HIVandMobility IOM

HIV and MobilityFrom Vulnerability to Resilience:: 

HIV and Mobility From Vulnerability to Resilience: An ongoing journey

Where We Work: 

Where We Work IOM started work in 20 villages: Thanbyuzyat Township Mudon Township Padan Ngan Tharyargone Kwan Thet Kyauktalone Kyonekadet Kawparan Setse Kawkhalwel Wakharu Kyeik Ywei Kyarkan Pyaingkamar Phaung Sein Set Thwei Aung Zeya Hne Pa Daw Aung Kutho Yaung Daung Weigali Kwang Hlar

Where We Work: 

Where We Work As of 2007, the project expanded to a further 75 villages in 6 townships of the Mon state Worked closely with NAP, State Health Director and Township Medical Officers/Basic Health Staff on site selection

Who We Work With: 

Established voluntary Village Mobility Working Groups (VMWGs); no per diems, no incentives 451 people in 20 villages (274 males, 177 females) including: Village leaders Representatives of local NGOs / MMCWA, MMA, others Teachers & basic health staff Lay workers from the monastery Restaurant owners Young men and women Internal migrants and external migrant returnees HIV infected and affected family members Who We Work With

Who We Work With: 

Who We Work With VMWGs, volunteers and IOM staff run community discussion sessions with different groups, eg: Young men & young women considered liable to migrate Internal migrants, returnees Migration affected family members Married men, married women People living with HIV and HIV affected family members Basic Health Staff Entrepreneurs; rubber plantation farm owners, hotel & guest house owners, managers Village elders Religious leaders, lay workers School teachers and students Members of local NGOs/ MMCWA, MWAF and other CBOs

Brief Intervention History: 

Brief Intervention History Started work in first 20 villages in July 2006 (one year, UNDP-funded pilot) May 2007, expanded both geographically (2 to 6 townships; 20 to 75 villages) and thematically under the 3 Diseases Fund Now also incorporate development of community responses to TB and malaria as well as to HIV and Aids

Community Profile: 

Community Profile

Community Profile: 

Community Profile

External Migration Patterns: 

External Migration Patterns Majority of migrants (all ages, both m/f) go to Thailand Reported destinations: Bangkok Phuket Mahachai Kyunphon (near Ranong) Ranong Kantchanaburi Maesot Also some reports of migration to: Malaysia, Singapore, Korea, Cambodia/Thai border

External Migration Patterns: 

External Migration Patterns Types of work reported (by broad groupings) Younger, unmarried men Younger, unmarried women Fishing Housekeeping Fish processing / other factories Fish processing / other factories Constructions sites Constructions Sites Restaurants and bar work Restaurants and bar work Manual labour Salesgirls Married, unaccompanied men* Couples (sometimes with children) Fishing Brick factories Fish processing / other factories Rubber plantation work Manual labour Pineapple & cotton farming Construction sites Constructions Sites * The project has received few reports of married, unaccompanied women migrating

External Migration Patterns: 

External Migration Patterns Duration of migration / contact with home Fishermen reportedly migrate for more than one year, but frequent visits home Couple migration often appears to be longer term migration (although the woman may return first if additional children are born) Migrants involved in all types of work return home for major festivals Telephone contact often maintained between migrant and family Limited contact from couples working in more remote situations (e.g. brick factories / farming) Limited contact from fishermen working on longer haul boats

Risk Profiles: 

Risk Profiles Fishermen & manual labourers (males; married & unmarried) Injecting drug use Group tattooing Bonding ritual of penis enhancement using shared instruments (e.g. injections, beads under the foreskin) Blood bonding brotherhood Sex work clients (although villagers report high awareness of the need for the use of condoms in commercial sex, and high levels of practice of condom use) Lack of access to / use of sexual health services

Risk Profiles: 

Risk Profiles Fish processing factories (all ages; male and female) Consecutive or concurrent non-commercial sexual relationships (in which condoms are not used, for reasons of ‘trust’) Lack of access to / use of sexual health services Restaurants and bar work (younger male and female) Consecutive or concurrent non-commercial sexual relationships (in which condoms are not used, for reasons of ‘trust’) Sex work clients (male; reported high awareness of need for / use of condoms) Rumours of sex work providers (female; unconfirmed) Lack of access to / use of sexual health services

Risk Profiles: 

Risk Profiles Housekeepers (women; all ages) Stories of women migrating expecting to become housekeepers but being sold into sex work (human trafficking) Exploitations and abuses Stories of rape Lack of access to / use of sexual health services, RH services Migrating couples seen as facing limited risk or decreasing vulnerabilities

Barriers to Prevention: 

Barriers to Prevention Shame – reluctance to talk about risk & protection (esp. for women) Issues of trust in non-commercial relationships Linked to stigma associated with condoms Perception of link between migration and ‘bad behaviour’ means those about to migrate were initially reluctant to: Accept condoms Discuss sexual health Ask for information on sexual health services in destination site

Barriers to Prevention: 

Barriers to Prevention Limited access to prevention services (esp. condoms) while a migrant Reluctance to access health services on return STI care VCCT OI treatment HBC RH care Known experiences of migration-affected people living with HIV and people with HIV related illnesses Difficulty for migrant's wife to negotiate VCCT and/or condom use with husband upon return

Experiences of HIV & AIDS(early stage of the project): 

Experiences of HIV & AIDS (early stage of the project) AIDS is known as ‘Thailand disease’, while STI is known as “city disease” Assumptions are made that if a returnee falls ill, he or she has HIV Returnees are considered ‘risky’; especially female returnees Some village leaders suggested introduction of compulsory HIV testing for all returnees High levels of fear and discrimination (arising from fear) Stigma arises from conflation of HIV with ‘immorality’ which is a way to think “only immoral people (ie. others) can be infected”

Resilience: 

Resilience Villagers hold a wealth of experience and knowledge related to migration (and HIV risk) which can be used to inform community conversations Strong communal desire to help each other already exists at village level (both in terms of promoting prevention and in terms of providing care and support) Community willingness to speak out, if supported Identifying and challenging real-life barriers to prevention Identifying and challenging stigma and discrimination

Resilience: 

Resilience Villages with highest levels of migration demonstrate highest levels of underlying empathy and understanding for migrants Migrants who have taken part in prevention activities at home will take their skills and knowledge with them to share with others

Slide21: 

Thank You for your attention