The Asia AIDS Commission report released in 2008 mentions that the Asian epidemic will be driven by men who visit sex workers. According to the report, Asia has some 75 million men who visit sex workers. Fifty million women are married to such men and are at risk of getting infected through their husbands. The report recommends Asian countries to redefine their epidemic. What does it mean to India in terms of re-strategising?
According to the latest 2007 round of HIV Sentinel Surveillance, India has an estimated 2.31 million people living with HIV-AIDS. The Indian epidemic is concentrated amongst what are called the high-risk groups: 7.4 per cent among Men who have Sex with Men (MSM), 7.2 per cent among Injecting Drug Users (IDU), and 5.1 per cent among Female Sex Workers (FSW).
The National AIDS Control Organisation (NACO) Programme attempts to cover these three populations - MSM, IDU and FSW. In addition, there is a focus on reaching out to bridge populations, the mobile and migrant workers, and rightly so: HIV prevalence among truckers is 2.5 per cent and among migrants is 3.6 per cent.
However, it is important to take into account that 39 per cent HIV infections in India are among women, and every effort needs to be undertaken to protect them from infection. The vital question therefore is: Are MSM, IDU and FSW the only most-at-risk groups or are there others yet to be identified? We need to undertake more research to gather evidence of risk in other groups so that appropriate interventions can be initiated.
Let me share some evidence from the construction sector. The International Labour Organisation (ILO) conducted a study in Raigadh district, Maharashtra, in 2008. The study revealed that sex work was happening around two-thirds of the construction sites. The workers, a majority of them migrants, were young. Twenty-five per cent reported sex with sex workers and 25 per cent of those did not report consistent use of the condom. Considering the fact that HIV prevalence in FSW sites in Pune, Mumbai and Thane is over 30 per cent in the recent surveillance, it is not difficult to imagine how risky these sexual encounters are for construction workers and, subsequently, their spouses. The workers reported a low knowledge of HIV transmission and prevention, and more than 50 per cent reported discriminatory attitudes towards people living with HIV.
Indian construction companies need to learn from their counterparts in South Africa. As reported by the South African Journal of Economics, direct and indirect costs of HIV and AIDS for construction companies could be in the range of 4.5 and 7.9 per cent of labour costs. Some companies such as Delhi Metro and Omaxe have started the HIV AIDS programme. They shared their experience at the ILO stakeholders meeting on HIV AIDS and the construction sector, in New Delhi, on November, 25, 2008. Delhi Metro has included the HIV AIDS clause in conditions of Contract on Safety, Health and Environment. Omaxe Foundation is taking up programmes in 10 sites to cover around 12,000 workers. Nirman Mazdoor Sanghthana, a trade union in Mumbai, is engaged in organising construction workers, undertaking advocacy with the State labour departments for inclusion of HIV and AIDS in social security/welfare for construction workers. As a result of the union's efforts, 25 construction workers have access to free Anti Retro Viral Treatment from the government and are thus able to work and earn a living.
It is noteworthy that not all construction workers will be covered under the migrant workers component of the national programme. The focus of the national programme is on single migrants who stay away from their families. The vulnerability for women construction workers is not addressed sufficiently.
There is anecdotal evidence of sexual exploitation of women workers by contractors/supervisors and anecdotal evidence of women workers working as part-time sex workers, particularly when they don't have work.
Women constitute around 25 per cent of the 402 million-strong work force in India, with 94 per cent of the work force in the unorganised sector - in agriculture and allied activities, construction, transport, mining, manufacturing, small and medium enterprises and as contract labour. Thus, HIV and AIDS workplace programmes in these sectors, with the involvement of the government, employers, industry and trade unions have much relevance.
The need for intervention exists even in those enterprises that employ educated and skilled workers. According to Knowledge, Attitude, Behaviour and Practices studies undertaken during an ILO Project in seven corporate and seven unorganised sector workers projects (2005-2006), 10.60 per cent of male unorganised sector workers had sex with non-regular partners within the past 12 months; and 43 to 70 per cent did not use a condom. On the other hand, 5.6 per cent of formal sector employees in large corporates reported sex with multiple partners and 43 per cent did not use a condom. Intervention for formal sector workers does not cost much but the cost of inaction or delayed action on the part of enterprises can be much higher.
Finally, despite the fact that sex work goes unnoticed and occurs well beyond the known brothels, there is growing evidence of the risk of HIV and vulnerability in different sectors of work. There is also an emerging profile of clients of sex workers. Workplace interventions are one way of providing a way to reach out to the clients of sex workers.
HIV undermines not just social well-being, but the economy as well. Ignoring the potential threat of HIV and AIDS, therefore, is something that India cannot afford to do.
(The writer is Technical Specialist (HIV-AIDS), South Asia and National Programme Coordinator, ILO Subregional Office. The views expressed by the author are his own.)
(Courtesy: Women's Feature Service)
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