Service to the Ones at the Edge

The main focus of the project “Understanding Social Power and Dynamics among High Risk Groups and Piloting Specific Packages Using Innovative Approaches” revolves around working with female sex workers (FSWs), involving them in awareness, advocacy of HIV/AIDS, educating them through trainings and workshops, in an attempt to make them aware of the problems and trying to prevent the AIDS pandemic. From situation analysis it was observed that sex worker is widespread in major urban cities of Pakistan. In Quetta there are a considerable number of mobile FSWs that walk streets and parks, others are housed in scattered communities while the high class FSWs carry out their trade from houses in posh areas of cities. It has also been observed that due to low literacy among FSWs, early initiation into the trade, disempowerment to make decision regarding their life results in low self esteem, lack of knowledge and information on major SRH issues (including STIs & HIV) and poor access to quality health care services. Multiple sexual partners, low condom use and little perception of self-risk increase their vulnerability to acquisition and the potential for transmission of STIs and HIV.

As for as there are more than 500 FSWs in the capital city of Balochistan. Certain areas have higher concentration than others and their geographic distribution is documented. Majority of FSWs are street based (SBFSW) and usually work full time whereas the rest are home based (HBFSW) and work part time, operating whenever required. Afghan refugees are also included in numbers that are higher than the existing local/refugee ratios. Condom use is low, knowledge on HIV/AIDS scanty and only half know of sexual intercourse as a mean of transmission. Only 10% know of a screening test for HIV and only 5% have been tested. One fourth of FSWs report having STIs in past six months, of these 25% have self treated the infection. Some FSWs report being arrested and some having indulged in IDU, and having met with IDU client in past six months. IDUs account for 10.27% of total high risk activities in Quetta. (Ref. HASP summary report-Balochistan 2005-06)

The project was initiation with a goal to reduce transmission of HIV&AIDS through improvement in the health seeking behavior of FSWs and providing them access to quality information and health care services.

After conducting a KAP study, quality sexual reproductive health and primary health care services were provided to female sex workers in collaboration with UNFPA and a local NGO ‘Voice’ in Quetta.

Inline with the finding of above mentioned KAP study a fully functional Drop in Centers (DIC) was established to provide services for primary health care, reproductive health and syndromic case management, to female sex workers and their families as well as to local communities.

Through this initiative Drop in Centers were able to provide health services to more than fifteen hundred clients included counseling services and drugs for discharge, backache, fever, irregular menstruation, lower abdominal pain cough joint pains etc.

To provide comprehensive counseling and communications the outreach workers and the peer educators, conducted focus group discussions and one to one counseling sessions with the stakeholders and gatekeepers on SRH, HIV&AIDS and its prevention, STIs and its effects. They also used IEC materials to increase their information and knowledge.

98 gatekeepers and key informants of the target areas were registered and sensitized. Awareness sessions were provided on prevention of STIs, HIV&AIDS, services available at Drop in Centres, condom usage, referrals for testing for HIV&AIDS and STIs etc. The outreach workers have distributed 8363 condoms to gatekeepers and key informers.

During the project 571 FSWs were registered whereas 450 FSWs were sensitized. Sensitization sessions on Sexual and Reproductive Health, STIs, and HIV and AIDS, condom promotion, domestic violence, Drug abuse and information of services available at DIC etc were provided to 439 FSWs by the peer educators. The peer educators had distributed 17716 condoms.

Sessions were organized on dual protection of condoms and negotiating skills. The accessibility and availability of condoms to target group was the priority of the project staff. As a prevention measure condoms were regularly distributed and replenished by the project staff and record maintained.

Project staff arranged the medical camps in the field. The participants sensitized, orientation session conducted on awareness about HIV and AIDS and STIs by LHV. During the project period 15 field medical camps were arranged. In the first month the ratio of participants was low but gradually it increased during the reporting total 258 FSWs attended the camps.

During the reporting period IEC material on HIV&AIDS was obtained from Balochistan Aids Control Programme and was distributed to the target group. The project staffs also used IEC material on HIV & AIDS, reproductive health and rights, developed by Rahnuma-FPAP in Urdu language. 1322 pieces of IEC material were distributed by the outreach team and during their visits to the DIC.

Up till date 161 FSWs were referred to VOICE VCT Center for screening. Rahnuma-FPAP received results of 130 reports. There were no HIV & AIDS positive cases reported. However post test counseling was provided to the FSWs by the DIC staff. And condom usage stressed NACP has adopted the strategies tested by Rahnuma-FPAP project.