Fruits of partnership

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The success of a truckers’ drop-in centre scheme in Bangladesh shows the potential for union partnerships. Dr Syed Asif Altaf reports

Care Bangladesh, a pioneer in HIV prevention in relatively low prevalence Bangladesh, knew from its field experience that when commercial sex workers learn about sexually transmitted diseases (STDs), they usually want to use condoms.

Ten years ago however, their clients, who include transport and migrant workers, were reluctant to do so. These workers had not been involved at close hand in education or health programmes, and were suspicious of the efforts of “outsider” organisations to provide them with health care services.

Care Bangladesh recognised the need to interact directly with transport workers to prevent the spread of STDs, including HIV, and to ensure the provision of quality medical services.

Due to bad past experiences with non-government organisations, the union initially had reservations about collaborating with Care. It resented the implication that truckers were responsible for HIV transmission, and even resisted the insinuation that truckers were sexually active outside marriage – though almost 60 per cent of truckers questioned in Care’s baseline survey reported having bought sex from a commercial sex worker in the previous month.

Developing trust

During the project’s initial period, Care staff devoted a great deal of time to developing a trusting relationship with union leaders. The level of HIV risk to drivers was established and accepted by the union, through its ongoing discussions with Care during the baseline survey process. Union leaders then developed an understanding that HIV could become a big problem for their members in the near future and that they had a duty to act to help keep them safe.

They realised that if they could ensure the provision of quality health care services at their doorsteps for an affordable price, the project would inspire respect and confidence from members.

Mr Roy Ramesh Chandra, the general secretary of the Bangladesh Truck Drivers’ and Workers’ Federation, became a crucial and visionary agent for change, helping to start and expand the project.

The union came to see that Care was meeting its commitments: providing quality clinical services at affordable prices; providing important information in education sessions; and hiring as paid peer outreach workers the truck drivers recommended by the union. They agreed to offer space in the union offices for drop in centres and to bear the related maintenance costs. The centres are still going from strength to strength.

Multi-purpose centres

Transport workers can come into the centres to pass their leisure time and meet friends, as well as to receive information about safer sexual practices and the prevention of STIs and HIV. To avoid the potential for stigma, these centres are also used as general medical service centres. They provide transport workers with accessible, inexpensive, and high-quality care in a friendly setting, coupled with education and access to condoms.

One of the most important activities of the union and its leaders is to bargain collectively with transport owners and broker agencies for their participation in the project activities, as their support is important in making the programme sustainable.

Drop-in centres are located within union offices because transport workers feel that these offices are their own. The project now charges Taka 30 (40 US cents) for each medical consultation, achieving 50 per cent of the cost of recovery. The union will be able to increase this charge when necessary, or continue by establishing links with an external service provider. This means clinic services will not collapse when the funding secured by Care at the start of the project decreases or ends.

Any such funding shortages may make it difficult to sustain the cost of outreach workers (around US$55 per month). But the initial awareness raising will have been accomplished, and because of all the peer education, the knowledge will still exist in the community.

With the active involvement of the unions, this programme has now expanded to 45 drop-in centres, serving 300,000 transport workers, providing nationwide access to quality, confidential care. More information is available from the case book Engaging key stakeholders: ensuring the right to HIV/AIDS education and health care services, which is available as a download at www.newtactics.org/main.php/engagingkeystakeholders

Dr Syed Asif Altaf worked for Care Bangladesh as HIV programme coordinator, until taking up his present post as global HIV/AIDS project coordinator for the ITF

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