INTRODUCTION

HIV /AIDS is undoubtedly the most formidable public health problem confronting India today. It has been estimated that around 75% of the transmission of HIV/AIDS occurs via the sexual route and over 90% of all infected cases belong to the sexually and economically active age group of between 15 and 49 years. The infection has begun to pass from individuals involved in high – risk behavioural activities to the general population, making the shift from urban to rural areas and so infecting more and more women.

HIV/AIDS poses a major challenge to all sectors of society. The Indian Government and NGOs are acting now to check the spread among vulnerable groups such as sex workers, truck drivers, women, and auto-drivers. However, there has been little or no concentration on the industrial workforce.

This workforce represents an enormous number of people who are potentially at risk of contracting HIV/AIDS. The practicalities involved in reaching this target group are made easier because of their already existing work groups. Despite the opportunity to reach large numbers as well as the easy accessibility, the industrial workforce has largely been ignored in HIV/AIDS prevention and education programmes. This paper describes the efforts by PREPARE to reach the industrial workforce in an appropriate manner, and in informing and educating its community about AIDS.

INDUSTRY and AIDS PREVENTION

Much of the fear and panic about HIV/AIDS is the result of misinformation. People believe that AIDS spreads through touch and blood donation. They believe that people with AIDS should be isolated and that women are the cause of the spread of AIDS. They believe also that STDs always result in AIDS. The only way to deal rationally with the problem and to prevent the further spread of fear is for employers and employees to be adequately informed about the infection. For employees who are not infected, there is the concern about the safety of working with people who are infected. For those with the infection, there are fears of discrimination and of losing employment, benefits and friendships. Employers are concerned about how to manage the problem in general and the specific HIV/AIDS issues in particular. Management and workers both have equal vested interests in ensuring that the disease has the least possible impact in the workplace.

Attitudes towards AIDS and policies developed in the workplace will have a profound impact on the eventual social and economic outcome of the epidemic. Managers of large and small enterprises, in cities and smaller towns, and in all sectors of industry and commerce, as well as union leaders and organisers will need to have a basic understanding of this disease in order to adopt attitudes and develop policies that are both informed and rational.

The epidemiology of HIV/AIDS in India clearly indicates that about 89% of all reported cases belong to the sexually active and economically productive age group. It is commonly understood that the above group is found mostly in self-employed sectors, business establishments and private sector companies, besides government employment. In addition to this number are the millions of people in this age group spread out in the agricultural and unemployed sectors.

The incidence of HIV/AIDS in the workforce and in the surrounding community directly affects industry. There is a rise in employee absenteeism when a sick member of the family needs to be cared for and an increase in employee turnover due to the disabling effect of associated illnesses, the need for persons to stay at home to look after the ill and deaths. Inevitable are the higher insurance premiums and government health expenditures, the difficulty in replacing skilled personnel and decrease in net earnings as more money goes towards cost of AIDS management.

To counter this problem, industry must work to build employee morale by providing supportive work environment for people who are infected and for their families. For companies that want to project a socially conscious profile, the demonstration of such concern is a particularly urgent task.

ABOUT PREPARE

PREPARE is a non governmental organisation formed in 1983 towards social and economic and political justice, and focusing on democratic development, environmental protection, food security, gender equity and human rights.

Initiating with disaster preparedness, PREPARE has diversified to deal with basic injustice affecting dalits tribals and fisherfolk catering to related intervention groups. PREPARE felt the spread of HIV/AIDS as a socio – economic threat to the poor and thus included HIV/AIDS action to its existing healthcare and development initiatives. Now PREPARE has three main focus areas within a broad HIV / AIDS work, Commercial Sex Workers in Chilkalurpet in A.P., Truckers and highway prostitution stake holders in Gudur – Guntur in A.P. and Slum dwellers and street children in Chennai . Having its office in close vicinity to industries in Ambattur, PREPARE naturally chose concentrates on the industrial workforce, even as we stepped into this area of HIV/AIDS prevention.

Workplace intervention in AMBATHUR INDUSTRIAL ESTATE

The office of PREPARE is located in the heart of the Ambattur Industrial Estate in west Chennai, Tamil Nadu, India and therefore has easy access to this Industrial area. Ambattur Industrial Estate is South East Asia’s second largest industrial unit. There are now between 2000 official and 1,000 unofficial industrial units in the Ambattur/Padi area and about 200, 000 to 300, 000 people. Of these, 40 percent are women, because of the large number of garment industries in the area. The availability of such a large sexually active population coupled with the fact that many of them are migrants living alone away from families and therefore exposed to casual sex and associated high risk situations, prompted us to choose this population. Additional consideration leading to this choice of target group were of a mission amended nature; behavioural change , if brought about, could have considerable impact in terms of lives saved, and economic productivity and this was the.

THE FIRST PHASE

FRAMING THE ISSUE

The project started in September 1996. An initial analysis of the situation showed that employees were at risk for HIV / AIDS for several reasons.

Travel to the work site from distant places, leads to less time with families and the tendency to seek sexual satisfaction near the workplace. There is also the opportunity to have unprotected homosexual encounters even while travelling in the electric train. Those residing in small groups in local areas closer to the work site and away from their homes for long, have a greater tendency to turn to FSWs. There is pressure on the migrant girls to make money through sexual services to meet living costs and to support families back home in small towns and villages. Influence of alcohol and drugs leads people to ignore safer sex , to seek casual relationships and also to involve in commercial sex.

Economic and sexual exploitation of women at the workplace by the male supervisors whom they have to please in order to save themselves from being retrenched during this economic recession, is another contributing factor to a high risk situation.

Migrant girls in the industries come from towns and cities as near as 70-80 km. as well as Villages as for as 1000-15000 Km. away. Some are run away girls white some have come with the consent of the families. They earn for their existence and stay either in groups renting a house or in hostels. As sexuality goes, many try and stay away from relationships till their families get them married. Some strike up acquaintances/friendships with men whom they come in contact with and may or may not marry them.

In the context of the industry, the women have male supervisors who have to certify the produces (made by these girls) them for payment and tend to sexually harass them in return for this favour. The girls are made to sleep with them in a convenient place elsewhere. This harassment is common although not an organised one. We came to know of this, in our counselling sessions and this is one of the reasons why we developed Health Education messages on sexual exploitation and gender concerns. We find that these charts help us to establish an immediate rapport with such girls whereas the conservative housewives consider that these stimulate casual sex among unmarried girls and are therefore irrelevant and unnecessary,

The objectives of the project are thus came to be formulated as follows :

To sensitise the workforce to a basic understanding of STD/HIV/AIDS and issues related to alcohol, drugs, sexuality, power and gender relations.
To enhance STD/HIV/AIDS prevention by promoting the use of condoms and providing information about its proper use in STD/RTI care.
To develop an AIDS policy in the workplace that opposed discrimination in the workplace in line with the guidelines laid out by the ILO/WHO.

IMPLEMENTATION METHOD

The team gathered some preliminary understanding about the local Industrial sector, its priorities, and its pattern of functioning : the management their professional associations, their relationship with employees, their recruitment patterns, and the facilities and benefits offered to employees. The area was mapped and the units classified according to size (i.e. No of employees).

We then went about developing health education material for our use among the employees. Most of the materials available in India were Western oriented, and hence carried assumptions and values totally alien to our culture. In order to develop health education materials which would be relevant to this intervention group, with a sample size of 50 women and 199 men employees. Our main findings of prevalent attitudes were

AIDS is a killer disease and HIV infected should be shunned;
AIDS was curable if detected early;
STDs are a symptom of AIDS;
Women were the prime cause for the spread of AIDS;
AIDS can be spread by social contacts like sharing toilets & food;
A person affected by HIV can be easily recognised by their external appearance.

In general, employees were negative toward HIV/AIDS. There was refusal to work among HIV+ co-workers or claim for rights to a disease-free environment, discriminatory attitude towards HIV+, and fear & stigma regarding STD & AIDS.

The next step was to create awareness among the management about the need for an AIDS prevention programme in the workplace. We met company heads on an individual basis and discussed our mission in order to convince them to give us an opportunity to provide health education to their employees. We stressed the socio-economic impact that AIDS would have on companies if they did not take preventive efforts now- the loss of trained human resource, number of days of lost due to sick leave, the reduction in productivity, the cost of retraining new teams, medical costs, insurance costs, cost of litigation if the management demands resignation of infected persons, the animosity of un- informed /mis-informed colleagues who would demand discrimination against the infected, the loss of morale among the working community when loved ones pass away. and discrimination against working women.

Initially we thought that the data on HIV/AIDS prevalence and epidemiology would be sufficient to persuade companies to adopt a prevention programme but, we were wrong. The management did not believe that HIV/AIDS had reached the of their factory gates. They believed that the employees know enough about HIV/ AIDS as there was plenty of publicity in the television, papers news and radio. Even if their work force was infected the number will be small enough for them to manage, They could prevent AIDS through pre – employment screening of their employees.

The employers were reluctant to give us time for our educational programme during working hours, since this would slow down production. However, most company heads agreed to allow us atleast about half-an-hour during the lunch break and after factory working hours to meet the employees.

TRAINING CONTENT

Apart from a half hour to hour long talk about STDs and HIV/ AIDS setting out the basic facts, the course designed by PREPARE is divided into eight modules , of one hour each catering to 30 to 40 participants at a time. The modules offer comprehensive information about STDs, HIV & AIDS in relation to developmental, social economical, cultural and gender aspects.

The curriculum covers basic facts on HIV/AIDS; STDs in relation to HIV; safer sex methods; understanding AIDS as a community / individual responsibility; developing positive attitudes & responsible behaviour towards those infected; counselling & testing aspects & ethics; legal aspects of HIV in the Indian context and gender & promotion of basic human rights.

We pilot tested the tools and methodology of awareness creation and modified our approach according to the culture of the local population. The educational tools & aids used were :

slide & OHP projector to understand basics of HIV;
video show to promote understanding beyond basics;
flash cards and flip charts to promote knowledge on STD/HIV/AIDS, gender inequalities and RTI cases;
condom demonstrations using a phallus/banana/candle to promote regular and proper use;
case studies, and sharing by HIV+ volunteers to remove unfounded fears ;
to focus on community / individual responsibility, and encourage non-judgmental attitudes;
games & exercises to personalise the issue of AIDS.

Among the above health education tools, the most successful were the slides and video followed by open discussions. Case studies helped in emotional involvement. Success was less forth coming in gender mixed groups or in groups where individuals of vastly differing age groups participated or in groups of individual of mixed marital status. Sexuality could not be openly discussed in the first two kinds of groups, which in the last, openness was less and with the married individuals, trying to be more closed and judgmental than the unmarried.

Further sessions held at the end of the day were more relaxed and open than those held in-between working hours. Younger team members and younger health workers were able to have a more frank discussion on sexuality than the others, as they were able to identify with each other.

It is interesting to look at the concerns, questions, myths and fears voiced by different groups. With the 16-20 age group, the questions are diffidently asked – they are worried about vaginal infections, menstrual problems, pregnancy, sexuality, gender concerns, escaping from high risk situations and symptoms and signs of HIV and about cure. With the married women, the questions are on STD, risk of multipartner sex, condom usage, HIV/AIDS symptoms, communicability, complications, breast-feeding by HIV positive women and cure. They were in general not open about their own sexuality. While we found that Health Education materials could not be formulated to cater to each such group, we learnt how to use the same material differently with each different group and how to steer the discussions as per their need. Case studies were a tremendous help – taking up for discussions ways and means of preventing high risk situations commonly encountered, evoked a more frank exchange.

About 5 to 10 minutes spent on breaking the ice was definitely helpful in eliciting participation. The presence of management representatives was an inhibiting factor to free interaction dissuaded.

The videos we use only help to initiate the awareness process. It would be a good idea to enact high risk situation or present them through videos to bring out the hidden concerns to the open, atleast in small groups. We found from our experience that even among close friends, sexuality was not discussed at all. Our interventions act as a catalyst to further the desired openness, which would help them to prevent gender exploitation and STDs.

The participants were followed up with discussions on a one-to-one basis or one-to- group basis as well as with informal counselling sessions, either in the company premises if permitted, at the gates or near the bus stops.

CHALLENGES AND CONSTRAINTS

Apathy of the management and their lack of commitment to the cause was the main challenge faced by us. Frustrated, and to overcome this we took the message to the trade unions, focusing on the rights of the employee and how these rights would be violated when HIV / AIDS enters the industry sector in a significant way. We focused on the rights to information, to choose whether to be screened or not for STDs and HIV, to confidentiality. We stressed the need to look at HIV/ AIDS as any other chronic disease, the issue of medical treatment costs to be met by industry, insurance, availability of universal protection methods in the accident prevention or treatment centres, availability of condoms, the issue of discrimination and retrenchment of those infected, etc. This created a stir among trade union members and there also arose the demand for health education and counselling for behaviour change. The Personnel management then called us for a discussion and gave us time to mount a brief intervention with a view to test us out. In fact, they were hesitant to allow discussion of anything related to sex within their professional premises. They also fought shy of the easy familiarity that might emerge if such discussions took place in their presence and resented our growing closeness to the trade unions arising out of our discussions on workers ‘ rights as spelt out by the ILO. But once the health education sessions commenced, and they were able to see the ease with which the whole aspect of sexuality was handled, they started to be more helpful in giving us time and space for our intervention.

Problems and constraints in dealing with the workers on HIV prevention.

Most of the workers do not live near the industrial estate and are anxious to get back to their home/hostels early. Some of them have to travel 1-11/2 hours daily by train to do so. It is not easy to get them to stay for discussions or counselling after factory hours. We are able to meet only about 2-5 persons a day for such discussions.

This makes it difficult for us to assess the impact of our Health education on their sexual behaviour. This is especially so in the case of women. When conducting awareness sessions in the factory premises, within the constraints of time and space, we are not able to segregate the younger from the older workers. The younger respond easily if they find that we are non-judgmental, familiar with their jargons, and able to laugh with them and wink at their jokes . The older are more judgmental, even among men, and it sometimes is not a comfortable situation. The questions also differ. The older ones do not want to look at the pictures of STD with ease when the younger ones are around and vice versa.

An open discussion an sexuality becomes difficult in such circumstances we try to overcome this by meeting the younger ones at the gates after work, and speak to them giving them an opportunity to open up.

While STD is a reality, often experienced by atleast some of them, AIDS is still an unfamiliar phenomenon. They have not yet seen deaths due to AIDS. Connecting the threat to sex becomes a problems to many of them. Our culture is blessed with many kinds of traditional healthcare systems. No one , not even the so-called learned is able to negate or swear by the effectiveness of these . Therefore it is difficult for us to convince the workers that there is no cure for AIDS. This is especially so, because of the publication every now and then, of the various trials being carried out by the alternate health care systems, added to the unethical claims of may quacks in the news magazines commonly read by the workers. Western medical information is not always accepted as truth and statistics do not always help to prove that most HIV positive persons suffer and die eventually. We have to patiently deal with this.

Although the rationale of condom usage is accepted we are unable to ensure whether there is universal usage at all high risk sexual encounters. women feel that they are still not in control of the situation as men are often more powerful in their relationship and that they do not have the bargaining power especially within marriage. Discussions on gender are not easy for want of time.

Despite this, our experiences in the pilot project were frustrating, because although in quantitative terms we seemed to have done a lot in qualitative terms, there was hardly any indication of behaviour change, nor of internalisation of the issue by the industry. We realised that for the programme to be successful, it had to become flexible and innovative, and adapt to the companies’ schedules. Therefore, we changed our approach in Phase Two.

PHASE 2

CHANGING THE APPROACH

The advisory committee consisting of NGOs. Lawyers, trade unions, management, health personnel, and Communication and counselling specialists with whom our performance is discussed in a detailed manner. This has greatly helped us to steer the program in a fresh direction.

What we sought to do in this phase was to make our interventions more acceptable and sought after by both the management and the employees. Thus the focus was on two areas – to work closely with the management, meeting their priorities, and persuading them to adopt a worker friendly approach with regard to HIV/AIDS, while trying not to infringe on their time. The other was to keep most of our follow-up interaction with the employees outside the portals of the company, and try to build-in peer influence in the direction of safer sex.

With the Management our strategies were as follows, we first classified the companies into three groups:

(i) those that were not favourable to HIV/AIDS intervention in company premises; (ii) those which gave us space to interact with employees within a restrained time frame and (iii) those which valued our intervention and facilitated it willingly.

With the first group our strategy was to use the Associations of Management which is where policy decisions are made for members and which lobbies with the external environment on issues concerning member industries. We held discussions with the Executive Committee members both individually and in group, and explained to them the reason why many leading industries both in the industrialised and developing countries have formulated policies favourable to HIV/AIDS prevention in the workplace.

These associations then allowed us entry into their Council meetings, which gave us a good opportunity to convince them further. The Association also gave us space in their news magazine, to feature information pertaining to HIV/AIDS prevention on a regular basis. Debates, seminars and workshops were held for the management to motivate and sensitise them on the need for and the benefits of including HIV/AIDS related intervention in their policies and administration.

Some of the industries requested us to organise health camps for their employees, as display of staff welfare concerns towards gaining their goodwill. We saw this as an opportunity of working for our own gain. Thus we organised health camps which included screening for diabetes, hypertension, tuberculosis, as well as obstetric and gynaecologic care to the women. But we always included in these camps, an attractive stall on STDs/HIV/AIDS with different kinds of audio-visual aids. Condom demonstration was an important part of these camps. Counsellors were available at the stalls for consultations.

We were able to reach many workers on HIV/ AIDS, and young girls with STDs and RTIs found these camps particularly useful as they could access sensitive and professional care, as well as counselling with regard to safer sex, early and complete treatment of STDs and partner treatment. The management was pleased, and we were able to achieve our objective.

With those management that were more cordial, we continued to provide our inputs, tailoring them to the time they allotted to us.

We also held sensitisation workshops for the management through their associations. Here we discussed the progressive steps – employee friendly HIV/AIDS policies at the workplace made by the industrial sector of developed countries such as Canada as well as that of Zimbabwe and Uganda, and the recognition by Confederation of Indian Industry of the need for HIV/ AIDS education in the workplace, all of which had been widely covered by the media. We shared with them the ILO convention related to this issue. Case histories relating to employees, housewives, and children, especially, evoked interest. Slowly the understanding grew that HIV/ AIDS could be a threat to the prosperity of their businesses and also something that could disrupt their own lives and those of their loved ones. A remarkable change in attitudes came about after these workshops, especially among the large industries. Seeing this trend, the smaller industries also started opening their doors to us, atleast for the sake of recognition equal to their larger colleagues.

Another strategy we used is to go through the Employees State Insurance Hospitals [ESI Hospitals] which are the official caretakers of the health of the employees and which is closely connected to their reimbursements, medical certification, retirement schemes, and Insurance and accident schemes. The medical officers were sensitised and we had good acceptance among them. We also held counselling sessions in these hospitals. Exhibitions here became quite popular. This also furthered our acceptance by the industries.

Our close association with these Associations and entry into their council meetings has brought about a significant reduction in the tendency of the management to retrench workers infected with HIV and to do compulsory pre-employment HIV test of employees. Some of the companies carry out mandatory VDRL/HIV testing of provisionally selected employees with or without the knowledge of the persons concerned as part of the selection process, training or promotion. There is a long-standing feeling among the employer’s that they have a right to conduct mandatory medical examination in order to protect themselves from low productivity and medical expenses that may ensue if unhealthy employees are selected. Any employee challenging such examination or blood test would be refused employment on some other pretext. A deliberate refusal to submit to this medical requirement would be construed as in insubordination, and therefore liable to disciplinary action. The mandatory HIV antibody testing as a method of screening out individuals is not only inefficient and ineffective but also violate the basic individual right to privacy and dignity. We continued to lobby with the management on this issue and after about three years have been able to bring about a change in the attitude of the management with regard to this.

WORKER STRATEGIES

Despite these successes, we were convinced that we could not rely totally on the management to take ownership of this intervention as they were under other pressures for effecting tangible increases in productivity. Since HIV/AIDS prevention is PREPARE’s mission, it is we who have to find the means to reach the employees and work with them towards safer sex and behavioural change. Therefore we started to explore means to strengthen our access to the employees.

We made ourselves available to the employees outside the gates of the industries, in order to be able to reinforce our STD/ AIDS prevention messages, to be able to spend quality time and be available for counselling towards behaviour change. We put up small tents and exhibitions by the roadside which employees had to transit through to go to the bus terminus. We held video shows, street plays, role plays, or simply played music to attract the crowd. We even hired a magician, trained to impart AIDS prevention messages.

Information through a periodical newsletters proved helpful. PREPARE circulated a bi-monthly newsletter called SAVAAL (challenge) in Tamil and English, giving brief and clear messages. Within the company premises, in order to reinforce our other efforts we put up AIDS prevention messages.

During festivals celebrated by the company and in the colonies where the employees’ families stay we organised street plays and cultural shows.

The garment industries have a large number of young women working in them. Here we held regular counselling. Counselling on sexual health hygiene and HIV/AIDS was also effected through the phone .

Periodical health camps focussing on STD/RTI care were organised at company premises. With the help of local medical institutions, NGOs, Government hospitals and ESI hospitals, these camps were held especially for garment industry workers.

Condom promotion was geared up, popularising it through promotion of conventional and non-conventional outlets within and outside company settings. Initially the company heads were reluctant to agree. They feared misuse and protests from workers that would create labour problems. Periodical persuasion and a sustained approach enabled us to convince them to agree to this. A pilot test was done by placing condoms at company toilets and departments.

PEER EDUCATION

The value of peer educators is recognised the world-over. However in the industry setting,the employees were available to us neither during working hours , nor after work.

We resorted to using the worker education group for this purpose. Every established company has an institution called the ‘worker Education Group (WEG) the members of which are hand-picked by the management, based on their seniority experience and work performance. The role of these WEGs is to train other workers of their respective departments in the latest developments. We are able to successfully persuade the management to let us train them as peer educators in a limited way for HIV/AIDS prevention.

OUTREACH TO OTHER STAKE HOLDERS

PREPARE recognised the need to include actors in the local communities with a strong potential to influence off-workplace behaviour – autorickshaw drivers, barbers, tea shop operators, laboratory technicians, wine shop owners, petrol station owners and local unemployed youth.

There is a well knit network of barbers in this area and this was made use of by us. The barbers were first sensitised to their possible role as health educators, and to facilitate this role their saloons were transformed into dispensing outlets for calendars, pamphlets and, signboards with AIDS messages, and condoms

Involuntary HIV testing has become an instrument to identify and discriminate against persons who are found to be HIV positive. Besides hospitals, local general practitioners and companies casually carry out HIV testing. The results are used either to deny employment after interviews or to terminate an employee found to be HIV positive. In this connection 52 local laboratory technicians were identified, satisfied and trained in the clinical and ethical aspects of HIV/AIDS, and encouraged to refer their clients to us for counselling.

We surveyed the local petrol station employees and sensitised them to the issues relating to HIV/AIDS. We were able to negotiate with them the placement of a few condom dispensers in these stations. The condoms are replaced fortnightly and the distribution audited.

As found in the adjacent states where PREPARE is working, there is a national-wide effort by oil companies to put up large scale departmental stores and retiring rooms adjoining the petrol stations, to cater to the various needs of the consumers. This could be easily exploited to our end, by including prevention education and condoms for distribution and sale.

The drivers of autorickshaws a popular three wheeler mode of transport were an important audience for our efforts. Besides being exposed to high-risk situations themselves, they contribute a major link between sex workers and their clients , who often consist of industry employees.

These drivers were identified and trained as peer educators, and encourage to display HIV/AIDS prevention messages on the rear portion of the autos, and below the meter. The drivers also refer customers to us for counselling and treatment.

INTERIM NARRATIVE REPORT

FOR PERIOD BETWEEN

1st April ‘99 to 31st March 2000.

1. Health Education

During this time the focus for sensitisation on STD/HIV/AIDS was on Smaller & tiny sector units. This was because there was good reception from there units. We also learnt informally that workers’ rights were not given importance to by this sector.

We moved from the South phase of Ambattur Industrial Estate where we had concentrated so far, to the North Phase. We covered the following units spending atleast between 15-30 days to complete one unit.

Best & Crompton	Devi Heat Treaters
Samsun Rubber	Enjoys Engineering Works
Cookson India	Nadeem Leatherware Exports
Ashok Leyland	Kishore Engineering
Madras Conveyors Pvt. Ltd.	E.S.Haji & Co
Vijay Industries	Elfab
Tal Bros Industries	Electrical Construction & Maint. Co.
Basker Fabricators	Mathura Auto Co.(P) Ltd.
Bright India Ltd.	Vidya Enterprises
BOC	Venkateswara Chemical & Plastics
Arasan Timbers Ltd.	(P) Ltd.
Suster Tools Pvt. Ltd.	Sterling Industries
Coromandel Garments Ltd.	Sri Matha Fabricators
Unimax International	Spinax Chemical Industries (P) Ltd.
Neo Textile Industries (P) Ltd.	South India Marketing Agency
Apollo Leathers	Gorval Galvanising Works
Kaleen Corporation	Precision Controls
Univaac Convertors	Siva Plastics
Renusood	Quik Lite Industries
Ambattur Clothing Factory	Quality Engineering Works
Standard Switchgears	Solker Industries
Sri Balaji Steel Industries

No. Of Industries Contacted 112

No. Of Industries Covered 42

No. Of Sensitisation discussions held 210

(Average of 5 education sessions in batches for an Industry)

No. Of Workers Covered 2520 (Men – 1624 ; Women – 896)

At the garment industries a regular clinic was conducted with Dr.Sathyavathi Mohan, M.D., D.G.O. as the Lady Medical Officer. The Companies benefitted are Dignity, Innovations, Fabulous International, BNT Connections and G.V.Exports. During the clinic and health camps we had the opportunity to discuss in open with the workers (Male and Female) about sexuality, Myths & Misconceptions, reinforce messages on AIDS & Counsel them.

OUTREACH TO FAMILIES OF INDUSTRIAL WORKERS

The employers were motivated to hold health camps to their workers and families with a focus on STD/RTI treatment, HIV/AIDS education and counselling on sexual health.

We approached the industries whom we have a good rapport with for the above.

The following camps were held accordingly :

S. No	Name of Industry	Date	Resource Team	Specialisation	Group	Nos.	STD/RTI Treated
1.	TI-Diamond Chains	16.3.99	Abimaan (NGO)	STD & …	Women Worker	186	–
2.	Tube Products of India	15.7.99	Purush Male only Clinic	STD Camp	Men	23	–
3.	Hindustan Photo Films MFG Ltd.	23.8.99	Govt. G.H.	Dermatology & STDs	Worker Men	46	–
4.	Labour Tenement Unit-Ambattur Estate	30.10.99	Govt. G.H.	RTI & General	Worker Families (Mixed group)	112	4
5.	TI Millers Ltd. Kakkalur Unit	17.11.99	KKR ENT Hospital	ENT	Worker Men	86	–
6.	TI Cycles	3.6.99	ESI Hospital	STD	Canteen Boys	67	44
7.	TI Diamonds Putlur Village (Thiruvallur)	15.11.99	Eye Camp	Dr.Balakrishna Hospital	Worker Families	102	–
8.	TI Diamond Chains India Ltd.	10.3.2000	Govt. GH.	Derma	Worker Men	186	5
9.	TI Cycles of India	19.3.2000	Govt G.H.	RTI	Worker Wives	50	3
10	TI Millers, (Madanakuppam) Village	21.3.2000	General Hospital	STD, General Health	family	126	–

During the camps we had attractive stalls for Condom Promotion and separate rooms for confidential discussions on sexual health. Persons with history of unprotected sex were screened for STD at request. We do not encourage HIV testing, though requested by the Management.

We had the opportunity to meet the worker’s wives and families in the nearby towns and living in high risk situations. Proper use of condoms was focussed and Condom promotion took up well.

The Programme Staff visited the villages for follow-up of the Camp and counselled those who were VDRL+ve for treatement. Those who were infected were treated through the ESI or Govt. G.H. under the personal support of programme staff.

Meeting Workers after working hours

We held health education sessions through Street Theatres at 18 industrial colonies identified as strategic places where workers hung around after working hours for shopping, boarding the bus, or while refreshing themselves with a sip of tea. The street theatre sessions helped to relax these people and were received well. We saw many women gathering to watch the street plays standing on the road for more than half-an-hour to listen to message on STDs, Condom use and the need for compassion towards those infected and affected. We took this opportunity to address the additional messages of HIV/AIDS, reinforcement to those already covered and making them comfortable with the issue of STD/HIV/AIDS.

The cultural programmes were conducted by the teams of NESAKARAM & Jeevajothi.

After working hours we met the workers individually on their way back at convenient points and discussed further on these areas.

LIASONING WITH ESI HOSPITALS

We continued to liaise with ESI Hospitals as they are officially responsible for the treatment of all the industrial workers. We had built a good coordination and amicable relationship with all the divisions of ESI hospitals – the State Administrative Office at Teynampet, ESI hospital at Ayanavaram – K.K.Nagar in Chennai and ESI dispensaries under the jurisdiction of Ambattur and Padi.

On 29th April’99 we had an exhibition at STD Dept., ESI Hospital, Ayanavaram during the out patient (O.P.) hours. The exhibition gained good response and we replicate this at other ESI dispensaries in Ambattur and Padi.

We discussed with the concerned authorities about Managing workers with HIV/AIDS and tried to understand their existing policies on this. We are convinced that the ESI policies would be ‘AIDS friendly’ when it comes to caring for those infected and affected. There are provisions to provide for funeral expenses, care and support to the terminally ill and supportive ethics in terms of recommending insurance, leave and other benefits to the affected employee. We would like to discuss this with other NGOs working on this area and build on this initiative.

Imprinting aids prevention message in the minds of workforce:

The past years of our experience has made us to understand that workers are liable not to give importance to what they have learned. They are preoccupied with reaching too many targets set forth by the Management. This calls for the need to work out a plan to remind them each time about the presence of STD/AIDS and the need for protection.

We modified our BI-monthly SAVAAL to simple monthly illustrations / messages targeting the message of STD/AIDS. These illustrations were displayed on the company notice boards and departments for attention of the workers. This initiative enabled us to further reinforce messages, facilitate referrals and enhance the use of telephone counselling services.

Addressing the enabling environment

We organised periodical exhibitions and mass events with attractive stalls and games at roadside places covering Ambathur & Padi, to draw the attention of shop owners, vendors etc. to sensitise them on STD/HIV/AIDS, as they form the enabling environment with whom the workforce have regular contacts and relationship.

TRAINING OF GRASSROOTS CBOs

We had continued to build the skills and capacities of CBOs by information sharing, IEC distribution and training.

We have continued to work with a network of NGOs working on prevention of HIV/AIDS among, sexworkers and their clients . The 7 NGOs are – WORD, ATSWA, MEDAL, WLLEDS, MERCY TRUST & CSED.

They had been trained on the following areas

Programme implementation of AIDS related projects – Needs assessment, building on objectives and activities, program planning and review.
Guidance on setting quantitative and qualitative parameters / targets for monitoring and evaluating HIV/AIDS work.
Condom programming.
Inbuilding AIDS prevention in developmental initiatives.

Working with auto drivers

We continued health education on regular basis and had strategic discussions with auto leaders for STD prevention, condom promotion and sexual health counselling.

Through the cooperation of auto leaders, we organised STD camps at the following auto stands;

1. Muthamilzh Auto Stand, Mogappair

2. Wavin Auto Stand

3. Golden flats Auto Stand

At every level of our planning and distribution we discussed with other NGOs experienced in similar areas and incorporated their suggestions and insights.

TNVHA
Rural development Society
Indian Network of people living with AIDS
South India AIDS Action programme
Initiatives for women in Development.
Purush Mala only clinic, T.Nagar
KKR ENT Hospital, Poonamallee High Road
Madras Medical Mission Hospital, Collector Nagar
ABIMANNA, SRP colony
Field Publicity Board, Sastri Bavan
Rotary Hospital, A.I Estate

CONCLUSION

At the end of three years of working, we in PREPARE believe that we have gained substantial ground and have a good rapport with many industrial units in this area. This has resulted in a few companies contributing towards the programme cost where we have moved from a ‘care giver’ to ‘consultant’ role. This is an indicator that the programme has gained importance. The employees turn to us for counselling and themselves introduce us to other companies which need to be sensitised. Women workers in particular are in regular contact with us . There seems to be a higher condom usage.

Our pilot programme of trying to install Condoms at industrial sites (toilets & departments) did not work out well because of industries feared it would encourage promiscuity this was especially with garment factories, where women and men work together. So, we tried making it available to Worker Education Groups, Personnel Officers & Occupational health staff. A limited quantity of condoms was distributed to the social and occupational health departments of the big industries and the workforce informed about it. Workers were able to get the condoms from the above sources. Stigma related to condoms was slowly came down by sustained sensitisation . The approach succeeded to a considerable extent wherever there was no ‘bureaucratic’ gap existing between the workers and personnel officers and occupational health staff. The personal officers were accessible to the workers as the latter periodically meet them reg. their labour welfare.

The condom off-take was closely monitored by Programme staff who made periodical visits received feedback from WEG, personnel officer is occupational health staff. Condoms were replaced when the stock dwindled to a hundred.

There were practical difficulties of sustaining this process as the period of functioning of the Worker Education Groups was brief. They were changed almost every year. The Program staff each time had to sensitize the new WEGs and this hindered our progress.

We also chose to work with ESI authorities. Initially condom promotion through their many ESI dispensaries, where workers and their partners seeking STD or RTI treatment could be given condoms. Once these persons are familiar with condom usage, they tend to use it as preventive method whenever a high risk situation is encountered.

Though companies are now open to talk about HIV/ AIDS and workers sensitised to the issue, there is still lethargy among others who deny the reality of AIDS. When our approaches do not work we feel that there should be some mandatory directives from the Government, to bring these companies to comply with worker education and a supportive environment with regard to HIV/AIDS.

The industrial sector will continue to expand and play a major role at all levels in countries like ours, and we need to find ways for a sustained intervention with regard to this important issue of HIV / AIDS.

INDUSTRY and AIDS PREVENTION

WORKER STRATEGIES

Working with auto drivers

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