IPP645 v3 ROADS AND BUILDINGS DEPARTMENT GOVERNMENT OF GUJARAT Gujarat State Highway Project - II HIV/AIDS Prevention Plan July 2013 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN CONTENTS E. EXECUTIVE SUMMARY .................................................................................... E-1 E.1 PROJECT BACKGROUND ........................................................................................... E-1 E.2 NEED FOR PREPARATION OF HIV/AIDS PREVENTION PLAN .................................. E-1 E.3 TARGET AND OBJECTIVES OF HPP .......................................................................... E-2 E.4 METHODOLOGY.......................................................................................................... E-3 E.5 HIV/AIDS SCENARIO IN GUJARAT AND KEY ISSUES................................................ E-3 E.6 IDENTIFICATION OF HOTSPOTS, HEALTH CARE CENTRES .................................... E-4 E.7 TARGET INTERVENTIONS AND HEALTH SERVICES ................................................ E-5 E.8 INTERVENTION STRATEGY........................................................................................ E-6 E.8.1. Environmental and Social Management Unit ..................................................... E-6 E.8.2. Roles and Responsibilities of NGO ................................................................... E-7 E.9 STRATEGIC COMPONENTS ....................................................................................... E-7 E.9.1. Information Education Communication (IEC)..................................................... E-7 E.9.2. Behaviour Change Communication (BCC) ........................................................ E-8 E.9.3. Care and Support ............................................................................................. E-8 E.9.4. Awareness Programmes at Construction Camps .............................................. E-8 E.9.5. Creating Enabling Environment ........................................................................ E-8 E.9.6. Action Plan ....................................................................................................... E-8 E.10 IMPLEMENTATION BUDGET ..................................................................................... E-15 1 INTRODUCTION ................................................................................................ 1-1 1.1 PROJECT BACKGROUND ........................................................................................... 1-1 1.2 Need for preparation of HIV/AIDS prevention plan ......................................................... 1-2 1.3 HIV /AIDS Prevention Plan – Target and Objectives ...................................................... 1-3 1.4 Approach and Methodology........................................................................................... 1-3 1.5 Report structure ............................................................................................................ 1-4 2 HIV/AIDS SCENARIO IN GUJARAT ................................................................. 2-1 2.1 NACO estimates ........................................................................................................... 2-1 2.1.1 Districts and Categorization of Vulnerability ...................................................... 2-1 2.2 Ongoing programs on HIV/AIDS in Gujarat.................................................................... 2-2 2.2.1 Target Intervention for Bridge Population .......................................................... 2-2 2.2.2 Initiatives of NACO / GSACS in Gujarat ............................................................ 2-2 2.2.3 Other key initiatives in the sector ...................................................................... 2-3 2.3 Overview of key stakeholders ........................................................................................ 2-4 2.4 Appraisal of the policy frameworks ................................................................................ 2-5 2.4.1 Operational guidelines by NACO ...................................................................... 2-5 2.5 key issues in the sector ................................................................................................. 2-6 3 APPRAISAL OF PROJECT LOCATION ........................................................... 3-1 3.1 identification of hotspots, health care centres ................................................................ 3-1 3.2 vulnerability along the corridors ................................................................................... 3-12 3.3 Target Interventions and Health Services .................................................................... 3-17 3.4 Truck parking areas, Highway Amenities, Rest Areas .................................................. 3-20 3.4.1 Pattern of Truck Movement and Spread Effect of HIV/AIDS ............................ 3-21 i Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.5 Tribal communities ...................................................................................................... 3-22 3.6 Industrial hubs and Migrant Workers ........................................................................... 3-22 3.7 Construction camps .................................................................................................... 3-22 3.8 Identified Hotspots along the Corridor.......................................................................... 3-23 3.8.1 Potential Hotspots: Dabhoi-Bodeli Corridor ..................................................... 3-23 3.8.2 Potential Hotspots: Dhandhuka-Dholera Corridor ............................................ 3-23 3.8.3 Potential Hotspots: Atkot-Gondal Corridor ....................................................... 3-24 3.8.4 Potential Hotspots: Mehsana-Himatnagar ....................................................... 3-24 3.8.5 Potential Hotspots: Umreth-Vasad (including Ladvel-Kapadvanj) Corridor ....... 3-25 3.8.6 Potential Hotspots: Bayad-Lunawada Corridor ................................................ 3-26 3.8.7 Potential Hotspots: Dhansura-Meghraj Corridor .............................................. 3-27 3.8.8 Potential Hotspots: Lunawada-Khedapa Corridor ............................................ 3-27 3.8.9 Potential Hotspots: Dhandhuka-Paliad Corridor .............................................. 3-27 3.9 Findings of Consultations ............................................................................................ 3-28 3.10 Survey and Consultation with Trucker Community ....................................................... 3-33 3.10.1 Consultation with Trucker Community ............................................................. 3-33 3.10.2 Analysis of Trucker Survey Data ..................................................................... 3-34 4 INTERVENTION STRATEGY AND ACTION PLAN .......................................... 4-1 4.1 Introduction ................................................................................................................... 4-1 4.2 Implementation plan ...................................................................................................... 4-1 4.2.1 Institutional framework ...................................................................................... 4-1 4.2.2 Environmental and Social Management Unit ..................................................... 4-1 4.2.3 Roles and Responsibilities of NGO ................................................................... 4-2 4.3 Strategic components ................................................................................................... 4-3 4.3.1 Information Education Communication (IEC) ..................................................... 4-3 4.3.2 Behaviour Change Communication (BCC) ........................................................ 4-5 4.3.3 Care and Support ............................................................................................. 4-5 4.3.4 Awareness Programmes at Construction Camps .............................................. 4-6 4.3.5 Creating Enabling Environment ........................................................................ 4-6 4.3.6 Action Plan ....................................................................................................... 4-7 4.4 Implementation budget ................................................................................................ 4-14 ii Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN LIST OF TABLES Table E-1: Action Plan - Summary ......................................................................................................... E-9 Table E-2: HPP Components in the Budget for Implementing NGO ................................................... E-15 Table 1-1: Project Corridors (widening and upgradation corridors - DPRs prepared)........................... 1-1 Table 1-2: Project Corridors (widening and upgradation corridors - DPRs to be prepared) ................. 1-1 Table 1-3: Project Corridors (Maintenance Corridors) ........................................................................... 1-2 Table 2-1: HIV Prevalence: Categorisation of Districts in Gujarat ......................................................... 2-1 Table 3-1: Identified Hotspots, Health Care Centres, NGO Intervention Areas and Major Industrial Areas: Present Scenario......................................................................................................................... 3-1 Table 3-2: Vulnerability features: Dabhoi – Bodeli Corridor Villages ................................................... 3-12 Table 3-3: Vulnerability features: Dhandhuka-Dholera Corridor Villages ............................................ 3-12 Table 3-4: Vulnerability features: Gondal – Atkot Corridor Villages .................................................... 3-13 Table 3-5: Vulnerability features: Mehsana - Himatnagar Corridor Villages........................................ 3-13 Table 3-6: Vulnerability features: Umreth Vasad Corridor (Including Kapadvanj) Villages ................. 3-14 Table 3-7: Vulnerability features: Bayad – Lunawada Corridor Villages ............................................. 3-15 Table 3-8: Vulnerability features: Dhansura – Meghraj Corridor Villages............................................ 3-16 Table 3-9: Vulnerability features: Lunawada – Khedapa Corridor Villages ......................................... 3-16 Table 3-10: Vulnerability features: Dhandhuka-Paliyad Corridor Villages ........................................... 3-17 Table 3-11: Health Service Centres and Target Intervention: Dabhoi-Bodeli Corridor ....................... 3-18 Table 3-12: Health Service Centres and Target Intervention: Dhanduka-Dholera Corridor............... 3-18 Table 3-13: Health Service Centres and Target Intervention: Atkot – Gondal Corridor ..................... 3-18 Table 3-14: Health Service Centres and Target Intervention: Mehsana-Himatnagar Corridor ........... 3-19 Table 3-15: Health Service Centres and Target Intervention: Umreth-Vasad (including Ladvel- Kapadvanj Corridor............................................................................................................................... 3-19 Table 3-16: Health Service Centres and Target Intervention: Bayad – Lunawada Corridor .............. 3-19 Table 3-17: Health Service Centres and Target Intervention: Dhansura Megharaj Corridor ............. 3-20 Table 3-18: Health Service Centres and Target Intervention: Lunawada – Khedapa Corridor .......... 3-20 Table 3-19: Health Service Centres and Target Intervention: Dhandhuka-Paliyad Corridor ............. 3-20 Table 3-20: Distribution of Intra and Inter-state movement of Goods Vehicle .................................... 3-21 Table 3-21: Hotspot Network: Dabhoi-Bodeli ....................................................................................... 3-23 Table 3-22: Hotspot Network: Atkot – Gondal Corridor ....................................................................... 3-24 Table 3-23: Hotspot Network: Mehsana-Himatnagar Corridor ............................................................ 3-25 Table 3-24: Hotspot Network: Umreth-Vasad Corridor (Including Ladvel - Kapadvanj)...................... 3-26 Table 3-25: Hotspot Network: Dhansura – Meghraj Corridor .............................................................. 3-27 Table 3-26: Details of Consultations with Stakeholders....................................................................... 3-28 Table 3-27: Level of awareness among Truckers ................................................................................ 3-35 Table 4-1: Action Plan ............................................................................................................................ 4-8 Table 4-2: HPP Components in the Budget for Implementing NGO.................................................... 4-14 iii Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN LIST OF FIGURES Figure 3-1: Situation Assessment: Dabhoi-Bodeli Corridor ................................................................... 3-2 Figure 3-2: Situation Assessment: Dhandhuka-Dholera Corridor.......................................................... 3-3 Figure 3-3: Situation Assessment: Atkot – Gondal Corridor .................................................................. 3-4 Figure 3-4: Situation Assessment: Mehsana-Himatnagar Corridor ....................................................... 3-5 Figure 3-5: Situation Assessment: Umreth-Vasad Corridor................................................................... 3-6 Figure 3-6: Situation Assessment: Ladvel-Kapadavanj Corridor ........................................................... 3-7 Figure 3-7: Situation Assessment: Bayad - Lunawada Corridor ............................................................ 3-8 Figure 3-8: Situation Assessment: Dhansura - Meghraj Corridor .......................................................... 3-9 Figure 3-9: Situation Assessment: Lunawada - Khedapa Corridor ..................................................... 3-10 Figure 3-10: Situation Assessment: Dhandhuka-Paliyad Corridor ...................................................... 3-11 Figure 4-1: HIV/AIDS Prevention Plan: Implementation Structure ........................................................ 4-2 Figure 4-2: Sample copy of IEC Materials developed by NACO ........................................................... 4-4 Figure 4-3: Sample copy of IEC Materials developed by GSACS in Gujarati language ....................... 4-5 Figure 4-4: Signboards in Construction Campsites: IEC to Combat HIV/AIDS ..................................... 4-6 LIST OF APPENDICES Appendix 1.1: Trucker Survey Questionnaire Appendix 2.1: Details of NACP- III Appendix 3.1: Sample Population of Trucker Survey Appendix 4.1: Template of Monthly Progress Report Appendix 4.2: IEC Materials iv Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ABBREVIATIONS AND TERMS AIDS Acquired Immuno Deficiency Syndrome AMCACS Ahmadabad Municipal Corporation AIDS Control Society ANC Ante Natal Clinic ART Antiretroviral Therapy BMGF Bill & Melinda Gates Foundation BCC Behaviour Change Communication BSS Behavioural Surveillance Survey CBO Community Based Organisation CHC Community Health Centres CMIS Computerized Management Information System CST Care, Support and Treatment CSW Commercial Sex Worker DAPCU District AIDS Prevention and Control Unit DFID Department For International Development FSW Female Sex Worker GFATM Global Fund for AIDS, TB & Malaria GIPA Greater Involvement of People living with AIDS GSACS Gujarat State AIDS Control Society HIV Human Immuno-deficiency Virus HLFPPT Hindustan Latex Family Planning Promotion Trust HPP HIV/AIDS Prevention Plan HRG High Risk Group ICTC Integrated Counselling & Testing Centre IDU Intravenous Drug User IEC Information, Education and Communication IPC Inter Personal Communication KP Key Population MDGs Millennium Development Goals M&E Monitoring & Evaluation MSM Men having Sex with Men MSW Male Sex Worker NACO National AIDS Control Organisation NACP National AIDS Control Programme NARI National AIDS Research Institute NFHS National Family Health Survey NGO Non-Governmental Organisation NHAI National Highway Authority of India NRHM National Rural Health Mission PHC Primary Health Centre PLHA People Living with HIV/AIDS PMU Project Management Unit PPTCT Prevention of Parent to Child Transmission RCH Reproductive & Child Health RNTCP Revised National TB Control Programme RTI Reproductive Tract Infection SACS State AIDS Control Society SHG Self Help Group SMO Social Marketing Organisation STD Sexually Transmitted Disease STI Sexually Transmitted Infection TCIF-BMGF Transport Corporation of India Foundation-Bill & Melinda Gates Foundation TG Trans-Gender v Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN TI Targeted Intervention ToR Terms of Reference TRG Technical Resource Group TSG Technical Support Group TSU Technical Support Unit ï‚· Bridge Population: Bridge populations comprise people, who, through close proximity to high risk groups are at the risk of contracting HIV. Quite often they are clients or partners of male and female sex workers. Truckers and migrant laborers are major bridge populations. ï‚· Long Distance Truckers (LDT). Those who are carrying goods from source to destination through travelling 800 kms. ï‚· Flying Sex Worker: those who come to one point for contacting their clients & go with them from that particular point to various distant destinations for sexual activity. ï‚· Kothi: Passive Partner of MSM. ï‚· Panthi: Active Partner of MSM ï‚· Gariya: Active Partner of MSM. ï‚· Double Decker: Having both sexual exposure as Active & Passive Partner of MSM. ï‚· Core Composite: NGOs implementing HIV/AIDS prevention project with both FSWs & MSMs group. vi E. EXECUTIVE SUMMARY E.1 PROJECT BACKGROUND 1. The Government of Gujarat (GoG), through the Roads and Buildings Department (R&BD), has taken up the second Gujarat State Highway Project (GSHP-II), covering up-gradation, maintenance and improvement of identified core road network in the state. The GoG has proposed to take up this project with financial assistance from the World Bank. An Updated Strategic Options Study (USOS) was carried out by the R&BD in 2005-06 which was subsequently revalidated in 2010 for the State Core Road network. The improvements of 1003.22 km in the project includes: (i) upgradation corridors for a length of 644.05 km, involving the strengthening and upgrading of single/intermediate lane roads to standard 2-lane/ 2-lane-with-paved-shoulders / 4-lanes, and (ii) major maintenance, of the remaining 359.17km. In line with the prioritization exercise, R&BD has selected nine corridors, aggregating to about 394 km in length. The upgradation corridors to be taken up for implementation include thirteen corridors. Out of these, as part of DPR preparation, social safeguard reports have been prepared for 8 corridors. M/s LEA Associates South Asia Pvt. Ltd. (LASA) has been selected as Project Preparatory Works Consultant to prepare detailed project reports including HIV/AIDS Prevention Plan (HPP). 2. HPP assesses and addresses the pertinent issues with respect to the mobility pattern of high-risk groups (HRGs) and bridge population (refer para 3 for details) and analyses the potential risk factors on the local communities. HPP also suggests for appropriate mitigation measures and institutional arrangements for the sustainable delivery of project benefits to community. Data from various sources were collected and consultations with identified stakeholders were carried out in all the project corridors and this report presents a comprehensive prevention plan and strategic action plan. E.2 NEED FOR PREPARATION OF HIV/AIDS PREVENTION PLAN 3. Bridge populations are among the most vulnerable population in the context of HIV infection. They are those people who comprise truckers and migrant population, through close proximity to high risk groups (FSWs and MSMs), who are at a higher risk of contracting HIV. They are also clients or partners of male and female sex workers. Large number of migrant labourers works in various sectors across the Gujarat State. Due to the typical character of “mobility with HIVâ€?, the bridge population are considered to be the critical group and becomes the core part of any type of intervention designed to combat HIV/AIDS. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non-regular partners. Further, inadequate access to treatment for sexually transmitted infections aggravates the risk of contracting and transmitting the virus. 4. As per the findings of past studies on nature and modes of transmission of HIV particularly in transport sector, it has been proved that the linkages vis-à-vis prevalence of HIV/AIDS. Although HIV prevalence rate has come down over the period of time, still some areas are showing high E-1 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN prevalence as per ANC Sentinel surveillance survey. HPP has considered the following linkages between the prevalence of HIV and road sector. 1 2 ï‚· Approximately 36 percent of truckers are clients of sex workers and 15-20 percent of clients appear to be truck drivers. ï‚· Surveillance studies indicate that the prevalence of HIV among truckers in general may be more than 10 times higher than in the general population (7.4 percent among truckers as compared to 0.7 percent with the general population); ï‚· The National BSS of 1999 reveals that high risk sexual contacts during transit (87 percent) and poor condom usage among truckers, making vulnerable to STI and HIV/AIDS; ï‚· Various influencing factors which make truck drivers vulnerable to HIV/AIDS, such as stress, consumption of alcohol and drugs, staying away from family for longer period, easily accessible to sex networks operate along the highways and halt points; ï‚· Inconsistent usage of condom and lacking of early treatment seeking behaviour are common phenomenon; ï‚· Lack of awareness and capacity building among the bridge population and the representing organizations respectively elevates the spread effect of HIV; ï‚· In view of the tedious and continuous working hours leading to consumption of alcohol and drug use, the truckers are more likely to engage in unprotected sexual encounters with casual partners and sex workers; ï‚· Single male migrant populations are very large and diverse. The pro-development scenario of Gujarat offers plenty of employment opportunities in the industries and construction sector thereby resulting in a huge influx of temporary and permanent migrants elsewhere India. ï‚· A large number of migrants who come for construction work prefer to have sexual outlets with non- regular partners as they are away from home and many of them are single male migrants. E.3 TARGET AND OBJECTIVES OF HPP 5. Combating HIV/AIDS in the project locale with a definite prevention strategy during the project period (design stage, pre-construction, construction and post-construction stage), focusing on truckers, migrants, construction workers and communities residing alongside the road. The specific objectives of HPP are: a. To ensure that development initiatives make positive contribution to HIV prevention; b. To involve various stakeholders including government agencies, road-user groups and community in a participatory process during all stages of project planning and implementation; c. To provide specific measures to improve the quality of life of affected population, high risk groups and other direct and indirect stakeholders; d. To evolve sustainable intervention strategies which will have positive impact the living standards of local communities. 1 Healthy Highways Behaviour Surveillance Survey (BSS), I Round 2000 2 National BSS among clients of sex workers. E-2 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN E.4 METHODOLOGY 6. Participatory approach is adopted for the preparation of HPP. To achieve the objectives, various methods are followed for situation assessment, collection of information, create enabling environment and a sustainable prevention strategy. ï‚· Reconnaissance visit; ï‚· Coordinated effort and institutional survey; ï‚· Focus group discussions; ï‚· Individual interviews; ï‚· Consultation with key stakeholders; and ï‚· Telephonic interview and discussions. E.5 HIV/AIDS SCENARIO IN GUJARAT AND KEY ISSUES 7. The NACO estimated about 1.36 lakh people have HIV infection in Gujarat. The HIV prevalence was more than 1 percent among Anti Natal Clinic (ANC) attendees (proxy of general population). Six districts (Banaskantha, Dahod, Mehasana, Navsari, Surat and Surendranagar) are Category-A and four districts (Ahmedabad, Bhavnagar, Rajkot and Vadodora) are Category-B, as per the sentinel surveillance survey of NACO. The project corridors traverse one district of Category-A and all four districts of Category-B. 8. According to the National AIDS Control Organization (NACO), the HIV incidence increased in Gujarat state where as the prevalence rate was low in the last couple of years. The estimated adult HIV prevalence in the state is 0.37 percent which is higher than the national prevalence of 0.31 percent. 9. Progressive industrialization and resultant migration, especially of single-male migrants (both intra and interstate) in the textiles and infrastructure development sector, has increased the risk of HIV infection. 10. About 7 percent of FSWs are HIV positive and near about 8 percent of MSMs is HIV positive. FSWs are scattered and home-based and hence the reach of target interventions is constrained. There is a five-fold increase in the risk-behaviour of clients of sex workers in Surat, Vadodora and Rajkot districts. 11. Target Interventions (TI), in general have more focus on urban and semi-urban locations. There is pertinent requirement of focused and strategic intervention in rural Gujarat and also in the road and transport sector in view of the high percentage of bridge population. Inadequacy of quality NGOs also observed as a constraint in reaching to the rural population in an effective manner. 12. The existing intervention in the 8 major transshipment locations majorly focuses on immediate geographic vicinity and covers generally long-distance truckers. However, the high risk behavior pattern among short-distance truckers, migrant population and tribal communities are addressed in a limited manner. E-3 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 13. Corporate groups such as Reliance, ESSAR, Ambuja Cement Foundation and Apollo Tyres have been working on various activities such as Behaviour Change Communication, IEC, Condom Promotion, Service Delivery & Care and Support components at their industrial corridors. Apart from the major players, there are significant numbers of industrial units who invites migrants as employees. The risky environment emerged from such huge influx is often not addressed properly by such industrial units. The scope for intervention addressing behavior pattern of bridge population is wide. E.6 IDENTIFICATION OF HOTSPOTS, HEALTH CARE CENTRES 14. The major hotspots, healthcare centres, intervention areas of NGOs and major industrial areas along the project corridors have been identified. The information has been gathered for seven project corridors. There are 15 hotspots identified along the seven corridors. The categorization of hotspots is based on the discussion with NGOs, ICTC Counselors and discussion with trucker community. Out of the seven corridors, 3 corridors are part of target interventions by local NGOs funded by GSACS. Dabhoi-Bodeli and Dhandhuka-Paliyad corridors have prominent hotspots, NGO interventions is absent. Health care services are present in all the studied corridors. Potential vulnerability along the corridors is as follows: 15. Dabhoi – Bodeli corridor: There are considerable number of HRGs and HIV positive people identified by the intervention NGOs and ICTCs. HRG activities are taken place mainly in Dabhoi Town and few places of corridor’s Block villages. Gola Gamdi village of Sankheda block is starting point of a tribal block. 16. Dhandhuka – Dholera corridor: There are cases of HIV positives reported in Dhandhuka town. Out-migration of labourers is found to be high in this region and the vulnerability among female is observed to be high. NGO intervention is absent in the region. 17. Atkot – Gondal corridor: Jasdan and Gondal town area and outskirts have relatively higher percentage of HRG presence, compared to other urban or semi-urban areas along the corridor. LWS of Caritas India has been active in many of the villages along the corridor for the last 15 months. 18. Mehsana – Himmatnagar corridor: Presence of HRGs and HIV positive people indicate that focused intervention are required throughout the corridor. The movement of migrant labourers, especially single male migrants in view of the large number of small scale industrial units indicates the need of intervention. Apart from the urban settlements situated in the beginning and ending point of the corridor, the semi-urban and rural stretches like Visnagar and Vijapur has also high presence of HRGs. 19. Umreth - Vasad (Including Ladvel-Kapadvanj): Kapadvanj town has 7 HIV positive cases reported, which shows the potential vulnerability among the community. Presence of NGOs or any target intervention is lacking in the area despite the incidence. Another part of corridor, traversing Umreth (Keda District) and Vasad (Anand district), where presence of HRGs and HIV positives are reported. E-4 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 20. Bayad – Lunawada corridor: HRG presence is not reported along the corridor, however, the data from CHCs at Lunawada and Vatrak shows that there are HIV positive cases reported from nearby talukas. There is a need for HIV/AIDS awareness programme in this region in view of the increasing number of HIV positive cases reported since 2007. 21. Dhansura – Meghraj corridor: Along the corridor, major presence of HRGs have been reported at Malpur and Meghraj. An NGO is functioning in these locations catering to the needs of HIV positive children and ART follow-up, etc. Three persons have been tested HIV positive as per the records of the CHCs of Malpur and Meghraj. 22. Dhandhuka – Paliyad corridor: This corridor also starts from Dhandhuka3. HIV positivity in Paliyad is reported among migrant population and long-distance truckers. 23. Lunawada – Khedapa corridor: The corridor passes through fifth schedule area. The truck movement along the corridor is observed to be less and the presence of HRGs not reported along the corridor. HIV positive cases have been reported from Malanpur, Santrampur and Batakwada villages of Santrampur taluka and Pankhi village of Lunawada taluka. E.7 TARGET INTERVENTIONS AND HEALTH SERVICES 24. Adequate numbers of Community Health Service (CHC) centres, Primary Health Service (PHC) centres and village based Sub Centres (SC) established by Health & Family Welfare Department, Govt. of Gujarat are functioning, along the project corridors. ICTC established by GSACS, are found at all the CHCs pertaining to the corridors. ART centres established by GSACS are also available at major cities like Mehsana and Himmatnagar. Major health care centres and NGO based TIs identified along the project corridors. 25. Tribal communities and Vulnerability: Among the 10 corridors, 4 have concentration of tribal communities. Corridors such as Bodeli-Alirajpur, Lunawada-Khedapa and Lunawada-Bayad pass through tribal villages. Some villages of Sankheda Taluka in Dabhoi-Bodeli corridor have majority tribal population. Rathva, Tadvi and Vasave are the major tribes reside in these areas. 26. FSWs belonging to tribal community are reported by the NGOs along the corridor. These FSWs indulge in home-based sexual activity. MSMs are also active in these regions, and the activities are street based and promiscuous places nearby bus station and outskirts of the settlement areas. 27. Around 35 industries such as cotton & ginning units, cold storage units and tiny oil units are situated along the Pilavi-Vijapur area of Himmatnagar-Mehsana corridor. Majority of these industries have employed a large number of migrant workers who hail from Bihar, Uttar Pradesh and Madhya Pradesh. Discussion with the industrial unit operators and NGO personnel reveals that more than 50 percent of the migrant workers are ‘single-male-migrants’. Most of the workers engage for an average period of 8 months in a year depending upon the seasonal requirement of 3 Dhandhuka is the starting point of two Corridors, Dhandhuka-Dholera and Dhandhuka-Paliyad. E-5 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN the employment in cotton & ginning units. Consultations with NGOs reveal that the migrant workers are involved with HRGs. 28. Industrial hubs and Migrant Workers: Along the Dhanduka-Paliyad corridor, about 15 small-scale industrial units are situated near the Dhanduka-Ranpur stretch. Apart from the small- scale industrial units, quarry and stone-crushing units are located in Nagnesh, Bodiya and Kinara villages. Similar industrial clusters are not observed along other project corridors, except one located in Kotdasangani village along Gondal-Atkot corridor. 29. Migration of workers from Paliad to other districts such as Surat, Bhavnagar, Vadodara is reported. Discussions with the ICTC counsellors reveal that Paliad town has 11 numbers of HIV positive people from among the migrant labourers, thereby elevating the risk and spread effect of the disease. E.8 INTERVENTION STRATEGY 30. Implementation of HPP in the project corridors for the benefit of local community, bridge population and HRGs is a pre requisite of the road development project. The reconnaissance visit and the interactive discussions have gathered pertinent information from various sources. The data gathered for project corridors formed the basis for this report. Comprehensive analysis of the data and the content analysis of consultations held with local NGOs, corporate bodies, medical health care service personnel, etc helped in evolving the HPP. It is learnt that there is a well-knit system already in place functional under NACO and GSACS/AMCACS, which has focussed on various components such as information education communication (IEC), behaviour change communication (BCC), condom promotion, care and support, creating an enabling environment, etc. 31. In view of the potential strategy for the prevention of HIV/AIDS in the project corridors, the existing institutional structure has been assessed. The Target Intervention as envisioned by NACO/GSACS and materialized through NGOs, ICTCs, CHCs, etc has already established a comprehensive management plan for preventing HIV/AIDS targeting a larger public domain. A segment of the intended population of HRGs and bridge population identified as part of the situation assessment of GSHP-II forms a subset of the larger public domain. 32. Based on the understanding of the HIV/AIDS scenario in the project corridor locations, and in view of the strategy, a structure is suggested. The structure seeks an implementation arrangement with IEC, sensitization programmes and training programmes for R&BD personnel, contractors and other stakeholders in the transport sector, as a key tool. The HPP will cater to various stages like design, pre-construction and post-construction. E.8.1. Environmental and Social Management Unit 33. An Environmental and Social Management Unit (ESMU) proposed at the Project Implementation Unit (PIU) of R&BD for the implementation of Resettlement Action Plan (RAP), Tribal Development Plan (TDP) and HPP. The ESMU at PIU will interact with GSACS/ AMCACS. The Social Specialist at ESMU with the assistance of RAP implementing NGO will be the responsible person interacting with GSACS/AMCACS and will provide the following information: E-6 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ï‚· Details of the project corridors and proposed development; ï‚· Potential areas of HRG activities along the corridor; ï‚· Details of the construction camp sites and labourers including migrant labourers; 34. The IEC materials developed by NACO and GSACS for awareness creation among trucker community, migrant labourers, etc., will be disseminated in identified locations along the project corridors and construction camp sites. The services of NGO proposed to be selected for the implementation of RAP and mitigation of adverse impacts due to the project shall be utilised. The roles and responsibilities of the NGO is summarised as follows: E.8.2. Roles and Responsibilities of NGO Awareness Creation on HIV/AIDS Prevention 35. NGO shall carry out awareness programs along the corridors at identified locations such as toll-plazas, construction camp sites and truck-parking lay-by in respective corridors. For the purpose, the IEC materials as well as technical advice from GSACS will be utilized in a timely manner. The NGO shall ensure in collaboration with ESMU that medical facilities and health check-ups which may include diagnosing of STD/HIV for the workers are provided at the construction camps. ï‚· Awareness programs for construction labourers; ï‚· Facilitating medical health care services including STI treatment; ï‚· Interaction with CHCs, ICTCs; ï‚· Coordination with Target Intervention NGOs, Link Worker Schemes and other agencies working in the field of HIV/AIDS awareness and prevention; ï‚· Conduct sensitization programs for officers of SRP divisions, contractors and other stakeholders; ï‚· Interaction with transporters and brokers; and ï‚· Ensure availability of condoms (both socially marketed & govt.) through established condom depots. Assistance in Monitoring of HIV/AIDS Prevention Plan 36. NGO shall assist the Project Management Consultant (PMC) in monitoring and evaluating HPP and all related components incorporated in contract document of each corridor to be executed by the contractor. NGO shall prepare and submit the monthly progress report on item wise/activity wise implementation/execution of the plan and expenditure incurred thereof. E.9 STRATEGIC COMPONENTS 37. The components suggested for effective implementation of HIV/AIDS Prevention Plan in respective corridors with the objective of sustaining the project initiatives has been worked out and presented in the following sections. E.9.1. Information Education Communication (IEC) 38. Awareness creation through IEC will be adopted for identified locations. These locations are communities along the road, hospitals, major junctions, truck parks, toll plaza, construction camp sites etc. The content could be massage about prevention strategy, threat of HIV/AIDS and proper use of condoms. The IEC materials developed by NACO/GSACS will be utilised for awareness creation among target groups along the proposed project corridors. E-7 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN E.9.2. Behaviour Change Communication (BCC) 39. BCC is an interactive process with communities (as integrated with an overall program) to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community and societal behaviour change; and maintain appropriate behaviours. PIU will interact with NACO/GSACS and thereby guide the implementing NGO to assist the target population in accessing the services of TI NGOs and ICTCs in BCC. E.9.3. Care and Support 40. People who are infected with HIV require social and psychological support from the society and from their family members. The strategy will be aimed at providing care and support services to cent-percent HIV infected people. The implementing NGO will assist the identified infected people in accessing the services of ICTCs and CHCs in the vicinity and also will introduce the person to the TI NGO. E.9.4. Awareness Programmes at Construction Camps 41. Health problems of the workers will be taken care of by providing basic health care facilities through a health centre set up at the construction camps. The implementing NGO shall carry out periodic awareness programme on HIV/AIDS in coordination with CHCs/ICTCs and TI NGOs supported by GSACS. E.9.5. Creating Enabling Environment 42. A favourable environment for the smooth implementation of the intervention will be created with the following components: ï‚· Police personnel will be made aware of the specific intervention programme; ï‚· Active participation of representatives from various CBOs will be ensured. This will help the PIU in fulfilling the programme-objectives in the given time frame; ï‚· Regular interactions with representatives of Medical Institutions will be carried out to ensure a consistent delivery of their services; ï‚· Interactive meeting with Transport Companies operating from the project corridor will be done; ï‚· Consultation with the major Corporate Bodies with respect to make provisions to reduce the time duration of transhipment of goods; and ï‚· Consultation with petrol pumps, major dhabas, located along the project corridor will be carried out. This is aimed at the creation of information centres and service outlets in rest facilities for STI care, condom distribution and counselling through the established network of GSACS. ï‚· Target group congregation events/observance of AIDS Day, etc. E.9.6. Action Plan 43. The specific action plan to execute the HPP along respective corridors has been presented in Table E-1. Appropriate action plan has been developed based on the outcome of the situation assessment exercise carried out along the corridors. The action plan shall be implemented by the NGO to be contracted for the implementation of RAP/TDP/HPP. E-8 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table E-1: Action Plan - Summary Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) Dabhoi-Bodeli Presence of HRGs in 6 out of 29 villages/town Intensive IEC campaign in 6 locations - Distribution of IEC Dabhoi, Sankheda, Pitha, Kundi Tappe, materials and carryout awareness programmes for HRGs/Local Suryaghoda, Ali Kherva Community on monthly basis Presence of 2 Hotspots Assist the target population in accessing the services (BCC, Dabhoi, Sankheda ART, etc.) of TI NGO/CHC IEC campaign on 6-months interval till completion of construction works Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/Junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [5 locations (Ch. 29+600, construction works 32+085, 32+700, 46+725, 68+417)] Dhandhuka- No HRG presence Dholera No Hotspots Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC E-9 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [2 locations (Ch.0+000, construction works 27+000)] Atkot-Gondal Presence of HRGs in 7 out of 13 villages/town. Intensive IEC campaign in 7 locations - Distribution of IEC Jasdan, Virnagar, Gondal, Dadva materials and carryout awareness programmes for HRGs/Local Hamirpura, Ghoghavadar, Kotda Community on monthly basis Sangani, Ramod Presence of 2 Hotspots Assist the target population in accessing the services (BCC, Gondal, Jasdan ART, etc.) of TI NGO/VCTC Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/junctions along construction period; Large numbers of trucks from programmes for truckers on 3-month interval till completion of the corridor with focus on Gondal [2 various states of India, (Long Distance) arrive at construction works [at Gondal, the IEC distribution and locations (Ch.209+800, 245+000)] Gondal Market Yard awareness programme shall be on 2-month interval] Mehsana- Presence of HRGs in 11 out of 27 villages/town Intensive IEC campaign in 11 locations - Distribution of IEC Mehsana, Heduva Hanumat, Devrasan, Himatnagar [Mehsana District is under ‘A’ category (high materials and carryout awareness programmes for HRGs/Local Visnagar, Vijapur, Motipura, Pilavi, prevalence) and the out-migration of rural Community on monthly basis Dabhala, Vasai, Kotdi, Himatnagar population elevates the vulnerability] Presence of 6 Hotspots Assist the target population in accessing the services (BCC, Mehsana, Palvasana, Devrasan, Vasai, ART, etc.) of TI NGOs/ICTCs/CHC Vijapur, Himatnagar Large numbers of single male migrant group has Distribution of IEC materials and carryout awareness Visanagar, Pilavi, Vijapur presence in cotton & ginning & other small programmes for migrant workers on 6-month interval till E-10 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) industry units along the corridor completion of construction works Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period; Since the transporters & programmes for truckers on 3-month interval till completion of the corridor with focus on Mehsana and brokers are located at Mehsana & Kadi, the truck- construction works [at Mehsana and Kadi, the IEC distribution Kadi [8 locations (Ch. 103+275, halt-time increases for more than half day & they and awareness programme shall be on 2-month interval] 117+066, 126+950, 135+260, 139+000, organize night halts at these place/s 140+050, 161+335, 163+752)] Umreth-Vasad Presence of HRGs in 6 out of 16 villages/town [no Intensive IEC campaign in 6 locations - Distribution of IEC Kapadvanj, Umreth, Bechari, Anand, (incl.Ladvel- HRG presence in Ladvel-Kapadvanj section] materials and carryout awareness programmes for HRGs/Local Ode, Vaherakhadi Kapadvanj) Community on monthly basis Presence of 4 Hotspots [3 in Umreth-Vasad and 1 Assist the target population in accessing the services (BCC, Umreth, Ode, Sarsa, Kapadvanj in Ladvel-Kapadvanj section] ART, etc.) of TI NGOs/CHCs Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along E-11 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) construction period programmes for truckers on 3-month interval till completion of the corridor [9 locations (Ch. 0+000, construction works 2+500, 8+143, 8+960, 9+230, 19+138, 0+000, 20+535, 32+067)] Bayad- No HRG presence Lunawada No Hotspots Proximity of the corridor to tribal area /Potential IEC campaign and interactive discussions with CBOs/NGOs Lunawada involvement of tribal people in sex work working for tribal welfare Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [5 locations (0+000, 17+961, construction works 6+450, 9+625, 0+006)] Dhansura- Presence of HRGs in 9 out of 33 villages/town Intensive IEC campaign in 9 locations - Distribution of IEC Dhansura, Malpur, Nanavada, Sompur, Meghraj materials and carryout awareness programmes for HRGs/Local Satarda, Bhempur, Laljina Pahadiya, Community on monthly basis Surana Pahadiya, Meghraj Presence of 1 Hotspot Assist the target population in accessing the services (BCC, Dhansura/Modasa ART, etc.) of ICTC Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, E-12 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) ART, etc.) of CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [5 locations (Ch.38+501, construction works 64+584, 67+712, 72+760,84+987)] Dhandhuka- No HRG presence Paliyad Presence of 1 Hotspot Assist the target population in accessing the services (BCC, Paliyad ART, etc.) of CHC Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [3 locations construction works (Ch.104+800,131+000,151+200)] Lunawada- No HRG presence Khedapa No Hotspots Corridor pass through tribal area / Potential IEC campaign and interactive discussions with CBOs/NGOs Santrampur, Kadana involvement of tribal people in sex work working for tribal welfare Establishment of construction camp sites for road Health checkups for all construction workers on 6-month interval Construction camp sites development works and influx of migrant till completion of construction works. NGO shall associate with labourers and their likely interaction with local concerned CHC for treatment support community IEC campaign on 6-months interval till completion of E-13 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Locations/Village/Town Corridor Strategy/Action Suggested Identified (locations en-route) construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion of the corridor [4 locations (Ch. 130+010, construction works 162+775, 0+000, 9+625)] E-14 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN E.10 IMPLEMENTATION BUDGET 44. Implementation of HPP is proposed to be carried out by an NGO and the budget for the same is included as part of NGO activities in the overall RAP budget. The relevant components of HPP in the RAP budget are presented in Error! Reference source not found.. The overall budget also provisions for contingencies. Escalation of the budget for implementing NGO is considered at an annual inflation rate of 7% based on consumer price index. E-15 1 INTRODUCTION 1.1 PROJECT BACKGROUND 1. The Government of Gujarat (GoG), through the Roads and Buildings Department (R&BD), has taken up the second Gujarat State Highway Project (GSHP-II), covering up-gradation, maintenance and improvement of identified core road network in the state. The GoG has proposed to take up this project with financial assistance from the World Bank. An Updated Strategic Options Study (USOS) was carried out by the R&BD in 2005-06 which was subsequently revalidated in 2010 for the State Core Road network. The improvements of 1003.22 km in the project includes: (i) upgradation corridors for a length of 644.05 km, involving the strengthening and upgrading of single/intermediate lane roads to standard 2-lane/ 2-lane-with-paved-shoulders / 4-lanes, and (ii) major maintenance, of the remaining 359.17km. In line with the prioritization exercise, R&BD has selected nine corridors, aggregating to about 394 km in length. The upgradation corridors to be taken up for implementation include thirteen corridors. Out of these, as part of DPR preparation, social safeguard reports have been prepared for 8 corridors. List of project corridors considered under GSHP-II are presented in Table 1-1, Table 1-2 and Table 1-3. M/s LEA Associates South Asia Pvt. Ltd. (LASA) has been selected as Project Preparatory Works Consultant to prepare detailed project reports including HIV/AIDS Prevention Plan (HPP). Table 1-1: Project Corridors (widening and upgradation corridors - DPRs prepared) Length Present Improvement Sl.no Link Name (km) Configuration Options 1 Dabhoi – Bodeli 38.60 2L 2L+PS+HS 2 Dhandhuka - Dholera 27.00 IL 2L+HS 3 Atkot – Gondal 35.55 NTL 2L+HS 4 Mehsana-Himatnagar 60.70 2L/2L+PS 4L+HS+Drain 5 Umreth- Vasad (incl. Ladvel -Kapadvanj) 41.91 2L 2L+PS+HS & 4L+FP+CD 6 Bayad – Lunawada 44.86 IL, SL/2L 2L+HS 7 Dhansura – Meghraj 43.05 SL, IL 2L+HS 8 Lunawada – Khedapa 56.70 2L/SL 2L+HS SL – single lane, 2L – two lane, IL – intermediate lane, NTL – narrow two lane, 4L – four lane, PS – paved shoulders, HS – hard shoulders, FP+CD – footpath with closed drain Table 1-2: Project Corridors (widening and upgradation corridors - DPRs to be prepared) Length Present Improvement Sl.no Link Name (km) Configuration Options 1 Bagodara - Bhavnagar 129.30 2L 4L 2 Jamnagar – Mewasa (Link to Bhavad- 68.20 IL, SL/2L 2L+HS Jamjodhpur) 3 Tarapur - Anand 34.60 2L 2L+PS 4 Kheda - Nadiad 29.70 2L 2L+PS 5 Kapadwanj - Balasinor 29.45 2L 2L+PS SL – single lane, 2L – two lane, IL – intermediate lane, NTL – narrow two lane, 4L – four lane, PS – paved shoulders, HS – hard shoulders, FP+CD – footpath with closed drain 1-1 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 1-3: Project Corridors (Maintenance Corridors) Sl.no GSHP-II Maintenance Corridors Length(km) District 1. Paliyad-Dhandhuka (DPR Corridor) 46.00 Ahmedabad 2. Palanpur – Danta 36.00 Banas kantha 3. Atkot-Paliyad 22.25 Rajkot,Bhavnagar 4. Tharad – Deesa 54.89 Banas Kantha 5. Chanasma – Deesa 45.05 Patan 6. Vallabhipur-Rangola 26.60 Bhavnagar 7. Viramgam–Nandasan 51.85 Mehsana,Ahmedabad 8. Pardi – Dixal 67.40 Valsad 9. Bechraji-Chanasma 29.00 Patan,Mehsana 10. Karjan – Borsad (Partly under RMC) 55.15 Anand,Vadodara 11. Savar Kundla – Dhasa 70.30 Amreli,Bhavnagar 2. It has been proved that infrastructure development project such as highways project will have positive impacts on development and economic growth, but there are some adverse implications among the truckers, road users and local communities who are at risk as far as the vulnerability to HIV/AIDS is concerned. The high risk activities related to unsafe sex are common along the highways. The truck parking areas, bus terminals, rest areas, road side eateries along the corridors are predominant meeting places for sex workers and their clients, mostly trucker community. Apart from trucker community, another most vulnerable group is the construction workers and migrant workers. 3. HPP assesses and addresses the pertinent issues with respect to the mobility pattern of high- risk groups (HRGs) and bridge population (refer para 4 for details) and analyses the potential risk factors on the local communities. HPP also suggests for appropriate mitigation measures and institutional arrangements for the sustainable delivery of project benefits to community. Data from various sources were collected and consultations with identified stakeholders were carried out in all the project corridors and this report presents a comprehensive prevention plan and strategic action plan. 1.2 NEED FOR PREPARATION OF HIV/AIDS PREVENTION PLAN 4. Bridge populations are among the most vulnerable population in the context of HIV infection. They are those people who comprise truckers and migrant population, through close proximity to high risk groups [female sex workers (FSWs) and male having sex with male (MSMs)], who are at a higher risk of contracting HIV. They are also clients or partners of male and female sex workers. Large number of migrant labourers works in various sectors across the Gujarat State. Due to the typical character of “mobility with HIVâ€?, the bridge population are considered to be the critical group and becomes the core part of any type of intervention designed to combat HIV/AIDS. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non-regular partners. Further, inadequate access to treatment for sexually transmitted infections aggravates the risk of contracting and transmitting the virus. 5. As per the findings of past studies on nature and modes of transmission of HIV particularly in transport sector, it has been proved that the linkages vis-à-vis prevalence of HIV/AIDS. Although HIV prevalence rate has come down over the period of time, still some areas are showing high prevalence as per ANC Sentinel surveillance survey. HPP has considered the following linkages between the prevalence of HIV and road sector. 1-2 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ï‚· Approximately 36 percent of truckers1 are clients of sex workers and 15-20 percent 2 of clients appear to be truck drivers. ï‚· Surveillance studies indicate that the prevalence of HIV among truckers in general may be more than 10 times higher than in the general population (7.4 percent among truckers as compared to 0.7 percent with the general population); ï‚· The National BSS of 1999 reveals that high risk sexual contacts during transit (87 percent) and poor condom usage among truckers, making vulnerable to sexually transmitted infections (STI) and HIV/AIDS; ï‚· Various influencing factors which make truck drivers vulnerable to HIV/AIDS, such as stress, consumption of alcohol and drugs, staying away from family for longer period, easily accessible to sex networks operate along the highways and halt points; ï‚· Inconsistent usage of condom and lacking of early treatment seeking behaviour are common phenomenon; ï‚· Lack of awareness and capacity building among the bridge population and the representing organizations respectively elevates the spread effect of HIV; ï‚· In view of the tedious and continuous working hours leading to consumption of alcohol and drug use, the truckers are more likely to engage in unprotected sexual encounters with casual partners and sex workers; ï‚· Single male migrant populations are very large and diverse. The pro-development scenario of Gujarat offers plenty of employment opportunities in the industries and construction sector thereby resulting in a huge influx of temporary and permanent migrants elsewhere India. ï‚· A large number of migrants who come for construction work prefer to have sexual outlets with non- regular partners as they are away from home and many of them are single male migrants. 1.3 HIV /AIDS PREVENTION PLAN – TARGET AND OBJECTIVES 6. Combating HIV/AIDS in the project locale with a definite prevention strategy during the project period (design stage, pre-construction, construction and post-construction stage), focusing on truckers, migrants, construction workers and local communities. The specific objectives are, ï‚· To ensure that development initiatives make positive contribution to HIV/AIDS prevention ï‚· To involve various stakeholders including government agencies, road-user groups and community in a participatory process during all stages of project planning and implementation ï‚· To provide specific measures to improve the quality of life of affected population, high risk groups and other direct and indirect stakeholders ï‚· To evolve sustainable intervention strategies that will have positive impact on the living standards of local communities. 1.4 APPROACH AND METHODOLOGY 7. Participatory approach is adopted for the preparation of HPP. To achieve the objectives, various methods are followed for situation assessment, collection of information, etc. 8. Reconnaissance visit: All the ten project corridors have been visited with the objectives of framing a survey plan for detailed data collection and situation assessment. The visit has identified major transport nodes, industrial hubs, construction sites, health-care service centres, etc. 1 Healthy Highways Behaviour Surveillance Survey (BSS), I Round 2000 2 National BSS among clients of sex workers. 1-3 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 9. Coordinated effort and institutional survey: Rapport has been established with Gujarat State AIDS Control Society (GSACS) and Ahmadabad Municipal Corporation AIDS Control Society (AMCACS), Transport Corporation of India Foundation (TCIF), etc. Information regarding preparation of comprehensive HIV/AIDS Prevention Plan for the selected project corridors has been shared. Appraising the rationale of HPP for the highway development, various stakeholders at state level and at regional level has offered cooperation for materializing the objectives. As a first step, the contact details and preliminary information regarding corridor-specific and local level interventions are obtained. This has enabled the environment for the collection of local-specific data on HRGs, activity places, hotspot networks, NGOs, sex workers and other stakeholders. 10. Secondary sources of information: National AIDS Control Organisation (NACO) at the national level and GSACS along with intervention NGOs formed the basis for secondary sources of information. Content analysis of secondary data are carried out and correlated with the primary data collected through focus group discussions, individual interviews and consultations. 11. Focus Group Discussions: discussions at various levels are carried out with NGO Personnel functioning in respective villages along the project corridor. Discussions are also held with HRGs in view of assessing the scenario of HIV/AIDS and its potential spread effect concomitant with the development of the highway. 12. Individual Interviews: interviews with NGO Personnel and HRGs are done to appraise the location specific vulnerability factors. The behaviour pattern of population and the socio-economic profile are assessed based on individual interviews. The questionnaire used for collecting information from truckers is presented in Appendix-1.1. Interviews with ICTC Counsellors helped in obtaining number of HIV positive cases and also the case by case background information. 13. Consultation with key Stakeholders: The Industry Personnel, NGO Partners and Medical and Health Institute Personnel are consulted to assess the scenario of HIV/AIDS along the project corridors. The migrant pattern of workers, influx of truckers, duration of truck-halt and information on hotspots are obtained through consultation with key stakeholders. 14. Telephonic Interview and Discussions: contact details are collected during the site visit and primary data collection. Some of the information obtained from respective sources has been cross analyzed through telephonic interviews and discussions. 1.5 REPORT STRUCTURE 15. Introduction: Introductory chapter deals with project background information, corridor details, need for HPP and the methodology used for preparing the HPP. 16. Assessment of HIV/AIDS in Gujarat: The chapter is based largely on secondary source of data regarding ongoing programmes and focus areas of GSACS and AMCACS. The key stakeholders in the sector are given in this chapter. Apart from a brief review of various operational guidelines developed by NACO, the key issues derived out of the analysis have been summarised. 17. Appraisal of Project Location: The chapter gives in detail the result of situation assessment carried out along the corridor. Information on identified hotspots, vulnerability features, availability of health care services, NGOs functioning in the area of HIV/AIDS and the social dynamics related to HRGs and their network has been given. 1-4 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 18. Intervention Strategy and Action Plan: The chapter presents the strategy for the implementation of HPP and explains the institutional framework and roles and responsibilities of NGOs proposed for the implementation. The strategic action plan in areas of Information Education Communication (IEC), Behaviour Change Communication (BCC), care and support, awareness programmes at construction sites and creation of an enabling environment, are discussed in this chapter. 1-5 2 HIV/AIDS SCENARIO IN GUJARAT 2.1 NACO ESTIMATES 19. The NACO estimated about 1.36 lakh people have HIV infection in Gujarat. The HIV prevalence was more than 1 percent among Anti Natal Clinic (ANC) attendees (proxy of general population). Six districts (Banaskantha, Dahod, Mehsana, Navsari, Surat and Surendranagar) are Category-A and four districts (Ahmedabad, Bhavnagar, Rajkot and Vadodora) are Category-B, as per the sentinel surveillance survey of NACO. The project corridors traverse one district of Category-A and all four districts of Category-B. 20. According to the National AIDS Control Organization (NACO), the HIV incidence increased in Gujarat state where as the prevalence rate was low in the last couple of years. The estimated adult HIV prevalence in the state is 0.37 percent which is higher than the national prevalence of 0.31 percent. 21. Progressive industrialization and resultant migration, especially of single-male migrants (both intra and interstate) in the textiles and infrastructure development sector, has increased the risk of HIV infection. 22. About 7 percent of FSWs are HIV positive and near about 8 percent of MSMs is HIV positive. FSWs are scattered and home-based and hence the reach of target interventions is constrained. There is a five-fold increase in the risk-behaviour of clients of sex workers in Surat, Vadodora and Rajkot districts. 2.1.1 Districts and Categorization of Vulnerability 23. The overall HIV prevalence at National Level among different population groups in 2008-09 continues to portray the concentrated epidemic in India, with a very high prevalence among High Risk Groups – Intravenous Drug Users (IDU) (9.2%), MSM (7.3%), FSW (4.9%) and low prevalence among Anti Natal Care (ANC) clinic attendees (0.49%). 24. The NACO estimated about 1.36 lakh people have HIV infection in Gujarat. HIV prevalence was > 1% among ANC clinic attendees (proxy of general population) in 6 districts viz; Banaskantha, Dahod, Mehsana, Navsari, Surat and Surendranagar, has been considered as Category-A (high prevalence). While, districts such as Ahmedabad, Bhavnagar, Rajkot and Vadodora have been categorized as B (moderate prevalence) and the remaining districts have low prevalence. Table 2-1: HIV Prevalence: Categorisation of Districts in Gujarat District Category No of NGOs working for Target Intervention (TI) for S. No Name of District A,B,C,D vulnerable groups. 1 Banaskanta A 2 NGOs - Core composite 2 Dahod A 1 NGO – Core composite 3 Mehsana A 2 NGO – Core composite 4 Navsari A 1 NGO – Core composite NGOs 25 [ Migrants-9, FSW-5,MSM-5, Truckers-1, IDU-1, 5 Surat A Core - 5- 6 Surendranagar A 2 NGOs- Core composite 20 NGOs -Ahmedabad - 2 NGOs ; AMCACS - 19 NGOs 7 Ahmedabad B working in Ahmedabad municipal areas Core composite, MSM, FSW, Migrants, Truckers 8 Bhavnagar B 8 NGOs [ Core composite-1, MSM-4,FSW-2, Migrants-1 2-1 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN S. No Name of District District Category No of NGOs working for Target Intervention (TI) for 9 Rajkot B vulnerable 1- NGO ( Truckers)- FSW, MSM,groups. Core composite 10 Vadodora B 8 NGOs [ Core composite-1, MSM-4,FSW-2, Migrants-1 11 Amreli C 2 NGOs – Core composite 12 Anand C 2 NGOs – Core composite 13 Bharuch C 1 NGO – Migrants 14 Dang - - 15 Kachchh C 5 NGOs - Core composite, Migrant and Truckers 16 Narmada C 1 NGO - Core Composite 17 Panchmahal C 2 NGOs- Core composite and Migrants 18 Patan C 2 NGOs – Core composite 19 Sabarkantha C 2 NGOs – Core composite and IDUs 20 Gandhinagar D 1 NGO – Core composite 21 Jamnagar D 7 NGOs - Core composite, MSM, FSW, Migrants, Truckers 22 Junagadh D 3 NGOs – Core composite, FSW and MSM 23 Kheda D 1 NGO – Core composite 24 Porbandar D 1 NGO – Core composite 25 Valsad D 4 NGOs - Core composite, MSM, FSW, Migrants, Truckers Category A: More than1% ANC prevalence in district in any of the sites in the last 3 years Category B: Less than 1% ANC prevalence in all sites during the last 3 years with more than 5% prevalence in any HRG site (STI/FSW/MSM/IDU) Category C: Less than 1% ANV prevalence in all sites during the last 3 years with less than 5% in all HRG sites, with known hotspots (migrants, truckers, large aggregation of factory workers etc) Category D: Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites with no known hotspots or no or poor HIV date. ANC – Ante-natal clinic ; HRG – High Risk Group; STI – Sexually Transmitted infections; FSW – Female sex workers; MSM – Men who have sex with men ; IDU – Injecting Drug User Source: GSACS, 2011 2.2 ONGOING PROGRAMS ON HIV/AIDS IN GUJARAT 2.2.1 Target Intervention for Bridge Population 25. Target Intervention for Bridge Population (Truckers and Migrant community): GSACS and AMCACS have implemented 28 projects for migrants and 7 projects for truckers in the state through NGOs. Apart from government funding, two more projects are being implemented under Public Private Partnership (PPP) model with the support of Apollo Tyres. 26. With regard to migrants intervention, the projects are concentrated in urban and semi urban areas where migrant community largely present. Targeted intervention projects for migrant community are being implemented by NGOs in Surat, Ahmedabad, Jamnagar, Rajkot and Bhavnagar districts. 27. Truckers Interventions, through NGOs, are being implemented in major Transhipments locations in Kutch (Gandhidham), Jamnagar (Moti Khavadi), Rajkot (RUDA, Marketing Yard Area), Surat (Hazira & Ambuja Cement company site), Valsad (VAPI near GIDC NH 8), Ahmedabad (Narol, Sarkhej and Aslali Transport Nagar). Truckers intervention, by and large, are functional in transhipment locations, covering about 5 Kms radius of the location. 2.2.2 Initiatives of NACO / GSACS in Gujarat 28. GSACS is implementing the intervention programme, under the guidelines of NACO III. The goal of NACP III is to “halt and reverse the epidemic in Indiaâ€? over the period of 5 years (2007-2012). GSACS is directly working through NGOs to reach out the core groups of female sex workers, MSM and IDUs in the states. And also, the bridge population such as truckers and migrants are targeted 2-2 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN with set of strategies. In addition, Ahmedabad Municipal corporation AIDS control society (AMCACS), also carrying out intervention programme through NGOs in Municipal corporation limits. 29. Drop-in-Centre (DIC): Runs at 16 centers at Ahmedabad (3), Surat (3), Palanpur, Mehsana, Kutch, Surendranagar, Dahod, Vadodara, Bhavnagar, Rajkot, Jamnagar and Navsari with positive network and catering to the needs of positive people. 30. Link Worker Scheme (LWS): This scheme has been established in 11 districts (Navsari, Surendranagar, Dahod, Banaskantha, Ahmedabad, Rajkot, Bhavnagar and Mehsana under Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Round – VII. With the support of CARITAS - INDIA and UNICEF, the LWS has been established in Surat, Vadodara and Valsad respectively. LWS facilitated the scattered the high risk group (HRG) of rural areas and involves youth and women in the villages to generate awareness and linkages with services. 31. Details of various programmes and initiatives of NACO have been given in Appendix 2.1. Various Schemes implemented by Government of Gujarat for PLHA & CLHA ï‚· Project Jatan- Travel assistance is extended to PLHA and their dependents while they go for treatment in the state. ï‚· PLHA families belong to the category of Below Poverty Line (BPL) are eligible to avail the service of Antyodaya Anna Yojana through Food & Civil Supply Department. ï‚· Rs. 500/- month is paid to PLHAs who fall in the category of Socially and Economically Backward Class (SEBC) and avail Nutritional Support under Medical Aid help scheme from Social Justice & Empowerment Department ï‚· Widow Pension- All BPL widow eligible for Rs. 500/- Month and Rs. 80/- Month per child up to 18 years of age (up to 2 children through S.J. & E. Department). Agencies working with GSACS help in identifying such women for the assistance. ï‚· Education scholarship to infected and orphan or destitute children of HIV +ve parents is implemented by S. J. & E. Department ï‚· Office order issued to all Govt. Schools to sanction special leave to Children Living with HIV/AIDS (CLHA) for Anti-Retroviral Therapy (ART) and to ensure no discrimination should take place. ï‚· Two orphanage homes established at Gandhinagar and Surat for HIV infected children run by S. J. & E Department ï‚· Allocate time to representative of Gujarat State Network of People Living with HIV/AIDS (GSNP+) for sensitizing on HIV in Boards/Corporations/Head of Department (HOD) meetings. ï‚· Rs.1000/month under Mata Pita Scheme is paid to people who adopt HIV positive orphans. The scope of this scheme has been extended to entire state. ï‚· Government of Gujarat provides with cash incentive of Rs. 1000/- for institutional delivery of those HIV positive pregnant women. 2.2.3 Other key initiatives in the sector 2.2.3.1 Status of TSU, TSG and SMO 32. Through NACO support, Technical Support Units (TSUs), Technical Support Groups (TSGs) and Social Marketing Organization (SMO) are existed in many states of India. These agencies play major role in HIV/AIDS prevention, Care and Support programmes, focusing on quality of services, effective monitoring & capacity building aspects. 2-3 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 33. In the state of Gujarat, the TSU is not in functional mode for the technical monitoring, support and capacity building of NGOs since 2008. 34. Centre for Operations Research & Training (CORT) was considered as State Technical Resource Centre (STRC) by NACO. CORT provides capacity building and training support to core composite (FSWs, MSMs & IDUs) for targeted Intervention projects. While, supportive monitoring at field level is carried out by TI supervisors of GSACS. 35. In June 2010, DKT was chosen as SMO by NACO for supplying condoms at reasonable rate to community and also carry out condom related awareness programme across the state. However, DKT is not in functional since July 2011. 36. Transport Corporation of India Foundation (TCIF) was considered as Truckers’ TSG by NACO. TCIF provides technical inputs for monitoring, capacity building and handholding supports to truckers targeted Interventions in seven transhipment locations in the state. 2.2.3.2 Global Fund for HIV AIDS, TB and Malaria-Link Workers Scheme (Round 7) 37. Link Workers Scheme (LWS) under the round 7 of Global Funds are functional in Gujarat state. In partnership with NACO and GSACS, Caritas India (CI), a leading NGO has implemented LWS project that aims to address the high risk population in the rural areas as well as the young people at 5 districts of Gujarat namely Dahod, Navsari, Banaskantha, Surendranagar and Mehsana. 2.2.3.3 Corporate Social Responsibility (CSR) Initiatives 38. Well known corporate groups such as Reliance, ESSAR, Ambuja Cement Foundation & Apollo Tyres have been working on various activities such as Behaviour Change Communication, IEC, Condom Promotion, Service Delivery & Care and Support components at their industrial corridors. 2.3 OVERVIEW OF KEY STAKEHOLDERS 39. National and State Level Functionaries: Gujarat has taken a progressive step in availing the services of various institutions and development agents in the field of HIV/AIDS preventions. In the implementation of NACP-III, the guidelines of NACO have been successfully coordinated by GSACS and AMCACS. Any intervention, either mainstreaming or target intervention shall integrate its objectives or strategies within the established framework of these state level agencies. Some of the government agencies to be part of any interaction with respect to HPP include, a. Department of Health and Family Welfare b. Department of Women and Child Development c. Department of Tribal Development d. Department of Transport e. Gujarat State Road Development Corporation 40. Non-Governmental Sector: NGOs and ICTCs have been taking up prominent role and function as an authentic supporter to the state-level government functionaries. The service of non- government sector cannot be ignored in the context of HIV/AIDS interventions in the state. Interactions with NGOs at project locations help in bringing out the real prevalence rate and suggest measures for right kind of intervention. The identified agencies in this sector includes: 2-4 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN a. Caritas India b. UNICEF c. TI NGOs funded by GSACS and other NGOs and Corporate Bodies 41. Corporate Sector: The involvement corporate bodies like Reliance, ESSAR, Appolo Tyres, Ambuja Cement, etc in social development of Gujarat is an emulative model for other states. The corporate social responsibility wing has done genuine works in the field of HIV/AIDS prevention in the state. Apart from the corporate bodies involve in the sector, the following development partners could be included in the overall planning. a. Transporters and Brokers Association b. R&BD empanelled Contractors 2.4 APPRAISAL OF THE POLICY FRAMEWORKS 2.4.1 Operational guidelines by NACO 42. NACO has developed operational guidelines for various target groups including core population, bridge population, health-service providers, condom social marketing organizations, NGOs etc. A review of operational guidelines has been carried out to appraise and evolve suitable intervention strategies and also as a guideline for collecting project specific information. The brief overview of some operational guidelines relevant in the context of roads and transport sector is given. Operational Guideline for Targeted Intervention for Truckers 43. NACP-III has prioritized HIV/AIDS prevention among truckers as one of the key components as far as the imperative strategy to reduce the sexual transmission of HIV and its adverse impacts are concerned. The purpose of these guidelines is to ensure delivery of quality HIV prevention interventions to the trucker population in India. The guidelines outline standardized operating procedures for implementing comprehensive HIV prevention services for the trucker population on a national scale. 44. The operational guideline gives specific strategies to be followed in the target interventions addressing truckers. It also gives the guidelines for NGOs who are involved with trucker community. Operational Guideline for Targeted Intervention for Migrants 45. Appreciating the migration as an important source of HIV-related vulnerability is the operation guideline elucidates the strategy to be adopted in addressing the migrant population with a gender sensitization approach. The male migrants and female migrant population are to be addressed with unique intervention packages of outreach and communication, condom promotion services, creating enabling environment and community mobilization. The guideline gives details about appropriate ways of mapping of migrant population and evolving designs for linking programmes. Operational Guideline for Core High Risk Groups 46. The operational guideline for core HRGs identifies the place of activity (street-based, lodge- based, home-based, brothel-based, dhaba-based etc) as a major indicator for target interventions. The guideline also advocates for participation of HRGs in designing and operation of TIs. The recruiting, 2-5 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN capacity building and programme management of NGOs/CBOs or other networks to implement TIs has been detailed out in the guideline. 2.5 KEY ISSUES IN THE SECTOR 47. Out of 25 districts in Gujarat, 6 districts (Banaskantha, Dahod, Mehsana, Navasari, Surat and Surendranagar) are high prevalence districts and falls under Category-A. 48. The prevalence rate among adult population is estimated to be 0.37 percent which is higher than the national prevalence of 0.31 percent. 49. There is high influx of migrants to the industries of rural and urban Gujarat. The migrants are reportedly single-males with a potential of engaging in unprotected sex with non-regular partners. 50. High risk behaviour of clients of sex workers has increased by 5 times and the MSMs are the most vulnerable in this category. This scenario is worse in districts like Surat, Vadodara and Rajkot. 51. TIs in general have more focus on urban and semi-urban locations. There is pertinent requirement of focused and strategic intervention in rural Gujarat and also in the road and transport sector in view of the high percentage of bridge population. Inadequacy of quality NGOs also observed as a constraint in reaching to the rural population in an effective manner. 52. The existing intervention in the 8 major transhipment locations majorly focuses on immediate geographic vicinity and covers generally long-distance truckers. However, the high risk behaviour pattern among short-distance truckers, migrant population and tribal communities are addressed in a limited manner. 53. Corporate social responsibility based interventions from major Industrial firms though addresses the HIV/AIDS related issues in an effective manner, the reach of such programmes are limited and too focused. Apart from the major players, there are significant numbers of industrial units who invites migrants as employees. The risky environment emerged from such huge influx is often not addressed properly by such industrial units. There is enough scope for intervention addressing behaviour pattern of bridge population. 2-6 3 APPRAISAL OF PROJECT LOCATION 3.1 IDENTIFICATION OF HOTSPOTS, HEALTH CARE CENTRES 54. The major hotspots, healthcare centres, intervention areas of NGOs and major industrial areas along the project corridors have been identified. The information has been gathered for project corridors. There are 16 hotspots identified along the corridors. The categorization of hotspots is based on the discussion with NGOs, ICTC Counsellors and discussion with trucker community. Three corridors are part of target interventions by local NGOs funded by GSACS. In Dabhoi-Bodeli and Dhandhuka-Paliyad corridors have prominent hotspots, NGO intervention is absent. Health care services are present in all the studied corridors (Table 3-1). The corridor-specific information is also given in corridor-maps. Table 3-1: Identified Hotspots, Health Care Centres, NGO Intervention Areas and Major Industrial Areas: Present Scenario NGO Major Health care Sl.No Project Location/Corridor Hotspots Intervention Industrial services Areas Areas 1. Dabhoi – Bodeli 2 3 1 - 2. Dhandhuka - Dholera 0 4 0 1 3. Atkot - Gondal 2 5 1 1 4. Mehsana – Himatnagar 6 5 2 3 5. Umreth-Vasad (including Ladvel 4 6 3 1 – Kapadvanj) 6. Bayad – Lunawada 0 2 0 0 7. Dhansura – Meghraj 1 3 0 0 8. Dhandhuka-Paliyad 1 5 0 2 9. Lunawada – Khedapa 0 3 0 0 Total 16 36 7 8 Source: LASA, 2012 (reconnaissance visit and consultations) 3-1 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-1: Situation Assessment: Dabhoi-Bodeli Corridor 3-2 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-2: Situation Assessment: Dhandhuka-Dholera Corridor 3-3 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-3: Situation Assessment: Atkot – Gondal Corridor 3-4 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-4: Situation Assessment: Mehsana-Himatnagar Corridor 3-5 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-5: Situation Assessment: Umreth-Vasad Corridor 3-6 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-6: Situation Assessment: Ladvel-Kapadavanj Corridor 3-7 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-7: Situation Assessment: Bayad - Lunawada Corridor 3-8 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-8: Situation Assessment: Dhansura - Meghraj Corridor 3-9 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-9: Situation Assessment: Lunawada - Khedapa Corridor 3-10 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 3-10: Situation Assessment: Dhandhuka-Paliyad Corridor 3-11 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.2 VULNERABILITY ALONG THE CORRIDORS 55. Dabhoi – Bodeli corridor: There are considerable number of HRGs and HIV positive people identified by the intervention NGOs and ICTCs. HRG activities are taken place mainly in Dabhoi Town and few places of corridor’s Block villages. Gola Gamdi village of Sankheda block is starting point of a tribal block. Table 3-2: Vulnerability features: Dabhoi – Bodeli Corridor Villages Total Population in District Taluka Villages HRGs Presence HIV +ve Villages VADODARA DABHOI Simaliya 2875 Gopalpura 449 Akotadar 1103 Pansoli 1976 Timbi 898 Morpura 451 Dabhoi 54952 27 FSWs + 19 32 (10 Female + 22 MSMs Male) (data from 2009 to till date) Tarsana 1024 2 (2010-’11) Nada 2131 SANKHEDA Sankheda 7 FSWs + 5 MSMs Kherva 363 Zankharpura 1243 Salpura 336 Bamroli 1646 Garol 624 Bodeli 10490 Patna 748 Pitha 934 1 FSW Kundi Tappe 376 1 FSW Bahada Dormar 784 Suryaghoda 1652 2 MSMs Jojva 381 Bhadrali 820 Bhulvan 1106 Lotiya 776 Ali Kherva 6248 2 MSM + 7 FSW 2 Female Gola Gamdi 1889 Kunteshwar 1468 Manjrol 2728 Source: HRGs’ details from NGO Vikalp Woman's Group. Number of HIV +ve details of last two years (2010 & ’11) from Dabhoi & S ankheda CHCs’ ICTC of Vadodara District 56. Dhandhuka – Dholera corridor: There are cases of HIV positives reported in Dhandhuka town. Out-migration of labourers is found to be high in this region and the vulnerability among female is observed to be high. NGO intervention is absent in the region. Table 3-3: Vulnerability features: Dhandhuka-Dholera Corridor Villages Total Population in HRGs District Taluka Villages HIV +ve Villages Presence Dhandhuka 15 (10 Male + 5 Female) AHMEDABAD DHANDHUKA 29572 - Town Taluka Level Kothadiya 845 - - Rojka 2950 - - Bhadiyad 2630 - - Dholera 2637 - - Source: Number of HIV +ve details of last two years (2010 & ’11) from Dhandhuka CHC 3-12 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 57. Atkot – Gondal corridor: about 2/3 of the worker population occupied in the construction/manufacturing firms located along the corridor are single male migrants. LWS of Caritas India has been functioning in the villages for the last 15 months. Table 3-4: Vulnerability features: Gondal – Atkot Corridor Villages Total District Taluka Villages Population in HRGs Presence HIV +ve Villages RAJKOT JASDAN Jasdan Town 238 MSMs, 59 FSWs, 3 FSWs, 2 MSMs, 5 1M + 1 OVC = 2 Virnagar LDTs, 170 Out 5407 Migration Kharachiya Jam 2135 Ishvariya 1503 GONDAL Gondal city 96016 175 MSMs, 237 FSWs 6 FSWs, 4 MSMs, 4 3M + 2 F = 5 Dadva Hamirpara 8135 LDTs, 552 Out Migration 10 FSWs, 5 MSMs, 6 2M + 1F = 3 Ghoghavadar LDTs, 386 Out 3511 Migration Rupavati 1319 4 FSWs, 3 MSMs, 3 2M + 1 F + 1F OVC KOTADA LDTs, 485 Out =4 SANGANI Kotda Sangani Migration, Nana Mandava 1277 Pipaliya Karmal 537 3 FSWs, 2 MSMs, 2 1M + 1F = 2 LDTs, 518 Out Ramod 4685 Migration Vadipara 1284 Source: Number of HRGs and HIV +ve details from Caritas India (Link Worker Scheme) & Saurastra Gramin Vikas charitable Trust 58. Mehsana – Himatnagar corridor: Presence of HRGs and HIV positive people indicate that focused intervention are required throughout the corridor. The movement of migrant labourers, especially single male migrants in view of the large number of small scale industrial units indicates the need of intervention. Apart from the urban settlements situated in the beginning and ending point of the corridor, the semi-urban and rural stretches like Visnagar and Vijapur has also high presence of HRGs. Table 3-5: Vulnerability features: Mehsana - Himatnagar Corridor Villages Total HRGs District Taluka Villages Population in HIV +ve Presence Villages Mehsana Mehsana 300 FSWs + 213 (mehsana city) (136 500 MSMs Male + 77 Females) Heduva 1480 3 MSMs Hanumat Kukas 2640 Rampura 1104 (Kukas) Kadvasan 1527 Devrasan 3182 2 MSMs Visnagar 120 FSWs & 43 (27 M + 16 F) 120 MSMs Gunjala 1694 Udalpur 4040 2 Kamalpur 1870 (Kharavad GANDHINAGAR MANSA Vihar 3493 Bilodra 7228 Mehsana VIJAPUR 160 FSWs + 15 (12M + 3 F) 180 MSMs Motipura 1331 17 MSM + 12 Total: 7 to 8 3-13 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Total HRGs District Taluka Villages Population in HIV +ve Presence Villages FSW Vijapur(Rural) 10161 Devpura 2190 Vijapur 3096 Pilvai 7925 18 MSMs 2 Khanusa 4014 Dabhala 8354 50 LDTs 5 Kukarvada 12700 Vasai 12102 25 LDTs Kotdi 3215 22 MSM + 18 Total: 10 to 12 FSW Sabarkantha Himatnagar 250 FSWs + Total: 33 (18M + 15F) 200 MSMs Data: Himatnagar city area, year: 2010 & ‘11 Parabada 5069 Dhandha 869 1M Savgadh 5923 Lalpur 906 (Savgadh) Dedhrota 3012 10 (5M + 5M) Derol 2833 8 (5M + 3F) Navanagar 643 Source: HRGs’ details from 2 NGOs. 1. Young Citizens of India Charitable Trust, Mehsana. 2. Narottam Lalbhai Rural Developmen t Fund. Himatnagar, Sabarkantha. Number of HIV +ve details of last two years (2010 & ’11) from A. Mahesana & Himmat Nagar Civil Hospitals’ ICTC . B. Udalpur & Vijapur CHCs’ ICTC of Mehsana Block 59. Umreth - Vasad (Including Kapadvanj): The corridor is geographically spread into two parts. Kapadvanj town has 7 HIV positives reported, which shows the potential vulnerability among the community. Presence of NGOs or any target intervention is lacking in the area despite the incidence. Another part of corridor, traversing Umreth (Keda District) and Vasad (Anand district), where presence of HRGs and HIV positives are reported. Table 3-6: Vulnerability features: Umreth Vasad Corridor (Including Kapadvanj) Villages Total District Taluka Villages Population in HRGs Presence HIV +ve Villages KHEDA KAPADVANJ 15 (10M + 5F) of Taluka Kapadvanj 43950 FSWs, MSMs, 17 (11M + 6F) of total Truckers block. 7 (4M + 3F) from local Kapadvanj Town Garod 3723 Rampura 1989 (Sundarvad Sorna 2197 Savali 2465 KATHLAL 5 (3M + 2F) of total Taluka. Lasundra 2465 2 (1M+1F, couple) ANAND 43 (30M + 13F) UMRETH Umreth 32191 23 MSM + 1 FSW 4 (MSMs) Bechari 3322 13 MSM + 3 FSW Navapura 557 Hamidpura 2265 ANAND 207 FSWs, 282 MSMs Ode 18459 4 MSM Khambholaj 8212 Sarsa 14200 7 MSM Vaherakhadi 7045 3-14 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Total District Taluka Villages Population in HRGs Presence HIV +ve Villages Anklavdi 2281 Vasad 12487 Source: HRGs’ details from NGO Acil Navsarjan (Anarde Foundation) Ananad. Number of HIV +ve details of last two years (2010 & ’11) from A. Kapadvanj & Kathlal CHCs & Civil Hospital Nadiad 60. Bayad – Lunawada corridor: There is one CHC located along the corridor and there is no ICTC facility available in this CHC. The ICTC is located at Vatrak, which is around 6 kms away from Bayad. Table 3-7: Vulnerability features: Bayad – Lunawada Corridor Villages Total Population HRGs District Taluka Villages HIV +ve in Villages Presence SABARKANTHA BAYAD 7M + 4F = 11 Demai 8557 2M + 3F = 5 Talod 2336 Lank 2931 Vijayganj 286 Patel-ni-Muvadi 1215 Nagano Math 663 Hathipura 1884 1M Kashiyavat 142 Vajavat 720 KHEDA VIRPUR Tajpur 70 PANCHMAHAL LUNAWADA Hadod 2352 Khantana Bhensadav 434 Undra 5319 2M Pavapur 448 Hardaspur 1020 Lunawada 33369 5M + 3F = 8 Dhamod 1350 Charangam (Salawad 2066 Maliya 399 Lalsar 997 Salawada 833 Juna Kalava 85 Ucharpi 1681 Sadhakpur 558 Tanachhia 176 Untadi 621 Vakhatpur (ko- Maha 677 Kolwan 2819 Source: HIV +ve details from CHCs Lunavada & Vatrak 61. Dhansura – Meghraj corridor: Dhansura taluka place doesn’t have a full fledged ICTC facility. The ICTC facility available at CHC is mainly for ANC testing. The ICTC is established at Vatrak General Hospital, which is located about 10 kms away from Dhansura. The place Vatrak of Bayad Taluka has common ICTC for both Dhansura as well as Bayad town. Modasa – Shamlaji highway (around 30 kms) is the major influencing area for the HRGs and general population pertaining to Dhansura – Meghraj corridor. In the area of Malpur & Meghraj CHC, an NGO – GAP - is functioning for HIV +ve children, ART follow-up, etc. Majority of the truckers own trucks and functions in local district areas. Village Dachka-Billoo of Meghraj taluka has observed major male out migration for employment in Diamond Industry located at Surat. As a trend it’s also observed that educated people of this area also went to Rajasthan for their employment. FSWs of this area are from Laborer and construction workers background. 3-15 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 3-8: Vulnerability features: Dhansura – Meghraj Corridor Villages Total Population District Taluka Villages HRGs Presence HIV +ve in Villages SABARKANTHA DHANSURA Dhansura 12906 4 FSWs 1M + 1F = 2 Gadhada no kot 310 Karanpur 951 Vantda Suka 1911 Bhotudev-no- Math 361 Dhamaniya 1284 Bilvaniya 1744 Barnoli 3337 Sardi Sarkhandi 860 10 FSWs, 3 MALPUR Malpur 6512 MSMs Parsoda 1740 Hamirpur 161 Nanavada 1251 4 FSWs Sompur 424 1 FSW Kasvada 714 Medi Timba 311 Sonikpur 237 Vavdi 1625 1M Maljina Pahadiya 520 Juna Takhatpur 255 Satarda 3256 2 FSWs Bhempur 250 1 FSW Rasapur 404 Laljina Pahadiya 726 3 FSWs Surana Pahadiya 243 3 FSWs Aniyor 2937 Dodiya 1005 MEGHRAJ Iploda 1257 Kamroda 666 Jashvantpura 165 Vasna 517 Meghraj 9902 25 FSWs Prathipura 181 Source: Number of HRGs details from Seva Sangh Sarvajanik Hospital Trust, Modasa. HIV +ve details from CHCs Malpur & Meghraj 62. Lunawada – Khedapa corridor: The corridor from Lunawada to Santrampur is tribal dominated area. Out migration is observed from interior villages of the block. At Santrampur CHC total 18 (8M + 7F +3 Child) HIV positives have been detected during the last two years (2010 & ’11) from entire taluka places. No NGO intervention project on HIV/AIDS has presence in the area of corridor villages. No truck movement was observed on the corridor. Table 3-9: Vulnerability features: Lunawada – Khedapa Corridor Villages Total Population in HRGs District Taluka Villages HIV +ve Villages Presence PANCHMAHAL LUNAWADA Lunawada 33369 Ukedi 1324 Godna Muvada 601 Pankhi 253 1F Jesingpur 288 SANTRAMPUR Khedaya Alias Prat 7103 Simaliya 6103 Batakwada 7453 1M Ukhreli 4184 Dotawada 249 Sangawada 758 Santrampur 15777 2M Kunda 1049 Malanpur 783 1F + 1M = 2 3-16 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Total Population in HRGs District Taluka Villages HIV +ve Villages Presence Lalakpur 604 Ranijini Padedi 1978 Hadani Sarsan 631 Moti Sarsan 1023 Nani Sarsan 702 Bhandara 722 Godhar (West) 1581 Dhamotna Moyla 1081 Kanbina Moyla 160 Manchod 2000 Rafai 292 Barela 724 Motikharsoli 533 Ranani saran 536 Bahediya 173 KADANA Dahyapur 792 Source: HIV +ve details from CHCs Lunavada & Santrampur 63. Dhandhuka – Paliyad corridor: This corridor also starts from Dhandhuka 3. Major reasons for HIV positivity in Paliyad are reported among migrant population and long-distance Truckers. Table 3-10: Vulnerability features: Dhandhuka-Paliyad Corridor Villages Total District Taluka Villages Population in HRGs Presence HIV +ve Villages 15 (10 Male + 5 Ahmedabad DHANDHUKA Dhandhuka 29572 Female) Taluka Level Kotda 2703 Gunjar 2153 Morasiya 440 Vagad 1980 Ranpur Devaliya 2691 Ranpur 14486 Patna 195 Bodiya 1615 Kinara 743 Baraniya 1636 Alampur 2746 Rajpura 1762 Umrala 4163 Bhavnagar Botad Bodi 2261 Sankardi 601 16 (10 Male + 6 Paliyad 9278 Female) Babarkot 984 Source: Number of HIV +ve details of last two years (2010 & ’11) from Dhandhuka & Paliyad CHCs 3.3 TARGET INTERVENTIONS AND HEALTH SERVICES 64. Adequate numbers of Community Health Service (CHC) centres, Primary Health Service (PHC) centres and village based Sub Centres (SC) established by Health & Family Welfare Department, Govt. of Gujarat are functioning, along the project corridors. ICTC established by GSACS, are found at all the CHCs pertaining to the corridors. ART centres established by GSACS are also available at major cities like Mehsana and Himatnagar. Major health care centres and NGO based TIs identified along the project corridors are presented in Table 3-11 to Table 3-17. 3 Dhandhuka is the starting point of two Corridors, Dhandhuka-Dholera and Dhandhuka-Paliyad. 3-17 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 3-11: Health Service Centres and Target Intervention: Dabhoi-Bodeli Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services 4 5 6 Dabhoi – Bodeli Vadodra SH 011 Vega Junction Taluka Hospital (near Dabhoi) Pansolai Mobile health Sankeda Taluka Taluka hospital Bodeli CHC Gola Gamdi CHC Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-12: Health Service Centres and Target Intervention: Dhanduka-Dholera Corridor Name of villages / VCTC/ CHC / HIV/AIDS Route District SH No Towns ART services intervention Dhanduka - Ahmedabad SH- Dhandhuka CHC – Taluka Dholera 001 hospital Bhadiyad PHC Dholera PHC Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-13: Health Service Centres and Target Intervention: Atkot – Gondal Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services Atkot-Gondal Rajkot SH-001 Gondal CHC/VCTC GSACS – NGO’s Target intervention Kotada Sangani CHC - Ramod PHC - Mota Dadva PHC - Jasdan CHC / VCTC - Source: LASA, 2012 (reconnaissance visit and consultations) 4 Tribal community such as Thadvi, Vasave and Rathva live in Simaliya, Gopalpura, Pansolai and Dadhoi villages of Dabhoi Taluka 5 B Category district – Moderate prevalence 6 Social marketing of condom is being carried out in a shop, which is attached to the petrol bunk, with the support of DKT Company 3-18 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 3-14: Health Service Centres and Target Intervention: Mehsana-Himatnagar Corridor SH Name of villages / VCTC/ CHC / HIV/AIDS Route District No Towns ART services intervention Mehsana – Mehsana7 SH - Palavsaana Mehsana (ART GSACS - NGO Himatnagar 055 centre) intervention Rampura Circle Mehsana 8 Udlalpur Udalpur – ICTC LWS covering about 7 villages 9 Dabhla Vasai Chokadi Vihar Chokadi Pilavi10 Pilavai CHC Vijapur Taluka Hospital GSACS -NGO intervention Sabarkantha Himatnagar Taluka Hospital GSACS -NGO (ART Centre) intervention Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-15: Health Service Centres and Target Intervention: Umreth-Vasad (including Ladvel- Kapadvanj Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services Kapdvanj-Ladvel Kheda SH-151, Kapadavanj CHC SH-83, Lasundra PHC SH-188 CHC GSACS/NGO’s Umreth- Vasad Umreth intervention Anand Bechari Ode CHC Sarsa CHC Vaherakhadi CHC Anklavdi GSACS/NGO’s intervention Vasad CHC GSACS/NGO’s intervention Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-16: Health Service Centres and Target Intervention: Bayad – Lunawada Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services Bayad – Sabarkantha, SH-69, Bayad - - Lunawada Kheda, SH-63 Lunawada CHC/ICTC - Panchmahal VR, Undra PHC - MDR and SH- 63 Source: LASA, 2012 (reconnaissance visit and consultations) 7 A Category - High prevalence district 8 Link Workers Scheme, funded by CARITAS India, INGO 9 Long distance drivers more from this village; few of the truck drivers were found HIV+ as per CHC’s. 10 Industrial hub (Ginning and oil factories) situated from Pilavi – Vijapur. Migrant workers, from Bihar, UP, are employed. Most of them are single male migrant. They stay inside the factory premises. 3-19 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 3-17: Health Service Centres and Target Intervention: Dhansura Megharaj Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services Dhansura – Sabarkantha SH-145 Dhansura CHC / FICTC - Meghraj & Malpur CHC / ICTC - SH-145 Meghraj CHC / ICTC - Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-18: Health Service Centres and Target Intervention: Lunawada – Khedapa Corridor Name of villages / VCTC/ CHC / Route District SH No HIV/AIDS intervention Towns ART services Lunawada – Panchmahal SH-002, Lunawada CHC/VCTC - 11 SH-152 Khedapa Santrampur CHC/VCTC - ( Border) Batakwada PHC Source: LASA, 2012 (reconnaissance visit and consultations) Table 3-19: Health Service Centres and Target Intervention: Dhandhuka-Paliyad Corridor Name of VCTC/ CHC / SH HIV/AIDS Route District villages / ART No intervention Towns services Dhandhuka - Ahmedabad SH- Dhanduka CHC –Taluka Paliyad 001 hospital Vagad PHC Alampur PHC Ranpur CHC –Taluka hospital Devaliya Sub centre Bhavnagar Paliyad CHC –Taluka hospital Source: LASA, 2012 (reconnaissance visit and consultations) 3.4 TRUCK PARKING AREAS, HIGHWAY AMENITIES, REST AREAS 65. Major Truck Parking areas are identified in Himatnagar-Mehsana corridor and Dabhoi-Bodeli corridor. Mehsana city at the starting point and Himatnagar city at the end point of the corridor have truck parking areas. About 150 trucks halt per day near the park area of Janpath Hotel and also near Ramosana circle, Nirma Mandali and Bhagyodaya hotel situated along the Ahmedabad - Mehsana highway connecting Palavasana circle. 66. Within 15km vicinity, an industrial area - Kadi – along the Mehsana to Ahmedabad road is a major truck halt point. The halting time of trucks in the identified parking areas and also within Kadi industrial area is, on average 3hours to 5 hours. The major activities during truck halting are observed to be interactive deals between truckers, transport broker firms, vehicle maintenance and resting. Interaction with HRGs does take place in these truck halt areas as per field observation and also as per the discussions with NGOs. The activities are largely hotel and lodge based and about 25 such activity centres are located within the vicinity of truck halt areas. 11 Khedapa village in Santrampur Taluka has tribal population. 3-20 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 67. Along the Dabhoi-Bodeli corridor, Vega Circle is identified as a truck halting point, with an average halting size of 15 trucks during night hours. The accessibility to convenient rest areas (2 hotels) acts as a potential vulnerability location for the truckers and the local community. The road development would elevate the risk. Other project corridors are relatively free from truck halting and related HRG interactions. 3.4.1 Pattern of Truck Movement and Spread Effect of HIV/AIDS 68. The movement pattern of goods-vehicle has been analysed based on the information obtained from origin-destination (O-D) survey carried out as part of the detailed design preparation and also based on the trucker survey carried out as part of preparation of HPP. Inter-state movement of goods- vehicles are relatively higher in 3 of the corridors, Mehsana-Himatnagar, Umreth-Vasad (including Ladvel-Kapadvanj) and Lunawada-Khedapa. The surveyed goods vehicles ply to-and-fro Rajasthan, Maharashtra, Punjab, Delhi, Uttar Pradesh, and Kerala. 69. As per NACO Sentinel Surveillance data, Mehsana is identified as Category-A district implying high prevalence of HIV. With regard to truck movements, the Mehsana connects the truck routes with Rajasthan, Haryana and Punjab States and several number of trucks ply towards Jodhpur Rajasthan via Ahmedabad- Mehsana – Pali Jodhpur road and also the large number of trucks ply towards Udaipur Rajasthan through Ahmedabad- Mehsana – Himatnagar highways. Table 3-20: Distribution of Intra and Inter-state movement of Goods Vehicle Corridor/ Intra-state Inter-state Total Origin-Destination of Goods Vehicles Road Section No. % No. % No. [based on Traffic Survey and Trucker Survey] ï‚· Major O-D stations within the state are Sankheda, Vadodara, and Anand. Dabhoi-Bodeli 3869 98 81 2 3950 ï‚· Major O-D station outside the state is Madhya Pradesh, Uttar Pradesh, Bihar, Punjab and Rajasthan. ï‚· Major O-D stations within the state are Dhandhuka, Dhandhuka-Dholera 369 100 0 0 369 Bhavnagar, Sayyla and Chuda. ï‚· Inter-state goods vehicles not observed in this corridor. ï‚· Major O-D stations within the state are Porbander, Jasdan, Rajkot and Bhavnagar. Atkot-Gondal 1287 96 56 4 1343 ï‚· Major O-D stations outside the state are Maharashtra and Madhya Pradesh. ï‚· Major O-D stations within the state are Vijapur, Himatnagar, Mehsana and Ahmedabad. Mehsana-Himatnagar 3017 88 401 12 3418 ï‚· Major O-D stations outside the state are Rajasthan, Uttar Pradesh, Punjab, Delhi and Kerala. ï‚· Major O-D stations within the state are Anand, Vadodara, Junagarh and Ahmedabad. Umreth-Vasad 702 76 224 24 926 ï‚· Major O-D stations outside the state are Maharashtra, Rajasthan and Uttar Pradesh. ï‚· Major O-D stations within the state are Anand, Vadodara and Ahmedabad. Ladvel-Kapadvanj 1932 68 928 32 2860 ï‚· Major O-D stations outside the state are Maharashtra, Rajasthan and Uttar Pradesh. ï‚· Major O-D stations within the state are Virpur, Santrampur, Bayad-Lunawada 678 100 3 0 681 Bayad and Lunawada. ï‚· Inter-state goods vehicles not observed in this corridor. ï‚· Major O-D stations within the state are Malpur and Dhansura. Dhansura-Meghraj 237 99 3 1 240 ï‚· Inter-state goods vehicles not observed in this corridor. ï‚· Major O-D stations within the state are Godhra, Santrampur, Lunawada-Khedapa 364 89 44 11 408 Bayad and Lunawada. ï‚· Major O-D station outside the state is Rajasthan. ï‚· Major O-D stations within the state are Dhandhuka, Bhavnagar, Ranpur, Surat, Junagarh, Chuda, Jasdan and Dhandhuka-Paliad 1645 96 76 4 1721 Kapadvanj. ï‚· Major O-D station outside the state is Maharshtra. Source: Traffic Survey and Trucker Survey, LASA, 2012. 3-21 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.5 TRIBAL COMMUNITIES 70. Among the 10 corridors, 4 have concentration of tribal communities. Corridors such as Lunawada-Khedapa, Bayad-Lunawada pass through tribal villages. Some villages of Sankheda Taluka in Dabhoi-Bodeli corridor have majority tribal population. Rathva, Tadvi and Vasave are the major tribes reside in these areas. 71. FSWs belonging to tribal community are reported by the NGOs along the corridor. These FSWs indulge in home-based sexual activity. MSMs are also active in these regions, and the activities are street based and promiscuous places nearby bus station and outskirts of the settlement areas. In these locations, majority of the FSWs emanate from the occupational groups such as agricultural labourers, quarry workers, construction labourers and migrants. 72. Site visit and respective consultations brought out that the economic vulnerability of tribal women leads them to sex work. The CHC data shows that about 21 people (including 6 female and 4 children) are found HIV positive (data over the period of last 2 years). High level of migration is observed towards the construction sector in these areas. 3.6 INDUSTRIAL HUBS AND MIGRANT WORKERS 73. Around 35 industries such as cotton & ginning units, cold storage units and tiny oil units are situated along the Pilavi-Vijapur area of Himatnagar-Mehsana corridor. Majority of these industries have employed a large number of migrant workers who hail from Bihar, Uttar Pradesh and Madhya Pradesh. Discussion with the industrial unit operators and NGO personnel reveals that more than 50 percent of the migrant workers are ‘single-male-migrants’. Most of the workers engage for an average period of 8 months in a year depending upon the seasonal requirement of the employment in cotton & ginning units. Consultations with NGOs reveal that the migrant workers are involved with HRGs. 74. Along the Dhanduka-Paliyad corridor, about 15 small-scale industrial units are situated near the Dhanduka-Ranpur stretch. Apart from the small-scale industrial units, quarry and stone-crushing units are located in Nagnesh, Bodiya and Kinara villages. Similar industrial clusters are not observed along other project corridors, except one located in Kotdasangani village along Atkot-Gondal corridor. 75. Migration of workers from Paliad to other districts such as Surat, Bhavnagar, Vadodara is reported. Discussions with the ICTC counsellors reveal that Paliad town has 11 numbers of HIV positive people from among the migrant labourers, thereby elevating the risk and spread effect of the disease. 3.7 CONSTRUCTION CAMPS 76. Construction camp sites for the road construction work will be a major intervention site. This will be identified in consultation with the Engineering Team after finalization of the alignment plan. The field survey revealed that there are some construction camp sites already functioning alongside the project corridors. These sites are part of a bridge construction taking place in Atkot-Gondal corridor at chainage 209+800. Building and industry construction sites are located in Mehsana-Himatnagar corridor at chainages 142+600 and 146+300 respectively. The consultations with workers and management of these construction camps are scheduled and will be carried out. 3-22 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.8 IDENTIFIED HOTSPOTS ALONG THE CORRIDOR 3.8.1 Potential Hotspots: Dabhoi-Bodeli Corridor 77. Along the Dabhoi-Bodeli corridor, the major settlement locations are located in a sequence starting from Vega circle, Dabhoi town in Vadodara district. Vadodara is identified as Category-B district, implying a moderate prevalence of HIV. FSWs and MSMs activities in Dabhoi are identified by the local NGOs. Hotspots are located near the rail way station, bus stops, cinema hall and Vegas chockadi (junction) and Hirabhagol area. The preferred place for sexual activity for FSWs are largely home based, whereas MSM activities are mostly street-based. The hotspot network analysis of Dabhoi- Bodeli Corridor is given in Table 3-21 Table 3-21: Hotspot Network: Dabhoi-Bodeli Community Involved with Sl. No. Location HRGs Hotspots HRGs 1 Dabhoi 27 FSWs Home based, Lodge/hotel College Students, Truckers, local based, Street based drivers, General Population from local city & surrounding villages 19 MSMs Bus Stand, Garden, College Students, Truckers, local Railway Station, College drivers, General Population from area, highways, urinals, local city & surrounding villages 2 Sankheda 7 FSWs Lodge base, home base, Local Drivers, Small business farm house based class people 5 MSMs Open places like farms, School/College students, General river side areas & Population home/room based Source: LASA 2012 (Reconnaissance Visit and Consultations) 3.8.2 Potential Hotspots: Dhandhuka-Dholera Corridor ï‚· Around 30 kms far from corridor, highway stretch from Tarapore circle to Bagodara has major HRGs & hotspots available. ï‚· According to ICTC counsellor at Dhandhuka CHC, during the period of April ’10 to Dec ’11 (20 months) total 3387 HIV testing conducted for general population, out of which 15 (10 Male + 5 Female) found HIV positive. ï‚· At the same ICTC, during the similar period out of total 1307 ANC testing, none of the mother found HIV positive. ï‚· Those males, who found HIV positive, majority of them, were migrant labourers. ï‚· Community from the Native of Dhandhuka – Dholera corridor villages use to migrate at places like Surat, Botad & Bhavnagar districts. ï‚· Caritas India (INGO) has recently initiated LWS in some of the corridor villages. ï‚· The ‘Darbar’ community is prominent in the project corridor area and there are no hotspots or presence of HRGs found within the corridor villages. ï‚· At Dholera, few hotels/restaurants are located, where truck drivers organized their stay for on and around 1 to 2 hours for food and rest. Information on presence of HRGs at this rest area was denied by local sources. ï‚· HIV positive cases are reported from among migrant labourers. There is no HRGs or hotspots existing along the corridor. The HIV prevalence among ANC mothers is not reported. 3-23 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.8.3 Potential Hotspots: Atkot-Gondal Corridor 78. Majority (70%) of the people from the corridor villages are single-male migrants as well as many people are having daily out-migration. LWS of Caritas India has been active in many of the villages for the last 15 months. Activities mainly take place in vadi area, hotels/dhaba, lodges and home-based, as revealed from the discussion with Link Workers. ï‚· Jasdan: People from Virnagar village migrate temporarily to Surat as Dimond Worker and also to places like Ahmedabad and also to Mumbai. A good number of villagers are engaged as wage labourers in nearby places of Rajkot GIDC. ï‚· Gondal: A good number of villagers from Dadva Hamirpara and Ghoghavadar are occupied in nearby places of Rajkot GIDC, Ahmedabad GIDC and Surat as Diamond Workers. The influence of single- migrant population is found significant in the region. Majority of the PLHAs identified in this region are labourers. FSW activities are taking place mainly home-based. ï‚· Kotda Sangani: Out migration from Kotda Sangani and Ramod villages are taking place. The destination place for majority of the labourers hailing from the village is the GIDC area in Gondal. Table 3-22: Hotspot Network: Atkot – Gondal Corridor Community Involved with Sl.No. Location HRGs Place for Activity HRGs 1 Jasdan 238 MSMs (208 Kothis, 16 Open Places, Farms, Farm Labourer, Diamond Town Panthi, 6 Double Decker, Riverside area, Urinals, Bus Worker 1 TG) Station, Atkot Bus Station 59 FSWs (57 home Home based Diamond worker, Farmers, based, 2 street based) Local from general population, Business man 2 Gondal City 175 MSMs (158 Kothis, 12 Marketing Yard, College Local from general population, Panthis, 5 Double Decker) area, Garden, Panjrapole – Farmers, Truckers, Shop Bus stand area owners, College Students 237 FSWs (1 brothel, 2 Brothel, Home based Yard shop-owners, traders street bases, 234 home coming to the yard, locale base) people Source: LASA 2012 (Reconnaissance Visit and Consultations) 3.8.4 Potential Hotspots: Mehsana-Himatnagar ï‚· Mehsana: FSWs availability is very much present in street base, railway station and market place. The high risk activities take place in lodges and brothels (5 to 6 brothels have 70- 80 FSWs). Majority of the FSWs operate in home based, somewhere in settlements / slum areas. MSMs activities take place in institutional areas, highways, urinals and construction sites. In city area, one Transgender’s Akhada, having a number 45 MSMs offer home based activity with their partners. A large number of MSMs are kotis (receiving partner), followed by Gariya & Double Duckers ï‚· Visnagar: Majority of FSWs activity is lodge-based and home-based arrangements. Majority of them are claimed themselves as small scale workers. Whilst MSMs prefer to choose the places in gardens, bus stand and urinals. Many of them are from diamond worker/Industry. ï‚· Vijapur: FSWs prefer house based activity. whereas MSMs activities happen in nearby industrial units ï‚· Himatnagar: FSWs activities largely take place in home based and guest house and lodge based. While MSMs activity take place in promiscuous place such as gardens and ring road area ï‚· Ganeshpur circle: Miniscule number of FSWs who come in late evening and the major clients are truckers. These FSWs could be categorised as flying-sex workers. The primary place of contact being Ganeshpur circle, the activity place could be anywhere including within truck, or open places like agriculture field, or lodge-based. ï‚· Vasai circle has presence of good number of FSWs during late evening. 3-24 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 3-23: Hotspot Network: Mehsana-Himatnagar Corridor Sl. No Location HRG Population Hotspots Community Involved with HRGs 1 Mehsana City 300 FSWs Home based, Lodge/hotel Migrant workers, Labourers, based, Brothel based, Truckers, Students & General Street based Population from local city & surrounding villages 500 MSMs College area, highways, Students, Auto rickshaw driver, urinals, construction sites, Truckers & General Population Akhada/ home based from local city & surrounding villages 2 Visnagar Town 120 FSWs Lodge base, home base, Migrant workers, Labourers, brothels, street base Truckers, Students & General Population from local city & surrounding villages 120 MSMs Gardens, Bus stand & Migrant workers, Labourers & Urinals General Population from local town & surrounding villages 3 Vijapur Town 160 FSWs House based Migrant workers, Labourers, Truckers, & General Population from local town & surrounding villages 180 MSMs Cotton & Ginning Units, Migrant workers, Labourers & Cold Storage & some small General Population scale industry units 4 Himmatngar city 250 FSWs Home based, Street Base, Migrant workers, Labourers, Guest House based, Truckers, Students & General Brothels Population from local city & surrounding villages 200 MSMs Gardens, Ring Road Area, Students, Auto rickshaw driver, Home based & few of them Truckers & General Population available at Guest House from local city & surrounding villages Source: LASA 2012 (Reconnaissance Visit and Consultations) 3.8.5 Potential Hotspots: Umreth-Vasad (including Ladvel-Kapadvanj) Corridor 79. There are four major centres identified along the Umreth-Vasad corridor, where hotspots are located. The features of these centres, Kapadvanj, Dakore, Nadiad and Anand are summarised as follows: ï‚· Kapadvanj: is a small town where the presence of FSWs, MSMs and Long Distance Truckers are identified. Few truck drivers from Kapadvanj have migrated to places like Surat and Mumbai. Kapadvanj has the presence of good number of local drivers for internal transportation vehicle functioning on the interior roads of the area (shuttle service). The data obtained from CHCs and Civil Hospital reveals various cases of HIV positive people from among FSWs, migrant population and truckers in Kapadvanj. o One FSW at Kapadvanj found +ve & her husband died due to the same reason. o One family from Maharashtra (Malegaon) found positive at Kapadvanj (Husband + Wife + 2 Children). o One widow ANC & her 3 year old child was also found +Ve, while her husband died before 18 months at Kapadvanj. o Two truck drivers (1 at Kapadvanj & 1 at Kathlal) found +ve. ï‚· Dakore: is a known religious place. People from various places of Gujarat and other states visit Dakore as pilgrims during the event of every full moon (Poonam’s day). Activities of FSWs and MSMs are found to be at a high during this season. Dakore is also a major trade centre in the Kheda District. FSWs activities are observed in lodges/hotels, homes and also on streets in Khijalpur village area. At the same time, MSMs activities take place at Gomti pond site, lodge/hotels, bus stand area, Shedhi river site, Railway station area and also in Choultries. Clients of FSWs and MSMs include truckers, tourists, general population, labourers and auto-rickshaw drivers. 3-25 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ï‚· Nadiad: Nadiad is a major commercial, educational and health-care centre. Major government offices, commercial and trading establishments, industries such as Mafatlal Suiting and advanced health-care service providers are situated in Nadiad. ï‚· Anand: is a major commercial, educational and health care centre. This region is known for milk and milk products brand ‘AMUL’ and headquarter of National Diary Development Board (NDDB). FSWs are identified in Anand, and the activities are home based, street based, brothel based and lodge/hotel based. Chikodara circle in NH-8 Highway is a major activity centre. Clients of FSWs are truckers, service-class people, labourers, auto rickshaw drivers and also student community. MSMs activity locations are Bus station and Railway station area, gardens, hostel and street based. The hotspot network analysis is summarised in Table 3-24. Table 3-24: Hotspot Network: Umreth-Vasad Corridor (Including Ladvel - Kapadvanj) Community Involved Sl. No. Location HRGs Hotspots with HRGs 1 Dakor Town FSWs 139 (Home based Lodge/hotel Based, Street Truckers, Tourist, General 75, Street Based 58, Based, Home Based, Population, Labourer, Auto Brothel/Lodge base 6 Khijalpur village, Farm based rickshaw driver MSMs 322 (285 Kothis Gomti Pond site, Lodge/hotel Truckers, Tourist, General (receiving partner), 11 Based, Bus stand area, Population, Labourer, Auto Panthis (active partner), 26 Shedhi river site, Railway rickshaw driver Double Decker (having station area, Choultries both receiving & active within Dakore partner) 2 Nadiad Town FSWs 259 (Home based Home based, Street based, Truckers, Service class people, 63, Street based 87, Brothel based, Hotel/dhaba Tourist, General Population Brothel 6, Hotel based 32, based, Highway based from surrounding villages, Dhaba based 2, Highway FSWs activity places are Labourer, Auto rickshaw driver based 69) Tarapore & Vataman circle highway area MSMs 302 (195 kothis, 8 Railway station area, Bus Truckers, Service class people, panthis, 73 double decker, station area, Open Tourist, General Population 20 bisexual, 6 transgender) area/construction sites, Farm from surrounding villages, based Labourer, Auto rickshaw driver 3 Anand Town FSWs 207 (Home based Bus & Railway station area, Truckers, Farmers, Service 70, Street based 80, Home based, Street based, class people, Labourer, Auto Brothel based 11, Highway Brothel based, Lodge/Hotel rickshaw driver, Students. based 46) based, old NH 8 highway chikodara circle MSMs 282 (Kotis 207, 38 Bus & Railway station area, Students, Auto rickshaw driver, double decker, 15 Gardens, Hostel, Home Labourers, General Population bisexual, 22 Transgender) based, Street based from surrounding villages Source: LASA 2012 (Reconnaissance Visit and Consultations) 3.8.6 Potential Hotspots: Bayad-Lunawada Corridor ï‚· No major truck halt-points observed along the corridor. Major truck movement concentrates around 4-5 quarries located alongside the corridor. ï‚· NGO intervention project on HIV/AIDS is absent in this corridor. ï‚· One ICTC is functioning at Vatrak CHC, which caters to the needs to both Dhansura and Bayad Taluka, is in the influence area of Bayad-Lunawada and Dhansura-Meghraj. In this CHC, about 70 HIV+ve cases reported since 2007. The ICTC Counsellor of Vatrak CHC revealed that on average 3-4 HIV+ve cases are diagnosed in the last few months. ï‚· Apart from ICTC services, there a need for HIV/AIDS awareness programme in this region in view of the increasing number of HIV+ve cases reported in the last few months, as revealed from the discussion with the ICTC Counsellor. 3-26 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.8.7 Potential Hotspots: Dhansura-Meghraj Corridor 80. Modasa – Shamlaji Highway which is about 30 km away from the corridor is the major influencing area for the HRGs and general population pertaining to Dhansura – Meghraj corridor. Major activity places include lodges/hotels across the Highway, Hajira Industrial Area and vicinity of Shamlaji RTO Check Post on the highway. Along the Rajendranagar circle to Shamlaji Highway, a brothel is located at Davli-Chhatrispuri area having 5-6 FSWs from surrounding villages. Table 3-25: Hotspot Network: Dhansura – Meghraj Corridor Community Involved with Sl. No. Location HRGs Place for Activity HRGs 1 Dhansura 4 FSWs Guest house/Lodge/ Hotel based of Modasa, Labourer, Auto rickshaw Himatnagar & nearby area driver and service class people 2 Malpur 24 FSWs Street Base & Hotel based Labourer, Auto rickshaw driver shop keepers, truckers 3 MSMsRailway & Bus station at Modasa, River and Auto rickshaw driver, truckers Forest side areas and open places 3 Meghraj 25 FSWs Guest house/Lodge/ Hotel based at Modasa Truckers, Industry/GIDC city & Hajira Industrial area, highway bypass workers Source: LASA 2012 (Reconnaissance Visit and Consultations) ï‚· At Malpur CHC total 10 HIV +ve cases as detected from general population, while none of the ANC found HIV positive. Two HIV +ve cases were detected from local Malpur town. Out of which one +ve person died and another is alive. The person alive is driver and functioning at local level. ï‚· The FSWs in this area are wage-labourers. While, MSMs of this area are occupied in construction work, farming and private services. ï‚· Out of 129 villages of Meghraj Taluka, 102 (Male 45 + Female 57) HIV +ve cases have been reported at Meghraj CHC since 2008. Majority of the males occupied in farming activities, wage-labour and truck driving, etc., and females are mainly occupied in farming activities. 81. At present Meghraj town has 5 HIV +ve (2 Male + 3 Female). Males found +ve are from trucker community. 3.8.8 Potential Hotspots: Lunawada-Khedapa Corridor ï‚· At Santrampur CHC total 18 (8M + 7F +3 Child) HIV positives have been detected during the last two years (2010 and 2011) from within the entire Taluka region. ï‚· Santrampur Taluka is tribal dominated area and out-migration from interior villages of the block is observed. ï‚· No major truck halt-points identified along the corridor. 3.8.9 Potential Hotspots: Dhandhuka-Paliad Corridor ï‚· As per ICTC Counsellor’s information, there are 7 MSMs and 15 FSWs at Paliyad town who are basically wage labourers. ï‚· During the last two year (2010 and 2011) out of 3013 HIV testing done (General Population 1391 + 1622 ANC), 16 (10 Male + 6 Female) found HIV positive. Majority of them are migrant labourers. ï‚· At Paliyad Town, since 2008, altogether 20 long distance truckers are reported HIV positive, out of which 3 persons have died. ï‚· LWS of Caritas India (INGO) has recently initiated in some of the villages of corridor. ï‚· Within corridor there are no hotspots existing. 3-27 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 3.9 FINDINGS OF CONSULTATIONS 82. As part of the situation assessment and obtaining in-depth information regarding the behavioural pattern of HRGs, ongoing intervention details, etc, consultations with NGOs, interview of key informants and discussion with health-care centres are carried out. The findings from such consultations are summarized in this section. Table 3-26: Details of Consultations with Stakeholders Discussion with Intervention NGO in ï‚· Sex work activities are home-based and lodge-based. Mehsana ï‚· Increase of truck movements in Mehsana-Himatnagar highways observed and will again increase due to the progressive industrialization. ï‚· Major auto-industries are setting up plants in the vicinity which will attract more migrant labourers and also have impact on truck movements. ï‚· Along the corridors, there is no specific truck parking bays available for long stay. However, few junctions (chokadi) are spacious and vast areas where long distance drivers halt their vehicle for refreshments. ï‚· Need for specific place for truck bays (resting place) where a good number of truck drivers would take rest. Key Informant Interview with Link ï‚· The Link Worker Scheme is being implemented by the CARITAS Worker and District Resource Person India in support of GSACS. ï‚· LWS is functional in 7 villages along the Mehsana- Himatnagar corridor. The scheme will be useful to reach out to the rural population. ï‚· With the proposed highway development, large number of migrants would involve in road construction work. Owing to various influencing factors, migrant workers may indulge in sexual activity with the truckers, co-workers and local people who are at high risk. ï‚· Road workers with long term engagement in the construction of highways would be increasingly exposed to commercial sexual activity. Discussion with the Medical Officer and ï‚· There is adequate availability of health care service centres along the ICTC Counsellor in CHC, Udalpur highway. ï‚· The services including the STI management, integrated counselling and testing and referral services are widely available in district, taluka and primary health care centres. 3-28 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussion with Intervention NGO ï‚· There are several numbers of FSWs and MSMs who indulge in staffs and Peer Educators at Anand sexual activity and their activities are lodge-based and home-based and also street-based. ï‚· NGO and the Peer Educators (PE) say that safe-sex is practiced among the FSWs. Discussion with Counsellor of ICTC, ï‚· The Counsellor of ICTC, Kapadavanj Taluka hospital says there are Kapadavanj Taluka hospital no hotspots in and around the area. However, there is few sex workers indulge in sexual activity. ï‚· Awareness on HIV/AIDS prevention is required in this place. Discussion with ICTC Counsellor, Lab ï‚· The discussion at CHC, Kathlal, (near Ladvel) reveals that the Technician and other staff at Kathlal vulnerability to HIV/AIDS is high as the area is connected with a potential risk area of Nadiad town, which is about 25km from Kathlal. Discussion with Counsellor of ICTC, ï‚· There are no hotspots in and around the Dhanduka, Dandhuka Taluka hospital ï‚· LWS of CARITAS India has been recently initiated in surrounding villages. 3-29 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussion with ICTC Counsellor of ï‚· Few number of sex workers ICTC Counsellor of Paliyad Taluka Paliyad Taluka hospital hospital says that there is no intervention NGOs in this area. The LWS by CARITAS India is recently initiated. There is few sex workers noticed though any specific hotspots could not be identified. Discussion with Trucker TI NGO at ï‚· GSACS funded NGO is working for Truckers’ intervention in Rajkot and Resource Person of LWS Transhipment locations at Rajkot. ï‚· The target intervention includes components such as BCC, IEC, Counselling, General and STI treatment through Khushi Clinic Services, Condom Promotion, Referral and Linkages, etc. ï‚· LWS is being implemented by the CARITAS India in Rajkot. The scheme proposed by the National AIDS Control Programme (NACP- III) is specifically designed to reach out to the high risk and bridge populations in selected rural villages. At present under the LWS at Rajkot, around 100 villages are covered for awareness creation about HIV/AIDS aspect. Discussion with Personnel of Kushi ï‚· The clinic is situated in prime location of transhipment area where the Clinic in Transhipment location, Rajkot truckers are given syndromic treatment and counselling on the adverse impact of HIV/AIDS and safer sex practices. ï‚· This clinic serves as a ‘satellite clinic’ and effectively handles the referral mechanism to combat the menace of HIV/AIDS and STI. Discussion with the President of the ï‚· The President of the Motor Transport Association, Rajkot is one of South Gujarat Motor Transport the advisory committee members of the GSACS funded truckers’ Association, Rajkot intervention NGO in Rajkot. ï‚· There are number of long-distance trucks pass through Rajkot as the region is an industrial hub. About one-third of the trucks travel to Southern India states. ï‚· Awareness, care and support services to trucker community in Rajkot are important. 3-30 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussion with GSACS funded NGO at ï‚· The NGO is implementing the targeted intervention for the core Gondal composite (MSM and FSW). ï‚· Presences of MSMs are larger than the FSWs in the project intervention areas. ï‚· The majority of the female sex workers’ sexual activity is home based and they come from the nearby villages on pretext of wage works. ï‚· Male sex workers indulge in sexual activities in promiscuous places. ï‚· Target Intervention activities take place in and around Gondal town and the proposed corridor is not covered as part of the TI intervention. Discussion with Doctor, PHC, Ramod ï‚· Health care programmes including ICTC services are available in (Atkot-Gondal Corridor) Gondal Taluka. ï‚· PHCs are located at Ramod and Motadadva villages. The health care services cater to the needs of the communities. IEC about HIV/AIDS are displayed in PHCs ï‚· ICTC services are not available at both PHCs. Discussion with the ICTC Counsellor, ï‚· ICTC services for HIV/AIDS and referral services are available at the CHC, Jasdan taluka hospital (Atkot is located in Jasdon taluka and the taluka headquarter is 6 Kms away from Atkot). ï‚· Nearby communities including the people from Atkot avail treatment facilities at the CHC of Jasdan. Discussion with the ICTC Counsellor, ï‚· The counsellor says there is no HIV/AIDS intervention is taking place CHC Megharaj along the corridor. ï‚· 102 persons (male 45, female57) were tested HIV positive in the CHC since 2008. These reported cases are from nearby villages/talukas. ï‚· Majority of the people in the vicinity are occupied as Farm Labourer, Daily Wagers and Truckers. ï‚· ‘Modasa’ is the major influencing hotspot area, as opined by the ICTC counsellor. 3-31 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussion with the Counsellor and ï‚· At Dhansura CHC, FICTC facility for ANC has provided by GSACS. paramedical staff at CHC, Dhansura While ICTC services are offered at Vatrak General Hospital of Bayad Taluka, which is 10 kms from the Dhansura. ï‚· There is no GSACS funded community based NGO intervention projects are implementing in Dhansura Taluka and corridor villages. Discussion with the ICTC Counsellor, ï‚· Malpur CHC is located near the border of three district name CHC Malpur Panchmahal (Lunavada), Kheda & Sabarkantha. ï‚· Malpur being a major location in along the highway requires attention with respect to HIV/AIDS awareness. Discussion with NGO, Seva Sangh ï‚· GSACS funded NGO is implementing project on HIV/AIDS prevention Sarvajanik Hospital at Modasa with core composite group. ï‚· HRGs were identified from Dhansura-Meghraj corridor villages. ï‚· NGO were implementing Trucker-TI before the initiation of core composite group intervention. Discussion with the Chief Medical ï‚· Presence of HRGs not observed along the corridor. officer, CHC, Lunawada ï‚· There is no major truck halt-points located along the Lunawada- Khedapa and Bayad-Lunawada corridors. ï‚· There are a few number of HIV positive cases reported from nearby Talukas. ï‚· There is a need for HIV/AIDS awareness programme in this region in view of the increasing number of HIV positive cases reported since 2007. 3-32 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussion with the ICTC Counsellor, ï‚· The corridor passes through fifth schedule area and majority of Santrampur population are Scheduled Tribes. ï‚· The truck movement along the corridor is observed to be less and the presence of HRGs not reported along the corridor. ï‚· HIV positive cases have been reported from Santrampur and Batakwada villages of Santrampur Taluka. ï‚· There is a need for HIV/AIDS awareness among villagers, especially those villages which are located alongside the corridor. 3.10 SURVEY AND CONSULTATION WITH TRUCKER COMMUNITY 83. A detailed survey has been carried out among trucker community along all the project corridors. The survey aimed at assessing the knowledge level of truckers about HIV/AIDS, STI, condom usage, and health care services along the corridor. The team of enumerators for the survey included those with experience in health surveys especially with respect to sexual health interventions supported by GSACS. Apart from individual-based survey, consultations with trucker community, transport agents, NGO personnel, etc., have been carried out. 3.10.1 Consultation with Trucker Community 84. Consultations as well as individual interview with trucker community have been carried out along all project corridors (the questionnaire used to collect information from truckers is given in Appendix 1.1). Community of truckers are vulnerable to HIV due to the high prevalence of risky sexual behaviour, which results from a variety of social and economic factors as well as their work patterns. Since long-distance truckers move throughout the country, those who are at higher risk of HIV can form transmission “bridgesâ€? from areas of higher prevalence to those of lower prevalence 12 . The consultations with Trucker community has been done at locations such as highway-side hotels, guest houses, transporter/brokers office, truck parking areas, market yard, industries, eateries and circles/chalkadi on the corridors. Apart from the discussions on HIV/AIDS related awareness and prevention issues, the trucker community requested for provision of adequate parking areas, water supply and electricity connection in such areas. The major issues discussed is summarized as follows: ï‚· Among the truckers who belong to rest-of-Gujarat, majority hails from Maharashtra and Rajasthan. Moreover, truckers from states such as Haryana, Madhya Pradesh, Punjab, Uttar Pradesh, Tamil Nadu, Andhra Pradesh, Karnataka and Nagaland travel across the project corridors; ï‚· Truckers interact with sex workers in many places alongside the project corridors, such as road-side dhabas, hotels, guest houses, farm land, forest areas, riverside, etc. ï‚· Provision of health services including awareness about HIV/AIDS should be included as part of the highway improvement project. ï‚· Proper parking facility should be provided near toll plazas. Facilities for drinking water, lighting, eateries should be included in such areas. 12 Targeted Intervention for Truckers: Operational Guidelines. National AIDS Control Organisation. 3-33 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Discussions with Trucker Community alongside Discussions with Stakeholders at Transporter Umreth-Vasad (including Ladvel-Kapadvanj) Office, Atkot-Gondal Corridor Corridor 3.10.2 Analysis of Trucker Survey Data 85. Trucker survey has collected information from 340 respondents (334 truck drivers and 6 cleaners). Interviews were carried out at various locations such as, highway-side hotels, Guest houses, Transporter/Brokers Office, Truck Parking, Market Yard, Stone quarry work yard, Industries, Octroi Circle, Eateries and Circles on the corridors. 86. Those truck-drivers were interviewed who usually ply through the corridor. Interviews were conducted in truck drivers’ preferred language after confirming their mother tongue. Hence, the entire interviews were conducted in Gujarati and Hindi languages as per their convenience. Details of the sample population are presented in Appendix 3.1. Outcome of the data analysis is summarised as follows: ï‚· Native Place of Truckers: Major percentage of truck drivers (41 percent) belongs to Gujarat, and 19 percent each belong to Maharashtra and Rajasthan. The sample population included truckers from Tamil Nadu, Andhra Pradesh, Karnataka, Uttar Pradesh, etc. Majority of the truckers (71 percent) are in the profession for the last 10-15 years and 11 percent of the truckers are in the profession for the last more than 16 years. ï‚· Usual Halt Points: Long route trucks were having average more than 2 people per truck, while for halting they preferred places such as Hotel, Dhabas, Guest house, Petrol Pump, Transporter/Brokers Offices, highways, Factory/Industrial area and truck parking. Halt is usually for fooding, bathing, refreshment, etc. ï‚· Stay-away from Family: About 40 percent of the truckers meet their families once in a month, whereas 31 percent meet their families once in 15 days and about 11 percent of the truckers meet their families once in 6 months. ï‚· Marital Status: 71 percent of the truckers surveyed are married. Staying away from family, under such circumstances indicates it indicates a more vulnerability towards high risk behaviour. ï‚· Habits: 45 percent of the truckers consume alcohol on daily basis. Half of the surveyed truckers are aware about the sources (dhaba, villagers, pan shops, etc.) of obtaining alcohol or other substances. ï‚· About 54 percent of the respondents are aware about the sources (guest houses, highway sites, dhabas, etc.) of availing paid sex partners. ï‚· For having sex 52 drivers have paid Rupees 50 to 100, 46 drivers paid 100 to 200, 29 drivers paid 300 to 400, 11 drivers paid 400 to 500, while 20 drivers have reported to having sex in exchange of giving lift for travel or some gift to their sexual partner. Majority of the respondent truck drivers had sex with 3-34 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Female partner (138), while some drivers have reported to have sex with male (11) and transgender (9) as their sexual partner. ï‚· 28 percent of the truckers have engaged in sexual activity with labourer/migrants. The activity places included, work place, house of sex-worker, farm field, forest areas, river-side, dhabas, guest house, factories, and within the truck. ï‚· Condom use: 27% of respondent truckers have reported condom use. Out of them who reported condom usage with paid sex partner, 55% of them carry/purchase condoms themselves, while for 45% cases, their partners insist for using condoms. ï‚· Knowledge regarding health services: 42 percent of respondent truckers are aware about various health centres alongside the corridor and they avail health services from formal medical institutions. ï‚· Knowledge about HIV/AIDS, STI and ART: knowledge among truckers pertaining to HIV/AIDS and about the National Health Program, implementing since last 15 years, were enquired. It was found that 66% drivers are aware of HIV/AIDS. Those who have heard about HIV responded that they come to know about HIV through Radio, TV, and Newspapers. While some of them have reported that they heard through word of mouth from their friends and peers. ï‚· Further, to assess the knowledge on the HIV/AIDS, truckers were asked whether HIV and AIDS is same, 29% truck drivers responded that HIV/AIDS is same, 8% drivers mentioned that it is not same, 63% says don’t know about it or not responded. Regarding awareness about Sexually Transmitted Infection (STI), 17% truckers are aware of the same. The following questions with response reveal the level of awareness among truckers regarding HIV/AIDS. Table 3-27: Level of awareness among Truckers Sl. Number (Percentage) of Respondents Questions Asked No. Yes No Don’t know 1 By just looking at a person can you identify whether the - 124 216 person is infected by HIV, the virus that causes AIDS? (36%) (64%) 2 Do you personally know someone who is infected with 44 137 159 HIV or suffers from AIDS or has died of AIDS? (13%) (40%) (47%) 3 Do you feel that you might be at risk to be infected with 74 148 118 HIV/AIDS? (22%) (44%) (34%) Note: Total number of respondents – 340 Source: Trucker survey, LASA 2012 ï‚· HIV Test: out of the 340 respondent truckers, 33 (10 percent) have undergone HIV testing. ï‚· Khushi Clinic: 14 (4 percent) out of the 340 respondent truckers have heard about the Khushi Clinic services supported by NACO under the National Trucker TI Programme across India. Those who are aware about the Clinic came to know about it through peers and also through self experience. ï‚· 82 percent of the respondent truckers opined that providing health services including awareness on HIV/AIDS will be helpful and preferred such services on highway-based Clinics, hospital and locations near toll-plazas and suggested the following measures for effective reach. ï‚· Provide emergency ambulance service; ï‚· Provide hospital facilities; ï‚· Health check-up for truckers; ï‚· Toilet/bathroom facility alongside the highways; ï‚· Adequate facilities within Petrol Pumps; ï‚· Provide health facilities by individual industries; and ï‚· Provide free-of-cast medicine and health-insurance facilities. 3-35 4 INTERVENTION STRATEGY AND ACTION PLAN 4.1 INTRODUCTION 87. Implementation of HPP in the project corridors for the benefit of local community, bridge population and HRGs is a pre requisite of the road development project. The reconnaissance visit and the interactive discussions have gathered pertinent information from various sources. The data gathered for project corridors formed the basis for this report. Comprehensive analysis of the data and the content analysis of consultations held with local NGOs, corporate bodies, medical health care service personnel, etc helped in evolving the HPP. It is learnt that there is a well-knit system already in place functional under NACO and GSACS/AMCACS, which has focussed on various components such as information education communication (IEC), behaviour change communication (BCC), condom promotion, care and support, creating an enabling environment, etc. 88. NACO estimates show that six districts of Gujarat are Category-A and four districts are Category-B. The project corridors traverse one district of Category-A and all four districts of Category- B. Situation assessment of the corridor reveals that the existing network of health facilities and institutions which cater to the needs of population exposed to unsafe sexual practices, is well established and the interventions supported by NACO utilises the required facilities of CHCs and ICTCs. All the project corridors have the presence of CHCs within the vicinity of the corridors. 4.2 IMPLEMENTATION PLAN 4.2.1 Institutional framework 89. In view of the potential strategy for the prevention of HIV/AIDS in the project corridors, the existing institutional structure has been assessed. The Target Intervention as envisioned by NACO/GSACS and materialized through NGOs, ICTCs, CHCs, etc has already established a comprehensive management plan for preventing HIV/AIDS targeting a larger public domain. A segment of the intended population of HRGs and Bridge Population identified as part of the situation assessment of GSHP-II forms a subset of the larger public domain. 90. Based on the understanding of the HIV/AIDS scenario in the project corridor locations, and in view of the strategy, a structure is suggested. The structure seeks an implementation arrangement with IEC, sensitization programmes and training programmes for R&BD personnel, contractors and other stakeholders in the transport sector, as a key tool. The HPP will cater to various stages like design, pre-construction and post-construction. The institutional structure for the implementation of HPP is presented in Figure 4-1. 4.2.2 Environmental and Social Management Unit 91. An Environmental and Social Management Unit (ESMU) proposed at the Project Implementation Unit (PIU) of R&BD for the implementation of Resettlement Action Plan (RAP), Tribal Development Plan (TDP) and HPP. The ESMU at PIU will interact with GSACS/ AMCACS. The Social Specialist at ESMU with the assistance of RAP implementing NGO will be the responsible person interacting with GSACS/AMCACS and will provide the following information: 4-1 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ï‚· Details of the project corridors and proposed development; ï‚· Potential areas of HRG activities along the corridor; ï‚· Details of the construction camp sites and labourers including migrant labourers; 92. The IEC materials developed by NACO and GSACS for awareness creation among trucker community, migrant labourers, etc., will be disseminated in identified locations along the project corridors and construction camp sites. The services of NGO proposed to be selected for the implementation of RAP and mitigation of adverse impacts due to the project shall be utilised. The roles and responsibilities of the NGO is summarised as follows: PROJECT IMPLEMENTATION UNIT Chief Engineer (World Bank) R&BD Superintending Engineer TI NGOs Field NACO Divisions Executive Engineer GSACS Interaction and EE Knowledge Sharing H&FW CHC & PHC Field-I Environmental and W&CD Social Management Unit Information TDD EE (ESMU) Education Private- ICTC Field-II Communication Sector Environmenta Social EE l Specialist Specialist ICDS / Education Field-III Institution Information Education Communication Non Governmental Organisation (NGO) Figure 4-1: HIV/AIDS Prevention Plan: Implementation Structure 4.2.3 Roles and Responsibilities of NGO 4.2.3.1 Awareness Creation on HIV/AIDS Prevention 93. NGO shall carry out awareness programs along the corridors at identified locations such as toll-plazas, construction camp sites and truck-parking lay-by in respective corridors. For the purpose, the IEC materials as well as technical advice from GSACS will be utilized in a timely manner. 94. The NGO shall ensure in collaboration with ESMU that medical facilities and health check-ups which may include diagnosing of STD/HIV for the workers are provided at the construction camps. ï‚· Awareness programs for construction labourers; ï‚· Facilitating medical health care services including STI treatment; ï‚· Interaction with CHCs, ICTCs; ï‚· Coordination with Target Intervention NGOs, Link Worker Schemes and other agencies working in the field of HIV/AIDS awareness and prevention; ï‚· Conduct sensitization programs for officers of SRP divisions, contractors and other stakeholders; ï‚· Interaction with transporters and brokers; and ï‚· Ensure availability of condoms (both socially marketed & govt.) through established condom depots. 4-2 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 4.2.3.2 Assistance in Monitoring of HIV/AIDS Prevention Plan 95. NGO shall assist the Project Management Consultant (PMC) in monitoring and evaluating HPP and all related components incorporated in contract document of each corridor to be executed by the contractor. NGO shall prepare and submit the monthly progress report on item wise/activity wise implementation/execution of the plan and expenditure incurred thereof. A template of monthly progress report is given in Appendix 4.1. 4.3 STRATEGIC COMPONENTS 96. The components suggested for effective implementation of HIV/AIDS Prevention Plan in respective corridors with the objective of sustaining the project initiatives has been worked out and presented in the following sections. 4.3.1 Information Education Communication (IEC) 97. Awareness creation through IEC will be adopted for identified locations. These locations are communities along the road, hospitals, major junctions, truck parks, toll plaza, construction camp sites etc. The content could be message about prevention strategy, threat of HIV/AIDS and proper use of condoms. The IEC materials developed by NACO/GSACS will be utilised for awareness creation among target groups along the proposed project corridors. Sample copies of such IECs are presented as follows. Refer Appendix 4.2 for various types of IECs. 4-3 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 4-2: Sample copy of IEC Materials developed by NACO 4-4 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Figure 4-3: Sample copy of IEC Materials developed by GSACS in Gujarati language 4.3.2 Behaviour Change Communication (BCC) 98. BCC is an interactive process with communities (as integrated with an overall program) to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community and societal behaviour change; and maintain appropriate behaviours. PIU will interact with NACO/GSACS and thereby guide the implementing NGO to assist the target population in accessing the services of TI NGOs and ICTCs in BCC. The guiding principles of BCC can be summarised as follows: ï‚· BCC will be integrated with program goals from the start. BCC is an essential element of HIV prevention, care and support programs, providing critical linkages to other program components, including policy initiatives. ï‚· Formative BCC assessments must be conducted to improve understanding of the needs of target populations, as well as of the barriers to and supports for behaviour change that their members face (along with other populations, such as stakeholders, service providers and community). ï‚· The target population will participate in all phases of BCC development and in much of implementation. ï‚· Stakeholders need to be involved from the design stage. ï‚· Having a variety of linked communication channels is more effective than relying on one specific one. ï‚· Pre-testing is essential for developing effective BCC materials. ï‚· Planning for monitoring and evaluation will be part of the design of any BCC program. ï‚· BCC strategies will be positive and action-oriented. 4.3.3 Care and Support 99. People who are infected with HIV require social and psychological support from the society and from their family members. The strategy will be aimed at providing care and support services to cent-percent HIV infected people. The implementing NGO will assist the identified infected people in accessing the services of ICTCs and CHCs in the vicinity and also will introduce the persons to the TI 4-5 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN NGO. NGO will request respective ICTCs, CHCs and TI-NGOs to consider the identified infected persons as part of their interventions. The implementing NGO will aim at the following: ï‚· Identify people who are infected with HIV/AIDS among the HRGs (focus will be on Truckers) along the project corridors; ï‚· Coordinate with GSACS for easy access to medical facilities in the project vicinity; ï‚· Ensure uninterrupted supply of ART through regular interaction with CHCs and ICTCs; ï‚· Ensure treatment adherence through partnership development including PLWHA for de-stigmatizing people; and ï‚· Ensure identified infected people have received social care and psychological support. 4.3.4 Awareness Programmes at Construction Camps 100. Health problems of the workers will be taken care of by providing basic health care facilities through a health centre set up at the construction camps. The implementing NGO shall carry out periodic awareness programme on HIV/AIDS in coordination with CHCs/ICTCs and TI NGOs supported by GSACS. The following major activities will be carried ensuring an effective intervention. ï‚· Periodic health-checkups for all construction workers will be carried out. All workers will be tested at least once for HIV and STI and if required, coordinate with nearby medical institutions for treatment support; ï‚· Regular surveillance for disease outbreaks and health situation of construction camps will be carried out. This will be carried out in collaboration with the respective CHCs; ï‚· Periodic Health Education Campaigns will be organised for construction workers and communities along the project corridor. The campaign will focus on prevention and care messages for HIV and STI; ï‚· Distribution of IEC materials to construction workers and efforts with respect to BCC will be taken to make an intensive impact. This is expected to improve their knowledge level and motivate them to change their unsafe behavioural practices and thereby reduce vulnerability; and ï‚· HIV-awareness billboards will be built in the construction camps and arrangements for supply of condoms will be intensified in coordination with GSACS and partnering agencies. Figure 4-4: Signboards in Construction Campsites: IEC to Combat HIV/AIDS Source: LASA, 2012. 4.3.5 Creating Enabling Environment 101. A favourable environment for the smooth implementation of the intervention will be created with the following components: 4-6 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN ï‚· Police personnel will be made aware of the specific intervention programme; ï‚· Active participation of representatives from various CBOs will be ensured. This will help the PIU in fulfilling the programme-objectives in the given time frame; ï‚· Regular interactions with representatives of Medical Institutions will be carried out to ensure a consistent delivery of their services; ï‚· Interactive meeting with Transport Companies operating from the project corridor will be done; ï‚· Consultation with the major Corporate Bodies with respect to make provisions to reduce the time duration of transhipment of goods; and ï‚· Consultation with petrol pumps, major dhabas, located along the project corridor will be carried out. This is aimed at the creation of information centres and service outlets in rest facilities for STI care, condom distribution and counselling through the established network of GSACS. ï‚· Target group congregation events/observance of AIDS Day, etc. 4.3.6 Action Plan 102. The specific action plan to execute the HPP along respective corridors has been presented in Table 4-1. Appropriate action plan has been developed based on the outcome of the situation assessment exercise carried out along the corridors. The action plan shall be implemented by the NGO to be contracted for the implementation of RAP/TDP/HPP. 4-7 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Table 4-1: Action Plan Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified Dabhoi-Bodeli Presence of HRGs in 6 out of 29 villages/town Intensive IEC campaign in 6 locations - Distribution of IEC Dabhoi, Sankheda, Pitha, Kundi materials and carryout awareness programmes for Tappe, Suryaghoda, Ali Kherva HRGs/Local Community on monthly basis Presence of 2 Hotspots Assist the target population in accessing the services (BCC, Dabhoi, Sankheda ART, etc.) of TI NGO/CHC IEC campaign on 6-months interval till completion of construction works Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/Junctions along construction period programmes for truckers on 3-month interval till completion the corridor [5 locations (Ch. 29+600, of construction works 32+085, 32+700, 46+725, 68+417)] Dhandhuka- No HRG presence Dholera No Hotspots Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works 4-8 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/junctions along construction period programmes for truckers on 3-month interval till completion the corridor [2 locations (Ch.0+000, of construction works 27+000)] Atkot-Gondal Presence of HRGs in 7 out of 13 villages/town. Intensive IEC campaign in 7 locations - Distribution of IEC Jasdan, Virnagar, Gondal, Dadva materials and carryout awareness programmes for Hamirpura, Ghoghavadar, Kotda HRGs/Local Community on monthly basis Sangani, Ramod Presence of 2 Hotspots Assist the target population in accessing the services (BCC, Gondal, Jasdan ART, etc.) of TI NGO/VCTC Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points/junctions along construction period; Large numbers of trucks programmes for truckers on 3-month interval till completion the corridor with focus on Gondal [2 from various states of India, (Long Distance) of construction works [at Gondal, the IEC distribution and locations (Ch.209+800, 245+000)] arrive at Gondal Market Yard awareness programme shall be on 2-month interval] 4-9 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified Mehsana- Presence of HRGs in 11 out of 27 villages/town Intensive IEC campaign in 11 locations - Distribution of IEC Mehsana, Heduva Hanumat, Himatnagar [Mehsana District is under ‘A’ category (high materials and carryout awareness programmes for Devrasan, Visnagar, Vijapur, Motipura, prevalence) and the out-migration of rural HRGs/Local Community on monthly basis Pilavi, Dabhala, Vasai, Kotdi, population elevates the vulnerability] Himatnagar Presence of 6 Hotspots Assist the target population in accessing the services (BCC, Mehsana, Palvasana, Devrasan, ART, etc.) of TI NGOs/ICTCs/CHC Vasai, Vijapur, Himatnagar Large numbers of single male migrant group Distribution of IEC materials and carryout awareness Visanagar, Pilavi, Vijapur has presence in cotton & ginning & other small programmes for migrant workers on 6-month interval till industry units along the corridor completion of construction works Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period; Since the transporters & programmes for truckers on 3-month interval till completion the corridor with focus on Mehsana brokers are located at Mehsana & Kadi, the of construction works [at Mehsana and Kadi, the IEC and Kadi [8 locations (Ch. 103+275, truck-halt-time increases for more than half day distribution and awareness programme shall be on 2-month 117+066, 126+950, 135+260, & they organize night halts at these place/s interval] 139+000, 140+050, 161+335, 163+752)] Umreth-Vasad Presence of HRGs in 6 out of 16 villages/town Intensive IEC campaign in 6 locations - Distribution of IEC Kapadvanj, Umreth, Bechari, Anand, (incl.Ladvel- [no HRG presence in Ladvel-Kapadvanj materials and carryout awareness programmes for Ode, Vaherakhadi Kapadvanj) section] HRGs/Local Community on monthly basis Presence of 4 Hotspots [3 in Umreth-Vasad Assist the target population in accessing the services (BCC, Umreth, Ode, Sarsa, Kapadvanj and 1 in Ladvel-Kapadvanj section] ART, etc.) of TI NGOs/CHCs 4-10 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of TI NGO/CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion the corridor [9 locations (Ch. 0+000, of construction works 2+500, 8+143, 8+960, 9+230, 19+138, 0+000, 20+535, 32+067)] Bayad- No HRG presence Lunawada No Hotspots Proximity of the corridor to tribal area /Potential IEC campaign and interactive discussions with CBOs/NGOs Lunawada involvement of tribal people in sex work working for tribal welfare Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies 4-11 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion the corridor [5 locations (0+000, of construction works 17+961, 6+450, 9+625, 0+006)] Dhansura- Presence of HRGs in 9 out of 33 villages/town Intensive IEC campaign in 9 locations - Distribution of IEC Dhansura, Malpur, Nanavada, Meghraj materials and carryout awareness programmes for Sompur, Satarda, Bhempur, Laljina HRGs/Local Community on monthly basis Pahadiya, Surana Pahadiya, Meghraj Presence of 1 Hotspot Assist the target population in accessing the services (BCC, Dhansura/Modasa ART, etc.) of ICTC Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion the corridor [5 locations (Ch.38+501, of construction works 64+584, 67+712, 72+760,84+987)] Dhandhuka- No HRG presence Paliyad Presence of 1 Hotspot Assist the target population in accessing the services (BCC, Paliyad ART, etc.) of CHC Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works 4-12 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN Outcome of Situation Assessment/Issues Corridor Strategy/Action Suggested Locations/Village/Town Identified IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion the corridor [3 locations of construction works (Ch.104+800,131+000,151+200)] Lunawada- No HRG presence Khedapa No Hotspots Corridor pass through tribal area / Potential IEC campaign and interactive discussions with CBOs/NGOs Santrampur, Kadana involvement of tribal people in sex work working for tribal welfare Establishment of construction camp sites for Health checkups for all construction workers on 6-month Construction camp sites road development works and influx of migrant interval till completion of construction works. NGO shall labourers and their likely interaction with local associate with concerned CHC for treatment support community Health education campaign on 6-months interval till completion of construction works IEC campaign on 6-months interval till completion of construction works Assist the target population in accessing the services (BCC, ART, etc.) of CHC Install signboards/hoardings targeting construction workers Facilitate supply of condoms in coordination with GSACS/Partnering Agencies Increased movement of trucks in post- Distribution of IEC materials and carryout awareness Major truck halt points / junctions along construction period programmes for truckers on 3-month interval till completion the corridor [4 locations (Ch. 130+010, of construction works 162+775, 0+000, 9+625)] 4-13 Gujarat State Highway Project (GSHP) - II Roads & Buildings Department, GoG HIV/AIDS PREVENTION PLAN 4.4 IMPLEMENTATION BUDGET 1. Implementation of HPP is proposed to be carried out by an NGO and the budget for the same is included as part of NGO activities in the overall RAP budget. The relevant components of HPP in the RAP budget are presented in Table 4-2. The overall budget also provisions for contingencies. Escalation of the budget for implementing is considered at an annual inflation rate of 7% based on consumer price index. Table 4-2: HPP Components in the Budget for Implementing NGO Sl. Amount Category Unit Rate Number No (INR) 1 HIV/AIDS Expert Person months 40,000 36 1,440,000 2 HIV/AIDS awareness and prevention a Advocacy with key stakeholders Lumpsum per corridor 30,000 9 270,000 b Social marketing of condoms and Lumpsum (6 corridors) 25,000 6 150,000 facilitation c Audio-visual equipments Lumpsum (one set) 30,000 1 30,000 d Target group congregation Lumpsum per corridor 25,000 9 225,000 events/observance of AIDS Day, etc e Travel expense Months 40,000 36 1,440,000 TOTAL 3,555,000 4-14 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN Appendix 1.1 GUJARAT STATE HIGHWAY PROJECT-II Roads & Building Department, Government of Gujarat Project Preparatory Works Consultancy Services (PPWCS) for GSHP-II Survey of Truckers: Questionnaire Name of Corridor: Taluka: District: Place of Interview: Time Start: Time End: Basic Information 1. Vehicle Number of Interviewee: 2. Are you driver ‘Ustad’ or Helper/Cleaner? 3. How long have you been working as a truck driver? 4. What is your mother tongue? 5. What are the languages – speak / read / write 6. Language used to interview Trucker respondent: 7. Age in completed years: _____ 8. What is the highest grade you have completed? 9. Where is your native place (where your parents live)? 10. Are you staying now at your native? ( if you not staying at his Native). 12. If not, where do you stay now? (In case if he stays at his native) How often have you visited your native place in last 12 months? 13. Are you married? If married, how long you have been married? 1   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 14. Do you have children? And their gender and age? Profession / work 15. Are you owner of the truck? If yes, How many trucks you have? If no, move to question no: 17 16. At present are you carrying any goods with you? If yes, What kind of goods you carry? 17. If no, who is the owner of this truck? 18. At present with who are you engaged/attached as Truck Driver? 19. At present in which route are you carrying goods? 20. Which types of goods you carried normally? 21. Apart from current route, where do you carry goods ( probe for places), if yes 22. Which are those routs & what kind of goods do you carry on those routes? 23. Are there any other helpers/ cleaners or Drivers are working with you at present? 24. If yes, How Many? 25. Where do you usually halt? 26. For what reasons & how many hours? (Need to probe more & try to avail information about drinking alcohol or any other relevant information about addiction & availability of sources for fulfilling their sexual needs) Habits: 2   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 27. What kind of substances do you take for your pleasure /relaxation? 28. Do you take alcohol? if so 29. How often do you consume alcohol or any other substance? 30. From where do you get alcohol or any other substance? Sexual activity related info: 31. Do you have any idea about source of getting paid sexual partner, if someone wants to have sex to fulfill his sexual desire? 32. How do you come to know about it? 33. Do you know that are there any other drivers/helpers availing such paid sexual partner within this corridor or nearby? If yes, 34. From where do they avail paid sexual partner within this corridor or nearby? (If yes, please mention particular hotspot) 35. How much do they pay for sex worker per encounter? (any idea) 36. Have you ever availed paid sex partner within this corridor or nearby? if yes Please mention particular place? 37. How much amount you pay to sexual partner for having sex? 38. Was your paid sexual partner male, female or Transgender? 39. Do you know that laborers/Migrant female workers & Truck drivers have any kind of interaction? If yes, what kind of interactions they have? If it is sexual interactions then how frequent it happens? 3   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN Have you ever had such sexual interaction with any migrant/labour female worker? If yes, Where & When (Place)? Condom usage: 40. Was the sexual activity was involved with usage of condom? If yes Who gave condom to whom? (Please mention specifically, i.e paid sexual partner initiated condom use or her/his client initiated).. 41. Did your paid sexual partner insist on usage of condom? 42. Did you use condom during sex with your paid sex partner? 43. Do you know about the source of availing condoms along this corridor or nearby? If yes, Please mention the particular place? 44. Did you buy condoms from above mentioned place/s? 45. How much you had paid for availing condom/s? 46. If not used condom, then ask reason for not using condom? (Probe for reasons) Awareness / Knowledge on health: 47. Do you have any idea about availability of health services along the corridor? If yes, Please mention what kinds of health services are available along the corridor? 48. Have you ever approached/availed any of these health services you mentioned? If yes Please mention the name of health services where you approached/availed & for what reason? 4   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 49. If no, then, have you any idea about availability of health services nearby (after or before) corridor? 50. Did you fall in sick in last 12 months? If yes Please mention name of illness/s? 51. Whom did you consult for treatment? 52. Where (place/location) did you approach for treatment? 53. Why did you approach that particular health service/s provider? Knowledge / Awareness on STI/ HIV/AIDS/ Services / Treatment: 54. Have you ever heard about HIV/AIDS? If yes Through which sources? 55. What do you know about HIV/AIDS? 56. Do you know about how HIV spreads/Infected? ( Mode of transmission) 57. According to your knowledge, apart from human, which are the others, who can have chance/s of getting HIV infection? 58. Is HIV & AIDS are same? If no What is the difference between HIV & AIDS? 59. Do you know about what is AIDS? 60. Have you ever heard about STI? If yes Through which source/s it spread? 61. Can you describe any symptoms of STIs in men? 5   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 62. By just looking at a person can you identify whether the person is infected by HIV, the virus that causes AIDS? 63. Do you personally know someone who is infected with HIV or suffers from AIDS or has died of AIDS? 64. Do you feel that you might be at risk to be infected with HIV/AIDS? 65. What one should do in order to know whether he has an HIV infection? 66. Do you know about a place/center where HIV test is done? 67. Have you ever undergone for your HIV testing? If yes 68. When did you undergo HIV test? 69. Have you ever heard of ART (Anti retroviral therapy)? 70. What do you know about ART? If yes 71. How do you come to know? 72. Have you ever heard about Khushi Clinic? 73. If yes, how do you come to know about? 74. If the person has exposure to Khushi Clinic, then ask for what reason he went to Khushi Clinic, when & at which location? 75. Do you feel that providing health services/awareness about various health aspects including HIV/AIDS is important? What is your response? 76. According to your opinion how many truckers would like to avail such services if services are started? 77. How far such services will be helpful to you in your daily routing life cycle? 6   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 78. Do you have any suggestions that can be very useful to truckers’ community passing through this corridor with regard to health, hygiene, Traffic, Safety and felt needs? 79. Do you feel the role of Transport agency /Brokers, Industry/Private sector & government require for implementing the intervention programme? 80. Anything else you want to say or share with regard to Truckers’ Community, Private Sector, Industries, & Govt.? 7   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN APPENDIX 2.1 Programmes and Initiatives of NACO through NACP-III 1. NACP-III is based on the experiences and lessons learnt from NACP-I and II, It has drawn up the following aspects: a. The overall goals of NACP-III is to halt and reverse the epidemic in India over the next five years by integrating programmes for prevention, care and support and treatment. This will be achieved through a four-pronged strategy. b. Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scaled up interventions in the general population. c. Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels. d. Priority is given to intervention programmes for the vulnerable groups such as sex workers, men who have sex with men and injecting drug users. The second high priority in the intervention programmes is given to long-distance truckers and migrant community. e. NACP-III ensures that all persons who need treatment would have access to prophylaxis treatment and management of opportunistic infections. People who need access to ART will also be assured first line ARV drugs. f. Needs of children are addressed through universal provision of Prevention of Parent to Child Transmission (PPTCT) services. Children who are infected are assured access to paediatrics ART. 1.1.1 Blood Safety Programme 2. 141 Blood Banks are functional including 61 NACO supported Blood Banks. NACO supports Blood Banks including one Model Blood Bank, 11 Major Blood Bank (MBB), 10 Blood Component Separation Unit, Blood Banks & 39 District level Blood Bank (DLBB). As on October 2011, 41 Blood Storage Centres are functional in the State. 1.1.2 Sexually Transmitted Infection (STI) Control Programme 3. GSACS established STI clinics at - CHC/Taluka level Hospitals in Ahmedabad, Vadodara (Medical College), Tapi, Junagadh, Mehsana, Kheda, Banaskantha, Jamnagar, Bhavnagar, Surendranagar, Sabarkantha, Anand, Pachmahal, Dahod, and Navsari (2) districts and the target has been set to treat more number of STI cases through the clinics. 1.1.3 Target Intervention (TI) for Core Composite - FSWs, MSMs & IDUs 4. GSACS and AMCACS, supported by NACO, are implementing 114 projects in urban and semi urban areas for the targeted intervention activities through NGOs. 1 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN Table 1: Details of NGOs intervention among the target groups Funded by GSACS Funded by AMCACS Sl. No Typology No of NGOs involved No of NGOs involved 1 Core Composite 42 - 2 MSM 15 5 3 FSW 13 3 4 IDUs 1 - 5 Migrants 19 9 6 Truckers 5 2 Total 95 19 Source: GSACS, 2011 5. By October 2011, GSACS has covered 33322 truckers and 164962 migrant populations through targeted interventions. Table 2: Total Coverage of High Risk Group (HRG) by GSACS (as of October 2011) Female Sex Worker Men sex with Men Injection Drug Migrants Truckers (FSW) (MSM) Users (IDU) 29196 37747 836 164962 33322 Source: GSACS, 2011 1.1.4 Basic Service Division 6. 1167 ICTCs (Integrating Counseling and Testing Centre) are functional in the State out of which 305 stand-alone ICTCs and 859 Facility-ICTC (Public Private Partnership - PPP model & Primary Health Centre - PHCs) and 3 mobile ICTC. 7. Prevention of Parents of Child Transmission (PPTCT): Under this programme, GSACS has set a target for testing of women is 6 lakh in 2011-12 8. Early Infant Diagnosis: It started in October 2010 with the objective of identifying HIV infected infant child, below 18 months, at the initial stage of birth by testing them with Deoxyribonucleic Acid (DNA) – Polymerase Chain Reaction (PCR) test. At present there are 55 centers across the state where this facility is being provided to infants. 9. Care Support & Treatment (CST): As of now 22 Anti-Retroviral Therapy (ART) centers are functional in Ahmedabad (2), Surat (3), Rajkot, Bhavnagar, Mehsana, Vadodara, Surendranagar, Junagadh, Palanpur, Bhuj, Jamnagar, Himatnagar, Amreli, Navsari, Patan, Porbandar, Godhra, Bharuch and Valsad. A second line ART at Centre of Excellence (COE) are functional in Ahmedabad and Surat. The 7 CD4 machines are in place at various hospitals in Gujarat 10. Link ART Centre (LAC): 36 Link ART centers are functional in Deesa, Gandhinagar, Petlad, Nadiad, Dahod, Morbi, Gondal, Talaja, Palitana, Jamkhambhalia, Limdi, Rajpipla, Kadi, Vyara, Adipur, Una, Keshod, Botad, Mahuva, Chikhli, Bardoli, Idar, Savarkundla, Veraval , Silvassa, Tharad, Vijapur, Jasdan, Jetpur, Chotila, Gadhada, Manavadar, Bhachau, Mandavi, Sidhpur & Dholka. 11. Community Care Centre (CCC): There are 13 CCC functional in Ahmedabad (3), Bhavnagar, Jamnagar, Junagadh, Mehsana, Rajkot, Surat (2), Surendranagar, Banaskantha and Bhuj-Kutch. The centers cater to needs of the PLHA for their in-patient treatment. 2 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN 12. Information, Education and Communication (IEC): To generate awareness in general population on HIV/AIDS, GSACS handled various strategies such as TV serial namely “Zindagi Ek Safarâ€? and it was broadcast on Doordarshan Kendra, Ahmedabad. Behavioural Change Communication (BCC) materials have been developed for migrants, truckers & General Population. GSACS installed permanent hoardings in public places. A 15-minute radio serial “Padkarâ€? is being broadcast from 2nd August 2011 on every Wednesday on Vividh Bharati, Ahmedabad. 13. Jeevan Deep Project: Gujarat State initiated network of positive people at 20 centers with focusing on mainstreaming the issue of HIV/ AIDS with Government and civil society. 14. Red Ribbon Clubs (RRC): 530 Red Ribbon Clubs are being run in 7 universities of the state through 13 Non-Governmental Organizations. 1.1.5 Important Achievements of GSACS ï‚· Highest ratio of blood donation in the country in terms of utilization. ï‚· Gujarat has highest number of National Accreditation Board for Hospitals & Healthcare providers (NABH) Blood Banks (10) including First NABH Govt. blood bank and Govt. CD4 lab in country. ï‚· Use of Satellite Communication (SATCOM) in Targeted Intervention (TI) projects ï‚· Well established concept of Link ART Centre (LAC). ï‚· Permission to outsource CD4 testing (only Gujarat) enabling to scale up the CST services. ï‚· Support from National Rural Health Mission (NRHM) for Blood safety and CST (upgrading of ART centres). ï‚· State budget supports to provide travel support to PLHA coming for treatment. 3 Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN Appendix 3.1 Sample Population of Trucker Survey No. of Sl.no. Corridor Location Interviews Himatnagar 10 Vijapur 10 Visnagar 10 1 Mehsana – Himatnagar Mehsana 10 Kad 10 TOTAL 50 Vega circle 8 Gamdi circle 6 Dhokaliya circle 6 2 Dabhoi – Bodeli Karan petrol pump Bodeli 4 Khalikpur circle 6 TOTAL 30 CU check post 6 Fatehpura 8 3 Bodeli – Alirajpur CU transport 10 Pavijetpur 6 TOTAL 30 Vasad Highway 6 Vasad circle 5 4 Umreth – Vasad (Including Ladvel - Kapadvanj) Chikodara circle 15 Umreth highway 4 TOTAL 30 Hotels around Dholera Circle 25 5 Dhandhuka – Dholera Bhavnagar Road 5 TOTAL 30 Ranpur Circle 5 Nagnesh Quarry 15 6 Dhandhuka – Paliyad Military Road Market 5 Dhandhuka circle 5 TOTAL 30 Gondal Market Yard 30 7 Atkot – Gondal Cotton & Ginning Industries 20 TOTAL 50 Market Yard 12 Hotel Sarvottam 8 8 Lunavada – Khedapa Hotel Shivam 10 TOTAL 30 Vrundavan Hotel Mahadevpura 6 Parishram Stone Quarry 8 9 Bayad – Lunavada Vrundavan Stone Quarry 6 Sathamba Petrolpump 10 TOTAL 30 Modasa Hajira GIDC 12 Meghraj Circle 8 10 Dhansura – Meghraj Khalikpur Circle 10 TOTAL 30 GRAND TOTAL 340 1 Roads & Buildings Department, GoG APPENDIX 4.1 MONTHLY PROGRESS REPORT - OUTLINE 1.  INTRODUCTION .....................................................................................................................................   1.1.  PROJECT BACKGROUND ................................................................................................................................  1.2.  OBJECTIVES OF HPP .......................................................................................................................................  1.3.  CORRIDORâ€?WISE ACTIVITIES PLANNED FOR THE MONTH ............................................................................   2.  ..............................................................................................................................   PHYSICAL PROGRESS  2.1.  INFORMATION EDUCATION COMMUNICATION ...........................................................................................   2.2.  BEHAVIOUR CHANGE COMMUNICATION .....................................................................................................   2.3.  CARE AND SUPPORT ......................................................................................................................................  2.4.  AWARENESS PROGRAMMES AT CONSTRUCTION CAMP SITES .....................................................................   2.5.  ...........................................................................................................   CREATING ENABLING ENVIRONMENT  2.6.  ACTION PLAN: TARGETS AND ACHIEVEMENTS .............................................................................................   3.  FINANCIAL STATUS ................................................................................................................................   3.1.  COMPONENTâ€?WISE FINANCIAL STATUS ........................................................................................................   3.2.  TARGET AND ACHIEVEMENT FOR NEXT MONTH ..........................................................................................   4.  SHORTFALLS AND REMARKS ..................................................................................................................   4.1.  CONSTRAINTS FACED DURING THE MONTH .................................................................................................   4.2.  REMEDIAL MEASURES TAKEN / SUGGESTED ................................................................................................   4.3.  ACTION REQUIRED FROM PIU .......................................................................................................................       Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN   APPENDIX 4.2  IEC DEVELOPED BY NACO/GSACS    1   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN   2   Gujarat State Highway Project for GSHP-II Roads & Buildings Department, GoG  HIV/AIDS PREVENTION PLAN     3 Â