Reaching Across Borders with HIV Services for Migrant Workers

JANUARY  2009 — Family Health International is pioneering an approach to ensuring continuous access to antiretroviral therapy (ART) for Nepalis who cross international borders to work in India. The initiative is called Reaching Across Borders.

Nepalis in the country's mid- and far-western regions have traditionally migrated to India for work. Largely unskilled and lacking other employment options, they seek work in the transportation industry, hotels and food businesses, and factories. Labor migration was even more pronounced during the recently ended armed conflict in Nepal that severely restricted economic opportunities.
 
"Labor migrants…are at increased risk for HIV and other sexually transmitted infections," says Bhushan Shrestha, FHI team leader for Nepal's western regions. "Many migrants from this area go to Mumbai, where there is a concentration of sex workers and high HIV prevalence."

FHI country offices in Nepal and India coordinate across international borders to provide prevention and treatment services to the labor migrants, both in their home districts and in specific locations in Mumbai and Delhi. Programs focus on prevention of HIV and provision of integrated health services, including diagnosis and treatment of sexually transmitted infections, HIV counseling and testing, and treatment for HIV-positive migrants. Patient information on ART regimens is shared between service providers in both countries, allowing workers continuous access to treatment. Adherence rates are high, and very few people are "lost to follow-up" (lost track of) since the program began in 2006.
 
To date, more than 7,200 people have been tested through Reaching Across Border's voluntary counseling and testing services. Nearly 600 HIV-positive people have been screened to determine eligibility for ART, and more than 750 have begun treatment. In addition, more than 700 families have received home-based care.

Reaching Migrants through Satellite Radio 
Complementing Reaching Across Borders' care, support, and treatment initiatives is Desh Pradesh, a weekly satellite radio program targeting migrant workers and their families on both sides of the border. The first half of the 30-minute program is a drama offering HIV prevention messages. The second half comprises short interviews with experts in ART, prevention of mother-to-child transmission of HIV, and other areas. It also provides room for listeners themselves to broadcast messages to each other and their families and to stay connected across the border. "People can identify with the characters on the radio program, so the show is very popular," says Pranab Rajbhandari, a communications specialist with FHI/Nepal.
 
FHI partner organization Equal Access prepares the episodes with technical review from a content advisory group that includes communications experts, beneficiary group members, donors, and other stakeholders. Reaching Across Borders supports radio listener groups for the program in the far-west districts of Nepal. "Through Reaching Across Borders and Desh Pradesh, FHI is bringing critical support to those who need it," says Bhushan Shrestha.

Desh Pradesh is supported by USAID through FHI/Nepal's ASHA Project. Reaching Across Borders is supported by the Department for International Development's Asia Regional Directorate.

PHOTOS:  (Top) FHI supports integrated health services in Seti Zonal Hospital in far-western Nepal. (Bottom) Community members in Surkhet, midwest Nepal, gather to listen to Desh Pradesh, a radio program that provides HIV prevention and health education messages. (Photos by Prakash Raj Pandeya and Tilak Prasad Sharma, respectively.)