Risk management: A day in the life of Mumbai’s HIV screening camphttps://indianexpress.com/article/india/india-news-india/a-day-in-the-life-of-mumbais-hiv-aids-screening-camp/

Risk management: A day in the life of Mumbai’s HIV screening camp

Can India meet the UN target of ‘ending AIDS epidemic’ by 2030? Days ahead of World AIDS Day on December 1, a NACO team in a Mumbai slum battles odds in its fight against the virus

The van that serves as the screening camp. (Express Photo by  Narendra Vaskar)
The van that serves as the screening camp. (Express Photo by Narendra Vaskar)

As Tek Kumar Babli walks down a dusty road towards Govandi, a slum in Mumbai, children call out, “HIV wale, HIV wale”. The 31-year-old, though, looks straight ahead, ignoring the remarks.

For the next four hours, between 11 am and 3 pm, he and six other men, will walk through the narrow, serpentine alleys of the densely populated slum, looking for single migrant men, a “high-risk” group for contracting HIV.

They have a tough target — convincing 50 men to walk with them towards a screening camp near the slum, and get tested for HIV. Babli and his team form the many cogs of a large wheel that will work overtime to “end the AIDS epidemic by 2030”, a difficult target set by the UN on October 30.

Besides mobile camps such as this one in Govandi, the National AIDS Control Organisation (NACO) has decided to set up permanent camps at certain locations. The mobile camps are set up four times a month, each screening high-risk individuals such as sex workers, migrants, drug users, truck drivers, men having sex with men and construction labourers. The Govandi slum has some 15,000 migrant labourers, mostly from UP, Bihar and Nepal, who live in matchbox-size rooms.

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 Harish Singh tries to convince migrant workers at the Govandi slum to get themselves tested (Express Photo by  Narendra Vaskar)
Harish Singh tries to convince migrant workers at the Govandi slum to get themselves tested (Express Photo by Narendra Vaskar)

Indraprasad Ranamagar, Babli’s Nepali co-worker, walks inside a dingy zari workshop, where seven men are carefully stitching silver embroidery on swathes of fabric. Four of them having been tested for HIV at previous screening camps. Ranamnagar tries to convince the other three to walk down to the camp.

“Do you know what HIV is?” he asks 25-year-old Shravan Kumar, a migrant from Lucknow who has been working, and living, at the zari workshop since he was 16. Shravan nods in affirmation. But he doesn’t want to be tested. “I have never been in a relation with any woman. Why should I go for the test?” he replies. Ranamagar attempts to educate him about the other ways the virus spreads, such as blood transfusion, but Shravan is adamant. “I will have to come back to convince Shravan,” he says.

Convincing is a long process. In fact, it begins a few days before the screening camp is set up. Field workers spend a few days meeting people, identifying local leaders and using their help to get friendly with migrant labourers. “We tell them how HIV spreads and that it is not something to be ashamed of. We make them understand the need to stay fit for their family,” says Harish Singh, a field worker and counsellor.

Migrant workers also worry that if they test positive for HIV, and if their employers find out, they’d be fired. Babli talks of a migrant worker who had told his employer about his co-worker’s HIV positive status after the tests were conducted. “The employer asked him to look for work elsewhere. People still feel the disease spreads by living or eating together,” he says.

Some, like a tailor from Bihar who had tested positive a month ago, leave the city of their own will. “It took me days to bring him to the camp, where he tested positive. Three days after he was told to visit a NACO-run Anti Retroviral Treatment (ART) clinic, he quit his job and returned to his village,” says Singh, who has been unsuccessfully trying to track him through ART clinics in Bihar. “He has given me a wrong number,” he says.

It’s 1 pm, and Singh, Babli and Ranamagar have managed to get six men to the camp. They escort each one of them to the van that holds the screening camp, lest the men change their mind.

The camp has a doctor, a lab technician and a counsellor (Express Photo by  Narendra Vaskar)
The camp has a doctor, a lab technician and a counsellor (Express Photo by Narendra Vaskar)

The van has three cubicles — one for the doctor, one for the lab technician and another for the counsellor. For each of the six men, the field workers fill up a form with personal details such as home address, so that the migrant can be tracked for treatment in case he returns to his village after testing HIV-positive. Then, a doctor asks them about any illnesses they may have, and gives them medicines. Thereafter, a lab technician collects their blood samples, the results of which come out in 20 minutes. As they wait for the results, each of the six men is taken to the counsellor who advises them on the use of condoms and tells them to visit an ART clinic in case they test positive. A CD4 count is then taken at the ART centre — if it is less than 350, the patient is put on daily treatment; else, a six-monthly test is prescribed.

All six men test negative and return to their homes. The field workers go back to the slums looking for more labourers willing to get tested.

Meanwhile, a 34-year-old Nepali migrant who has been living in Mumbai for 20 years, walks into the camp. He had tested positive for HIV in 2012, and since then, he says, makes it a point to visit camps whenever they are held. He tells the doctors he has a CD4 count of 298 and is also suffering from tuberculosis. After he was diagnosed with the virus, he called off his wedding, which was scheduled to be held two months later, and got fired from a building where he worked as a watchman. He now sleeps at the railway station. “I haven’t gone home since I was diagnosed with HIV. But now I will, there is no life here,” he says.

Two out of 10 men do not return after testing positive in Govandi, says Babli.

The van is parked next to a landfill site, where ragpickers rummage through garbage. They too, says Babli, belong to the high-risk category. “Their working conditions are tough and they are usually high on Iodex, whitener or cough syrups,” he says. But they can’t be tested as “alcohol or addictive substances in the blood can impact the results”, he says.

A dozen curious teenagers gather around the camp but are shooed away. “NACO guidelines do not permit testing of under eighteens at camps, unless a guardian is willing to sign for them. With parents living in faraway villages, the boys form a significant proportion of undetected HIV cases,” says Ram Bahadur, NACO project director at Govandi.

NACO figures show that children under 15 account for seven per cent (1.45 lakh) of total infections.

Babli, who is paid a monthly salary of Rs 12,000, has been working as a field worker for HIV awareness since 2004, first with Tata Institute of Social Sciences, then in Mankhurd slums and now with NACO in Govandi. In a decade, the rise in his salary has been sluggish. Since April till November this year, the health workers say, they have received salary for only four months. From a team of 12, they have shrunk to seven. “Which is why we never meet our target of 50 screenings in a camp. How can they expect us to meet the 2030 target,” he says. Of the 15,000 estimated migrant workers in Govandi, only 3,000 have been screened since 2012.

This year, annual funds for the screening programme were cut down from Rs 18 lakh to Rs 12 lakh. “We use the funds to pay off salaries, for travelling, counselling, and camps. If the government provides even the current budget on time, we may survive,” Bahadur says.

Despite cuts, several health workers pay poor HIV patients for food from their own pockets. “We need to maintain a rapport with them. Otherwise they will discontinue their treatment,” says Kumar.

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It is 2.45 pm, and the camp is winding up. “Twenty two men screened today, all negative,” says Kumar as he scans the handwritten list. Just then, the project manager’s phone rings. “The accountant found another job. She wants to quit,” he says. It is the seventh resignation in a year.