Some of them had been suffering from Sexually Transmit Diseases for more than three years and the rest from a period of less than one year. The figure indicates that those who fall in ailment not having proper medical care, and attentions. Availability of NGOs at identified sites S. No. Name of NGO Name/s of Field Area covered 1 GVSS Transport General Health & STI - Outreach/ Area Jodhpur BCC, Condom promotion, Children education. Associated with Word Vision India 2 GRAVIS Jodhpur City STI Treatment, Outreach, Condom distribution, Health Camps, Free condom distribution, Counseling, Test of HIV, IEC, SHG, Youth groups 19
  20. 20. Chapter 5 SUGGESTIONS AND RECOMMENDATIONS  Outreach - Staffs should be oriented towards team work to achieve the goal through better coordination. - To covering more high risk group, enthusiasm of the workers should be increased through some intervention and regular training program about the disease.  Peer education - Peer groups need more in-house orientation program.  Community participation - Involvement of Local self governments and local leaders should be prioritising to sustain the project. - Networking needs to be strengthened. • Establishment of basic amenities: it is also necessary to uplift their living standards i.e. water, sanitation, resources for leisure time etc. • Union/ Group/ Forum can be formed – A platform to raise their voices • To provide healthy education a healthy environment is important. Education has a direct link to development. No education means no interest in any intervention and awareness programmes, no think for alternative livelihood options and also no any knowledge of better opportunities. • Schools should be open for children. • A tool of experience learning of old age can be developed • Awareness programme: develop IEC materials that give importance to family values. • Need of income generation programmes for better livelihood. Mostly for the wives of migrants. • Improve ways that they can directly assist others/ community to change attitude and behaviour. • Establishment of Protocols for the incooporation of stakeholder’ opinions and ideas into the strategy development process 20
  21. 21. Counsellor Sumitra with Migrants and landlord of residential building Community members of Rajiv Ghandhi Basti during FGD In-depth interview with president, Banjara Samaj Vikas Samiti 21
  22. 22. Discussion with women group 22

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